Ear Shape Differences - Pediatric

Doctor examining a toddler's ears

Congenital ear differences commonly occur in the following forms: a slight difference in ear curvature; ears “sticking out” (prominent ear); cupped ear (cryptotia); small, stub-like ear (microtia); or an absence of any ear at all (anotia).

Acquired ear differences usually result from traumas that lead to either a missing piece of the ear or a misshapen ear that is the result of significant scarring.

Contour differences of the ear come in as many different forms as there are ears. Below, some of the most common are listed.

  • Stahl’s ear is where the top part of the ear has an extra crus, which is a fold in the ear that causes the top portion of the ear to appear pointy.
  • Prominent ear happens when there a fold missing at the edge of the ear in addition to an over-abundance at the bowl of the ear. This results in the ears appearing larger than normal and “sticking out.” 
  • Microtia occurs when there is only a lump or small portion of the ear visible. Microtia occurs in many different forms and can be associated with other conditions, such as hemifacial microsomia (other underdeveloped parts of the face). There might or might not be an ear canal present.
  • Anotia is when there is no ear present. Because microtia and anotia can be seen with other types of birth differences, a comprehensive evaluation by several specialists is recommended. 

Contour defects of the ear can be genetic, however there are no definite causes. Microtia and anotia can be seen with other anomalies, although they can occur by themselves. Environmental factors might also contribute to contour defects, but there is no single cause known.


Contour deformities can be improved with surgical procedures where the cartilage is shaved and stitches are placed in specific areas. In the case of prominent ear, some cartilage may be removed as well. Constricted ear requires grafting skin and/or cartilage to “unfold” the ear. The complexity of microtia/anotia often requires three to five operations to achieve the desired result. At UK Pediatric Plastic Surgery, we typically prefer to make the ear out of the patient’s own tissues.

Stages of Ear Construction

The first stage is to take cartilage from the ribs to make the framework of the ear. This is then placed in the area of the missing ear under the skin. It is the largest, most important step of the reconstruction and requires an overnight hospital stay. Two small drains will be left around the new ear to ensure there is no fluid collection, and the drains are removed in clinic the following week.

The second stage is to construct the ear lobe from the surrounding tissue.

The third stage is to raise the ear from the head with a skin graft to the back of the ear.

The fourth stage is to further touch up the ear itself, potentially requiring the use of some skin or cartilage from the other ear. The shape and form of the other ear is not altered in the process. Every ear reconstruction is different, so discussion between each stage is necessary to determine the best course of action for each patient.

For more information about ear surgery, please refer to the American Society of Plastic Surgeons website.

Note: The previous descriptions and notes are intended to give an overview and are not at all comprehensive. Should you have any questions or concerns, please do not hesitate to contact UK Pediatric Plastic Surgery for a clinic consultation.


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