The remarkable surgery that enabled doctors to use cartilage from 10-year-old Olivia's rib to give her a new ear
Here's to a new ear: Olivia shows off her rebuilt ear
For years Esther Tysall’s daughter Olivia endured cruel taunts from playground bullies – simply because she looked a bit different.
‘She’d come home in floods of tears because other children had been picking on her,’ Esther recalls.
Ten-year-old Olivia suffers from a condition called microtia, meaning small ear, which caused a fleshy stump to grow where her right ear should be.
‘We explained to her that it was something she was born with and that it made her special – we used to call it her fairy ear – but nothing we said could make it better,’ her mother says.
The deformity, which affects one in 7,000 babies, leaves sufferers with no ear canal and only partial hearing – about 40 per cent – on the affected side. It is not fully understood why microtia occurs, although it seems to be hereditary in some cases. But no one in Olivia’s family has ever suffered from the condition.
Studies have shown that in five per cent of microtia patients, a member of the immediate family has an ear abnormality, although no specific gene has been identified. There is also evidence that an interruption of blood supply to the ear during a baby’s development, or even some medications, can cause the condition.
For Olivia, the main issue was not being unable to hear but that she didn’t look like other children.
‘Olivia didn’t notice her ear when she was little,’ explains Esther. ‘But when she started primary school it upset her. She grew her hair long to hide it and refused to wear a ponytail. Doctors told us there was nothing we could do about it and that she would have to live with it for the rest of her life.’
But today, thanks to remarkable medical advances, Olivia not only has hearing in both sides but surgeons have been able to craft her a new ear, with skin grafts and cartilage from her ribs.
To tackle the problem of her hearing, in November 2007, Olivia, then aged six, was fitted with a bone-anchored hearing aid (BAHA) during an operation at Birmingham Children’s Hospital.
Neil Bulstrode, consultant plastic surgeon at Great Ormond Street Hospital, says: ‘When a patient has no ear canal, a traditional hearing aid is pointless. Instead, we implant a hearing aid into the bone on the affected side of the head. The BAHA vibrates and transmits sounds directly to the cochlear nerve that sends sound signals to the brain.’
The operation involves lifting a section of skin by the ear and removing fat from the area before fitting a titanium screw into the skull bone so the hearing aid can be clicked into place each day. This allows the patient to hear through the bone in the head.
Free from taunts: Olivia with her mother Esther. Remarkably the 10-year-old can hear from both her ears
Although doctors successfully treated Olivia’s hearing loss with the BAHA, her parents still hoped something could be done to change the appearance of her ear. ‘Of course we think Olivia is gorgeous the way she is, and we’ve always told her as much,’ says Esther. ‘But we knew how much she was desperate to have a pair of normal ears.
‘It broke our hearts that we couldn’t give her that – we were told traditional plastic surgery wasn’t possible because of the delicate nature of the ear. And although there was always the option of wearing a prosthetic ear, it would need to be removed each night, could fall off at any point – and we knew it was never going to look the same as a real one.’
A breakthrough came when Esther and her husband read on the internet about a pioneering two-part operation for microtia sufferers, which involved surgeons creating a new ear for the patient using cartilage from their own ribs.
'Fair ear': Olivia as a toddler before her surgery
Cartilage is a type of connective tissue that provides structure to other tissues, such as skin. It is more flexible than bone but stiffer than muscle tissue. It also coats joints to prevent bones wearing away.
The advantage of this type of surgery is that the new ear forms its own blood supply and the body does not reject it as it comes from the patient’s own tissue. In March 2011 the first stage of Olivia’s ear reconstruction was carried out at Great Ormond Street Hospital. It involved removing a piece of cartilage from her ribcage and fashioning it into a realistic-looking ear.
The operation took five hours, during which Olivia was put under general anaesthetic while doctors made a 2in incision into her ribcage.
Mr Bulstrode, who carried out the surgery, performs about 40 such operations a year. He says: ‘We make a pocket of skin where the ear needs to go and thin the skin so it mimics the skin on the ear. Then we harvest three pieces of cartilage from the ribs before rebuilding them with thin tubes containing the remaining cartilage mixed with a glue-like substance.’
Patients can undergo the procedure only once they are about ten so that sufficient amounts of cartilage can be harvested without damaging the ribcage. ‘Using the patient’s other ear as a template, we create the framework for the new ear using a wire frame, before placing it under the thinned pocket of skin and sewing the flap down over the framework,’ adds Mr Bulstrode.
Olivia remained in hospital for a week. For the first few days after the operation she was in terrible pain and said she regretted having the procedure. But as the pain in her ribs subsided, she became excited.
‘The rib pain cancelled out any head pain,’ says Esther. ‘The ear looked swollen for the first four days but after that, as the fluid was drained and the skin was tightened against the cartilage, it looked real. She was overjoyed.’
For Olivia, the main issue was not being unable to hear but that she didn’t look like other children
Six months later, the second stage of Olivia’s operation was carried out. This involved releasing the back of the ear from the head and inserting another piece of cartilage behind it to create the normal, slightly projected position on the head. The cartilage used is harvested during the first operation but is stored under the skin’s surface, ready for it to be used later. After this, the ear should be fully healed within three months.
This cartilage is then covered with a skin graft. In Olivia’s case it was taken from her scalp. The procedure has a 90 per cent success rate and the ear continues to grow with the child.
Aftercare is minimal – only daily cleaning with an antibacterial ointment is required until it is healed. For Olivia, the result has been a resounding success.
‘I wasn’t scared when I went in for the operation because I wanted an ear so much,’ she says. ‘I was nervous when I looked in the mirror for the first time but as soon as I saw it, I was really happy. I love my new ear and I’m always asking my mum to put my hair up to show it off.’
Esther adds: ‘When she saw herself in the mirror for the first time after the operation, she squealed with delight. It’s so nice to finally see a smile on her face.’
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