What is it?
A prominent ear protrudes excessively from the side of the head. It is frequently a source of teasing, using names like ‘Dumbo, FA Cup, Jug Ears, and Wing Nut’.
Surgical correction of prominent ears is usually performed under general anaesthesia in children. It can also be done under local anaesthesia. There are many ways of performing this surgery. Most frequently, an incision is made behind the ear, some skin is removed, and the cartilage remaining is marked on the front surface to allow it to bend backwards towards the head. Dissolving sutures are then used to hold it in the new position. A dressing is placed to keep the ear comfortable. Many surgeons use cotton wool and a bandage to end up like a turban to avoid disturbing the new position of the ear. The procedure is usually done as a Day Case.
The cartilage of the ear is very soft immediately after childbirth and it is possible to have moulds made which can gently re-shape the ear in the first few weeks of life. Some people get so upset about the prominence of their ears sticking out that they have even used ‘super glue’ to hold them to the side of their head.
Before the Operation
Sort out any tablets, medicines, inhalers that your child is using. Keep them in their original boxes and packets. Bring them to hospital with you. On the ward, your child may be checked for past illnesses and may have special tests, ready for the operation. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After – In Hospital
There may be some discomfort following the surgery. If the surgery is performed under general anaesthesia, local anaesthesia is also given so that when the patient wakes up they usually do not feel pain, but they may have some discomfort.
It is likely that there may be a bandage, dressing or turban around the head to protect the ears in the new position. The dressing may cover the external ear canal and make hearing difficult. One should not interfere with the dressings, however, as this can lead to infection and poor healing of the operation scar. Children often try and scratch their itchy ears under the dressings. This should be discouraged.
Some pain and discomfort will follow when the local anaesthetic wears off. This is usually well controlled using simple painkillers like Paracetamol. If there is unexpected pain or discomfort it may be necessary to have the dressings removed and the ear reviewed by a nurse or the surgeon.
After – At Home
It is useful to sleep upright the night following the surgery. The bandages should not be interfered with and it is best to make sure that children do not stick their fingers up to try and scratch the back of their ears. This can lead to infection. The head bandage is left on for up to ten days following surgery. On removal of the head bandage the ears are cleaned. Examination is performed to make sure there is no collection of blood between the skin and the cartilage. Rough games should be avoided for up to two months following surgery. A ‘sweat band’ at night-time is useful for up to three weeks following surgery.
When the head bandage is removed, there is often bruising and swelling of the ears. This can occasionally continue to make them look as if they are still sticking out. The swelling and bruising does take some weeks to finally resolve. There may occasionally be some bruising and scabbing over the skin on the front part of the ear. This will heal by itself.
Complications are unusual. There can be a collection of blood between the skin and the cartilage-giving rise to a ‘cauliflower type’ ear. This can be treated surgically. The skin on the front of the ear is very thin and occasionally after surgery it may be bruised. On rare occasions the skin can become scabbed and one needs to be particularly careful, with regular reviews of dressings, to make sure that the underlying cartilage does not become exposed and dry out. If the cartilage dries out, it can lead to a misshapen ear.
The ears may be red and sensitive after the surgery and take some time to settle. The scar behind the ear can sometimes become red and raised, exceeding the height of the normal surrounding skin. It is often difficult to make both ears absolutely symmetrical and there are often minor irregularities on the skin surface. Less than 1 in 10 patients require any surgical re-correction.
It is often useful to try and have the surgery performed in children out of school time. However this may not always be possible and some children have to go to school wearing the turban type bandage in order to protect the ears.