Cause and development
During pregnancy, the ears gradually develop from cartilage tissue that forms into the outer ear. This process is sensitive to external pressure. When the foetus lies with its ear against the wall of the womb for a long time, or when space is tight (for example with little amniotic fluid or with multiple births), the soft ear cartilage can become temporarily deformed.
Because a newborn's ear is still floppy and flexible, this deformity is still present at birth. However, it is not a genetic abnormality or a structural defect. The deformity is purely the result of mechanical pressure and the not yet hardened structure of the cartilage.
How do you recognise a crumpled ear?
A crumpled ear is usually clearly visible at birth. Parents notice that one or both ears do not have the normal shape. The outer ear is then:
- folded or crumpled
- folded over at the upper edge
- asymmetrical compared with the other ear
- sometimes tilted forwards or inwards
The skin over the ear looks normal and the ear feels soft and flexible. In many cases it is a mild deformity, but sometimes the abnormality is more pronounced. Importantly, hearing almost always functions normally, unless there is another condition.
How common is it?
Crumpled ears are more common than many people think. An estimated 20 to 30 percent of newborns have a mild to moderate form of ear deformity. In a large proportion of these children, the shape corrects itself in the first weeks after birth. In other cases, the deformity persists without treatment.
Because many parents think it will “grow out by itself”, action is not always taken straight away. That is a pity, because it is precisely in the first weeks that correction is simple, quick and completely pain-free.
When to treat?
The best time to treat a crumpled ear is within two weeks of birth. In this phase, the cartilage still contains large amounts of oestrogen (from the mother), which makes it extra soft and malleable. This increased flexibility gradually disappears after three to six weeks.
In the acute phase, immediately after birth, simply relieving the pressure on the ear can sometimes help. This so-called ‘offloading’ can consist of keeping the ear free and preventing constant pressure while the baby is lying down. Although this is not an active correction, in mild cases it can contribute to spontaneous recovery.
Correction is done using ear moulding: a medical device that brings the ear into the correct position and holds it there for several weeks. This can be done without surgery, without anaesthetic and without pain for the child. The treatment is usually continued for between three and six weeks, depending on the severity of the deformity.
The earlier the treatment starts, the shorter the correction period and the better the result.
How does ear moulding work?
With ear moulding, a soft mould or splint is placed around the outer ear. It is specially shaped to the child's ear and holds the ear continuously in the desired position. The system is designed to be comfortable and not to damage the skin. During the treatment, parents should:
- keep the ear clean and dry
- be careful when dressing and undressing the child
- leave the splint in place, unless the doctor advises otherwise
There are various systems on the market, such as EarWell®, which is often used in clinics. The choice of moulding type depends on the age of the child, the shape of the deformity and the experience of the treating doctor.
What if there is no treatment?
Without treatment, there is a good chance that the deformity will partly or fully correct itself in mild cases. With clear or severe deformities, however, the ear remains in the deformed position. The ear then continues to grow in the wrong shape, which can lead to cosmetic concerns later in life. Although the child usually has no functional problems, the appearance of the ear can affect their self-image, especially at primary school age.
However, such an ear reconstruction is more complex than early correction with ear moulding, because the cartilage has then fully hardened. The result is less predictable and the procedure requires more recovery time. This correction usually only takes place from the age of five or six, when the ear has largely finished growing. The procedure is usually performed under general anaesthetic and has a longer recovery time than moulding.
Difference from other ear conditions
A crumpled ear is relatively easy to distinguish from other congenital ear abnormalities, such as:
- Stahl's ear: an extra cartilage fold at the upper edge of the ear, giving it a pointed shape
- Constricted ear: an abnormality in which the rim of the ear is pulled tightly inwards, sometimes with loss of cartilage
- Microtia: a serious condition in which the ear is (partly) missing or underdeveloped
With a crumpled ear there is no cartilage deficiency, no malformation of the ear canal and no hearing loss. This makes it a relatively mild, easily treatable condition.
Conclusion
A crumpled ear is a common congenital abnormality of the outer ear in which the ear is crumpled, folded or deformed. It is usually caused by temporary pressure in the womb during pregnancy. Although it can look striking, it is a harmless condition that does not affect hearing.
The key to effective treatment lies in the timing. If correction is started within a few weeks of birth, it is possible to correct the ear completely and without pain using ear moulding. This method is safe, comfortable and gives a lasting result. If there is no treatment and the deformity persists, plastic surgery can be considered later in life.
For parents, it is important to pay attention to the shape of the ears after birth. Are you unsure about the symmetry or position of the outer ear? Then it is advisable to have this assessed by a doctor within the first weeks. Early recognition makes the difference between a simple correction and a longer course of treatment later in life.
See also our page about Ear correction or Treatments of the ear.
