Microtia, meaning little ear, is a congenital ear deformity resulting from underdevelopment of the outer ear during the first trimester of pregnancy. Microtia can affect the appearance of a baby in a variety of ways, usually resulting in abnormally small ears that resemble peanut-like lobes on the side of the head. In the majority of cases, microtia affects only one ear, usually the right ear, and is more common in males. Microtia is also often associated with the absence or narrowing of the ear canal.


Symptoms include abnormally small ear(s), narrow or no ear canal, or an ear canal that does not lead to the middle ear.

Microtia varies in severity and is broken down into grades:

  • Grade 1: Smaller than normal ears but still functional
  • Grade 2: Also called conchal type microtia, where some features of the ear are missing, while most of the lower ear is still present. The ear canal may be present but will be very narrow.
  • Grade 3: The most common type of microtia, where the only feature remaining is a small peanut-shaped ear lobe. It is also called lobular type microtia, and the ear canal is usually completely absent.
  • Grade 4: A complete absence of the external ear; it is also called anotia and is very rare.


Microtia is usually diagnosed at birth as a visible deformity. Sometimes, a doctor uses a noninvasive imaging procedure called a computed tomography (CT) scan to get a detailed picture of the baby’s ear to look for abnormalities of the ear bones of the middle ear.


Microtia treatment will vary based on the specific needs of your child, and the North Carolina Cleft and Craniofacial Center team will accommodate these needs in a personalized care plan. A new ear can be created in two or four stages. Typically, the procedures are spread over three to six months, with a total duration of treatment up to one year.

Reconstruction of the ear canal, tympanic membrane (eardrum) and ossicles (ear bones) is usually delayed until the external ear reconstruction is nearly or completely finished. CT scans help our doctors determine when your child is ready for these surgeries. If reconstruction of the external canal is not an option surgically, bone-anchored devices can be offered to restore normal hearing in the affected ear, as cochlear function is typically normal.