Is ear lidding a normal finding in newborns?

Is Ear Lidding Normal in Newborns?

Yes, ear lidding is a common and benign cosmetic ear deformity observed in newborns that frequently resolves spontaneously without intervention. 1

Understanding Ear Lidding

Ear lidding is classified as a congenital ear deformation (not malformation), which means it involves abnormal shaping of otherwise structurally normal cartilage. 2, 3 This is an important distinction because:

• Deformations can be treated non-surgically when diagnosed early, whereas malformations require surgical correction only 4
• Approximately 30% of newborns have some degree of congenital ear anomalies, though the minority will resolve spontaneously 4
• The overall incidence of auricular deformities is approximately 11.5 per 10,000 births (excluding microtia) 2

Natural History and Spontaneous Resolution

The most reassuring evidence comes from a prospective observational study showing that 10 out of 10 consecutive newborns with ear lidding had complete spontaneous resolution within an average of 40 days without any intervention. 1 This suggests that:

• Many cases of less severe ear lidding will resolve naturally 1
• Cosmetic treatment may be unnecessary for milder cases 1
• Families and physicians can be reassured that observation is a reasonable initial approach 1

When to Consider Intervention

While spontaneous resolution is common, intervention may be considered for:

• More severe cases that are unlikely to self-correct 1, 5
• Persistent deformities beyond the early neonatal period when cartilage malleability decreases 2, 4
• Parental preference for early correction to avoid potential psychological concerns (bullying, depression) in older children 1

Timing of Treatment

If treatment is pursued, timing is critical:

• Optimal window: First 1-2 weeks of life when ear cartilage is most malleable due to maternal estrogen effects 2
• Treatment can be initiated up to 12 weeks of age with good results, though earlier is better 4, 5
• Earlier initiation, less severe deformities, and longer treatment duration are the most significant predictive factors for better outcomes 5

Important Clinical Considerations

Risk Factor Assessment

While ear lidding itself is benign, craniofacial abnormalities (especially morphologic abnormalities of the pinna and ear canal) are risk factors for sensorineural hearing loss and warrant hearing screening. 6

Any newborn with ear abnormalities should:

• Undergo universal newborn hearing screening before hospital discharge 7, 8
• Have ongoing developmentally appropriate hearing screening if risk factors are present 7
• Receive at least one diagnostic audiology assessment by 24-30 months if risk factors exist 7, 8

Treatment Options if Needed

Non-surgical ear molding systems (EarWell, LiangEar, InfantEar) achieve:

• Substantial efficacy for most ear deformities including lidding 3, 5
• Treatment duration of 6-14 weeks on average 4, 3
• Comparable effectiveness between different systems, though costs vary 5

Common Pitfalls to Avoid

• Do not rush to treatment for mild cases, as spontaneous resolution is common 1
• Do not delay hearing screening based on the presence of ear deformities 6
• Do not confuse deformations with malformations—the former can be treated non-surgically, the latter cannot 4
• Do not miss the optimal treatment window if intervention is chosen—cartilage malleability decreases significantly after the first few weeks of life 2, 5