Monday 23 July 2018

Dear Dr Nina: I want to have surgery on my ears. Do I need a referral from my GP?

Most ears protrude at an angle of 20 to 35 degrees
Most ears protrude at an angle of 20 to 35 degrees

Nina Byrnes

I am in my 40s and I am terribly self-conscious about my ears. They stick out at an almost 90-degree angle from my head. I have always tried to cover them with my hair, but it never works.

I really want to do something about it now that I have a bit of money to pay for whatever surgery is necessary. What options are available to me and do I need to be referred?

Should I go the cosmetic surgery route or through a regular hospital? Also, my one-year-old niece has inherited the condition, even though her mother didn't have it. What options are available for babies?

I don't want my niece to go through what I did.

Dr Nina replies: Ears are felt to protrude if they stick out more than 2cm from the side of the head. Most ears protrude at an angle of 20 to 35 degrees - more than 35 degrees is considered above normal. About 5pc of the population has protruding ears. It can run in families but may occur sporadically also.

Otoplasty, which is the surgical correction of protruding ears, is the most common cosmetic procedure carried out on children. Those who have protruding ears may be self-conscious or be subjected to ridicule and bullying, so many parents seek treatment for their children. The procedure normally takes place once the ears are fully-grown - somewhere between the age of six and nine.

If you are self-conscious about your ears and it is affecting your self-esteem then seeking correction is a reasonable path. Surgical cosmetic procedures are not generally covered in the public system and so you may need to be referred to a private surgeon or clinic. Do start with your GP - they can direct you to the right service.

The surgeon should be registered and practising full time in Ireland. They should be registered on the specialist register of the Irish medical Council as a plastic or ENT surgeon. You should attend for a pre-operative consultation. At this review you should be able to have any questions answered. The cost and process of the procedure should be fully reviewed and explained.

It is important that you meet the doctor who will be carrying out the procedure and that they examine you, discuss the surgery and advise you of any possible risks or complications. It may not be nice to think of what might go wrong but if you are attending a clinic, you should ask what hospital they are affiliated with and where you would be cared for if any complications arise. Otoplasty is normally a straightforward procedure that is undertaken as a day case. It can be done under local anaesthetic but general anaesthesia is normally used in children. Surgery involves reshaping the cartilage at the outside of the ear. A bandage needs to be worn all the time for a few days afterwards and at night for a few weeks while the ears are healing. You can return to normal activity and exercise within two weeks of surgery but contact sports need to be avoided for several months.

There is a new minimally invasive procedure that involves inserting an implant into the ear that can be folded to hold the ears at the appropriate angle. This is done under local anaesthetic and has no down time.

Start with a visit to your GP and discuss the pros and cons of undertaking a cosmetic procedure. Cost varies from clinic to clinic but, wherever you go, don't be afraid to discuss the cost.

It may be worth exploring the possibility of public out-patient review. In general, cosmetic procedures aren't covered but if the problem is severe or if there has been a significant impact to your mental health this may be taken into account. A very small number of cosmetic procedures do take place in public hospitals if there is a genuine need for the surgery. Your niece is a bit young yet as her ears are still growing.

Q. My GP tells me that my two-year-old  daughter needs grommets in her ear. What are these and how do they work? What precautions do we need to take so they don’t fall out?

Dr Nina replies: Grommets are tiny ventilation tubes that are placed in the eardrum to allow ventilation between the middle and external ear. They are most commonly recommended in children when a condition called glue ear leads to chronic congestion of the middle ear — resulting in reduced hearing.

Recurrent ear infections may lead to a build up of fluid and pus behind the eardrum. This leads to a build up of pressure in the middle ear, which can cause pain and reduced hearing. Reduced hearing may not be so obvious in younger children who are still learning to talk but there may be some signs. They may want the TV turned up louder. Speech may not develop as rapidly as that of their peers. They may mishear things or ask you to repeat yourself. If glue ear is suspected, a formal hearing test will be arranged. During this test the pressure in the ear is also usually measured. Grommet insertion usually takes place under general anaesthetic as a day-case procedure. Grommets, once inserted, stay in the ear for about six months to a year before being pushed out by them selves. There may be discharge from the ear for a little while after the grommets are inserted — this is just fluid clearing from the middle ear.

When grommets are in place there is an opening between the outer and middle ear. Surgeons used to advise keeping the ear canal dry to prevent fluid getting into the middle ear and to avoid swimming for a few weeks. More recent research reviews suggest that there isn’t much difference in the rate of infection between children who keep water out of their ears and those who don’t. It does make sense to avoid overtly forcing water into the ears but normal exposure during showers and swimming shouldn’t cause a problem.

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