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Introduction to Outer Ear Disorders

by Bradley W. Kesser, MD

The outer ear consists of the external part of the ear (pinna or auricle) and the ear canal (external auditory meatus—see see Figure: A Look Inside the Ear). Disorders of the outer ear include blockages (obstruction), foreign bodies, infections (external otitis, malignant external otitis, and perichondritis), dermatitis, and tumors. The outer ear is also prone to certain types of injury (see Ear Injury).

Developmental abnormalities of the outer ear include microtia (also called small ear) and aural atresia. Microtia refers to an auricle that has not fully developed. There are varying degrees of microtia depending on how well developed the auricle is. The degree of auricle development can range from simply a small ear with all the proper cartilage (grade I) to a small "nubbin" or peanut ear where there is no cartilage, just a mound of skin and soft tissue (grade III). Rarely, people are born without an auricle, a condition called anotia. A plastic surgeon skilled in microtia repair can often rebuild the ear to a very favorable appearance using a prosthesis, the person's own rib cartilage, or an implant.

Microtia is often accompanied by aural atresia, which is failure of the ear canal to open. This absence of the ear canal is also usually associated with underdevelopment of the middle ear and middle ear bones (hammer, anvil, and stirrup). Children have hearing loss because the sound energy is not efficiently carried, or conducted, into the middle ear. In some children, surgery can be done to open the ear canal, build an eardrum, and restore the natural sound-conducting pathway of the ear canal and middle ear to the healthy inner ear.