From the Experts: Ear Deformities Require Early Referral for Best Treatment

During the first six weeks of a newborn’s life, parents study their babies intently. What color eyes did my child inherit? Do they have dimples? Are my child’s ears misshapen?

That last question is one for pediatricians to consider seriously and explore early with the parent. Some newborns are born with mild asymmetries of the head shape or the ears, which might self-correct. While the “wait-and-see” approach is often effective, the best management for many congenital ear deformities is early referral to a plastic surgeon and prompt treatment within the first few weeks of a baby’s birth. 

The Cleft and Craniofacial Center at Hasbro Children’s is one of the oldest in New England and has been accredited by the American Cleft Palate-Craniofacial Association since 2009. Our program has treated thousands of children and adults with cleft lip, cleft palate, craniosynostosis, and other craniofacial anomalies. We know that being the parent of a child with a craniofacial condition can feel confusing and overwhelming. 

A Discussion About Ear Deformities and Treatments with Albert S. Woo, MD, FCAS

The center’s director is Albert S. Woo, MD, FACS, chief of pediatric plastic surgery, a board-certified plastic and reconstructive surgeon with nearly two decades of experience in the specialized care of kids and adults with craniofacial anomalies and cleft deformities. Dr. Woo is an associate professor at The Warren Alpert Medical School of Brown University.

Early Treatment

Ear molding is a non-surgical, corrective treatment that can prevent more invasive and costly surgery later in life. But it must be completed within the first six weeks of the child’s life when the cartilage is soft and malleable. Over time, as the newborn matures, the estrogen levels from its mother decreases, firming the cartilages of the ear. It is within this brief window of time when the non-invasive approach of ear molding is most effective. Unfortunately, many studies have found that ear molding is not as successful after six weeks of age.

Common Ear Deformities

An example of ear deformities that respond well to ear-molding include:

  • Protruding ear: Ears that project from the head more than normal.
  • Constricted ear: Flattened or rolled out ears.
  • Stahl’s ear: A pointed upper ear, sometimes referred to as elf ears or Spock ears.

How Ear Molding Works

The process of ear molding isn’t very complicated. Tiny, custom-molded guides are placed around the outer ear. Ideally, this procedure should begin as soon as possible once a baby is born. The ear molds are typically worn for 4-6 weeks, allowing enough time for the ear to grow and conform to a more normal shape. 

Benefits of Ear Molding

Ear molding is a non-surgical option that, when performed during the first few weeks of the baby’s life, is covered by most insurance companies. On the other hand, surgery to improve a child’s ear shape is almost always considered a cosmetic problem and not covered by insurance.

Early intervention is an investment for the child’s future social development and mental health, too. For centuries, prominent ears have been the target of teasing and ridicule by childhood (and adult) bullies and peers. 

Weighing the Pros and Cons of Ear Molding

Ear molding is a low-risk procedure with positive outcomes. When considering it as an option, parents and providers should know: 

  • A slight ear defect at birth may not correct on its own and lead to a permanent deformity.
  • Ear molding is completely non-surgical, is done in the office, and usually takes only a few weeks until completion.
  • Ear molding is not harmful and (when successful), its benefits last a lifetime.
  • If not achieved very early in a child’s life, the only other option is surgery, which parents will have to pay for out of pocket.
  • The sooner that treatment is started, the faster improvement is typically seen.

Make an "Ear"ly Referral

The team of specialists at the Cleft and Craniofacial Center at Hasbro Children’s encourage healthcare providers and parents to seek a consultation immediately after a baby’s birth or as early in a newborn’s life as possible. Taking action sooner than later can have resounding results. Unfortunately, referral even at two months of age, might mean that ear molding is no longer an option.

Cleft and Craniofacial Center