Stick-Out Ears

Stick-Out Ears are also known as Dumbo, FA Cup, Bat, Jug, Wing-Nut and Prominent Ears. The overall frequency of prominent ears in North America (defined as those which stick out from the side of the head at an angle greater than 40 degrees) is 4.5% but many more people are concerned about smaller degrees of prominence. About two thirds (61%) of prominent ears are noticeable soon after birth. The remaining third become obvious around three months of age, as baby’s head shape changes and as the cartilage framework of the ear hardens during early life. They be corrected at birth or soon after by parents at home with EarBuddies™ Splints. If the opportunity to use EarBuddies™ is missed, then surgery is the only option.

Surgery to Treat Prominent Ears

Surgery to correct stick-out ears is currently the most common paediatric plastic surgery undertaken in the UK. They are treated with a procedure known as Otoplasty, Pinnaplasty, Set-back of the Ears & Pinning Back the Ears. A suture technique is safest, minimising the risk of haematoma and infection associated with cartilage scoring techniques. Click here for more information on different Otoplasty Techniques

Otoplasty can be carried out after the age of 5, under local or general anaesthetic. Prior to this, the cartilage is especially soft and efforts to reshape it may instead cause irregularity. There is no upper age limit for surgery. It is quite common for women to request set back of ears so that they can wear their hair up to marry, for example, or in the case of men, as they start to lose their hair.

Sometimes parents [quite understandably] request that their child’s prominent ears are corrected when the child [equally understandably] is reluctant to have the operation. It is safest in such a situation to put the wishes of the child first. Sometimes the need to wear hair up in a ballet class, for example, will prompt a request for surgery. It is essential before surgery to discuss the desired position of the ears. Some patients want only a gentle change whilst, for others, only ears which are flat to the side of the head are acceptable.

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No two prominent ears are the same. The commonest problem is an inadequate antihelical fold. This can cause the ear to protrude at right angles to the mastoid skin. In other ears the bowl of the ear (the conchal bowl) is excessively deep but the antihelical fold is normal. A grading scale for prominent ears has been put forward by K. Graham and D. Gault, which also includes factors such as elasticity and memory of the cartilage. Some ears will need additional attention to a protruding lobe or an isolated protrusion of the upper pole alone. Some ears are pinned back specifically so that a hearing aid can be worn, and in these, space must be left for the device - too tight a set-back should be avoided.

For more information about Otoplasty, as well as techniques, click here.

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Relevant Publications

Books:

Gault DT and Rothera M
Management of Congenital Deformities of the External and Middle Ear - a chapter for Scott Brown's Otorhinolaryngology, Head and Neck Surgery, 7th Edition Arnold

Academic Papers:

Ridings P, Gault DT and Khan L. (l994)
Reduction in post operative vomiting after surgical correction of prominent ears
British Journal of Anaesthesia - 72 : 592 - 593.

Tan ST and Gault DT. (1994)
When Do Ears Become Prominent?
British Journal of Plastic Surgery 47: 573 - 574.

Tan ST, Shibu MM and Gault DT. (1994)
A Splint for Correction of Congenital Ear Deformities
British Journal of Plastic Surgery 47 : 575 - 578.

Gault DT. (1995)
Invited commentary on: Congenital anomalies of the auricle: correction through external splints
European Journal of Plastic Surgery 18: 291 - 292.

Gault DT. (1995)
Can I Bend Your Ear?
You and Your Baby Magazine page 72.

Laing H and Gault DT. (1995)
Bat Ears - A European Perspective
Christmas Edition of the British Medical Journal 311: 1715.

Graham KE and Gault DT. (1997)
Endoscopic Assisted Otoplasty: a preliminary report
British Journal of Plastic Surgery 50: 47-55.

Graham KE and Gault DT. (1998)
Clinical Experience of Endoscopic Otoplasty (Letter)
Plastic and Reconstructive Surgery 102:2275.

Gault DT. (1998)
Ear Splintage Face 5: 211-212.

Sylaidis P and Gault D.
Antihelical folding for pinnaplasty using one posterior cartilage score and horizontal mattress sutures.
Annals of Plastic Surgery Vol 45 (no 3) Sept 2000 341-342.

Horlock N, Misra A, Gault D.
The postauricular fascial flap as an adjunct to Mustarde and Furnas type otoplasty.
Plastic and Reconstructive Surgery 108: 6 1487 - 1490, 2001.

Beckett KS and Gault D
Operating in an eczematous surgical field; Don’t be rash, delay surgery to avoid infective complications
Accepted by the British Journal of Plastic Surgery 2006

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