Stanford Medicine Children’s Health’s Microtia and Ear Canal Atresia clinic provides cutting-edge ear reconstruction and hearing implants in one, coordinated approach
Aylene Tapia, age 16, is a modern-day Cinderella of sorts. She used to be shy and avoid talking to people. She didn’t want to be noticed or have people ask about her missing ears.
Being different got harder as she grew older. As most preteens do, she yearned to look more like her peers who were wearing earrings and styling their hair in fancy updos.
Aylene was born without ears due to a condition called bilateral microtia, where ears don’t develop properly in the womb. When she was a child, her parents told her about a surgery that she could have to give her new ears. As a preteen, she was ready to explore the idea, so they brought her to Stanford Medicine Children’s Health, where her transformation to a confident young woman began.
Coming to Stanford Children’s for ear reconstruction
The Microtia and Ear Canal Atresia clinic at Stanford Children’s offers patients and families an advanced approach to ear reconstruction that’s backed by the latest research. The multidisciplinary care team includes world-renowned otolaryngologists—head and neck surgeons—who specialize in treating microtia and performing reconstruction in two surgeries instead of the traditional three or four.
During Aylene’s first microtia surgery, her surgeons harvested some of her rib cartilage to form the framework of her new ears. They use an innovative surgical method that stacks cartilage for a more natural form of the ear, giving the ear more realistic detail. Most children have a remnant of an ear, and that remnant is used to create the fleshy part of the ear.
“Some people feel that it’s a lot to harvest a part of your ribs just for an ear, but I am not sure they understand how significant it is to have something missing from your face,” says Mai Thy Truong, MD, otolaryngologist, and one of Aylene’s microtia surgeons. “The confidence I see in kids after reconstruction is striking. When we use part of a patient’s own body for the reconstruction, we know it can last a lifetime.”
Stanford Children’s specializes in more complex cases, like Aylene’s. The team cares for children from across the nation and world, and also cares for adults with microtia.
“Bilateral microtia reconstruction is more challenging than unilateral (one-sided) microtia because the two underdeveloped ears often don’t match, making it harder to make the ears look the same,” Dr. Truong says. With unilateral microtia, Stanford Children’s creates a unique 3-D printed model of the missing ear from a mirror image of the existing ear to make it easier to match.
“The doctors took care of Aylene like she was one of their own children. We are so grateful to them and everybody on the team,” says Alberto Sr., Aylene’s father.
Aylene’s second surgery occurred a few months after the first, allowing the cartilage to heal and a healthy blood supply to establish. During the surgery, Dr. Truong and her partner Kay Chang, MD, otolaryngologist, elevated her ears off of the side of her head with skin grafts to help her ears naturally project outward.
Improving hearing at the same time
During Aylene’s second surgery, she also received cutting-edge hearing implants. Being born without an outer ear or ears doesn’t mean a child cannot hear. Their inner ear and cochlea still work. However, without the outer ear and ear canal to direct sound and allow sound to enter, they do not hear as well and often need hearing aids. Poor hearing can result in speech delays and learning problems.
“It’s important to us to provide holistic care for children that solves all problems associated with microtia,” Dr. Chang says. “That’s why we enhance hearing with advanced hearing implants during the second surgery.”
In the past, children with microtia wore a headband to push the hearing aid against the ear bones, or a magnet under their skin. It was not always comfortable. By placing a bone conduction hearing implant, the Stanford Children’s microtia team gives children a better quality of hearing with added comfort and more pleasing aesthetics.
Stanford Children’s is special in its approach to placing hearing implants at the same time as performing the ear reconstruction whenever possible. At many children’s hospitals, the two procedures are done separately, and with a different team of surgeons.
“By working together and performing both surgeries at once, we increase continuity of care and decrease the number of surgeries and incisions a child needs,” Dr. Truong says. “We are publishing a study that shows how patients do better when the two procedures are completed at the same time—there’s less infections, better placement, and it’s much easier on the child and parents.”
After recovering from the reconstruction, Aylene could not believe how good her ears looked—just like natural ears. The first thing she did was ask to get her ears pierced.
“You can’t even tell she wasn’t born with them. Her ears look perfect,” Alberto Sr. says.
Celebrating at a ball in her honor
Aylene had her own version of a Cinderella ball—a quinceañera to celebrate her 15th birthday and mark her transition from girl to woman—complete with a beautiful gown, stylish earrings, and a flattering hairstyle.
Aylene had a special wish: to have her Stanford Children’s doctors attend. During a care visit, she asked, “My quinceañera is coming up—do you have time to be there with us?”
“Dr. Chang and I were so honored to be asked. It was wonderful to witness her transformation,” Dr. Truong says.
During the celebration, Aylene’s mother, Ruth, removed her daughter’s tennis shoes and placed modern-day glass slippers on her feet—sparkly high heels—to mark her evolution from girl to young woman.
“I was bawling, it was so beautiful. I really felt her mom’s pride and love,” Dr. Truong says.
Aylene was glowing from the inside out. “Seeing her so happy made all of us so happy,” Alberto Sr. says. “She smiled the whole night.”
Caring for little brother Alberto
This fairytale has a twist. Aylene’s younger brother, Alberto, age 7, also has bilateral microtia. Microtia is genetically inherited about 5% of the time; the interdisciplinary microtia care team includes pediatric geneticists to help with these rare cases, along with otolaryngologists, audiologists, and radiologists.
Alberto is also receiving care at Stanford Children’s. Dr. Chang placed the same bone conduction hearing implants that Aylene received to improve Alberto’s hearing and speech. When he gets a little older, he will have ear reconstruction like his sister.
“Alberto had hearing aids before, but he always had a speech delay. With his new hearing implants, he is hearing much better, and his speech delay has improved 100%,” Alberto Sr. says. “You can really understand him now. His teachers have noticed, too. They say he is more outgoing and willing to raise his hand in class.”
Stepping into a bright future
Aylene is no longer quiet. Because of her improved hearing, her speech is clear and she’s not afraid to use her voice. She’s outgoing, engaged in high school, getting good grades, playing flag football, and running track. She’s been transformed from a shy girl into a confident young woman.
“Nothing stops her. She is a beautiful young woman who lives an amazing, active life, and who also happens to have a hearing aid and reconstructed ears,” Dr. Truong says.
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