Some children are born with a missing or malformed small ear due to a rare congenital condition called microtia. In most cases, the child's ear canal is also very small or absent, resulting in hearing loss.
The surgical procedures used to correct microtia require the skills of both a sculptor and surgeon -- making it the perfect specialty for Sheryl Lewin, MD, a craniofacial plastic surgeon who began her training as an artist and architect.
Lewin's career has been devoted to treating microtia through her private medical practice and nonprofit organization called Earicles, which helps children born with missing or deformed ears through education, research and free or reduced-cost treatment. I recently spoke with Lewin about her work:
As an architecture major, what inspired you to become a physician?
When I was in architecture school at UC Berkeley, I loved the challenge of design, where you can use your own creativity to solve visual and spatial problems. My program was heavily artistic -- we drew, painted and sculpted. But what was missing was the ability to use those skills to directly affect someone's life in a tangible and meaningful way.
During college, I lived across the street from an elementary school that served underprivileged kids, which inspired me to start a volunteer organization of Berkeley undergraduates that mentored disadvantaged children in the local community. I recognized that I really enjoyed working and helping kids, and medicine was a way to do that.
When I went to medical school at Stanford, I was drawn to surgery as it gave me the ability to work with my hands. I decided to pursue pediatric plastic surgery after I saw my first cleft lip surgery on a tiny infant, whose life was transformed in a couple of hours. I realized it absolutely used the same skill set that I was used to working in: design, thinking three-dimensionally and visualizing symmetry. It was very much like sculpture.
Years later in medical school, I saw my first surgery to correct a rare condition called microtia. Once I saw what was involved, there was no doubt that I would love the challenge of making ears, which is considered by many plastic surgeons to be one of the most technically difficult things we do. But what really sealed the deal was the intangible feeling you get taking care of these children and their families. I came home that day and told my husband, 'I know what I want to do with the rest of my life.'
What is microtia?
Microtia is a congenital condition in which the ear does not develop properly. The word microtia translates to 'small ear.' It occurs in about one in 6,000 to 12,000 children worldwide, with a higher prevalence among Hispanics, Asians and Native Americans.
The cause of microtia is not well understood, particularly regarding the role of environmental and genetic factors. Some medications have been linked to microtia when ingested in the first trimester of pregnancy, including Thalidomide and Accutane. However, it's important to understand that microtia is rarely caused by what a mother does during pregnancy.
How do you treat microtia?
Ninety-five percent of the world treats microtia by removing rib cartilage from the chest, carving it into an ear framework and then slipping it under the skin. In order to have enough cartilage, surgery must be delayed until children are six to ten years old. Three to four surgeries are required with this technique, and the ability to match the opposite ear is limited.
Several colleagues and I use a different technique. In an eight- to ten-hour outpatient surgery, I customize a porous polyethylene implant into a three-dimensional ear shape that matches the opposite ear. This implant is then covered with vascular tissue. This allows for a symmetric and natural appearing ear to be created in just one operation as early as three years of age.
Children with microtia almost always have conductive hearing loss -- since the ear canal is missing but the auditory nerve is functional. During the ear reconstruction surgery, I can do an additional scarless procedure to help restore hearing. I implant a titanium device in the skull that is connected to a bone conduction hearing processor, commonly referred to as a BAHA. The hearing processor captures sound and transmits these vibrations to the skull through the implant, which stimulates the auditory nerve that processes it as sound.
What is most rewarding about your work?
This surgery not only helps provide functionality, such as giving children the ability to wear eyeglasses, but it's often about helping children attain the simplest human need: to feel the same as everyone else.
One of my favorite moments involved a four-year old boy named Davin, who had microtia of both ears. I was sitting next to him as he was about to see his second ear for the first time. He looked me in the eyes and said, 'Dr. Lewin, do I have two big boy ears now?' I said, 'Yes Davin, two beautiful ears.' Then, out of nowhere, he leaned over and planted a big kiss right on my lips and said, 'Dr. Lewin, I love you.' For a moment, I was speechless, and then managed to say, 'Davin, I love you too.' It really can't get any better than that in my book.
Previously: Stanford reconstructive surgeon Jill Helms reminds us that "beauty isn't defined by our faces alone", Ancient surgical technique still used to rebuild noses today and Stanford hearing study upends 30-year-old belief on how humans perceive sound
Photos courtesy of Sheryl Lewin