Cause and development
During pregnancy, the ears gradually develop from cartilage tissue that forms the outer ear. This process is sensitive to external pressure. When the fetus lies with the ear pressed against the uterine wall for a long time, or when there is limited space in the womb (for example due to low amniotic fluid or a multiple pregnancy), the soft cartilage of the ear can become temporarily deformed.
Because the ear of a newborn is still soft and flexible, this deformation remains visible at birth. However, this is not caused by a genetic disorder or structural defect. The deformation is purely the result of mechanical pressure and the immature, pliable structure of the cartilage.
How to recognise a Frommel ear
A Frommel ear is usually clearly visible at birth. Parents may notice that one or both ears do not have the usual shape. The outer ear may appear:
- folded or crinkled
- folded over along the upper rim
- asymmetrical compared to the other ear
- tilted slightly forward or inward
The skin over the ear looks normal, and the ear feels soft and flexible. In many cases the deformation is mild, but sometimes it is more pronounced. Importantly, hearing almost always functions normally unless another condition is present.
How common is it?
Folded ears are more common than most people think. It is estimated that 20 to 30 percent of newborns have a mild to moderate ear deformity. In many of these children, the shape improves naturally within the first weeks of life. In other cases, the deformity remains without treatment.
Because many parents believe the ear will “grow out of it,” treatment is not always started early. This is unfortunate, because the first weeks after birth offer the best window for simple, quick and completely painless correction.
When to treat
The best time to treat a Frommel ear is within the first two weeks after birth. During this period, the ear cartilage still contains high levels of maternal oestrogen, making it extra soft and shapeable. This increased flexibility gradually decreases after three to six weeks.
Correction is done using ear molding: a medical device that holds the ear in the correct position for several weeks. This can be done without surgery, without anaesthesia, and without pain for the baby. Treatment usually continues for three to six weeks, depending on the severity of the deformation.
The earlier treatment starts, the shorter the correction period and the better the final result.
How ear molding works
In ear molding, a soft mold or splint is placed around the ear. It is shaped specifically for the child’s ear and holds it in the desired position. The system is designed to be comfortable and gentle on the skin. During the treatment, parents should:
- keep the ear clean and dry
- be careful when dressing or undressing the baby
- leave the splint in place unless otherwise instructed by the doctor
Several systems are available, such as EarWell®, which is commonly used in clinics. The choice depends on the child’s age, the shape of the deformity and the experience of the treating physician.
What if treatment is not started?
Without treatment, mild deformities may partially or fully correct themselves. However, in more noticeable or severe cases, the ear tends to remain in the deformed shape. As the child grows, the ear develops in the wrong position, which may later lead to cosmetic concerns. Although the child usually has no functional issues, the appearance of the ear can affect self-esteem, especially during school-age years.
If the ear remains deformed later in childhood, plastic surgery may be an option. This correction is usually performed from the age of five or six, when the ear is mostly developed. The procedure is typically done under general anaesthesia and requires a longer recovery period than molding.
Distinguishing Frommel ear from other ear conditions
A Frommel ear is relatively easy to distinguish from other congenital ear deformities, such as:
- Stahl’s ear: an extra cartilage fold that gives the ear a pointed shape
- Constricted ear: the outer rim of the ear is pulled inward tightly, sometimes with cartilage missing
- Microtia: a serious condition in which the ear is partly missing or underdeveloped
In a Frommel ear, there is no cartilage deficiency, no deformity of the ear canal, and no hearing loss. This makes it a mild and well-treatable condition.
Conclusion
A Frommel ear is a common, congenital deformation of the outer ear in which the ear is folded, creased or misshapen. It usually develops due to temporary pressure in the womb during pregnancy. Although it may look noticeable, it is a harmless condition that does not affect hearing.
The key to effective treatment is timing. When correction begins within the first weeks after birth, the ear can be fully and painlessly corrected using ear molding. This method is safe, comfortable and provides lasting results. If treatment is not started early and the deformity persists, plastic surgery may be considered later in childhood.
For parents, it is important to pay attention to the shape of the ears after birth. If you are unsure about the symmetry or position of the ear, it is advisable to have it assessed in the first weeks. Early recognition can make the difference between a simple correction and a more extensive treatment later on.
