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Ear reshaping

Introduction

About 1% of people in the UK think that their ears stick out too much. Having protruding ears does not usually affect a person’s hearing, but they can sometimes cause embarrassment and psychological distress.

Ears are one of the first parts of the body to develop to full adult size, so if they protrude they can be particularly noticeable in children and may lead to teasing or bullying.

Sometimes, the parents of a child with protruding ears worry more than the child. They are often concerned that their child’s ears will upset the child and lead to them being bullied at school.

Adults with protruding ears can have practical problems. For example, they may find it difficult to wear certain items of headgear, such as a motorbike helmet. Women with protruding ears may also feel uncomfortable or embarrassed about wearing their hair up.

The outer ear

The outer ear, known as the pinna, is made up of a number of ridges of cartilage. The outer ear collects and channels sound waves into the middle ear before they are transferred to the inner ear. Sound information is then sent from the inner ear to the brain.

Cartilage is a tough, flexible tissue that is found throughout the body. It is used as a shock absorber in joints and for creating specially shaped and curved body parts that would otherwise have no support from the bones, such as the outside of the ears and the nose.

Protruding ears

Protruding ears can be a characteristic that runs in families, but they often occur for no obvious reason.

The outer ear is designed to stick out from the side of the head at an angle of about 20 to 35 degrees. However, in a small number of people, the angle is more than 35 degrees, resulting in protruding ears.

Protruding ears can happen if there is too much cartilage, or if the ridge of cartilage at the top of the ear does not fold properly during development. They can also be the result of an injury to the ears.

Remodelling

Surgery to reshape the ears involves remodelling the cartilage into a more attractive and less obvious shape. The two main techniques for correcting protruding ears are:

  • ear splinting – a procedure that can be used to treat babies who are six months old or younger; it involves reshaping the soft cartilage and using a splint (support) to keep the ear in the new position
  • otoplasty – a surgical technique, sometimes known as a pinnaplasty, where the cartilage is remodelled to create the missing folds and position the ear closer to the head

For more information about ear splinting and otoplasty, see Ear reshaping - when it should be done and how it is performed.

Availability on the NHS

Financial support for treating protruding ears varies considerably between different health boards.

Some health boards will not fund corrective treatment that is carried out purely for cosmetic reasons. Others may request psychological or psychiatric reports as proof that a person’s ears are causing them significant psychological distress before agreeing to fund any treatment.

A number of criteria have to be met for an otoplasty to be made available on the NHS. Ear splints are available in some health boards and GP surgeries. See Ear reshaping - availability for more information.

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When should it be done?

Ear splinting

Ear splinting is a simple and safe procedure that is often performed on newborn babies to correct protruding ears. It is often carried out within the first three months of birth because this is when it is most likely to be effective.

Ear splinting can only be carried out in infants who are six months old or younger. After six months, the cartilage in the ear becomes too hard to be remodelled with splints, and surgery will be the only treatment option.

Otoplasty

An otoplasty can be carried out after the ears have reached their full size. Most children’s ears will be almost full size by the time they are five years old.

Otoplasties tend to be less successful when they are carried out on children younger than five. Young children have soft cartilage in their outer ear, which is less likely to hold stitches. Surgery performed at this age may also distort the area being operated on because the cartilage will continue growing until around five years of age.

Otoplasties are mainly carried out by:

  • plastic surgeons
  • ear, nose and throat (ENT) surgeons, and occasionally by
  • paediatric surgeons – surgeons who specialise in surgery involving children

Surgeons usually recommend that an otoplasty is performed when a child is old enough to understand what the operation involves, and they are able to express a desire to improve the appearance of their ears.

Informed consent

As with all forms of surgery, consent (permission) must be given before an otoplasty can be performed. This is a legal requirement that is known as ‘informed consent’.

Children who are 16 years old and of sound mind (able to make informed decisions) can sign a legal document to confirm that they understand what the procedure involves and are happy for it to go ahead. In cases where the child is under 16 and/or is not of sound mind, their parent or legal guardian will need to sign the document on their behalf.

Before you or your child signs the consent form, the surgeon carrying out the operation will explain what it involves, as well as the aims, benefits and potential risks of the procedure.

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Availability

Cosmetic surgery on the NHS

An otoplasty (surgery to correct protruding ears) will usually only be carried out on the NHS for cosmetic reasons (to improve appearance) under exceptional circumstances. For example, in rare cases where a person’s ears are causing them significant psychological distress.  
 
A number of criteria must be fulfilled before cosmetic surgery for prominent ears is granted on the NHS:

  • the patient’s age will be considered by the health board involved (the cut-off age for surgery varies between health boards)
  • patients seeking cosmetic surgery for prominent ears should be assessed by an NHS plastic surgeon, an ear, nose and throat surgeon or a paediatric surgeon; if necessary, a psychologist may also carry out an assessment

In making a decision, the following will also be taken into consideration:

  • the level of psychological distress felt by the patient
  • whether it is the child or the parents who are concerned about the prominent ears

The decision to provide otoplasty surgery to correct protruding ears on the NHS is made on a case-by-case basis. It will depend on the above criteria and the individual’s circumstances. Be aware that most requests for otoplasty surgery are not supported by health boards.

Private cosmetic surgery

If otoplasty surgery is not available on the NHS, you could consider having the procedure carried out privately. The cost of private otoplasty surgery varies between practices, but will usually be around £2,500 to £5,000. 

See the Health topic about Cosmetic surgery - considering cosmetic surgery for information and advice about what to consider when deciding whether to have cosmetic surgery.

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How is it performed?

Ear splinting

Ear splinting should be carried out as soon as possible after a baby is born. Evidence suggests that the procedure is more effective if it is started in the first three months of life. 

Ear splinting is a simple and painless procedure. Small splints (supports) are placed on the outer groove of the ear cartilage. They are kept in place by small strips of tape. The baby’s ear will be taped to the side of their head with a larger piece of tape.

The splints help to keep the ears in the new position without moving, and prevent them from protruding outwards.

Ear splints are available in a variety of different materials, including:

  • wire covered in silicone and plastic
    foam
  • dental material
  • dental bite and impression waxes
  • thermoplastic material – this can be remoulded and reshaped when heated or cooled

The length of time that splinting is required will depend on when treatment begins. The earlier splinting is started, the less time the splints will be needed. For example, splinting that starts when an infant is a few weeks old will only be needed for around two weeks. However, if splinting starts when your child is four or five months old, the splints will be needed for a few months.

See Ear reshaping - results for more information about what to expect after ear splinting.

Otoplasty

The aim of otoplasty surgery is to improve the appearance of a person’s ears and to make both ears as symmetrical as possible. However, it is unlikely that a perfect match will be achieved. Be aware of this before deciding to go ahead with otoplasty surgery.

Otoplasties involving older children and adults are often carried out under local anaesthetic. This means that medication will be used to numb the affected area so that no pain or discomfort is felt during the procedure. Younger children may need to have a general anaesthetic, which means they will be unconscious and will not feel any pain during the procedure. 

A sedative may also be given to older children and adults. This type of medication will help you keep calm and relaxed during the procedure. It will be injected intravenously (through a vein), and will be used in combination with the local anaesthetic.

During an otoplasty, the surgeon makes a small cut behind the ear to expose the ear cartilage. The cartilage is repositioned and shaped by removing small pieces, then scoring and stitching the remaining structure into the desired shape and position.

The length of time that it takes to perform an otoplasty will depend on the complexity of each case. However, the procedure generally takes one to two hours.

After having an otoplasty, there will be a small scar behind each ear. The scars will fade over time and will not be very noticeable because they are behind the head. 

See Ear reshaping - results and Ear reshaping - recovery for more information about what to expect following an otoplasty.

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Results

Ear splinting

If ear splinting is carried out during the first four weeks of life (the neonatal period), it is usually very effective at correcting a child’s protruding ears and preventing the need for surgery later in life.

A study carried out in New Zealand in 2003 involving 30 infants (16 male and 14 female) found that in 87% of cases, remoulding achieved either complete correction or a significant improvement.

Only four infants showed no, or limited, improvement after an average of seven weeks of remoulding.

Slight skin irritation from the tape that is used to hold the splints in place may occur. However, this complication is rare.

Otoplasty

Most people who have an otoplasty are happy with the results. But before deciding to have this type of surgery, it is important to have realistic expectations about what it can achieve. While surgery can make your ears less prominent and smaller (if required), is not always possible to achieve perfect symmetry.

Otoplasties are very safe procedures. However, as with all types of surgery, there is a small risk of complications. Some of the possible complications of otoplasty surgery are outlined below.

  • Infection where the cut was made – this will usually be treated with antibiotics; drainage of the affected area may also be required. It is possible for the area surrounding the incision to become infected, which could lead to a permanent ear deformity. However, this is very unlikely.
  • Inflammation of the ear cartilage (chondritis) – this may require drainage.
  • blood clot – this may form in the skin of the ear, which could lead to an ear deformity. Your surgeon may need to remove it with a needle.
  • Scarring behind the ears.
  • Recurrence – in 5% of cases, the ears continue to protrude.
  • Unsatisfactory appearance.
  • Mild bruising around the ears – this may last for up to two weeks after surgery.
  • Numbness over the ears – this can last for several weeks or, occasionally, a few months.
  • Stiff ears – these can take several months to become flexible again.
  • Soreness – this is particularly noticeable at night, but rarely lasts for more than a few months.
  • Problems with stitches – for example, they can occasionally be forced or pushed out a month to a year after surgery. However, the stitches can be easily and painlessly removed at your local clinic or hospital.    
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Recovery

Otoplasty

After the otoplasty, a bandage may be wrapped around your head to protect your ears and the surrounding area from infection and to help keep it clean.

Depending on your progress, the bandage may need to be kept in place for up to a week after the operation. During this time, you will not be able to wash your hair. You will be able to wash your hair after the bandage has been removed, but avoid getting the affected area wet.

Some surgeons recommend wearing a head band at night for several weeks to protect your ears while you are asleep.

While you are recovering from an otoplasty you will need to avoid:

  • swimming for up to eight weeks after surgery
  • sports or activities that put your ears at risk of injury, such as judo or rugby, for up to 12 weeks after surgery

If you had a general anaesthetic, avoid driving or using heavy machinery for 48 hours after the operation. If you were given an intravenous sedative, driving and operating heavy machinery should be avoided for 24 hours.

After the stitches and dressing have been removed, keep your ears and the surrounding area clean to help prevent infection.

Pain and discomfort

During the first few days after having an otoplasty, your ears may be sore or tender. They may also feel numb and you may have a slight tingling sensation for a few weeks.

Mild to moderate pain and discomfort can be treated with painkillers, such as paracetamol and ibuprofen, which are available over the counter from pharmacies. When taking painkillers, always ensure that you follow the dosage instructions on the patient information leaflet that comes with the medication. Aspirin should not be given to children who are under 16.

If your pain is severe, your GP may prescribe a stronger painkiller for you, such as codeine.

If you are having very severe pain, contact the specialist who is responsible for your care as soon as possible. They will be able to check whether your ear or the surrounding area is infected, and whether your ear cartilage is inflamed (chondritis).

Returning to work or school

Most children can return to school around one to two weeks after an otoplasty. To prevent injuring your ears, avoid contact sports and playground games that involve physical contact.

The recommended timescale for avoiding these types of activities varies between surgeons. Some surgeons recommend that they should be avoided for a minimum of eight weeks after the procedure. Others recommend up to 12 weeks.

Adults can return to work about a week after having an otoplasty. As with children, any activities that could cause trauma or injury to the ears should be avoided during the recovery period.

There may be some slight bruising around the ears, which can last for about two weeks after the operation. To avoid attracting attention, some people may delay returning to work or school until the bruising has disappeared.  

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