Deformed ear at birth (without ear canal)
This picture depicts a congenitally malformed ear without an ear canal.This problem could be unilateral or bilateral.Although the outer ear is malformed the inner ear which contains nerve cells for hearing is spared in this condition.Therefore hearing is not severely impaired. If an impairment is suspected,hearing assesment can be done at very early age to provide hearing aids.There is a problem of fitting hearing aids due to absence of outer ears. There are two options.One is to provide an aid with a head band and vibrators to stimulate the bone surrounding the ear. Other option is to provide a bone anchored hearing aid which involves surgery to implant the aid inside the bone. The child must be at least seven-years-old to undergo corrective plastic surgery. If the problem is unilateral, normal ear is taken as the template for reconstruction. At the age of seven the other ear would have developed to an adult size. The child may himself be aware of the problem and want it corrected. His peers may be teasing him and this can be stressful. Plastic surgery will involve several steps and require periodic hospitalization. Cartilage is harvested from the wall of the chest. The ear will be carved in several sections, joined together and buried under the skin. These cartilage pieces get nutrition from the overlying skin. At the second stage an ear is formed with this cartilage which is already covered with skin.
It is very difficult to produce a perfectly shaped ear, however experienced or skilled the surgeon may be. Children in most developed countries are, therefore, fitted with plastic ears using titanium nuts and sockets. As titanium is a very expensive metal, Third World countries still perform traditional plastic surgery. Making a hole resembling an ear canal is not necessary.