What happens next?

From birth until about 3 years olds there isn’t really all that much you can do as a parent to reconstruct the “small ear” or give your child normal hearing. Surgical reconstruction, prosthetic replacements and most hearing aid devices typically aren’t implanted until age 5 or later.


However psychology is critical at this stage: regardless of whether you ultimately decide to pursue reconstruction or not, it is extremely important to accept your child as he or she is, without any special attention paid to the microtic ear. Children are hyper-perceptive: if you as the parent make a point of covering up the ear with longer hair, the child is far more likely to develop a shame complex over it, affecting their self-esteem and self-image. By making it seem like a non-issue, their happiness will depend only on the love and respect you give them. You as a parent need to be convinced that your child is a normal child with some special characteristics. To grow a happy and outgoing child you must concentrate all your love and effort into them.

When I saw my little Andrea for the first time, I thought she was the most wonderful child in the world, even with a small ear. A deep love overcame me to protect my little daughter when I held her in my arms. I promised myself that Andrea would be the happiest girl in the world and would have every opportunity I could give her to enjoy her life.


However, since most brain development of the hearing pathways occurs between birth and age 10, there are non-invasive hearing aid fixes that can be started immediately to ensure the best possible access to sound for your children in all environments. These are required for normal development in children with bilateral microtia and atresia, but are up to the discretion of parents and physicians in children affected unilaterally. Traditionally, children with unilateral hearing loss did not receive any hearing aid, since it was considered unnecessary. More recent investigations have shown though that while children with unilateral hearing loss function well in quiet environments, they have a difficult time in high background noise environment.

Bilateral Microtia and BCHA/BAHA

If your child has bilateral microtia a Bone Conduction Hearing Aid (BCHA) or a Bone Anchored Hearing Aid (BAHA), both on softbands, will be necessary to ensure proper development of your child’s hearing from birth. Children with unilateral microtia can use one of these aids as well, as chosen by the parents. Use of these devices typically starts around week 6. The primary difference between the two devices is a regulatory distinction for insurance purposes: BCHA is an older device that is classified as a hearing aid whereas the BAHA is a newer device classified as a medical device, since it was designed to be implanted into the skull.

Since the bones in children are too soft for surgical implantation until the age of 3, both of these units are held to the mastoid, directly behind the ear on a softband that wraps around the head. A receiver collects sound signals from the environment then transmits the sound through the conductive bone of the skull directly to a fully functional inner ear. You can approximate what is heard by plugging both of your ears: what you hear is largely transmitted through your jaw bones.

Unfortunately this type of hearing aid will only be useful in children that have a normal inner ear. In the rare cases that the inner ear is not functional as well alternative options will need to be pursued.


The ear, nose and throat specialist ultimately decides if your child needs a hearing aid based on a battery of hearing assessment tests. If the specialist considers a hearing aid unnecessary, as was the case with my daughter Andrea, then it is crucial that regular hearing, speech and language assessments are conducted to ensure unilateral hearing is not stunting their development.