Is Microtia genetic?
There are many families who give birth to a child with Microtia when no one on either side of the family has ever had Microtia as far back as history can show. It appears to be a randomly occurring event or anomaly that happens during early development. Families can have a child with unilateral Microtia (right or left ear) or have both ears (bilateral Microtia) affected. One child may be born with Microtia where his/her twin sibling may not show any signs of having Microtia.
Yes, Microtia has shown up in past family generations. Currently, there is no sound scientific evidence that can say or show that Microtia is completely genetic.
How does Microtia affect my child?
Microtia affects the outer ear only. Often times, Microtia is accompanied by Atresia (absence of an ear canal and is often associated with a hearing loss), or Hemifacial Microsomia (where one side of the face has a shorter jaw bone pulling the face slightly upward) or by other associate syndromes or genetic characteristics such as Treacher Collins or Goldenhar Syndrome. However, Microtia does not affect a child’s intelligence, their motor skills or their shot at a normal life to live.
How do I know if my child is deaf or hard of hearing?
Most often, Microtia is accompanied by Atresia (the absence of an ear canal resulting in a loss of hearing). After birth, your new born will be referred to a hearing screening. Once your child fails the newborn hearing screening, you can take your child to an ENT and an audiologist to have further hearing exams that will reveal how much of a hearing loss your child has. With the help of an ENT and an audiologist, you should be informed about which options can help your child best.
How many people have Microtia?
Studies and findings to date show that Microtia occurs approximately anywhere from a 1 in a 6000 chance to a 1 in 12000 chance of happening. So, let’s say that Microtia has a chance of occurring 1 in 9,000 times. These are our estimates.
South Africa statistics
SA has a population of 60 million that means there are approximately 6500 people in SA with Microtia. 1.2 Million children are born every year, meaning approximately 140 children are born with Microtia in SA every year.
Africa has a population of 1.2 Billion that means there are approximately 130 000 people in Africa with Microtia, meaning approximately 2900 children are born with Microtia in Africa every year.
What specialists should I be taking my child to?
Neonatologist: Your child may be seen by a neonatologist or in conjunction with your pediatrician to help evaluate your child for a proper diagnosis and to help answer questions you may have about your child.
Otolaryngologist and Audiologist: Your child should first be seen by an Otolaryngologist (ENT/ear-nose-throat specialist) and an audiologist for hearing checks and to find out at what level your child’s hearing loss is. Ask your ENT and audiologist about what options are available that can help your child hear better. Set up quarterly visits to stay on top of ear infections.
Craniofacial Surgeon and Oral Surgeon: If your child has Hemifacial Microtia, Treacher Collins or Goldenhar Syndrome, you may want to consider setting up an appointment with a craniofacial surgeon and an oral surgeon. Begin inquiring in information that can help your child as he/she develops and ask about the possibility of surgery and at what age your child should begin surgery if surgery is being considered.
Pediatrician or General Family Physician: These are the doctors that your child will see most of the time. Make sure they are kept in the loop on information from other medical specialists by having copies of evaluations and checkups.
Microtia Reconstructive Surgeon and a Canalplasty Surgeon: If you are interested in finding out more about surgical options for your child, you may want to consider scheduling an appointment with an expert reconstruction specialist or plastic surgeon who specializes in facial reconstruction surgery and Atresia repair. Ask questions so you can learn what options are available for your child and how to begin planning for surgery.
Can Microtia affect my child’s growth? No.
Microtia usually does not affect the growth of a child.
Are there other options for Microtia other than surgical options? Yes.
How common is Microtia?
90% of Microtia cases are unilateral. It occurs in one out of 6 000- 12 000 births (Bilateral 1 / 25 000). Microtia occurs more often in males than in females and affects the right ear more than the left. Bilateral Microtia/ Atresia is more commonly associated with syndromes
It is felt that microtia may be caused by ischemia or decreased blood flow during development.
Can Microtia affect my child’s growth? No.
Can Microtia be detected in an ultrasound? No.
Typically, sonographers do not focus on looking for Microtia or the details of the ears. Sonographers focus more on the organs of the baby, to make sure everything is developing correctly. Ultrasounds are used to detect abnormal features such as in Down’s Syndrome or mis-shapen limbs, along with general blood screening if requested, etc… Even in a 3D and 4D ultrasounds and Quad Screenings, Microtia is typically not picked up on the sonogram. It is possible that you can ask the sonographer to look for more details as ultrasound technology today has improved greatly. However, this would only notify you that your child would have Microtia. An ultrasound cannot prevent Microtia from happening nor can it fix it.
Should we have a CAT scan?
Only if your paediatrician believes your child should have a CT following birth, should you have one. Sometimes, following the delivery of a child, the child may have other associated syndromes and disorders that the doctor may like to rule out. The doctor may also choose to have a CT taken in order to be certain there is no head trauma or any other associated issues related to brain issues, especially if the child is not responding very well. However, it is strongly suggested by surgeons that a new-born child or a child or younger age not be subjected to a CT until they are older due to the amount of radiation exposure being emitted. The main reason for waiting until the child is older is that CT scans do not always pick up everything. It is also possible that at the time of CT being taken, your child is still developing and therefore, the tiniest bones may not be clearly visible. This would mean your child would now have to be subjected to a second, additional CAT scan. Wait if you can. Many canalplasty (Atresia repair) surgeons suggest waiting to have a CT taken when your child is closer to having ear reconstructive surgery. CT scans are particularly of use in finding out if your child is a candidate for canalplasty. Otherwise, ask your paediatrician or surgeon if a CAT scan is absolutely necessary and if it can wait until later.
Can someone with Microtia have reconstructive ear surgery?
Yes, there are two surgical options for ear reconstructive surgery for Microtia.
Surgical Options for Microtia Repair (reconstructive surgery):
1. Rib Graft Surgical Technique:
Known as the “Gold Standard” for ear reconstructive surgery and has been around since the 1920’s. A three to four stage surgery that involves using a section or a piece of rib cartilage (rib graft) and a section of your skin needed to cover the ear (skin graft). Together the rib cartilage and skin graft are used to reconstruct an outer ear. The 1st stage involves the harvesting of the rib cartilage (requires a 1” to a 1.5” length incision) and then carefully sculpting the rib cartilage into a newly shaped framework that is shaped like an ear. The newly shaped framework is then sewn into a skin flap or skin pocket beneath the scalp on the skull (where the ear will be located). The 2nd stage involves creating the earlobe. The 3rd stage involves making a slit behind the ear to careful release the ear from beneath the scalp skin, lifting it away giving it projection or a high profile look. A skin graft is then used to help covering up the rest of the ear (back side of the ear). This is known as the elevation stage. The third stage is where the tragus (little cartilage like flap located in front of the ear canal) is constructed and any other symmetrical issues with the ear are then corrected at best. This stage of the surgery also helps create a pseudo ear canal with a shadowing affect that provides a depth perception look as if an ear canal exists (if a patient is not a candidate for canalpasty (atresia repair). Any additional stages are typically only required for tweaking of the ear itself, such as tweaking the shape of the ear more or the earlobe. Since a rib graft ear is made of living tissue from the body, the ear will grow with the individual and will be undersized when compared to the existing non-Microtic biological ear so that it can grow to approximately the same size of the existing ear. The newly reconstructed rib graft ear will be slightly stiffer than the biological ear as the rib cartilage tissue used is thicker or stronger than ear cartilage, although the ear appears to physically be similar in thickness to the human eye. The ear will feel pain, experience bleeding, and heal. The earliest age to consider Rib Graft surgery is age five. More common ages for Rib Graft surgery range between six and ten years of age.
Note: Some surgeons can achieve ear reconstructive surgery in fewer than three or four stages. For example, surgeons who practice the “Nagata” technique, named after Dr. Satoru Nagata of Japan, perform Rib Graft surgery in only two stages. Some surgeons can even perform Rib Graft in only one stage. Surgery time for each stage ranges anywhere from one hour to five hours or more, depending on the stage and what needs to be done to the ear for best results. Longer surgery times and additional stages may be required for children having Goldenhar Syndrome and Treacher Collins because of the challenge of centrally positioning the ear and working with a lower or higher hair line. Surgeries typically performed in three stages most-likely utilize the “Brent” technique, named after Dr. Burt Brent of California.
2. Medpor Surgical Technique:
A surgical technique that eliminates the additional stages required for harvesting rib cartilage for rib graft procedures. Medpor surgery utilizes a synthetic pre-made framework that can be carved to match the shape of the existing non-Microtic ear (or two newly made ears if having bilateral Microtia). The Medpor surgical technique uses a porous polyethylene material, the same material that has been used in facial craniomaxillofacial surgeries for over forty years. Medpor surgery can be achieved in just one stage. Surgery time can range anywhere from eight to twelve hours depending on the complexity of the surgery. A second stage may be required to tweak the earlobe if needed. The ear is constructed to be slightly larger in size (around .5mm or less in size) than the already existing non-Microtic ear, allowing the biological ear to grow to the same approximated size of the newly reconstructed Medpor ear. A Medpor ear will be stiffer than a rib graft ear as the material the synthetic framework is made up of is a bit thicker or stronger than ear cartilage, although the ear appears to physically be similar in thickness to the human eye. A Medpor ear does become vascularized where blood vessels become integrated throughout the porous holes within the polypropylene frame. This allows the ear to feel pain, experience bleeding, and heal. The earliest age to consider Medpor surgery is three years of age.
3. 3D Printed Ears
In 2018, Dr. Lewin started using a high-resolution 3D scanner based on blue light technology to create a precise mirror-image of a patient’s natural ear. Dr. Lewin performs the 3D scan in her office. It is an easy, painless study done in a few minutes while the child is awake. The scan eliminates the need to sedate a child for expensive CT or MRI scans. For more info https://lewinear.com/3d-lewin-ear
What hearing aid options do I have?
BAHA / Ponto / Sophono
Soundbridge / Bonebridge
Ear canal reconstruction, Tympanoplasty/Canalplasty
What are some myths about Microtia?
- Microtia is a disease. No, Microtia is not a disease, nor is it a virus or a contagion. You cannot catch Microtia from anyone or from visiting a foreign country. It is a congenital deformity that just happens.
- Microtia is caused by taking fertility drugs, such as Clomid (Clomiphene). There is no evidence proving that the use of fertility drugs can cause Microtia.
- Microtia is caused by drinking certain types of milk. There is no evidence proving that by drinking milk in general (any and all types) can cause Microtia. There is also no proof that by eating or drinking anything from your environment can lead to causing Microtia.