Can long hair solve my problem? Is there any glue that would stick my ears? What causes the defect of protruding ears?
These are just several questions I asked myself during my whole childhood. As long as I remember, I have always had long hair. My mum used to tie it up in a ponytail hanging loose on my back and decorated it with a huge ribbon. In this way, she tried to hide my protruding auricles. And after school, as soon as I could, I had my hair loose. When I was a kid, I loved swimming. I started learning it when I was 4. My classes in the swimming pool took place several times a week. Soon, at the age of 6 I started swimming professionally in a sport club. It gave me a great pleasure. Besides, no one could see my outstanding ears, then, because they were covered by the swimming cap. However, the most unpleasant moment for me was drying my hair. I was afraid that one of my friends could see them and simply start laughing at me that would, of course, make me feel sad and probably could make me give up swimming. But my mum tried to prevent it. As soon as my swimming classes finished, she ran to the changing room to dry my hair quickly, whereas at school I used to wear colorful terry cloth headbands during my sport classes. It was extremely difficult to buy them in Poland at that time, and I remember I got them from my cousin from Australia.
Modeling, tying and brushing hair were all a nightmare for me, especially after my swimming classes. I always dreamt of short cut hair. Less hair means less work with it. I dreamt of getting rid of all my hair kits such as hair pins and buckles as well as headbands. Although my hair was long dark and curly, I didn’t like it.
That’s the way I survived up to the eighth grade. During the last year at my primary school a lot of duties I had helped me to forget about my problem for a while. I got used to the way my face looked like to a certain degree, of course. I thought that the nature bestowed on me this type of beauty and I simply had to accept it whether I liked it or not. Some people are thick, some are thin, some have red hair and face full of freckles and other need to wear glasses. All of these become usually the reason to be made fun of by other children. “Well, tough luck” I thought then. “I will have protruding ears” and I even got used to them.
But one evening when we all set around the table to have dinner, my parents brought up the problem of my ears. They asked me whether I would do something with my ears if had a chance to change them. I must admit that I was surprised then and scared at the same time. Of course earlier I asked my parents many times about the correction of my ears, but their answer was always negative. On hearing such news I just started thinking of the cost of a possible surgery. I asked my parents whether they meant Polanica Zdrój. But they denied. They found out that there was a possibility to carry out such a surgery also in our town. Earlier they got all the necessary information concerning the surgery as well as the cost. They suggested that we should go together to consult it with a surgeon. Without any hesitation I agreed. After a few days since the conversation took place, we were all sitting in the waiting room in front of the doctor’s office. He asked us to come in and took a look at my “tragic” auricles and told me every detail about the procedure as well as what I needed to be ready for after all. On being asked whether I was ready to undergo the surgery, I immediately answered YES and if that was possible I would stay in the clinic at once. The doctor, however, suggested my holidays as a perfect time to do it. Holidays were more favorable mainly due to two reasons. First, none of my friends would see me having head wrapped up in a dressing, and secondly, my new friends at my new school that I was to start from September would know me with beautiful ears. “This is a perfect idea” I thought. The time I spent waiting for my vacation was the longest one in my whole life. I looked through a dozen or so catalogues with haircuts. They all were wonderful, but I was interested only in those with short hair. Finally, the longed for end of the school year came. On this day my mother and I went straight ahead to the clinic. In the waiting room I was welcomed by a nurse that gave me a pair of pyjamas to put on and a capsule of antibiotics to swallow. About 10 minutes later I was taken to an operating room. The moment I entered it, my knees started shaking and I felt fear. However, the will to correct my ears was stronger than my fears connected with the surgery I was to undergo. The surgery itself was performed under local anesthesia. The doctor explained to me the details and asked me often whether I was ok. “Everything is ok” I always answered. I felt a few injections and after a while my ear was numb. Since that moment I could feel nothing. I just could hear some nice talks, music pleasant to the ear and soft clinking of the medical tools. After 45 minutes my right ear was ready. My head was turned on to the other side and the surgery continued. Again I felt a few unpleasant pricks of a needle. After all I was put a dressing around my head and an elastic bandage. It was already the end. I regretted then that I hadn’t undergone this surgery earlier. I went to get dressed and everyone could see a smile on my face. I got also some water to drink and two pills of a painkiller.
Equipped with all the things I needed I returned home. Luckily, my mother called a taxi. It was already dark outside. I didn’t meet any neighbors of mine as well as any friends. I didn’t want anyone to see me. Earlier I told everyone that I was going to visit my relatives for holidays. I had to wear a dressing all week long. I had to sleep having it on my head and I couldn’t wash my hair. On the first day nothing hurt me, however, on the second and third day my ears hurt me a little bit. The doctor warned me that I could suffer a little. Well, I could do it. The vision of having a nice haircut buoyed me up. So the week passed. Finally, I could see the result of the surgery and wash my hair. The dressing was taken off in the clinic and I was given a mirror. I took a look and …”wow they are beautiful” I exclaimed and gave a big hug to the doctor. Never had I been so happy before. I even gave a kiss the doctor and ran to my mother. Indeed the result was very nice. At the very end I found out that I needed to sleep with a headband, the same I wore during my sport classes, one month more. After a week or so I went to the hairdresser. I cut my hair and did a nice short haircut. I was happy. My friends I was seeing within the next few days didn’t recognize me at first. In September I went to a new school. There, no one laughed at me because of my protruding ears as they were not protruding any more. My dreams finally came true. Indeed, the dreams can really come true…
The correction of protruding auricles
Although protruding ears are a congenital defect occurring most often in the region of head and neck, there were only 8 % of the operated patients whose defect could be observed in their families. The protruding auricles are the concern of about 5 % of the population. They are purely an aesthetic problem and usually other defects accompany it very rarely. At about 61% of children, the defect is visible just after the birth irrespectively of sex. Usually the defect is bilateral rarely unilateral, and it occurs most often at the female sex. The defect of protruding auricles described by Luckett results from the failure of antihelical fold to develop, the occurance of a large and deep concha as well as the abnormal ending of the edge of the helix. Very often the incorrect structure of the ear lobule also occurs. The technique of correcting auricles, i.e. otoplasty, was first described by Sushrut and Tagliacozzi. The modified era of otoplasty, however, dates back to the year 1848 when Dieffenbach described the correction technique of microtia. In 1881 Ely, in order to correct protruding auricles from the region of behind the ears, removed a strip of skin from the conchonavicular angle from the posterior surface of the ear, and it was Keen who modified the technique so that a scar remaining after the surgery could be as minute as possible. The next century brought about various further technical solutions. Since 1940 the corrective surgery of protruding auricles consisted in removing a fragment of the cartilage from behind the ears approach. Also instead of removing the cartilage, it is possible to incise its posterior surface. In 1960 Mustarde used non-absorbable stitches to create an antihelical fold from the posterior approach by ellipsical excision of the skin. Three years later Stenstrom and Chongchet made a posterior excision of a fragment of the cartilage to make the fold elastic. In 1968 Furnas described the procedure based on the Miller’s technique that consisted in attaching the concha up to the periosteum of the scull mastoid process in order to diminish the conchonavicular angle. Currently, there are about 200 surgical techniques described that correct the defect of protruding auricles including endoscope method, too. However, what is most important for the patient and the surgeon is obtaining the best cosmetic effect leaving the smallest scar on the posterior surface of the ear. Each of the above described surgery techniques consists in breaking subcutaneously the anterior surface of the antihelix (according to Stenstrom), putting on non-absorbable stitches that break the antihelix (according to Mustarde) and additional stitches between the concha and the periosteum of the scull mastoid process to diminish the conchonavicular angle (Furnas’ maneuver).
The ear corrective surgery is most often performed after the age of seven. Then, a child’s ear is fully developed and stops growing. In the case of small children the surgery is performed under general anesthetic, whereas, in the case of adults under local anesthetic using 1% lidokaine with adrenaline. On the posterior surface of the ear concha a little elliptical excision of the skin is made. Next, the skin is pulled off from the surface of the cartilage on the posterior wall of the ear, and by means of needles, the region of break of the future antihelical fold is marked. The posterior surface of the cartilage is incised and from the back approach non-absorbable stitches are put on in order to form a fold. Additional stitches are put on to diminish the conchonavicular angle between the ear concha and the periosteum of the scull mastoid process. An absorbable stitch is usually put on the skin in a continuous way.
A dressing with antibiotics ointment is put directly after the surgery. Prophylactically, just before and three days after the surgery, antibiotics are taken orally. The dressing should be worn for a week. One cannot wash his/her hair and it is recommended to refrain from school, professional and social life. Winter or summer vacations are the best moment to undergo the corrective surgery in the case of children. After a week, the dressing is taken off in the clinic, and the ears are a little swollen and red. However these symptoms disappear after two or three days. For the period of two months after the surgery, sleeping in a special elastic headband made of terry cloth is recommended. This kind of protection is also recommended during sport classes and practicing sport, generally. It is necessary due to the danger of “dodging” the auricle during an injury. The cartilage rebuilds itself within the period of two months. After such a period of time it becomes hard, elastic and resistant to damages.
- Infections. In order to prevent them, antibiotics are administered prophylactically as well as caution and full aseptic are kept during the surgery and one-week-long convalescence after the surgery
- Coming out of the non-absorbable stitches through or under the skin on the posterior surface of the auricle. It is the most common and the slightest complication. It refers to about 10% of the operated cases. After the period of two months since the surgery was performed, the outstanding stitches should be taken out under local anesthetic
- Ear “dodging”, i.e. the return to the initial state. It happens extremely rarely and only in the case when stitches are taken out too early. In such cases another surgery is needed.
- Bleedings and haematomata. They occur very rarely and refer to about 2% of the operated. Not big haematomata, bruises and oedema in the region under the ear appearing on the second and third day after the surgery are something normal.
The corrective surgery of protruding auricles allows not only for the radical change of the appearance, but it is also very beneficial to the psyche of a little patent.
Małgorzata Kolenda, M.D. Ph.D.