Diagnosis Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 49–52 (DOI: 10.1159/000350604)
Follow-Up of Psychological Changes in Patients Prior to Surgery Kimitaka Kaga National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
Microtia/atresia of the external auditory canal (EAC) may be unilateral or bilateral. Parents of children with this condition are quite shocked when their child is born with a congenital ear anomaly, whether it is unilateral or bilateral. They want to know why their child was born with microtia/atresia. Such a situation is not limited to the parents of microtia patients, and it is especially serious when the anomaly is associated with characteristic facial features such as facial paresis, micrognathia, temporomandibular joint hypoplasia, or Treacher-Collins syndrome. Psychological care is required for parents as well. Most parents say that they have never seen a child with this anomaly in their community or hospitals. In fact, microtia/atresia of the EAC is a rare disease that occurs in 1 in 10,000–15,000 births. Occurrences in Japan are estimated to be around 100 births annually. Unilateral cases are generally reported to account for 90% of cases and the bilateral type for 10%. We are managing two associations for parents of microtia patients called the ‘Blue Sky Association’ and the ‘Association of Parents of Treacher-Collins Patients’ to facilitate exchange among parents and medical doctors and to provide the latest medical knowledge. MacGregor et al. [1] stated in ‘Facial disfigurement: problems and management of social interaction and implications for mental health’ that patients with severe anomalies are less troubled than those with mild anomalies. Will this also be applicable to microtia patients?
Hearing aids are not necessary in patients with unilateral microtia/atresia of the EAC because auditory acuity is typically normal in the unaffected ear. Only the shape of the auricle is a problem. Many patients become conscious of the auricular anomaly when
Downloaded by: Univ. of California Santa Barbara 198.143.33.33 - 3/25/2016 2:32:03 AM
Unilateral Microtia/Atresia of the External Auditory Canal
Fig. 1. A self-portrait by a 7-year-old girl with the right microtia.
Fig. 2. A self-portrait by a 10-year-old boy with the left microtia.
they reach school age. It may be a reaction to teasing or bullying by their peers, or a psychological reaction due to incompleteness of one’s own physical image. During follow-up, to give patients hope, we explain that surgery to make the ear as same as the unaffected ear can be performed when they are 10 years old. The mental state of the child is nevertheless influenced and it is often expressed in psychological painting tests. Some examples are shown in figures 1 and 2. The microtia side was painted black in figure 1. Figure 2 shows a self-portrait of a child; firstly, when it was still unconscious of the microtia, and, secondly, a profile of the unaffected side drawn on purpose when the child was older and became conscious of the microtia. An innocent child turns into a child with a deep impact on their mental state.
Use of bone-conduction hearing aids is planned by the age of 1 year in patients with bilateral microtia. In children with no anomaly other than bilateral microtia/atresia of the EAC, joint surgery is performed when they are around 10 years of age. The first stage, for each
50
Kaga
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 49–52 (DOI: 10.1159/000350604)
Downloaded by: Univ. of California Santa Barbara 198.143.33.33 - 3/25/2016 2:32:03 AM
Bilateral Microtia
‘I am not alone’ A boy in the 6th grade of elementary school in a local area in Japan I have not had ears since birth. I only have earlobes. It is because of a very rare disorder called microtia. I have no ear holes, so I use bone conduction hearing aids, which stay right on top of my bald head, and I have no trouble with hearing. They are my ears, very important ears. People often ask me “What happened to your ears?” and “What are you wearing on your head?”. Every time they ask, my mother explains, “My son has microtia …”. My mother used to hold me and my older sister and say “I love my son with small ears, I love my son with hearing aids, I love everything about my son”. I think my father and mother had been trying very hard. I am not alone because I have doctors in Tokyo who created my new auricles and external auditory canals.
Fig. 3. Essay of a child who underwent surgery for bilateral microtia. This essay was awarded the best essay prize in his town.
Recollection A 33-year-old man “Bullying …” I was often called “no ears” when I was bullied by other children or when I quarreled with them. I grew my hair long, but sometimes a cord of the bone conduction hearing aid could be seen or my voice sounded strange… They often asked to me to say “a. e. i. o. u”. Once they understand, they stop doing it, but I loathed the change of classes that took place once every 2 years. I used to cry when I thought of having to explain all over again, but I did not complain to my parents. I might have experienced a rebellious age sooner because of it. I could not get up early in the morning. I could sleep well when I did not wear hearing aids because of the silence. My parents often scolded me for not getting up earlier, but I got angry at them and retorted, “Why did you give birth to me in this state?” out of stress due to everyday bullying. I am very sorry for that and am grateful for what they have done for me.
ear, is subcutaneous transplantation of an auricle frame made of rib cartilage by a plastic surgeon, and the second stage is a joint surgery performed by plastic surgeons and otologists for auricle prosthesis and reconstruction of the EAC and ossicular chain. At least two surgeries are performed for both ears. Even if surgery is started when a patient is 10 years old, the patient will be 12 years old by the time surgeries for both ears are complete. Trust between the patient, his/her parents, and the surgeon is therefore important. The personalities of children with bilateral microtia are usually naïve and modest. Drawing tests are not likely to reveal the mental state of a patient, although it may be revealed for the first time by an essay written after the surgeries (fig. 3). The contents of a child’s essay are usually bright and rarely appear to show shadows. However, both
Psychological Reaction in Microtia and Atresia
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 49–52 (DOI: 10.1159/000350604)
51
Downloaded by: Univ. of California Santa Barbara 198.143.33.33 - 3/25/2016 2:32:03 AM
Fig. 4. Essay of an adult patient who underwent surgery for bilateral microtia when he was 33 years old.
unilateral and bilateral patients who underwent surgery recalled in compositions written after having grown up that they had been teased, bullied and had feelings of isolation during childhood (fig. 4). Children may become introverted without verbally expressing their feelings. When the auricle and EAC are newly constructed and the use of in-canal-type hearing aids in both ears becomes possible, children with bilateral microtia/atresia of the EAC no longer need to use headband bone-conduction hearing aids. Then, they can experience biaural listening, and use eyeglasses and face masks for the first time. As a result, a naïve child turns into an open and bright self-confident child. Such a transformation in behavior greatly encourages us, the surgeons.
Reference
Kimitaka Kaga National Institute of Sensory Organs, National Tokyo Medical Center 2-5-1 Higashigaoka, Meguro-Ku Tokyo 152-8902 (Japan) E-Mail [email protected]
52
Kaga
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 49–52 (DOI: 10.1159/000350604)
Downloaded by: Univ. of California Santa Barbara 198.143.33.33 - 3/25/2016 2:32:03 AM
1 MacGregor FC, Abel TM, Albert B, Lauer E, Weissmann S: Facial Deformities and Plastic Surgery. Springfield, Thomas, 1953.
Follow-Up of Psychological Changes in Patients Prior to Surgery Kimitaka Kaga National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
Microtia/atresia of the external auditory canal (EAC) may be unilateral or bilateral. Parents of children with this condition are quite shocked when their child is born with a congenital ear anomaly, whether it is unilateral or bilateral. They want to know why their child was born with microtia/atresia. Such a situation is not limited to the parents of microtia patients, and it is especially serious when the anomaly is associated with characteristic facial features such as facial paresis, micrognathia, temporomandibular joint hypoplasia, or Treacher-Collins syndrome. Psychological care is required for parents as well. Most parents say that they have never seen a child with this anomaly in their community or hospitals. In fact, microtia/atresia of the EAC is a rare disease that occurs in 1 in 10,000–15,000 births. Occurrences in Japan are estimated to be around 100 births annually. Unilateral cases are generally reported to account for 90% of cases and the bilateral type for 10%. We are managing two associations for parents of microtia patients called the ‘Blue Sky Association’ and the ‘Association of Parents of Treacher-Collins Patients’ to facilitate exchange among parents and medical doctors and to provide the latest medical knowledge. MacGregor et al. [1] stated in ‘Facial disfigurement: problems and management of social interaction and implications for mental health’ that patients with severe anomalies are less troubled than those with mild anomalies. Will this also be applicable to microtia patients?
Hearing aids are not necessary in patients with unilateral microtia/atresia of the EAC because auditory acuity is typically normal in the unaffected ear. Only the shape of the auricle is a problem. Many patients become conscious of the auricular anomaly when
Downloaded by: Univ. of California Santa Barbara 198.143.33.33 - 3/25/2016 2:32:03 AM
Unilateral Microtia/Atresia of the External Auditory Canal
Fig. 1. A self-portrait by a 7-year-old girl with the right microtia.
Fig. 2. A self-portrait by a 10-year-old boy with the left microtia.
they reach school age. It may be a reaction to teasing or bullying by their peers, or a psychological reaction due to incompleteness of one’s own physical image. During follow-up, to give patients hope, we explain that surgery to make the ear as same as the unaffected ear can be performed when they are 10 years old. The mental state of the child is nevertheless influenced and it is often expressed in psychological painting tests. Some examples are shown in figures 1 and 2. The microtia side was painted black in figure 1. Figure 2 shows a self-portrait of a child; firstly, when it was still unconscious of the microtia, and, secondly, a profile of the unaffected side drawn on purpose when the child was older and became conscious of the microtia. An innocent child turns into a child with a deep impact on their mental state.
Use of bone-conduction hearing aids is planned by the age of 1 year in patients with bilateral microtia. In children with no anomaly other than bilateral microtia/atresia of the EAC, joint surgery is performed when they are around 10 years of age. The first stage, for each
50
Kaga
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 49–52 (DOI: 10.1159/000350604)
Downloaded by: Univ. of California Santa Barbara 198.143.33.33 - 3/25/2016 2:32:03 AM
Bilateral Microtia
‘I am not alone’ A boy in the 6th grade of elementary school in a local area in Japan I have not had ears since birth. I only have earlobes. It is because of a very rare disorder called microtia. I have no ear holes, so I use bone conduction hearing aids, which stay right on top of my bald head, and I have no trouble with hearing. They are my ears, very important ears. People often ask me “What happened to your ears?” and “What are you wearing on your head?”. Every time they ask, my mother explains, “My son has microtia …”. My mother used to hold me and my older sister and say “I love my son with small ears, I love my son with hearing aids, I love everything about my son”. I think my father and mother had been trying very hard. I am not alone because I have doctors in Tokyo who created my new auricles and external auditory canals.
Fig. 3. Essay of a child who underwent surgery for bilateral microtia. This essay was awarded the best essay prize in his town.
Recollection A 33-year-old man “Bullying …” I was often called “no ears” when I was bullied by other children or when I quarreled with them. I grew my hair long, but sometimes a cord of the bone conduction hearing aid could be seen or my voice sounded strange… They often asked to me to say “a. e. i. o. u”. Once they understand, they stop doing it, but I loathed the change of classes that took place once every 2 years. I used to cry when I thought of having to explain all over again, but I did not complain to my parents. I might have experienced a rebellious age sooner because of it. I could not get up early in the morning. I could sleep well when I did not wear hearing aids because of the silence. My parents often scolded me for not getting up earlier, but I got angry at them and retorted, “Why did you give birth to me in this state?” out of stress due to everyday bullying. I am very sorry for that and am grateful for what they have done for me.
ear, is subcutaneous transplantation of an auricle frame made of rib cartilage by a plastic surgeon, and the second stage is a joint surgery performed by plastic surgeons and otologists for auricle prosthesis and reconstruction of the EAC and ossicular chain. At least two surgeries are performed for both ears. Even if surgery is started when a patient is 10 years old, the patient will be 12 years old by the time surgeries for both ears are complete. Trust between the patient, his/her parents, and the surgeon is therefore important. The personalities of children with bilateral microtia are usually naïve and modest. Drawing tests are not likely to reveal the mental state of a patient, although it may be revealed for the first time by an essay written after the surgeries (fig. 3). The contents of a child’s essay are usually bright and rarely appear to show shadows. However, both
Psychological Reaction in Microtia and Atresia
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 49–52 (DOI: 10.1159/000350604)
51
Downloaded by: Univ. of California Santa Barbara 198.143.33.33 - 3/25/2016 2:32:03 AM
Fig. 4. Essay of an adult patient who underwent surgery for bilateral microtia when he was 33 years old.
unilateral and bilateral patients who underwent surgery recalled in compositions written after having grown up that they had been teased, bullied and had feelings of isolation during childhood (fig. 4). Children may become introverted without verbally expressing their feelings. When the auricle and EAC are newly constructed and the use of in-canal-type hearing aids in both ears becomes possible, children with bilateral microtia/atresia of the EAC no longer need to use headband bone-conduction hearing aids. Then, they can experience biaural listening, and use eyeglasses and face masks for the first time. As a result, a naïve child turns into an open and bright self-confident child. Such a transformation in behavior greatly encourages us, the surgeons.
Reference
Kimitaka Kaga National Institute of Sensory Organs, National Tokyo Medical Center 2-5-1 Higashigaoka, Meguro-Ku Tokyo 152-8902 (Japan) E-Mail [email protected]
52
Kaga
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 49–52 (DOI: 10.1159/000350604)
Downloaded by: Univ. of California Santa Barbara 198.143.33.33 - 3/25/2016 2:32:03 AM
1 MacGregor FC, Abel TM, Albert B, Lauer E, Weissmann S: Facial Deformities and Plastic Surgery. Springfield, Thomas, 1953.
