2 Creating an ear

Benjamin, who has a case of microtia or congenitally absent right ear, is so pleased with the reconstruction he is considering fixing his other ear. Benjamin (not his real name), 20, always felt different while growing up as he did not have a right external ear. In place of where the external ear should have been was a small lump of mishapen flesh. He is deaf in this ear.

He can only hear with his left ear, which is also slightly misshapen.

After years of being teased mercilessly by classmates, Benjamin had a lifeline thrown his way two years ago when he enlisted for national service.

A doctor conducting the routine check-up introduced him to Dr Tan Ying Chien, a plastic surgeon at KK Women's and Children Hospital who specialises in ear reconstruction.

'I wasn't sure at first if I should see the doctor,' said Benjamin. 'I've never thought of having surgery because I've become used to my condition.'

However, a chat over lunch with someone who had had his ear reconstructed changed his mind. Said Benjamin: 'He told me about his experience. He also told me how to prepare myself for surgery and how to cope after that.'

Dr Tan, who operated on Benjamin, said reconstructing the microtia - which is the medical term for a congenitally absent ear - is not easy as most of the ear has to be created from scratch.

Two operations are needed, he said. The first is to remove rib cartilage from the patient and carve it into the shape of an ear. The structure is then inserted under the skin at the ear area. This takes about seven hours.

As the inserted ear tends to lie flat against the side of the head, a second operation is needed to lift the reconstructed ear away from the head to achieve a normal appearance. This normally takes place six months after the first operation and takes about four hours to perform.

The entire procedure may be painstaking but using rib cartilage instead of an artificial material helps to make the ear look and function more naturally.

'The rib cartilage is part of the body,' said Dr Tan. 'This way, when the skin at the ear breaks, for example, it will heal.'

While one can opt for a prosthetic ear made from silicon, problems like discolouration and infection are common, said Dr Tan. 'The prosthetic ear also doesn't age together with the rest of the body,' he added.

Microtia affects about one in every 7,000 babies worldwide. Generally, it occurs more in boys than in girls and can affect one or both ears. Most will have decreased hearing capabilities.

Benjamin, who is very happy with his new right ear, is considering a similar surgery to improve the appearance of his left ear. 'The finished look is beyond my expectations,' he said.

3 Pinning back the ear

To correct protuding ears, a surgical procedure called otoplasty is done where the ears are "pinned back" to reduce their prominence.

You might not have been aware of it, but you were actually making fun of a physical deformity. The condition is known as 'bat ears'.

The most common but least serious of ear deformities, a bat ear, is determined by the presence of at least one of three factors, said Dr Tan Ying Chien, a plastic surgeon at KK Women's and Children Hospital who specialises in ear reconstruction.

These are: a large angle between the ear and the side of the head; an absence of the antihelical fold (the y-shaped fold at the upper ear); and a large conchae, which refers to the 'bowl' of the ear.

Any of these factors can make one's ears appear too prominent.

Although hearing is not affected, the condition may have a psychological impact on children when they are subjected to teasing and name-calling by their schoolmates.

To correct protruding ears, a surgical procedure called otoplasty is done where the ears are 'pinned back' to reduce their prominence.

The ear cartilage is first softened by a series of small cuts to make it flexible. A stitch is then made to pull the ear back so that it rests at a smaller angle against the side of the head.

The surgery takes only about one hour and the patient does not have to be hospitalised, said Dr Tan.

However, the patient will need to wear something, like a bandana, for about two weeks after the surgical dressing is removed. This is to keep the ears in place while the cartilage settles into its new shape and position.

Otoplasty can be done on patients as young as four years old.

Adverse post-surgery effects are uncommon, Dr Tan said. In extreme cases where the stitching is too tight, a 'telephone ear' may result - where the middle part of the ear appears too pinched back in comparison to the top and bottom parts.

An interesting observation is that Asians appear to be more tolerant of this condition than Caucasians, said Dr Tan. Many do not seek surgery until they are much older, like when they are in their 20s.

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This article was first published in Mind Your Body, The Straits Times.