Microtia in Children

What are the signs and symptoms of microtia and atresia?

Microtia can be diagnosed and seen on a 20-week ultrasound. However, it is not routinely evaluated during a normal pregnancy.

Once a baby is born, parents and health care specialists will notice:

• Unusual ear size
• Unusual shape of the outer ear 
• A closed or very small ear canal opening

What is the risk of future children having microtia-atresia?

The risk of having a child with microtia-atresia is low. The risk of having more than one child with microtia-atresia is also low unless your ethnicity has a high rate of occurrence, like Native American. However, it is still rare to have parents and children or siblings with microtia-atresia.

What tests are used to diagnose microtia-atresia?

Newborn testing

All newborns with microtia-atresia should receive a diagnostic Auditory Evoked Potentials (AEP or auditory brainstem response/ABR) evaluation within three months of birth. The test can be done as early as any routine newborn hearing screening.

An AEP/ABR evaluation is completed by a Doctor of Audiology (AuD). It is highly recommended that newborns diagnosed with hearing loss find a pediatric audiologist for care. Learn about the Audiology, Speech and Learning Center at Children's Colorado.

Testing for older children

All children should receive a hearing screening when starting public school and then be referred for a diagnostic hearing test. However, hearing loss can be missed in newborns if screening isn't done prior to hospital discharge after birth and/or if follow-up for young children is not recommended by the pediatrician or birth hospital. This can happen if microtia/atresia is only in one ear because hearing loss in one ear is harder to detect.

How do specialists at Children's Colorado make a diagnosis?

In order to diagnose microtia-atresia, your child should see a microtia specialist. When you visit Children's Colorado's Microtia Clinic, a specialist completes an evaluation of the child's ear.

During the evaluation, the specialist:

• Evaluates the outer ear and ear canal (if there is one)
• Tests hearing in both ears, even if the canals are not closed 

An otolaryngologist (ear, nose and throat specialist) or a plastic surgeon and an audiologist, who are knowledgeable about microtia, complete the evaluation and provide a diagnosis. Sometimes, the child sees other specialists, such as a speech therapist for a language delay.

Atresia treatment

Atresia is a condition in which a child is born without an ear canal. Atresia can be treated with surgery. Two procedures are available at Children's Colorado:

• A bone anchored hearing aid (commonly known as BAHA) 
• An ear canal opening procedure 

If the hearing loss is sensorineural (nerve deafness), then hearing aids, preferential seating in the classroom and speech therapy are advised.

Microtia treatment

Microtia is a condition that affects how an ear looks. Depending on the child's and parent's wishes, treatment of the microtia affected ear can be left natural or can be reconstructed.

Reconstruction of the outer ear (ear surgery) can be done with a prosthesis or rib cartilage grafting. Reconstruction usually begins when the child is 6 or 7 years old. Boys with microtia/atresia often wait until they are 8 to 10 years old, which is when the shape of their outer ear becomes important to them.

Microtia-atresia treatment timeline

Below is an example of a timeline of care that is adjusted for each patient's needs.

Birth – 3 years old

• Establish care with an audiologist (hearing specialist)
• Consider a trial with sound amplification and daily use of a BAHA or bone aid
• Early intervention services
• Visit the Microtia Clinic every one to two years

3 – 6 years old

• Hearing (audiology) visits per recommendations by a specialist or as- needed for sound amplification
• Visit the Microtia Clinic annually

6 years old +

• Visit the Microtia Clinic for ear surgery and prosthetic options based on how the ear looks
• Hearing (audiology) care annually or as-needed for sound amplification

What to expect at the Microtia Clinic

The Microtia Clinic is held once a month in the afternoon on a Tuesday at Children's Colorado Anschutz Medical Campus, Aurora. Appointments last 60-90 minutes. 

Families meet with the ear, nose and throat specialist, a family consultant and an anaplastologist (who makes prosthetic devices) at the beginning of the visit. They meet with the audiologist as needed for hearing tests, amplification consultations and to schedule future appointments. 

Families can stay longer to meet other families and patients, but are not required to do so.

Why choose Children's Colorado to treat your child's microtia and atresia?

Children's Colorado provides patients and their families the unique opportunity to learn treatment and rehabilitative options for microtia and atresia from a team that supports each child with his/her own needs. 

Our philosophy allows the individual patient to receive current and accurate information from a surgeon, audiologist, family consultant and anaplastologist. This allows the patient to be confident and feel supported in his/her individual treatment choices for microtia-atresia. Additional supports, such as parent-to-parent, patient-to-patient and psychological and social work resources are available as needed.

Colorado Families for Hands & Voices
Parent-run organization that supports families with children who are deaf or hard of hearing without a bias around communication modes or methodology.

Colorado Hearing Resource Coordinator
Assists families with children birth to 3-years old in obtaining access to funding, community resources, coordination of services and providing expertise about hearing loss.

Colorado School for the Deaf and Blind
Hard of hearing and deaf adult role models who are trained to provide awareness experiences to increase understanding of the needs of a student who is hard of hearing/deaf and to improve this child's sense of identity and self-esteem.

Ear Community
Online support group for individuals with microtia and atresia.

Phonak Guide to Access Planning
Provides information that is important to effectively and independently advocate and be responsible for your communication access supports.