HEAD AND NECK

Prominent ear: Prominent ear is a small aesthetic variation with no functional or other impact to the organism. Nevertheless, for several people this little variation may be disturbing. Quite oddly, it results even more annoying when it affects the one ear, perhaps because asymmetry between the two pinna becomes more perceptible.

Pinna protrusion is due to the fact that the so called antihelix, an anatomic prominence of the ear cartilage in the upper part of the ear pinna is not sufficiently formed. If, during clinical examination we refold the pinna, so that the anthelix can take a sufficient form, we immediately notice that the pinna occupies a normal position, being only something more than a centimeter away from the skin of the head. More rarely, there may also be a protrusion in the lower part of the ear, the earlobe.

Surgery for the correction of prominent ear is relatively simple. In adults it is performed under local anesthesia, in children however we must use general anesthesia. The surgeon must pay special attention to antiseptic rules and try to ensure that the two pinna are symmetrical. Sometimes, a patient too bothered by prominent ear, may ask for what we call excessive or overcorrection. However, it is wrong to stick the pinna on the skin of the scalp or hide the helix behind the rest of the pinna. We must explain all this to the patient, perhaps by using references of the international bibliography. Postoperatively, antibiotics are administered and the ears are covered with an elastic bandage for a week.

In children, surgery should be done after the age of six. As we already said the intervention is simple and if the child seems to be bothered, there is no reason for the parents not to give their consent. On the other hand, if the child is not really bothered, there is no reason to suggest the idea to child. After all, prominent ear is something that can be corrected at any age of puberty or adult life.

Agenesis of the pinna: Aplasia or hypoplasia of the pinna from birth is a rare phenomenon. It may occur to both ears and the reasons are often unknown. It may be a part of a broader malformation syndrome of the face or the rest of the body and may coexist with aural atresia. The term can include congenital anomalies of the middle or inner ear and the internal auditory canal. Without establishing a perfect match, the degree of aplasia of the pinna is often indicative of the anomalies of the middle and inner ear

The aplasia of the pinna is an aesthetic problem. Correction of the problem may be done after the age of six but we also can wait till the patient becomes an adult so that he / she can decide if one wishes to treat the problem choosing whatever method one prefers. The atresia of the ear, however, must be immediately treated when it is bilateral because it is related to the hearing ability and therefore to the development of speech. When it affects only the one ear and the hearing ability of the other ear is sufficient, we can wait until the patient becomes an adult in order for him / her to decide whether he / she wants to treat it and which method to choose.

The treatment of aplasia must precede that of atresia. If surgery for atresia comes first, the ischemic and relatively fibrous tissue which will be created in the area, is not a good substratum for the future correction of the pinna. Considering that aplasia should not be treated before the age of six, in case of bilateral atresia, bone anchored hearing aid is provisional but a direct solution. It is placed on the cranial bone and transmits the sound to the hearing nerve, by-passing the atresia suffering ear.  In order to do the above, we take for granted that there is a functional hearing nerve and by performing a small incision we place the hearing –aid in the skin behind the ear without disturbing the blood circulation into the tissues of the area.

The correction of a pinna with congenital aplasia or deformations due to mutilation by injury is one of the most difficult plastic surgeries not only because these cases are very rare but mainly because of the complicated relief of the ear. And it becomes more difficult if the one ear is completely formed thus rendering the asymmetry evident even after a successful surgery. As a result of the above mentioned difficulties, the patient in many cases chooses not to deal with the problem or prefers an artificial pinna.

The atresia of the ear is characterized from the absence of external auditory canal. It is due to aplasia of the tympanic bone, and the ossicles of the middle ear are found in the bone of the mastoid apophysis. As previously mentioned, if the atresia is unilateral and the child uses the other ear to hear, then the problem is treated when the child enters adulthood. If the atresia is bilateral, then a bone-suspending hearing aid may be placed after the first year of age or a brainstem implant if the cochlear nerve is not functional in both sides. After attempting to correct the pinna, then we may talk about the possibility to create the external auditory canal performing an otosurgical operation. The procedure is a mastoidectomy and tympanoplasty surgery, during which the surgeon must be very careful with the facial nerve which may have a different course than usual. This intervention has the advantage that then the patient may not have to use hearing-aid anymore however as far as hearing is concerned there is not always the expected result. The surgery’s disadvantage is that instead of the normal auditory canal, a cavity is produced which needs protection from the water and care every six months. These difficulties make many persons remain with the bone-suspending hearing aid support.

Congenital aplasia of the pinna and congenital atresia are rare diseases. They often require a complicated and demanding treatment. Therefore, the medical team that will deal with it must have sufficient experience while psychological and technological support are also necessary.