Dawaa Reference

chronic

Congenital anomaly of the ear

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

GeneReviews - Branchiootorenal Spectrum Disorders (NCBI Bookshelf NBK1380) - https://www.ncbi.nlm.nih.gov/books/NBK1380/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class HD55 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Congenital anomaly of the ear - disease-level clinical article (congenital-ear-anomaly-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Microtia is usually noticed at birth or during infancy, sometimes on a routine newborn exam
  • Microtia can occur alone or together with hearing loss, facial asymmetry, inner ear problems, heart defects, or kidney malformations [hearing loss]
  • Patients may describe difficulties with body image, self-confidence, and acceptance by peers

Signs — what you find (5)

  • A fully formed adult ear is roughly 6 cm tall, tilted about 20 degrees back, and set 2 to 2.5 cm from the mastoid bone
  • In more severe cases, only parts of the earlobe and helix may be present
  • Associated findings can include an underdeveloped half of the face, pits in front of the ear, extra skin tags, or absence of the ear canal
  • Conductive hearing loss is common, and a tuning fork test can help confirm it [hearing loss]
  • In the most severe grade, the whole outer ear and earlobe are absent, called anotia

Tests (6)

  • The Marx grading system is widely used to classify how severe the ear underdevelopment is
  • Auditory brainstem response testing should be done early, especially in young children
  • One-sided absence of the ear canal typically causes moderate to severe conductive hearing loss of 50 to 65 dB, and 10 to 15% also have some sensorineural loss
  • The unaffected ear should also be tested rather than assumed to hear normally
  • CT of the temporal bone grades the severity of ear canal absence and assesses surgical candidacy, but should wait until age 6 to limit radiation exposure
  • A 10-point surgical-candidacy score is used, with a score of 7 or higher predicting a better hearing outcome after repair

If not this — what else fits (3)

  • Goldenhar, Treacher-Collins, and Melnick-Fraser syndromes should be considered when an ear anomaly is found
  • Prominent ears, cryptotia, cup or lop ear, Stahl's ear, and lobule deformities can be mistaken for microtia but are treatable with ear molding within 3 weeks of birth because newborn cartilage is still flexible
  • Absence of the ear canal is linked to the more severe grades of microtia and should be evaluated for

SourceStatPearls "Ear Microtia" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Structural ear anomalies present at birth (skin tags, prominent ears, and rarer anomalies of the pinna or canal); most need only reassurance, with referral to ENT or plastic surgery for cosmetic correction or when hearing may be affected. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Structural ear anomalies present at birth (skin tags, prominent ears, and rarer anomalies of the pinna or canal); most need only reassurance, with referral to ENT or plastic surgery for cosmetic correction or when hearing may be affected.

Cautions
  • Associated canal atresia or other malformation affecting hearing must be assessed with audiology; syndromic features (renal, craniofacial) warrant broader work-up.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Infants with microtia or aural atresia require early objective hearing assessment (auditory brainstem response testing), including testing of the non-atretic ear.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.