Dr. Sheryl Lewin with PatientThe psychological effects of Microtia on your child are influenced by many factors, including your culture’s attitudes toward children with differences in appearance, your knowledge of and attitude toward Microtia, your child’s age, personality and gender, the severity of the Microtia, and the level of peer teasing your child experiences. You’ll be comforted to know, however, that the way you deal with your child’s microtia will be the strongest factor in their ability to create and maintain a strong self-image and self-confidence.

When will my child notice his/her Microtia?

It’s generally thought that children become aware of how they are like and unlike others at about two to three years of age. Children with Microtia begin to notice that their ear(s) are unlike those of other children and, naturally, other children will stare, comment and ask questions, or even tease your child, especially when your child begins to socialize at pre-school or kindergarten.

How can I help my child deal with Microtia?

With positive support from you, other family members, teachers, and friends, you can help your child successfully deal with the reactions of others as well as with his or her own internal struggle with Microtia. While your child will respond according to his or her personality, a supportive, matter-of-fact approach that helps your child to both understand Microtia and the plan for their ear(s) to be repaired can minimize the risks for low self-esteem and lack of self-confidence. To help prepare your child for questions and staring when they are in social settings, practice different ways to respond with them.  For example, your child can say: “I was born with Microtia, that means I have a small ear. The doctors are helping me and I feel good. Let’s go play.”  Remember, Microtia is just one aspect of your wonderful son or daughter—not his or her entire being. Raise your child as you would any other! This will go a long way toward helping your child cope with Microtia and avoid social difficulties with peers, social withdrawal, and academic and behavioral problems.

Should we plan an early surgery or wait until our child can be involved in the decision?

Some parents schedule ear reconstruction surgery before the age of five to prevent their child from experiencing teasing and self-consciousness. Other parents decide to wait until their child is old enough to be involved in the decision. If your child has no apparent concern or self-consciousness about Microtia, and is progressing well academically and socially, there may be no need for early ear reconstruction surgery. By carefully observing how your child deals with Microtia, and by thoroughly researching and evaluating your options, you are in an excellent position to decide what is the best option for your child.

Are there studies about psychosocial effects of Microtia on children?

Yes, there are, but all studies to date on the psychosocial impacts of Microtia (before and after ear reconstruction surgery) are based on Rib Cartilage Ear Reconstruction. This surgical technique is age-dependent, because Rib Cartilage Ear Reconstruction surgery requires enough rib cartilage to form an ear, which is generally not available until the child is 6 or 7 years old. Some cartilage surgeons delay reconstruction even longer, until the child is 10 years old, in order to have better projection of the ear.  As a mother, Dr. Lewin understands that children at these ages can sometimes unwittingly or intentionally be insensitive and cruel, resulting in children with microtia experiencing social and psychological difficulties. For that reason, a main advantage of Medpor surgery is the ability to complete the reconstruction by 3 years of age.

The Medpor technique uses a customizable porous polyethylene implant to form the ear and, therefore, is not age-dependent. The Medpor surgical technique can be performed as early as 3 years of age, allowing you to avoid much of the teasing, staring, and risks to self-esteem that your child might otherwise experience.

Both as a mother and a surgeon, Dr. Lewin has a deep concern about the psychosocial effects of craniofacial differences in children. Her experience treating these children since 2005 has led her to believe that early ear reconstruction surgery can, in large part, prevent the negative psychological effects experienced by older children. In an attempt to prove her hypothesis, Dr. Lewin, along with her colleagues, Alexis Johns, Ph.D., a Pediatric Psychologist at Children’s Hospital Los Angeles, and Daniel Im, BS (Albert Einstein College of Medicine) started a long-term scientific research study in 2008.  This study involves both a prospective and a retrospective comparison of psychological profiles of Dr. Lewin’s patients before and after Medpor Ear Reconstruction surgery. Preliminary results were presented at the American Psychological Association (San Diego, 2010) and the American Cleft Palate – Craniofacial Association (Puerto Rico, 2011). (read more)

Letter from a Patient

Grade 1 Microtia EaThe following letter is from a gentleman who was born with the ear shown to the left. This is a Grade 1 Microtia with aural atresia, where the ear is smaller and somewhat misshapen compared to a normal ear, but still has recognizable features of the helical rim, the earlobe and some other structures. He has no ear canal and a severe hearing loss. Relative to children born with grade 3 microtia, it would seem to be a more mild physical diagnosis.

When this patient was a boy, his parents took him to a prominent surgeon who did not recommend surgical repair as his condition was too mild to warrant surgery.  From that point on, no further efforts were made to try to correct this patient’s ear. In fact, he believed until this year that nothing could be done.  When I met him for the first time, he explained to me how significant an issue growing up with this ear condition was for him, and how he felt it has affected nearly every aspect of his life in a significant way.  Although he related to me, as did his wife, that he rarely spoke about his ear, the psychological component of microtia was extremely significant.

The following letter was written by this patient about 3 weeks after I took him to surgery to correct his Microtia.  He did not require either Cartilage Rib Graft or Medpor, but rather a complex reconstruction and rearrangement of the cartilage of his own ear.


Dear Dr. Lewin,

You asked me if I would write you a letter describing what it was like to grow up and live with microtia from birth to adulthood.  I readily agreed in the hope that my experiences and views might be helpful to parents that have children with microtia and aid them in determining whether to repair the microtia.

First, a little background.  I am a man in my 40s, married with children.  I was born with microtia which was not repaired until recently by you.  My microtia was never repaired before because my parents did not know surgery was available and it was only a few months that I discovered that surgical repair was possible for me. Perhaps one of the best ways to describe my feelings about my microtia is to respond to some of the points made by parents of some children with microtia.

The child seems fine with it and does not care. This seems to be a common refrain among parents of children with microtia.  The truth is that at a very young age children don’t really care about things like physical differences and, frankly, don’t know better.  As they get older though, they do know and it does matter.

I will say from my own experience that although as a young child I certainly knew of the  microtia, it didn’t really bother me tremendously until I reached about 11 or 12.  Part of this could be due to the different hairstyles of the time.  I grew up in the 1970s and 1980s.  In the 1970s, most males had longer hair and I was no exception.  So to some extent it may have been out of sight, out of mind.  While I knew I had the condition (and had atresia as well, so no real hearing in that ear), I don’t recall it weighing on me that much.

But I can still remember how it hit me like a thunderbolt when I was around 11.  I went from basically not thinking about the microtia to thinking about it all the time.  How much my ear bothered me only grew worse as I grew older.  The 1980s came and men’s hairstyles started getting shorter, yet I felt like I was unable to cut my hair short. This became a big deal in high school – a very big deal.  I can recall one kid who would keep asking me why I didn’t cut my hair.  I remember another kid saying that no one has ever seen my ears and so I need to “lift my hair”.

I cannot fully express how stressful living with microtia was and the constant anxiety of trying to make sure that no one saw my ear.  I lived with the stress my whole life – every day until I had the surgery.  One might think that a person would get used to it, but I never did.  I spent my life trying to ensure that no one saw my ear. This would mean determining where I stood in a room, where I sat at a table, etc.  The pressure was tremendous.  There was lots of fear too– fear of the unknown.  That is, if someone saw my ear what would it mean?  What would the reaction be?  Even when I was out of school and an adult in the business world, this was always in my thoughts.  My work was impacted to the extent that I wasn’t fully focused when I was worrying about my ear.  Any social situations, such as staff meetings, caused great anxiety because I was so self-conscious about my ear.

So I would say although a very young child may not care, at some point they definitely will.  They may learn to accept it (I never did), but they will care and almost certainly be bothered by their ear.

Everyone has something about them that they do not like. This comment seems to arise in the context of “so my child has microtia, plenty of people have something about them they wish they could change.”  Some people have a big nose or are too short or too tall.  Some people are slow or bad athletes.  Yes, it is true, even a super model would likely change various things about their body.  However, I think the difference is not a difference in degree, but a difference in kind.  For example, while a big nose may not be optimal, it’s common.  People may not like it, but no one really thinks twice about it.  The ear, however, is different.  Microtia is not common – it is a rare facial deformity.  People aren’t used to seeing an ear that didn’t form properly.  It draws negative attention in a way that a big nose does not.  So yes, while many (most?) people have things about themselves they might want to change, there is a difference between the usual and the unusual.  All of us, especially children, want to fit in and be normal.

No one notices, and if they do, they do not care. This is easy for someone without microtia to assume.  Certainly people do notice the microtia.  Do they care?  I don’t know.  What I do know is that I spent my whole life trying to hide my ear for fear that someone would see it and feel negatively towards me.

Conclusion. In spite of my microtia, I have lived a full and enjoyable life.  I have a great family and a successful career.  But I know too that it was always with me and made my life more stressful than it needed to be.

It is not for me to tell parents of kids with microtia that they should or shouldn’t fix their child’s ear.  I wouldn’t presume to do that.  Each parent has to decide what they believe is best for their child.  I am just sharing my life story.  I am a parent too. Thankfully my kids were not born with the condition, but if they had microtia, I would have chosen surgery for them without hesitation.   I would do so in the hope of sparing them the stress and hardship that I endured until my recent surgery.  Since I had my microtia repaired I have never felt so free and relaxed in social settings like restaurants.  I am much less self-conscious and it feels as if a weight has been lifted from me.

I would add that if parents choose to go forward with repair, that I think you are a tremendously talented and creative surgeon.  I discovered that this type of surgery is not like others that can always be done “by the book”.  You are able to work with the uncertainty of the reconstruction or procedure in order to achieve the best result possible.  More than that, you are a wonderful and caring person who always made me feel comfortable with the process.  If you could do this with my curmudgeonly self, I just think with amazement of what you could do for a child.  I should note too that I say these things of my own free will.  I was not paid, no promises were made to me nor was my arm twisted in any way!  My hope is that sharing my own experience will help other families with microtia.

Kind regards,
A Patient

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