DESKTOP VERSION (MOBILE BELOW)

Psychological Effects of Microtia

Children may become aware of their own facial differences as early as two to three years of age. Although not always the case, microtia can have a significant psychological impact on children and their families. This is especially important to be aware of when children with microtia attend school as they may experience more teasing, and even bullying, from their peers.

Watch how 3-year old Trey interprets his microtia!

Several published studies on the psychological effect of microtia have found:

Increased difficulty in social integration and lack of self confidence for children with microtia.1-3

Mood disorders (depression, social difficulties, aggression) increase with age in microtia patients who have not had reconstructive surgery.4

Teasing from peers and the emotional impact on parents were risk factors for depression, social difficulties and aggression.5

A higher prevalence of interpersonal sensitivity, depression and anxiety are seen in mothers of children with microtia.6

Ear reconstruction has a significant psychosocial benefit to the majority of patients.7-10

(See references below)

Despite these studies, parents should know there are ways to minimize potential negative psychological effects. Many experts believe a parent’s attitude toward their child’s microtia is the most important factor in the psychological health of the child. Professionals and parents of children with microtia offer the following advice:

psych_girl-heart

a nurturing, matter-of-fact approach to your child’s microtia will help lessen the damage of peer teasing and staring

Build confidence, focusing on your child's incredible qualities

Help prepare your child for questions and staring by practicing a response. For example, your child can say: “I was born with Microtia, that means I have a small ear. I don't hear as well on that side. I really love soccer, want to play?”

Be honest and open about the condition and explain that it does not define who they are

Take time to educate others on microtia and hearing loss

Avoid the nearly universal tendency to blame yourself for your child’s Microtia

Some children internalize these effects and parents may not be aware of the extent that microtia/atresia are affecting their child. Look for behaviors that show your child’s increasing concern about their microtia:

  • never wears hair up
  • avoids photos and mirrors
  • avoids swimming and windy weather
  • asking when they will get a “big” ear
  • avoids playing due to “playground teasing”
  • sleeping difficulties
  • always wears hats/hoodies
  • anxiety
psych_girl-mirror

Dr. Lewin is a strong proponent for early reconstructive surgery to help families avoid negative psychological effects (as well as for improved surgical results). Since 2005, Dr. Lewin has worked with Dr. Alexis Johns, a psychologist specializing in the psychosocial effects of children with craniofacial conditions including microtia. They have published multiple studies together demonstrating the positive effect that early surgery can have on children with microtia. Children that have microtia ear reconstruction prior to entering school tend to experience less emotional trauma and little memory of the surgery. Even in very young children, parents report an almost instant boost in self-confidence once the surgery dressings are removed. “We sometimes forget our child was born with a little ear” is a frequent comment Dr. Lewin hears from her post-op patients.

Dr. Lewin's Articles

Pre and post-operative psychological functioning in younger and older children with microtia.
Johns AL; Lucash RE; Im DD; Lewin SL.Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 68(4):492-7, 2015 Apr

OBJECTIVES: Microtia ranges from a smaller ear to the absence of the external ear and has been associated with psychosocial distress. Traditional ear reconstruction takes place beginning at age six. Use of an alloplastic implant allows for earlier surgery starting at age three, which may reduce potential negative psychological effects. However, few studies have examined psychosocial outcomes of ear reconstruction with groups that include young children.

METHODS: Children (N = 23) with microtia and their parents completed two microtia-related scales, negative emotions and microtia social awareness, and the Behavioral Assessment System for Children -Second Edition (BASC-2) subscales of anxiety, depression, and social skills before surgery and one year after surgery. Participants (74% male) were three to nine years old with a mean age of 6.13 +/-2.10 years and were grouped by age at surgery, three to six years (n = 11) or seven to ten years (n = 12). The sample identified as Latino (96%) or “other” (4%).

RESULTS: Pre and postoperative scores by age group were compared using two-way repeated measures analyses of variance. Children and parents reported significantly less negative emotion and microtia social awareness following surgery, with an interaction for parental report of older children showing higher negative emotion preoperatively. Older children also had higher scores of depression and anxiety before surgery and both groups reportedsignificant decreases following surgery, along with improved social skills. Older children showed significantly greater gains in social skills.

CONCLUSION: All participants and their parents reported improved psychological functioning postoperatively. However, older children may be at greater risk of psychological concerns given the longer time they have to cope with the impact of microtia on self-image and exposure to social stressors. Undergoing reconstructive surgery earlier may be a protective factor for children with microtia.

Teasing in younger and older children with microtia before and after ear reconstruction.
Johns AL; Lewin SL; Im DD. Journal of Plastic Surgery and Hand Surgery. 51(3):205-209, 2017 Jun.

This study prospectively measured teasing and emotional adjustment before and after ear reconstruction in younger and older children with microtia. Participants with isolated microtia (n = 28) were divided into two groups by age at surgery, with a younger group aged 3–5 years (n = 13) with a mean age of 4.0 (0.71) years at the time of surgery and an older group aged 6–10 years old (n = 15) with a mean age of 7.87 (1.30) years. Children and their parents were interviewed preoperatively and a year after surgery about teasing and emotions about their ear(s). Teasing began between the ages of 2.4–4.8 years. A third of the younger group and all of the older group reported preoperative teasing. Before surgery, the older group reported higher rates of negative emotions about their ear(s) and teasing was correlated for all ages with feeling sad, worried, and mad about their ear(s). After surgery, teasingsignificantly decreased with increased happiness about their ear(s). Postoperative teasing was correlated with trying to hide their ear(s). There were significant interactions from before to after surgery based on surgery age for frequency of teasing, sadness, and feeling mad, with the older group showing relatively greater change postoperatively. Teasing and negative emotions about their ear(s) decreased for all ages after surgery, with apotential protective factor seen in younger surgery age.

Early Familial Experiences With Microtia: Psychosocial Implications for Pediatric Providers.
Johns AL; Im DD; Lewin SL. Clinical Pediatrics. 57(7):775-782, 2018 Jun.

This study focuses on early experiences of families with a child with microtia to better inform their ongoing care by pediatric providers. Parents and children (n = 62; mean age of 6.9 +/-3.9 years) with isolatedmicrotia participated in semistructured interviews in Spanish (66.1%) or English (33.9%). Qualitative analysis of responses used open coding to identify themes. Parents reported stressful informing experiences of the diagnosis with multiple negative emotions. Parents and children generally reported not understanding microtia etiology, while some families identified medical, religious, and folk explanations. Parental coping included learning about surgeries, normalization, perspective taking, and support from family, providers, religion, and others with microtia. Family communication centered on surgery and reassurance. Pediatricians of children with microtia need to understand families’ formative psychosocial experiences to better promote positive family adjustment through clarifying misinformation, educating families about available treatment options, modeling acceptance, psychosocial screening, and providing resources.

References

1. Brent B. Microtia repair with rib cartilage grafts: a review of personal experience with 1000 cases. Clin Plast Surg 2002;29: 
257-71 [vii].

2. Horlock N, Vogelin E, Bradbury ET, et al. Psychosocial outcome 
of patients after ear reconstruction: a retrospective study of 
62 patients. Ann Plast Surg 2005;54:517-24.

3. Steffen A, Klaiber S, Katzbach R, et al. The psychosocial con
sequences of reconstruction of severe ear defects or third-degree microtia with rib cartilage. Aesthet Surg J 2008;28: 404-11.

4. Jiamei D, Jiake C, Hongxing Z, et al. An investigation of psychological profiles and risk factors in congenital microtia patients. J Plast Reconstr Aesthet Surg 2008;61(Suppl. 1):S37-43.

5. Du JM, Chai J, Zhuang HX, et al. Psychological status of congenital microtia patients and relative influential factors: analysis of 410 cases. Chung-Hua i Hsueh Tsa Chih [Chinese Medical Journal]. 87(6):383-7, 2007 Feb 06.

6. Li D; Chin W, Wu J, Zhang Q, et al. Psychosocial outcomes among microtia patients of different ages and genders before ear reconstruction. Aesthetic Plastic Surgery. 34(5):570-6, 2010 Oct.

7. Soukup B, Mashhadi SA, Bulstrode NW. Health-related quality-of-life assessment and surgical outcomes for auricular reconstruction using autologous costal cartilage. Plastic & Reconstructive Surgery. 129(3):632-40, 2012 Mar. 

8. Hempel JM, Knobl D, Berghaus A, et al. Prospective assessment of quality of life after auricular reconstruction with porous polyethylene. HNO. 62(8):564-9, 2014 Aug. 

9. Steffen A; Wollenberg B; Konig IR; Frenzel H. A prospective evaluation of psychosocial outcomes following ear reconstruction with rib cartilage in microtia. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 63(9):1466-73, 2010 Sep.

10. Johns AL, Lucash RE, Im DD, et al. Pre and post-operative psychological functioning in younger and older children with microtia. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 68(4):492-7, 2015 Apr.

MOBILE VERSION

Watch how 3-year old Trey interprets his microtia!

Psychological EFFECTS of Microtia

Children may become aware of their own facial differences as early as two to three years of age. Although not always the case, microtia can have a significant psychological impact on children and their families. This is especially important to be aware of when children with microtia attend school as they may experience more teasing, and even bullying, from their peers.

Several published studies on the psychological effect of microtia have found:

Increased difficulty in social integration and lack of self- confidence for children with microtia.1-3

Mood disorders (depression, social difficulties, aggression) increase with age in microtia patients who have not had reconstructive surgery.4

Teasing from peers and the emotional impact on parents were risk factors for depression, social difficulties and aggression.5

A higher prevalence of interpersonal sensitivity, depression and anxiety are seen in mothers of children with microtia.6

Ear reconstruction has a significant psychosocial benefit to the majority of patients.7-10

(See references below)

psych_girl-heart

Despite these studies, parents should know there are ways to minimize potential negative psychological effects. Many experts believe a parent’s attitude toward their child’s microtia is the most important factor in the psychological health of the child. Professionals and parents of children with microtia offer the following advice:

Build confidence, focusing on your child's incredible qualities

Be honest and open about the condition and explain that it does not define who they are

Help prepare your child for questions and staring by practicing a response. For example, your child can say: “I was born with Microtia, that means I have a small ear. I don't hear as well on that side. I really love soccer, want to play?”

a nurturing, matter-of-fact approach to your child’s microtia will help lessen the damage of peer teasing and staring

Take time to educate others on microtia and hearing loss

Avoid the nearly universal tendency to blame yourself for your child’s Microtia

Some children internalize these effects and parents may not be aware of the extent that microtia/atresia are affecting their child. Look for behaviors that show your child’s increasing concern about their microtia:

  • never wears hair up
  • avoids photos and mirrors
  • avoids swimming and windy weather
  • asking when they will get a “big” ear
  • avoids playing due to “playground teasing”
  • sleeping difficulties
  • always wears hats/hoodies
  • anxiety
psych_girl-mirror

Dr. Lewin is a strong proponent for early reconstructive surgery to help families avoid negative psychological effects (as well as for improved surgical results). Since 2005, Dr. Lewin has worked with Dr. Alexis Johns, a psychologist specializing in the psychosocial effects of children with craniofacial conditions including microtia. They have published multiple studies together demonstrating the positive effect that early surgery can have on children with microtia. Children that have microtia ear reconstruction prior to entering school tend to experience less emotional trauma and little memory of the surgery. Even in very young children, parents report an almost instant boost in self-confidence once the surgery dressings are removed. “We sometimes forget our child was born with a little ear” is a frequent comment Dr. Lewin hears from her post-op patients.

Dr. Lewin's Articles

Pre and post-operative psychological functioning in younger and older children with microtia.
Johns AL; Lucash RE; Im DD; Lewin SL.Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 68(4):492-7, 2015 Apr

OBJECTIVES: Microtia ranges from a smaller ear to the absence of the external ear and has been associated with psychosocial distress. Traditional ear reconstruction takes place beginning at age six. Use of an alloplastic implant allows for earlier surgery starting at age three, which may reduce potential negative psychological effects. However, few studies have examined psychosocial outcomes of ear reconstruction with groups that include young children.

METHODS: Children (N = 23) with microtia and their parents completed two microtia-related scales, negative emotions and microtia social awareness, and the Behavioral Assessment System for Children -Second Edition (BASC-2) subscales of anxiety, depression, and social skills before surgery and one year after surgery. Participants (74% male) were three to nine years old with a mean age of 6.13 +/-2.10 years and were grouped by age at surgery, three to six years (n = 11) or seven to ten years (n = 12). The sample identified as Latino (96%) or “other” (4%).

RESULTS: Pre and postoperative scores by age group were compared using two-way repeated measures analyses of variance. Children and parents reported significantly less negative emotion and microtia social awareness following surgery, with an interaction for parental report of older children showing higher negative emotion preoperatively. Older children also had higher scores of depression and anxiety before surgery and both groups reportedsignificant decreases following surgery, along with improved social skills. Older children showed significantly greater gains in social skills.

CONCLUSION: All participants and their parents reported improved psychological functioning postoperatively. However, older children may be at greater risk of psychological concerns given the longer time they have to cope with the impact of microtia on self-image and exposure to social stressors. Undergoing reconstructive surgery earlier may be a protective factor for children with microtia.

Teasing in younger and older children with microtia before and after ear reconstruction.
Johns AL; Lewin SL; Im DD. Journal of Plastic Surgery and Hand Surgery. 51(3):205-209, 2017 Jun.

This study prospectively measured teasing and emotional adjustment before and after ear reconstruction in younger and older children with microtia. Participants with isolated microtia (n = 28) were divided into two groups by age at surgery, with a younger group aged 3–5 years (n = 13) with a mean age of 4.0 (0.71) years at the time of surgery and an older group aged 6–10 years old (n = 15) with a mean age of 7.87 (1.30) years. Children and their parents were interviewed preoperatively and a year after surgery about teasing and emotions about their ear(s). Teasing began between the ages of 2.4–4.8 years. A third of the younger group and all of the older group reported preoperative teasing. Before surgery, the older group reported higher rates of negative emotions about their ear(s) and teasing was correlated for all ages with feeling sad, worried, and mad about their ear(s). After surgery, teasingsignificantly decreased with increased happiness about their ear(s). Postoperative teasing was correlated with trying to hide their ear(s). There were significant interactions from before to after surgery based on surgery age for frequency of teasing, sadness, and feeling mad, with the older group showing relatively greater change postoperatively. Teasing and negative emotions about their ear(s) decreased for all ages after surgery, with apotential protective factor seen in younger surgery age.

Early Familial Experiences With Microtia: Psychosocial Implications for Pediatric Providers.
Johns AL; Im DD; Lewin SL. Clinical Pediatrics. 57(7):775-782, 2018 Jun.

This study focuses on early experiences of families with a child with microtia to better inform their ongoing care by pediatric providers. Parents and children (n = 62; mean age of 6.9 +/-3.9 years) with isolatedmicrotia participated in semistructured interviews in Spanish (66.1%) or English (33.9%). Qualitative analysis of responses used open coding to identify themes. Parents reported stressful informing experiences of the diagnosis with multiple negative emotions. Parents and children generally reported not understanding microtia etiology, while some families identified medical, religious, and folk explanations. Parental coping included learning about surgeries, normalization, perspective taking, and support from family, providers, religion, and others with microtia. Family communication centered on surgery and reassurance. Pediatricians of children with microtia need to understand families’ formative psychosocial experiences to better promote positive family adjustment through clarifying misinformation, educating families about available treatment options, modeling acceptance, psychosocial screening, and providing resources.

References

1. Brent B. Microtia repair with rib cartilage grafts: a review of personal experience with 1000 cases. Clin Plast Surg 2002;29: 
257-71 [vii].

2. Horlock N, Vogelin E, Bradbury ET, et al. Psychosocial outcome 
of patients after ear reconstruction: a retrospective study of 
62 patients. Ann Plast Surg 2005;54:517-24.

3. Steffen A, Klaiber S, Katzbach R, et al. The psychosocial con
sequences of reconstruction of severe ear defects or third-degree microtia with rib cartilage. Aesthet Surg J 2008;28: 404-11.

4. Jiamei D, Jiake C, Hongxing Z, et al. An investigation of psychological profiles and risk factors in congenital microtia patients. J Plast Reconstr Aesthet Surg 2008;61(Suppl. 1):S37-43.

5. Du JM, Chai J, Zhuang HX, et al. Psychological status of congenital microtia patients and relative influential factors: analysis of 410 cases. Chung-Hua i Hsueh Tsa Chih [Chinese Medical Journal]. 87(6):383-7, 2007 Feb 06.

6. Li D; Chin W, Wu J, Zhang Q, et al. Psychosocial outcomes among microtia patients of different ages and genders before ear reconstruction. Aesthetic Plastic Surgery. 34(5):570-6, 2010 Oct.

7. Soukup B, Mashhadi SA, Bulstrode NW. Health-related quality-of-life assessment and surgical outcomes for auricular reconstruction using autologous costal cartilage. Plastic & Reconstructive Surgery. 129(3):632-40, 2012 Mar. 

8. Hempel JM, Knobl D, Berghaus A, et al. Prospective assessment of quality of life after auricular reconstruction with porous polyethylene. HNO. 62(8):564-9, 2014 Aug. 

9. Steffen A; Wollenberg B; Konig IR; Frenzel H. A prospective evaluation of psychosocial outcomes following ear reconstruction with rib cartilage in microtia. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 63(9):1466-73, 2010 Sep.

10. Johns AL, Lucash RE, Im DD, et al. Pre and post-operative psychological functioning in younger and older children with microtia. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 68(4):492-7, 2015 Apr.