Microtia: Background Info and Treatment Options

Russell H. Griffiths, MD, is an accomplished and experienced ear reconstruction surgeon offering treatment for every type of microtia at his practice in Boise, ID. Dr. Griffiths seeks to educate parents of children with microtia so that they can pursue the safest and most effective ear reconstruction treatments.

What is microtia?

Microtia is a birth deformity of the external ear.  Microtia literally means "Small Ear".  It occurs in approximately 1 out of every 6,000 births and is bilateral (both sides) 10% of the time.  It is more common in children from Asia, South America, Central America, and Pacific ring islands.  More severe forms of microtia are associated with absence of the ear canal (aural atresia) and associated conductive hearing loss

The cause of microtia is unknown and is not believed to be caused by anything the parents did or did not do.  It is usually not inherited unless it is associated with other associated conditions like Treacher Collin’s syndrome.

How is microtia classified and how does it differ from anotia?

Microtia is a birth defect of the ear that can vary from mild to severe it is classified into 4 types.

Type I microtia

A slightly small ear with identifiable structures and a small but present external ear canal.

Type II microtia

A partial or hemi-ear with a closed off or stenotic external ear canal producing a conductive hearing loss.  Below is a child before and after her one stage surgery.

Before and after One-stage microtia ear reconstruction surgery for type II Microtia

Type III microtia

Complete absence of the canal with a small peanut-shaped remnant of pinna and lobule.  Below is a child before and after his one stage surgery

Before and after One-stage microtia ear reconstruction surgery Type III microtia.

Type IV microtia (Anotia)

 Complete absence of the ear canal with only a small bleb as an ear remnant.  Below is a patient with anotia.

Type 4 Microtia Anotia: Dr. Russell H. Griffiths MD Ear Reconstruction Specialist

Things to do once you learn your child has microtia atresia

If you have a new baby with microtia atresia you might feel a little overwhelmed. Some children are born in communities where their physicians are not knowledgeable about microtia atresia and are unable to provide adequate information or suggest appropriate referrals and tests. We are here to help!

*The first thing to do is to talk to your pediatrician about an echocardiogram or renal ultrasound. The ears develop in utero at approximately 5 to 6 weeks gestation which is the same time that the heart and kidneys are developing. These simple tests are very easy to do and are relatively inexpensive.

*Second, your child’s hearing needs to be tested. If your child has unilateral (one sided) microtia atresia, hearing in the normal appearing ear may also be compromised.

*Third, ask your pediatrician for a referral to an otolaryngologist (ENT or ear nose and throat specialist). This professional will help to ensure the health of your child's normal ear. It is important to maintain the health of your child’s normal ear and avoid potential hearing loss associated with undiagnosed inner ear infections (otitis media) which might require eardrum drainage tubes to be placed (tympanostomy tubes).

*Your otolaryngologist can also provide a prescription for a bone conducting hearing device with soft band. This device will enhance speech development and help stimulate the part of your child’s brain that processes sound (auditory cortex).

Click here to contact us for help obtaining a bone conducting hearing device with softband for your child.

Some physicians will want to order a temporal bone CT Scan for your infant to obtain information about the anatomy of the inner ear on the side with the microtia.  Scans at this age often do not provide adequate information because the anatomy is small and still developing and the scan often needs to be repeated later. We prefer to postpone the temporal bone CT scan until approximately five years of age. At this age, you child will be old enough for you to consider hearing restoration options.  Dr. Griffiths can reconstruct your child’s microtia at the same time that the hearing restoration surgery is performed (aural atresia repair).

What options are available for reconstructing Microtia-Anotia?

Type I microtia can often be reconstructed with an otoplasty. Type II requires a reconstruction of the upper half of the ear. Type III and type IV require complete ear reconstruction.

Options for microtia reconstruction  include a prosthesis, a MEDPOR polyethylene plastic ear framework covered by living tissue, or a living cartilaginous RIB GRAFT carved into an ear framework covered by living tissue.

Old Classification for Microtia Reconstruction Options

  1. Do nothing
  2. Auricular prosthesis
  3. Rib graft technique
  4. Medpor technique

Dr. Griffiths performs an ear reconstruction technique that does not fit into the common classification options listed above so he proposes a new classification system.

New Classification for Microtia Reconstruction Options

  1. Do nothing
  2. Auricular prosthesis
  3. Surgical reconstruction
    •  Rib graft multi-stage technique
    • Medpor technique
    • Dr. Griffiths One stage technique
      1. Rib graft framework
      2. Medpor framework
      3. Canalplasty (atresia repair) at the same time as the Microtia reconstruction

One-Stage Microtia Reconstruction

Dr. Griffiths can reconstruct an entire ear in ONE operation utilizing either Rib Cartilage or Medpor.

Before and After: One-stage microtia ear reconstruction surgery with rib graft.

One-Stage Microtia Reconstruction using a Rib Graft Framework

Before and After: One stage microtia reconstruction with Medpor.

One-Stage Microtia reconstruction using a Medpor Framework
(with canalplasty)

Ear Framework Options

To reconstruct an external ear surgically, a framework material must be selected that can withstand the contractile forces of the overlying skin and fascia. The two most widely used options include the patient’s own living cartilage (rib graft) or polyethylene plastic implant (MEDPOR™).

Contact Us to Get Started

Dr. Griffiths and his staff are ready to start discussing treatment options for your child's microtia case. Contact our practice with details about your son or daughter so we can begin advising you on getting the treatment they need to be happy and healthy.

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My son is experiencing a happiness and a confidence that I have never seen before. You have taken away a big, big hurt...Thank you for making my son happy. Michael, Father of a Former Patient

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Boise Office

100 E Idaho St
Ste 303
Boise, ID 83712

More Info Directions (208) 433-1736

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Boise Office

100 E Idaho St
Ste 303
Boise, ID 83712

More Info Directions (208) 433-1736