A missing or malformed outer ear can affect your child's appearance and self-confidence, and a narrowed or nonexistent ear canal can have more far-reaching effects on their hearing, speech patterns, and language processing skills. Fortunately, Dr. Reinisch performs microtia surgery at our Beverly Hills practice - the MEDPOR® ear reconstruction technique, which he pioneered in 1991, which uses a microporous high-density polyethylene implant. To learn more about these procedures and find out which one might be right for your child, schedule a consultation with Dr. Reinisch.
Surgery and Its Role in Microtia Treatment
Microtia is a rare congenital condition that affects approximately one in every 8,000-10,000 babies born in the U.S. Microtia rates are slightly higher in other parts of the world, and thanks to his reputation for excellence and comprehensive treatment, Dr. Reinisch works with patients from around the globe. Microtia surgery is designed to address both external ear deformity and inner ear canal deficiency. By using a patient’s own tissue, Dr. Reinisch can create a new ear structure. He also works with a top otologist, who can surgically create or correct the ear canal to improve hearing.
Microtia surgery should address both the cosmetic appearance and the loss of hearing difficulties resulting from aural atresia. To protect patients' health and safety, and ensure excellent surgical results, Dr. Reinisch works with several board-certified pediatric anesthesiologists and an experienced otologist who are trained and experienced in the treatment of aural atresia and hearing loss. Dr. Reinisch is a world-renowned microtia surgeon, and patients come from around the world to benefit from his skill, innovative approach to care, and compassionate treatment.
MEDPOR® Ear Reconstruction
Although rib cartilage reconstruction is an established and effective treatment option, Dr. Reinisch recognizes the limitations of this procedure. Dr. Reinisch created the revolutionary MEDPOR® ear reconstruction technique in 1991, and it is now recognized as an advanced surgical treatment for microtia. Using porous, biocompatible polyethylene, Dr. Reinisch creates an ear framework that matches a patient’s healthy ear. After attaching the structure, he covers it with the patient’s own tissue, and the cells and blood vessels integrate with the porous polyethylene. The MEDPOR® technique typically requires just one surgery, results in minimal scarring, and can be performed on patients as young as three years old. Consequently, patients can have enhanced hearing at a younger age, leading to more advanced speech and language recognition. Because it causes very little discomfort, it can be done as an outpatient procedure without the need for hospitalization or the use of post-operative drains.
Rib Cartilage Ear Reconstruction
Reconstruction using chest cartilage has been the traditional method of reconstruction for the past 55 years. This procedure requires harvesting a portion of three ribs from the chest to make the ear shape. Removing this material from the chest can be quite painful and requires patient to be hospitalized. In order to prevent chest deformity, surgery using this technique is typically delayed until patients are 8-10 years of age. The reason it is delayed is in order to obtain sufficient cartilage to make the ear framework. This procedure cannot be done in younger children without causing a chest deformity.
First, he will create an incision in the child’s chest and remove cartilage from several of the ribs. He will then use this cartilage to fabricate a new ear, carefully carving and suturing it so that it matches the shape of their healthy ear. Once the new framework is complete, he will create a pocket of skin and place the new ear in this pocket.
Silicone Prosthetic Ears
Patients who do not qualify for MEDPOR® or rib cartilage ear reconstruction may choose to enhance their appearance with a silicone prosthetic ear. Although Dr. Reinisch does not create restorations, he can help determine your candidacy, answer any questions you have, and refer you to an outstanding anesthesiologist. Silicone prosthetic ears are simply intended to address the cosmetic effects of microtia - doctors cannot use them to restore or enhance hearing. These prostheses are typically more suitable for adults, since children tend to knock them off during play. Lastly, since they need to be taken off and cleaned, prosthetic ears may not restore patients' self-esteem in the same way as a surgical procedure.
Inner Ear Reconstruction
Many microtia patients have a narrow or missing ear canal. Together with an otologist, Dr. Reinisch can perform a computed tomography (CT) scan to examine the tiny bones inside the inner ear. If they are not fused together, a patient may be suitable for middle and inner ear reconstruction. During the procedure, an otologist will surgically create a new ear canal before fabricating an eardrum using the patient’s own skin. This procedure can be performed before or during MEDPOR® surgery.
Aural Atresia Repair
Underdeveloped ear canals can impact your child’s hearing, speech, language development, and learning abilities. Fortunately, Dr. John Reinisch offers comprehensive aural atresia repair. In collaboration with an otologist, he can actually rebuild the inner ear, restoring near-complete hearing. Reinisch Plastic Surgery is the only practice that combines aural atresia repair and microtia treatment into a single outpatient surgery. In this way, we can minimize discomfort, recovery time, and expense. At the same time, if your child does not qualify for ear canal reconstruction, we can recommend an alternative treatment to improve your child’s hearing.
Candidates for Aural Atresia Repair
Aural atresia is a congenital condition that inhibits inner ear development. In some cases, the inner ear is missing entirely. As a result, sound waves are not able to travel through the ear to vibrate the eardrum, hearing bones, and inner ear fluid. Thus, the auditory nerve cannot transmit signals to the brain, where these signals would be registered as sounds.
Reinisch Plastic Surgery is the only practice that combines aural atresia repair and microtia treatment into a single outpatient surgery.
If your child suffers from aural atresia, he or she may be a candidate for ear canal reconstruction. Dr. Reinisch will take a CT scan of the inner ear to make sure that he or she has a healthy cochlea, which is necessary for successful surgery. The majority of patients meet this requirement. These images will also reveal whether the inner ear bones have fused together, another condition that will limit candidacy for surgical repair. Children must be at least two-and-a-half years old to receive a CT scan. Dr. Reinisch will consult with an audiologist, otologist, and other specialists to determine your child’s eligibility for treatment.
Ear Canal Reconstruction
A trusted otologist will perform ear canal reconstruction, also known as canaloplasty. Dr. Reinisch will perform the cosmetic aspects of the procedure, typically using a polyethylene MEDPOR® implant to create an outer ear framework.
Your treatment team will carefully plan the procedure during an initial consultation. The surgery itself will take place under general anesthesia. To ensure your child’s complete safety, we work with experienced pediatric anesthesiologists. Your child’s surgeon will first create an opening where the ear canal would normally be located. He or she will line this opening with a skin graft and, if necessary, reposition the inner ear bones to ensure better hearing. In some cases, the doctor may need to create a new eardrum as well, using an additional skin graft. Once this process is complete, Dr. Reinisch will reconstruct the outer ear, typically using the MEDPOR® technique.
These combined procedures can restore hearing as well as aesthetics.
Combined Atresia MEDPOR® (CAM) surgery is a rather extensive process. Though it is an outpatient surgery, we will still need to monitor your child’s progress and healing. In most cases, your little one will have the first follow-up one to two days after surgery. The second appointment will usually take place two weeks later. We know that many patients come from long distances to receive our care. We offer free accommodation for two nights at a nearby Four Seasons. We also partner with the local Ronald McDonald House to provide long-term housing.
This young patient can now hear properly while having a normal appearance.
Other Options to Address Aural Atresia
Although surgical repair is the preferred treatment for aural atresia, not all microtia patients will benefit from this procedure. Fortunately, Dr. Reinisch offers several treatment options that can greatly enhance a young patient’s life. These options will not restore hearing as successfully. Nonetheless, they can improve auditory processing and language development:
- BAHA: A bone-anchored hearing device will help transmit sound waves to the inner ear. Children must be at least five years old before they can receive one of these devices.
- Soft-band BAHA: A soft-band BAHA performs a similar function to a traditional bone-anchored hearing device. Because they are not surgically attached, babies can wear them from birth.
- Vibrant Sound Bridge: This middle ear implant also includes an audio processor, which can help to transmit sounds at higher frequencies.
Recovery from ear reconstruction is relatively short, but needs to be handled carefully and dutifully to ensure the best results for you or your child. Patients can generally return to light activities about three days after surgery. However, it could take up to three months for swelling to fully subside and permanent results to be visible. It is also important to consider the recovery needed if rib cartilage is harvested or if a skin graft is taken from the patient's body. Dr. John Reinisch and Dr. Youssef Tahiri personally plan and coordinate every surgery they perform.
Our team can provide you with comprehensive recovery information and answer any questions you may have before sending you or your child home after surgery.
Treating Children with the Utmost Care Following Surgery
We take the care we provide to our youngest patients very seriously. An essential part of treatment is administering the proper medication to manage pain and prevent infection. We can also provide extensive information, items for wound treatment, and anything else you may need to safely care for your child during the recovery period.
Immediate Post-Operative Care
Following surgery, patients are typically groggy and disoriented and will need someone to drive them to and from the procedure. Our doctors equip patients with a compression garment to wear for the first 24 hours following surgery. Younger patients may be tempted to touch and scratch their ear and the area around it, so constant supervision is important to ensure that the surgical area remains undisturbed.
Our team will be in close contact throughout the recovery process, and we will schedule follow-up visits to monitor your progress and provide ongoing care.
Patients will need a lot of rest, but it is crucial that they do not sleep on their recently operated ear. For restless sleepers, our doctors can provide additional information to promote proper healing.
Day Two and Three
For the next two days, patients will need to wear a special headband over their ears, but they should expect to see a significant reduction in swelling. During this critical time, bleeding and pain should subside as well. However, it is important to contact Dr. Reinisch or Dr. Tahiri if these symptoms do not diminish. Our team will be in close contact throughout the recovery process, and we will schedule follow-up visits to monitor your progress and provide ongoing care.
Ongoing Progress and Full Recovery
With the approval from your doctor, patients can return to work and other routines about one week after surgery. Supervision will still be important for younger patients during this time, and parents should discourage rough and strenuous activities that could displace the ear. Once the initial recovery is complete, patients can recommence all activities. However, they may not see permanent results until three months later, when swelling should subside entirely.
Breaking Down the Cost
After a microtia diagnosis is delivered, families are often left wondering: how much does microtia surgery cost? Overall, the cost of microtia treatment varies based on the severity of the deformity and how much of the ear has developed. As a microtia surgery specialist and the creator of the MEDPOR® surgical technique, Dr. John Reinisch can combine multiple procedures into a single treatment to reduce costs. Our clinic also has a number of resources to assist families with additional expenses, such as travel accommodations and financing options.
A Specialist Can Reduce Your Expenses
With his extensive experience treating microtia, Dr. Reinisch has developed techniques that reduce the need for multiple procedures, preserving our patients' health and reducing overall treatment cost.
To address your needs, Dr. Reinisch can perform the most efficient, advanced surgical techniques during your personalized treatment.
As microtia is a rare condition, there are few specialists who perform this type of surgery on a regular basis. As a result, it is important to choose a specialist, such as Dr. Reinisch, to help you avoid unsatisfactory results or multiple procedures. To address your needs, Dr. Reinisch can perform the most efficient, advanced surgical techniques during your personalized treatment.
The Costs Associated with Microtia Surgery
There are several factors that can affect the cost of microtia surgery. The extent and complexity of your surgery can often dictate the final cost of treatment. If you require both MEDPOR ear reconstruction and atresia repair, you can expect a higher treatment cost than an individual who undergoes MEDPOR treatment alone. For patients who also need rib cartilage reconstruction, which requires two to five surgeries, you can often incur greater costs than a single surgery. Additionally, the costs associated with anesthesia, and coordination with a skilled otologist, will also be a factor.
At Reinisch Plastic Surgery, we have reduced costs for our patients by performing microtia surgery on an outpatient basis. This means there are no additional fees associated with hospital stays or recovery time.
We include a two-night stay at the Four Seasons Hotel for all out-of-town microtia patients, to help minimize the cost of accommodations. We can also connect patients with local families, who have volunteered to host visiting patients at no cost.
Financing Your Surgery
Dr. Reinisch is an out-of-network provider, which means families may have higher out-of-pocket expenses. This does not mean your insurance will not cover microtia surgery at Reinisch Plastic Surgery, but it may mean coverage is reduced. For this reason, we accept CareCredit® financing to assist families with out of pocket cost. CareCredit is a consumer credit program that allows families to pay for medical expenses in a series of low interest or no-interest payments.
Although Dr. Reinisch is out of network, Dr. Youssef Tahiri is an in-network specialist for many major insurance providers in the United States. Dr. Reinisch refers many patients to Dr. Tahiri, who is an accomplished pediatric plastic surgeon.
Dr. Reinisch also works with the Small Wonders Foundation to coordinate support for out-of-pocket costs. This organization was founded in 2005 to provide assistance to families around the world with children born with bodily or facial deformities.
Microtia Surgery with Dr. Reinisch
If you choose MEDPOR® surgery, you and your child will benefit from Dr. Reinisch’s considerable skill, personal commitment to his patients, and partnerships with top medical professionals. Dr. Reinisch works with a pediatric anesthesiologist and an otologist to protect your child’s safety and ensure optimal surgical results. He will conduct comprehensive follow-ups to assess whether your child is healing properly and enjoying better hearing. Because many of his patients travel thousands of miles to benefit from his expertise, he provides two complimentary nights of lodging at the nearby Four Seasons Hotel. Like many families who choose to stay longer, you may decide to stay at the Ronald McDonald House, which Dr. Reinisch is proud to partner with.