What Is Stahl’s Ear?
Stahl’s ear is an ear deformity with which some children are born. This condition is also known as pointed ear, elf ear, Vulcan ear, or Spock's ear because of its pointy appearance. The pointed appearance at the top of the ear is due to the malformation of the upper portions of the outer ear and a flattened ear rim due to misshapen cartilage. This kind of defect in the shape of the ear can make a child conscious about his/her appearance and hence can affect their confidence and performance in class. They can be bullied by children of the same age group for their appearance.
Why Are Baby’s Ears Pointed?
Stahl's ear is a congenital ear deformity. The exact cause of this condition is unknown, and apart from the appearance, there are no symptoms associated with this condition. In normal conditions, two folds of cartilage, or crus, comprise the upper portion of the ear, the inferior fold, and the superior fold. Stahl's ear occurs when an extra fold of cartilage is present horizontally that extends to the helical rim, causing the helix to unfurl and create a pointed shape.
This ear deformity consists of the abnormal insertion of an intrinsic outer ear muscle called the auricular transverse muscle, which will create extra cartilage that crosses over the scapha, which is the elongated portion of the ear between the helix and antihelix. Stahl's ear can vary greatly in its degree of severity. Even though there is no functional impairment like hearing loss, or other symptoms, severe cases can result in people with defects, especially children prone to teasing and bullying for their appearance, which can affect their self-esteem. And hence, they will feel the need to get the defect corrected surgically.
What Causes Stahl’s Ear?
A defect in the cartilage causes Stahl's ear. It is characterized by an extra fold of cartilage (crus). Normally, there are two crus, the superior and the inferior. In this condition, there is a third horizontal crus. As a result, the helix or upper portion of the ear may straighten, giving the ear a pointed shape.
What Are the Symptoms of Stahl's Ear?
The symptom associated with Stahl's ear is physical appearance. Apart from that, no other symptoms are affecting the function. Children with Stahl's ear usually have normal hearing.
What Are the Treatment Options for Stahl’s Ear?
When the Stahl's ear is identified in the first few weeks to months after birth, surgery can be avoided by ear molding to correct this deformity. The ears of the infants are soft and flexible, which makes them responsive to molding. There are many other conditions in which ear molding is useful, like cryptotia, constricted ears, and protruding ears. In such cases, the earlier the intervention, the shorter the treatment. Early treatment will also produce better outcomes.
1. Non-Surgical Treatment- The time when the treatment is provided will decide if Stahl’s ear can be treated non-surgically or surgically. When the treatment is delivered within the first few weeks of life while the ear cartilage is still soft and malleable, the infant ear correction system can successfully mold the ear into a more aesthetically pleasing shape. When treating Stahl’s ear, it stretches the auricular transverse muscle to:
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Restore cartilage shape.
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Eliminate the transverse crus.
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Restore normal appearance to the superior crus.
2. Surgery- Surgical correction is needed in older children to correct the deformity. The correction surgery for Stahl's ear involves reshaping, repositioning, and suturing the abnormal cartilage to reverse the pointed shape of the ear. The surgery is under general anesthesia, the operation can be done on an outpatient basis, and the patient can return home the same day after the surgery. Reconstructive surgery (otoplasty) is usually done after age 5 when the ear cartilage has hardened. Once the cartilage has completely strengthened, the pediatric plastic surgeon can perform the otoplasty.
During the reconstructive surgery for Stahl's ear, the extra cartilage (third crus) is completely removed to eliminate the pointed portion at the top of the ear. If necessary, reshaping the ear using sutures placed in the cartilage of the ear may also be done. Dissolvable sutures are used to close the incision. The recovery post-surgery will take about approximately one to two weeks.
What Are the Complications of Surgery?
The complications can be divided into early and late complications. The complications are:
1. Early Complications:
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Infections- After any surgery, that is either minor or major, proper care should be taken otherwise they can be prone to develop infections.
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Necrosis of the Cartilage- After the surgery, when there is any problem with the circulation to the cartilage like the blood not reaching the cartilage, then it can lead to necrosis of the cartilage.
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Hematoma- This is the complication that is seen after surgeries and they are a collection of blood outside the vessels.
2. Late Complications: They can happen within weeks or months, and they are:
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Suture Granulomatosis - When there are remnants of the non-absorbable sutures left even after the removal of the sutures, they can act as foreign bodies and the body starts reacting against them leading to the formation of benign mass at the site.
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Extrusions- Following the surgery the corrected part may get extruded.
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Recurrence- The condition can get back to what it was before the surgery.
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Scarring- Scarring can occur at the site of surgery where the incision was made or the scarring may turn into a keloid scar which is painful and develop even after a year after the surgery.
Conclusion
Stahl’s ear is an ear deformity where the ear appears pointed and does not interfere with the functioning of the ear. The only problem with this condition is that of aesthetic concern. But because of the aesthetic, it can lead to mental or emotional problems especially in children so it is better to get it corrected when it is noticed. In case of deformity of the shape of the ear, consult the doctor to check for the ear's functioning and get guidance for treatment, if required.
