Parents brought a newborn with bilateral small ears without any other congenital anomaly. A case of grade III microtia.
Parents brought a 16-day-old neonate with complaints of unable to take feed since birth. Moreover, the baby was also having cough, discharge from the eyes, hearing impairment, bilateral small ears (microtia), and regurgitation of milk via nose and mouth. The baby was a product of a non-consanguineous marriage. He was born at term via normal vaginal delivery, having a birth weight of 2.750 gm.
This was the mother’s second pregnancy and she had no prenatal care or ultrasounds during the pregnancy. She did not take any multivitamins, iron, or folic acid either. However, she had taken two doses of tetanus toxoid during the pregnancy.
Family history was negative for microtia in the baby’s maternal or paternal family.
Physical examination of the neonate revealed bilateral underdeveloped ears. The ears were different in shape, small in size, and were not normally placed. The doctors diagnosed the baby with grade-3 bilateral microtia. However, the child did not have any other congenital malformations or diseases.
Serological investigations including CBC, CRP, and I/T ratio revealed abnormal values. The newborn was receiving nasogastric feeds from the first day of his birth. However, due to lack of standard aseptic technique, the baby developed sepsis. Additionally, the BAER test (Brain Stem Auditory Response Test) results indicated bilateral conductive hearing loss.
The doctor counselled the parents regarding the reconstruction of the ear. With their consent, the planned the surgery, once the baby would reach 4-5 years of age or above.
Children who have mild microtia without hearing impairment may not require any treatment. However, with grade 3 microtia, ear reconstructive surgery is the only treatment. Surgeons use rib cartilage to reconstruct the ear. Another option is to use synthetic (alloplastic) reconstruction which uses premade synthetic ear framework made of polyethylene.