59.1 Introduction

Prominent ear is a relatively common disorder suggested to be approximately in 5% of the population. ¹

It may be caused by several reasons including under-developed or absent antihelix, overdevelopment of the conceal wall, increased concho-scaphal angle more than 90 degrees, and increased cephalo-auricular distances; these causes may be isolated or combined. ^{2 , 3}

Prominent ear may be associated with other secondary deformities such as macrotia, constricted ear, Stahl ear (extra crus/fold), Darwin tubercle (thickening at the junction of upper and middle third of the helix), and mastoid prominence which may have impact on surgical planning.

The transmission pattern of protruding ears is suggested to be autosomal dominant inheritance. The pathogenesis is not so clear; however, point genetic mutations and some environmental factors such as hypoxia, radiation exposure, and certain drugs like thalidomide ⁴ may play a role in this process.

Although most of the operations are secondary to aesthetical problems, children who suffer from this condition may develop social and psychological difficulties, lack of self-confidence, emotional stress, and social isolations during young childhood. ^{5 , 6}

59.2 Anatomy of the Ear

The main anatomical structures of the ear are illustrated in ▶ Fig. 59.1.

In normal anatomy, the helix should project beyond the antihelix. The superior part of the ear typically correlates with the brow, and the inferior part usually descends to the level of the columellar base. Ear length reaches 5.5 to 6.5 cm and width increases to approximately 50% to 60% of length by adulthood. On the vertical axis, the ear normally projects postero-laterally by 15 to 30 degrees.

The helix-to-mastoid distance should be at the range of 10 to 12 mm in the upper third, 16 to 18 mm in the middle third, 20 to 22 mm in the lower third. ⁷ In anatomically normal shaped ears, the angle between the mastoid and the helix should not exceed 30 degrees. ^{8 , 9} In prominent ears, deviations may be seen at the antihelix, conchea, lobule, and helix-mastoid angle.

59.3 Preoperative Assessment

Preoperative evaluation should include the child capability of understanding and accepting the surgical procedure and postoperative care.

The following measurements should be always assessed prior to the day of surgery: the degree of antihelical fold, helical rim projection, conchal depth, mastoid helix degree, lobule deformity, maturity and quality of auricular cartilage, and the presence of other associated anomalies.

59.4 Timing of Surgery

By the age of 6 to 7 years auricle length will reach to about 90% of its mature size.

It has been shown that otoplasty in the pediatric population has no significant influence on later auricular growth. ¹⁰

The surgical timing may depend on several factors such as auricular growth, cartilage size and stability, child developmental status and psychological willingness, and before school age.

We prefer performing otoplasty surgery starting at the age of 6 to 7, always keeping in mind that non-cooperative patient or unrealistic expectations should not be operated.

59.5 Nonsurgical Treatment

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