Microtia, a congenital malformation of the outer ear, happens in only 1 out of every 10,000 to 20,000 births. Although the number of these patients is small, the impact on their lives can be tremendous, says Johns Hopkins facial plastic and reconstructive surgeon Jason Nellis.

Children growing up with microtia can suffer a severe psychosocial penalty, he explains, with many feeling self-conscious and experiencing bullying by peers. In addition, microtia is often associated with some degree of hearing loss, affecting school performance and further hindering social relationships.

As one of the few facial plastic surgeons in the region with interest and expertise to treat this condition, Nellis says he has repeatedly seen the impact of successful ear reconstruction. “I have videos and videos of kids smiling ear to ear after they see their new ear for the first time,” he says.

New patients often find Nellis through referrals from their pediatricians, online forums or word of mouth. In about 80% of cases, he explains, microtia affects only one ear, commonly on the right side. This condition is twice as common in boys than girls, it’s more prevalent in patients who are of Hispanic, Native American, or South American origin, and it’s often associated with other congenital abnormalities or syndromes, such as hemifacial microsomia.

At a patient’s first appointment, Nellis provides a comprehensive evaluation to ensure the patient is treated as a whole, and the team approach provides concurrent care for their hearing loss from an otolaryngologist and audiologist. He also assesses the severity of their microtia and whether similar or other associated issues run in the family, findings that could trigger referral to a geneticist or other team member. “They’re not just coming to me to make them an ear,” Nellis says. “I want to make sure they’re cared for overall.”

Nellis also begins planning for their reconstructive surgery. Although human ears are mostly grown to adult size by the age of 9 or 10, that’s long after kids begin attending school and bullying can begin, Nellis says — thus, deciding when to perform microtia repair is a balance between preventing social harm and optimizing the outcome from the reconstructive surgery, Nellis explains. Careful evaluation and surgical planning includes drawing the contralateral ear to determine the new ear’s proper size, position and shape. Patients’ families decide whether the reconstruction will be made from the patient’s rib cartilage — Nellis prefers using patient’s own tissue to reduce risks related to an implant — or from microporous high-density polyethylene.

On the day of surgery, Nellis and his colleagues carve rib cartilage harvested from the patient or the synthetic implant to match the patient’s contralateral ear, then insert it under a skin flap, tailoring incisions to the ear’s natural contours to minimize noticeable scarring. In a second stage, the team fine-tunes the ear’s placement, lifting it so patients can wear glasses or tuck hair behind the ear. Several months later, colleagues in otolaryngology work to restore the patient’s hearing, fashioning an ear canal and eardrum or implanting a bone-anchored hearing aid. Each plan and stage of surgery is customized to an individual patient’s needs, and no two are the same, Nellis says.

His end goal is to give patients a new ear that helps them blend in with their peers and lasts a lifetime.

“After surgery, parents tell me that their kids have a little more bounce in their step, and they get a huge boost in self-esteem,” Nellis says. “Who would think an ear makes such a big difference? But this surgery helps kids feel better about themselves, and combined with helping their hearing, it’s huge.”

To refer a patient, call 443-997-6467.