Bat Ear (Prominent Ear/Otapostasis)
"Bat ear" refers to prominent ear deformity (also called otapostasis or prominent auris), a congenital malformation characterized by abnormally protruding ears due to underdevelopment of the antihelix and scapha, or an overdeveloped concha. 1, 2
Anatomic Features
The condition results from cartilage deformity occurring during early ear development in utero and presents with the following characteristics: 1, 2
- Underdeveloped antihelix and scapha - the normal folding of the upper ear cartilage fails to form properly 1
- Overdeveloped concha - excessive conchal bowl depth pushes the ear away from the head 2
- Prominent lobule - the lower portion of the ear may also protrude excessively 2
The deformity can be unilateral or bilateral and represents a first-degree dysplasia of the external ear. 1, 2
Clinical Significance and Management
Referral Guidelines
Children with prominent ear deformity should be referred to a pediatric plastic surgeon or pediatric otolaryngologist for evaluation and surgical management. 3, 4
- The American Academy of Pediatrics specifically lists "prominent ear deformity" as a congenital malformation requiring specialist evaluation 3, 4
- A pediatric plastic surgeon has completed 6+ years of surgical training plus an additional year in pediatric plastic/craniofacial surgery 3
- A pediatric otolaryngologist has completed 4-5 years of otolaryngology residency plus 1-2 years of pediatric otolaryngology fellowship 3
Timing of Surgical Correction
Correction can be performed any time after the child reaches 5 years of age, though ideally should be done as soon as feasible to prevent psychological distress. 1
- At 4 years of age, patients are within the recommended age range for surgical correction according to AAP guidelines 4
- The procedure (otoplasty) is primarily performed for aesthetic and psychosocial reasons 1
Functional Considerations
Beyond cosmetic concerns, prominent ears can cause functional impairment including difficulty with masks, eyewear, and hearing devices, which constitutes legitimate medical necessity for correction. 4
Surgical Approach (Otoplasty)
The correction involves reshaping the ear cartilage to bring the ear closer to the side of the head while leaving the skin intact. 1
Surgical techniques are based on three basic methods: 5, 2
- Cartilage cutting - excision techniques 2
- Cartilage weakening - scoring or burring 2
- Cartilage shaping - suturing techniques (e.g., Mustarde sutures) 5, 2
Hearing remains completely unaffected by the operation. 1
Important Caveats
- Accurate preoperative assessment is imperative - the single greatest cause of unfavorable results is inaccurate diagnosis of the specific anatomic deformity 6, 7
- Surgeons must identify whether the prominence is due to conchal hypertrophy, antihelical underdevelopment, or both, as this determines the surgical approach 7
- Post-operative complications are uncommon but include hematoma, keloid formation, infection, and ear asymmetry 1
- Results are generally permanent with final outcomes visible after 2 weeks, with refinements continuing up to 12 months 1