Prominent ears

Prominent ears (protruding or “bat” ears) are ears that stick out from the head more than usual. It is the most common congenital ear deformity and, although it does not affect hearing, it can have a significant psychological impact, especially in childhood.

Why they happen

The shape of the ear depends on the folds of its cartilage. Prominent ears appear when one of those folds has not developed properly:

• Underdeveloped antihelical fold: the antihelix is the Y-shaped ridge that makes the upper part of the ear fold back towards the head. If it is faint, the ear stays open.
• Oversized or deep concha (conchal hypertrophy): the hollow central bowl pushes the ear outwards.
• Prominent earlobe, which makes the lower part stick out.

The first two causes, alone or combined, account for most cases. There is often a family history.

When an ear is considered prominent

As a guide, an ear is considered prominent when the angle between the ear and the head exceeds about 30-35 degrees, or when the outer rim sits more than about 2 centimetres from the skull. It can affect one ear or both, often asymmetrically.

Impact

Prominent ears cause no physical problems, but they are a frequent target of teasing at school and can affect the self-esteem of children and adults. That is why their correction is considered surgery with a clear psychosocial benefit.

Treatment

• Ear moulding in newborns: during the first weeks of life the cartilage is very malleable, and splints fitted to the ear can correct its shape without surgery. After that window it is no longer effective.
• Otoplasty: the surgery that permanently corrects prominent ears. It can be performed from 5-6 years of age, when the ear has almost reached its adult size, and at any point in adulthood. The antihelical fold is recreated with internal stitches, the concha is reduced or repositioned and, if needed, the earlobe is corrected. The scar is hidden behind the ear.

Tapes, headbands or glues sold as “home remedies” can hide the ears while worn, but they do not reshape the cartilage outside the newborn period.