Approximately 1 in 4,000 babies in Southeast Asia are born with 1 or two missing/barely developed ears in a congenital condition called microtia. This condition is often associated with atresia which is a non-development of the ear canal. The middle and inner ears are usually present, but the sound cannot reach those structures and so the child cannot hear in the affected side. Thus, patients with microtia and atresia suffer from both the stigma of deformity and the disability of deafness. If both sides are affected this is particularly disabling. In addition, the volume of motorbikes in Vietnam and the lack of full-face helmets leads to frequent ear avulsion injuries. These require reconstruction. Vietnam has been making significant strides in treating microtia. For instance, the British Foundation for International Reconstructive Surgery and Training (BFIRST) has been collaborating with local teams in Hanoi to develop advanced ear reconstruction techniques. These efforts have resulted in a strong ear reconstruction service that uses single-stage surgery and minimizes scarring. Additionally, there are ongoing efforts to improve hearing restoration for patients with microtia and atresia. Specialists are working on implementing surgical implant techniques to address congenital deafness.

Answer: The ear consists of three main areas: outer ear, middle ear and inner ear. The outer ear acts as the receiver for sound waves to travel through the outer ear canal and cause vibrations in the eardrum. The eardrum and the three small bones of the middle ear amplify the vibrations as they travel to the inner ear. There, the vibrations travel through the fluid in the cochlear structure in the inner ear (cochlea). Attached to nerve cells in the cochlea are thousands of tiny hairs that help convert sound vibrations into electrical signals that are transmitted to the brain. The brain turns these signals into sound signals. Small ear defects (ear defects) are not only deformed outer ear rings, but also often come with no ear canal and no eardrum (Atresia) resulting in loss or loss of hearing (inability to hear sounds) in defective ear. After your baby is born or when you adopt a baby, your baby usually hasn't had a newborn hearing screening. Once your baby has not had newborn hearing screening, you need to take your baby to an ear, nose and throat doctor and an audiologist for a hearing test to find out how much hearing loss your baby has. Hearing loss is if both ears are hearing loss (hearing loss). With the help of your ENT doctor and audiologist, you will be informed of options that best help your baby. Before the coronary imaging surgery, the patient may be asked to have an audiometric test, with a CT scan to check the middle ear. Based on the examination results and the specific situation, the doctor may recommend the use of hearing aids or surgery to create an external ear canal to increase hearing and hearing for the baby. That is why Dr. Nguyen Hong Ha, expert on ear shaping, also works closely with leading ENT specialists and audiologists to not only reconstruct the ear for children early from 3 4 years old but also counseling on hearing function treatment so that the children can integrate best in life.

On Monday (Nov. 4), good news from the hospital revealed that after two years of research and technical improvement, the doctors at the hospital’s Plastic Surgery Department have successfully performed MER using self-costal cartilages with only one operation under the support of an endoscopy. This is one of the most demanding challenges in plastic surgery and the well-known medical facility is the first hospital in Vietnam and one of the very few centres in the world to successfully carry out the most advanced MER, making it a routine operation. Assoc. Prof., Dr. Nguyen Hong Ha, Head of the Department of Plastic Surgery at the Vietnam - Germany Hospital, said that microtia maybe congenital or acquired due to an accidental loss of ear or burn. Although it is not dangerous to the life of the patient, it can leave a huge negative impact on aesthetics and psychology, especially for children at a pre-school age. Currently, there are two popular methods of ear reconstruction in the world, in which the use of autologous rib cartilage has been implemented in the past 50 years, but requires at least 2-3 major surgeries with full risks during anesthesia and surgery to build the ear canal, by removing rib cartilage No. 6,7,8 or 9 from rib cage and sculpting into an ear cartilage frame. The newer method is to shape the coronary ear with an artificial cartilage frame that patients only need one surgery at a very early age as 4-5 years old, in which could bring better aesthetic results than other methods. “So far, the latter using artificial cartilage has the most advantages. However, the disadvantage is that the artificial cartilage frame is very expensive and has not been covered by health insurance like other high-tech medical supplies such as artificial hip and knee joints. In Vietnam's economic conditions, only a few families are capable of purchasing artificial ear cartilage frames to implement this method for their children,” said Dr. Ha. In order to help Vietnamese children with congenital microtia, doctors at the hospital have improved the technique and successfully applied the new method of ear reconstruction, using rib cartilage with the help of laparoscopic surgery, which brings the same results as the artificial cartilage method, but the cost is much lower. “In this technique, we still use the patient's own cartilages to make an ear canal. But instead of having to bury the mold under the skin to wait a year later for the second surgery, the doctors immediately used the superficial temporal flap to cover the cartilage frame, and only with one surgery, the patients are able to get a new ear with almost normal function,” Dr. Ha said. According to him, the most difficult point of this surgery is how to cover the whole cartilage frame with the superficial temporal flap. Even a small 1-2 mm exposure in the frame can lead to infection or necrosis for the cartilage frame. Previously, to get the superficial temporal flap, doctors often had to carry out open surgery that would leave a 15-20 cm T-shaped scar on the temple area, causing hair loss or keloids. Currently, thanks to the application of laparoscopic technique, the hospital’s doctors can get the entire superficial temporal flap without having to make any scars. The application of laparoscopic not only minimises the smallest aesthetic scars, but also plays an important role in helping enlarge tiny blood vessels like hairs on the screen for close observation, helping to preserve all of these small blood vessels to ensure the superficial temporal flap can be 100% viable. After two years of technical research and improvement, the doctors at the hospital have successfully performed a range of MER surgeries using self-costal cartilages with the help of laparoscopy. "So far, only one or two of the most advanced centres in the world are able to perform this technique on a regular basis as at our hospital," Dr. Ha said. Integrating the advantages of both the most popular MER surgical methods in the world has created a new opportunity for patients in Vietnamese conditions, helping them still approach the most modern high-tech techniques in plastic and cosmetic surgery. From November 9 to 17, the Cosmetic Surgery Department at the hospital will collaborate with the world's leading team of UK experts on MER to offer free examinations and sharing experience in the field as well as face and neck plastic surgeries.

Microtia plastic surgery using a  plastic frame  is also called  MedPor ear reconstruction . First introduced by Dr. John Reinisch, Medpor is a surgery that uses a foam  polyethylene  ear frame with autologous tissue to shape the ear. The polyethylene frame is sculpted to resemble a healthy ear frame is implanted in the appropriate position  and then covered by a thin layer of tissue that turns down from the subcutaneous layer (called the temporal flap) and cover with a skin graft taken from patient’s own thigh or abdomen. All of these steps are performed in one operation. Advantages Disadvantages Can be done with three-year-olds, before they go to school; For children with hearing loss, surgery to restore the ear canal   can be done before or at the same time with reconstructing the defective ear; Minimizes pain relief while allowing children to go home (outpatient) one hour after surgery; Reconstructive surgery is performed once and in 80% of cases are outpatient; The reconstructed ear is formatted to correspond to the normal ear in size and appearance; The reconstructed ear can withstand most sports. The ear frame is the plastic that replaces the body’s tissue; Only a few surgeons are trained in this surgery, an inexperienced ear surgeon with a defective ear will lead to unexpected results.

Microtia plastic surgery using autologous rib cartilage is also simply called “reconstructive ear using rib cartilage”. This method has been in use for more than 50 years. According to this method, the surgical process consists of . The first is to remove a few pieces of cartilage from the ribs on the thorax, sculptural grafting them into the ear frame (Figure 1) and then transplanted under the scalp behind the defective ear (Figure 2). Then, it takes many operations to lift the ear frame off the scalp, create grooves behind the ears, cover the cartilage frame, skin graft on the scale and adjust other details of the ears.     Advantages Disadvantages Using tissues of the patient’s own body; With a good surgeon, the patient can get excellent, long-term results; The reconstructed ear can withstand most sports. Only children over 7 years old will have enough rib cartilage to make ear frame, need many operations (many stages) in a long time to make children go to school always with remarkable different ears; The rib cartilage dissection causes pain, permanent scarring of the chest and potentially deforming the chest wall; Ear canal surgery must wait after ear reconstruction is complete thereby delaying hearing recovery for many years.

In Vietnam, Dr. Nguyen Hong Ha, after a period of acquiring techniques from his mentor Pr. Reinisch, who is known worldwide for his design and development of the Medpor ear reconstruction technique. Dr Ha with his associates, has successfully performed many ear reconstruction surgeries using Medpor or Omnipore plastic implant at Vietnam-Germany Friendship Hospital. The ear reconstruction using the Medpor, Omnipore plastic implant done in the US or at Vietnam-Germany Friendship Hospital is similar in terms of technique. Before making any decision, you need to know more about the process of shaping ears using plastic implant. The plastic implant ear shaping method is one that only requires one-time operation (one-stage surgery). The rib cartilage classic method need 2-4 stage of surgery. Thus, if including the time of pre-operative examination and pre-operative counseling, the patient and caregiver take only about 1-2 month. The rib cartilage classic technique takes at least 2-3 years to complete this procedures.