What is Microtia?

Referral Photo side profile - taken at 8 months

I often get questions about Ian's special need from those familiar with adoption from China who know that our shorter timeline and male pronouns more than likely point toward a Special Need oriented adoption. For those who don't know the ins/outs of the process, we sometimes feel like we are obligated to mention Ian's ear to prevent shock or embarassment when they see it for the first time and weren't aware.

We had certainly never heard of Microtia (My-Crow-Shuh) before seeing Ian's file and I came to find out later that several families that were requesting files for a boy in his age range turned down the opportunity to consider his information, most likely because they were imagining his situation to be an enormous undertaking and assumed that it wouldn't fit the scope of what they felt they could handle. I am so glad that we had an open mind and did the research. In all, 3 families out of many reviewed his file and we were the only couple out of the three that came forward asking to submit a Letter of Intent for him.

I wanted to take a second and explain a little bit about Microtia for those who received my 2 second explanation or are curious. If you are visiting and are looking for more indepth information, please send me an email and I will point you toward the links and groups that have been such a wealth of knowledge as I research :

Microtia (meaning 'Small ear') is a congenital deformity of the outer ear. It can be unilateral (one side only) or bilateral (affecting both sides). It occurs in 1 out of about 8,000-10,000 births. In unilateral microtia, the right ear is most often affected and it occurs in boys more often than girls.

There are four grades of microtia:

Grade I: A slightly small ear with identifiable structures and a small but present external ear canal

Grade II: A partial ear with a closed off external ear canal

Grade III: Absence of the external ear with a small “peanut” skin & cartilage structure and an absence of the external ear canal

Grade IV: Absence of the total ear.

Ian has unilateral Grade III and it can be corrected by surgery. Typically, testing is first done to determine if the inner ear is intact and hearing is normal. Since this kind of testing was not done in China, we do not know the specifics of his inner ear anatomy or the extent of his hearing deficit. We do know that he can hear and turns his head to both sides to locate sound, but we’ll have to wait and see on a lot of the details.

Ian also has a condition called Atresia, which often goes hand in hand with Microtia. Atresia is the absence of the external opening to the inner ear. From the few glimpses we have had of his ear, it appears that he might have a small opening, which gives us hope that he has a functioning inner ear, but again, we won’t know until we have him with us back in the U.S of A.

Often, Microtia/Atresia patients can hear from the affected ear, but the sound is muffled… much like how things sound if you plug your ears and talk. I’ll spare the details of the reconstruction, but essentially, it can happen between the ages of about 6 and 8 and entails the use of rib cartilage to construct an ear. It’s absolutely amazing to me how natural the before and after pictures are. In almost every instance, the ear looks completely natural and symmetrical. It will grow with him, sustain trauma, heal itself, etc. There are other synthetic reconstructions, but I’ve yet to see anything as impressive as this.

There are several doctors around the country with rock star status in this field, and although we have several years before we need to face surgery, we’ll need to consider waiting lists for appointments, establishing a game plan, etc…that far out.

In the meantime, we may or may not need to worry about different therapies. For the most part, we will focus on learning more about Ian’s ear anatomy and hearing capacities, and then will concentrate mostly on bonding and acclimating to everything that’s new, different, and scary.