900 SE Oak St Ste 201

Hillsboro, OR 97123

Phone: (503) 648-8971

Fax: (503) 640-6461

Ear

Ear Treatment

Pediatrics

Hearing loss can affect those of all ages, including children. Diagnosing and treating hearing loss in the pediatric population requires different instruments than those used on adults, and children may suffer from different types of disorders than adults.To test the hearing of newborns and infants, subjective tests must be used, as newborns are unable to articulate what they can and cannot hear. Auditory Brainstem Response (ABR) provides information on how well a child’s cochlea and neural pathway is functioning. Electrodes are placed on and around their head to measure their brain wave activity in response to sounds. Otoacoustic Emissions (OAEs) are the barely audible sounds given off by the hairs lining the cochlea. A small probe is placed into the ear and a sound is played, to elicit the release of OAEs. If no OAES are detected this could mean there is a blockage in the ear canal, fluid in the middle ear or damage to the hair cells within the cochlea.

For slightly older children, visual response audiometry and conditioned play audiometry can be used. A sound is broadcast through speakers within a specially designed booth. Depending on the child’s age, they are either taught to turn their head towards an animated toy or video (visual response) or drop a block in a bucket (conditioned play) when they hear a sound. These versions of pure-tone testing cannot discern singe-sided hearing loss.

Speech discrimination tests can be performed on children three years of age and older. A series of words is read aloud to the child and they are either asked if they heard the words or they are asked to repeat the words back to the tester. This test may be performed in different environments with different levels of background noise.

Infections of the middle ear are the most common cause of hearing loss in children. An infection is caused by a buildup of fluid within the middle ear; if the fluid contains any bacteria it can lead to an infection. Eustachian tubes are small tubes that connect the middle ear with the back of the throat. These tubes are responsible for regulating pressure and fluid within the middle ear. In children these tubes are much smaller and sit horizontally, which means they are more likely to get blocked. A common solution to middle ear infections is ear tubes. A simple surgery creates a hole in the child’s eardrum and a small tube is placed within the hole to keep it open. This hole helps to prevent fluid from building up, reducing the odds of future ear infections. After a few months these tubes usually fall out on their own.

Hearing Loss

There are three distinct types of hearing loss: conductive, sensorineural and mixed. Conductive hearing loss is caused by a problem with the outer or middle portion of the ear; sensorineural is caused by an issue with the inner part of the ear. Mixed hearing loss is caused by a combination of the two.In order to hear, a sound wave is captured by the outer ear, funneled down the ear canal and hits the eardrum. This causes a vibration, which is passed through three small bones within the middle ear; together, these bones are known as the ossicles. The last bone in the ossicle series hits the oval window, located within the cochlea. The cochlea is filled with fluid and lined with tiny hairs. When the oval window is hit, this causes the fluid within the cochlea to move. The movement of the fluid causes the tiny hairs lining the cochlea to move as well. When these hairs move they create an electrical signal. This signal is passed through the auditory nerve to the brain; the brain is able to interpret this signal as sound.

Conductive hearing loss is caused by a problem capturing or transferring the sound wave from the outside world to the inner ear. This can be caused by fluid within the middle ear, a perforated eardrum, impacted earwax or a malformation in the outer or middle portion of the ear. This type of hearing loss is usually temporary and can commonly be treated through medical or surgical means.

Sensorineural hearing loss is caused by a problem within the inner ear or the auditory nerve. This is the most common type of hearing loss and is usually permanent. It can be caused by exposure to a loud noise, head trauma, aging or a virus or disease. Fortunately, even though this type of hearing loss cannot be corrected it is usually able to be treated with a hearing aid.

Mixed hearing loss is caused by a problem with the outer or middle ear and the inner ear. Typically, the cause of the conductive hearing loss is identified and treated first then the sensorineural is addressed.

Ear Infections

Ear infections, known as otitis media, are usually caused by a bacterial or viral infection in the middle ear. The middle ear is the air-filled space behind the eardrum.

There are three main types of ear infections: acute otitis media (AOM), otitis media with effusion (OME) and chronic otitis media with effusion (COME). AOM is the most common type of ear infection and usually includes an earache caused by fluid trapped in a swollen ear. A fever may also accompany AOM. OME occurs after an ear infection has run its course but fluid has remained trapped in the middle ear. COME happens when fluid either remains in the ear for an extended period of time or becomes frequently trapped in the ear, even if there isn’t an infection.

Ear infections usually occur after another illness, such as a cold or the flu. These often lead to congestion and swelling in the nasal passages, throat and the Eustachian tubes. The Eustachian tubes, a pair of narrow tubes connecting the middle ear to the back of the throat, are responsible for regulating air pressure and drainage from the middle ear. If these tubes become inflamed fluids will remain in the ear.

In order to diagnose an ear infection, your doctor will review your medical history and look into your ear with a lighted tool. Your doctor will then use a pneumatic otoscope, which pushes a puff of air into the ear canal to check for a buildup of fluid. If your doctor is still unsure whether there is liquid trapped in the middle ear, a tympanometry test is performed to measure the air pressure within the ear.

If you are not experiencing severe ear pain and don’t have a fever, your doctor may suggest the “wait-and-see” approach. This would simply involve waiting a few days to see if the symptoms go away on their own. Most ear infections will clear within one to two weeks. If the ear infection does not go away or the symptoms get worse, antibiotics will be prescribed to treat the infection. Chronic ear infections, defined as more than four episodes in a year, may require additional intervention in the form of ear tubes. Ear tubes are surgically implanted through a hole made in the eardrum into the middle ear to help with drainage.

While ear infections can affect individuals of any age, they are more common in children. One reason for this is that the Eustachian tubes of children are narrower, which means they are more easily clogged. Another reason is because of the adenoids. Adenoids are small pads of tissues located at the back of the throat near the opening of the Eustachian tubes. In children, they can easily become inflamed or enlarged due to infection. Inflamed adenoids will block the Eustachian tubes.

Tinnitus

Tinnitus is the sensation of hearing sounds, usually ringing, when no sound is actually present.

While tinnitus is most often associated with ringing, a buzzing, roaring, clicking or hissing sound may also be heard. There are two forms of tinnitus, subjective and objective. Subjective tinnitus is the most common type and is when only you hear the sounds. Objective tinnitus is when you and your doctor can both hear the sounds; this type is rare.

Tinnitus is thought of as a symptom of another condition rather than as a condition itself. Because of that, any number of issues can cause tinnitus. The most common cause of tinnitus is inner ear damage. If the small hair cells in your inner ear are damaged, they can “leak” random electrical impulses to your brain, causing it to hear sounds that are not there. Age-related hearing loss, exposure to loud noises and earwax blockage can all cause damage to the inner ear. Disorders such as Meniere’s disease, blood vessel disorders and temperomandibular joint (TMJ) disorder, head injury, high blood pressure and a number of antibiotics and other medications can also lead to tinnitus.

Since there is such a variety of issues that can cause of tinnitus, the best way to treat the symptoms is to determine the cause. In order to confirm if there is a problem with your inner ear, your doctor will perform a series of hearing tests. To rule out a blood vessel disorder, your doctor will check your eyes, jaw, neck and arm movement and may even order imaging tests, such as a CT scan or an MRI. Your doctor may also go through some trial and error by changing your medication or removing any earwax, hoping these changes can cause the symptoms to improve.

If the cause has not been determined, trying to decrease the noise to a manageable state is the next step. White noise machines help to cover up noise, especially while sleeping. Masking devices are worn in the ear and produce a low-level white noise that can also cover up the distraction. Tinnitus retraining devices are individually programmed with a specific tone to cover up the frequencies of the tinnitus symptoms you are experiencing. The retraining device’s goal is that over time, you will become accustomed to the tinnitus and the symptoms will no longer bother you.

If any of these symptoms sound like something you have experienced, contact us at (503) 648-8971 for a consultation.

Dizziness & Vertigo

Dizziness can be caused by a number of issues. One of the most common is a problem with the inner ear. The inner ear is made up of the cochlea, used for hearing, and the semicircular canals, which are used for balance. The semicircular canals are made up of three canals, the horizontal, the posterior and the superior. Each canal is lined with small hairs and filled with liquid, known as endolymph. With every head movement, the fluid within the canal also moves; this movement activates the hairs and they send an electrical impulse to the brain. The three canals all sit at different angles and each is responsible for a different sense of directional balance. The superior canal is responsible for detecting side-to-side movements, like moving your head towards your shoulder. The posterior canal detects forward and backwards motions, like sit-ups. The horizontal canal senses up and down movement, such as nodding your head.Vertigo is the sense that your surroundings are moving even though they are not. This is usually caused by an issue with the inner ear, causing signals to be sent to the brain that are not consistent with the information coming from your other senses. Feelings of vertigo can last for a few seconds to hours and are often accompanied by unsteadiness, lightheadedness and loss of balance. Severe cases may include a sudden and severe headache and vomiting.

Benign paroxysmal positional vertigo (BPPV) is one of the most common types of vertigo. Those with this condition experience intense feelings of spinning or moving lasting only for a brief period of time. This reaction is caused by sudden head movements, such as sitting up too fast or getting hit in the head.

Vertigo, often lasting for several hours, is a common symptom of Meniere’s disease. This disease is caused by a buildup of fluid within the middle ear, which can also cause hearing loss and tinnitus.

Dizziness can also be caused by issues not related to the inner ear, such as a drop in blood pressure, poor blood circulation, neurological conditions and certain medications.

In order to determine the cause of your unexplained episodes of dizziness your doctor will review your medical history and complete a physical exam, specifically checking how you walk and keep your balance while standing. Then, your doctor may order a series of tests. To test your eye movements your doctor will track your eyes as they try to follow a moving object. A Dix-Hallpike maneuver may be performed if your doctor suspects you are suffering from BPPV. The doctor will move your head then ask you to lie down; your eye movements for the next 45 seconds are measured.

A posturography is performed to help your doctor figure out which part of the balance system is causing the dizziness. You will be asked to stand on a moveable platform and then attempt to keep your balance while the platform moves. A harness is used to ensure no injuries occur during this test. A rotary-chair test is also performed. This test involves sitting in a moveable chair while your eye movements are measured.

Usually, episodes of dizziness will go away on their own. If your doctor has been able to determine the cause of your dizziness, there are a limited number of treatment options. Medications such as antihistamines can be used for short-term relief; anti-nausea medications and water pills can be used to treat Meniere’s disease. Therapy such as head position maneuvers, balance therapy or psychotherapy may be used to help teach you techniques for dealing with the dizziness.

Swimmer’s Ear

Known as acute external otitis, swimmer’s ear is an infection in the ear canal. This infection is usually caused by water becoming trapped in the ear after swimming. The water creates an ideal environment for bacteria to grow.Normally, your ear canal does a good job of keeping water from building up inside the ear. Earwax and the downward slope of the ear canal help drain water from the canal. If you are submerged in water (as with swimming) these normal defenses are unable to protect your ear. Cleaning your ear with a cotton swab can also contribute to bacterial growth within the ear canal, as a cotton swab can cause scratches inside the canal. These scratches are an ideal place for bacteria to become trapped and grow.

There are three levels of swimmer’s ear: mild, moderate and advanced. Mild symptoms include itching, slight redness inside the ear canal and some drainage of clear, odorless fluid. Moderate symptoms include more intense itching, pain and redness, discharge of pus and a feeling of fullness inside the ear. The symptoms of an advanced swimmer’s ear include severe pain, complete blockage of the ear canal and a fever. If you are experiencing severe pain and a fever you should contact your doctor immediately.

If swimmer’s ear is treated in a timely manner it is normally not serious. Occasionally, temporary hearing loss can occur, but this will go away as the infection clears up. Long-term infections, lasting longer than three months, can occur if the bacterial infection is not responding to treatment or if it is combined with a fungal infection.

The treatment for swimmer’s ear is quite simple, your doctor will most likely prescribe a combination of ear drops. An antibiotic will fight the infection and a steroid will reduce the inflammation within the ear canal. To fight the pain, over-the-counter medications, such as ibuprofen or acetaminophen will usually be recommended.

In order to prevent any future infections, always dry your ears after swimming. Use a soft towel and only dry the outer part of the ear. A one-to-one mixture of white vinegar and rubbing alcohol can be poured into the ear after swimming to help dry out the ear and prevent the growth of bacteria. Never use a cotton swab or other object to clear out the ear canal.

Surfer’s Ear

Exostosis, also known as surfer’s ear, is the term for an abnormal growth of bone within the ear canal. While a common affliction for avid surfers, surfer’s ear can affect anyone who is exposed to cold, wet and windy conditions.

Exposure to cold air and water can cause the bone surrounding the ear canal to thicken and bony growths to develop. While the bone growths themselves are not harmful, if the bone thickens too much the ear canal can become completely blocked, which would lead to hearing loss. Due to the slow progression of bone growths, this condition typically does not appear until your 30s or 40s.

A decrease in hearing sensitivity and an increase in ear infections are the common symptoms associated with surfer’s ear. Since the ear canal has become smaller, water, earwax and debris can easily become trapped, which can lead to an increase in ear infections.

The only treatment option for surfer’s ear is surgery to remove the boney growths causing the obstruction. A drill is used to remove the bone; depending on the location of the growths the drill can either be inserted through the ear canal or through an incision made behind the ear. After the surgery is completed, it is important to avoid any cold water activities for two to six weeks in order to prevent any infections.

The best defense for surfer’s ear is early prevention. While avoiding all cold water activities is ideal, if that cannot be done, using proper ear protection can help as well. Waterproof earplugs either store-bought or custom-made at Ear, Nose & Throat Associates (Hillsboro) can help keep your ears as warm and dry as possible. A hood and a swim cap should also be worn.

Perforated Eardrums

A ruptured, or perforated, eardrum is a tear in the thin membrane that separates the inner ear from the middle ear. The eardrum is an important part of how we hear, as it is instrumental in the process of converting a sound wave that enters the ear into an electrical signal that gets sent to the brain. The eardrum also works as a barrier to keep water and other objects from entering the middle ear.

Ear infections are the most common cause of a ruptured eardrum. An infection in the middle ear creates pressure; this pressure pushes against the eardrum. If the pressure gets too great, the eardrum can tear. Pressure changes, such as what occurs when a plane changes altitude quickly, can also cause a tear. Foreign objects inserted into the ear, head injury or acoustic trauma resulting from an extremely loud noise have been known to cause tears as well.

The symptoms experienced by those with a ruptured eardrum can vary. The most common symptoms are a sudden sharp pain, drainage from the ear, buzzing or hearing loss. Some don’t feel anything at all.

If you experience any of these symptoms, contact your doctor as soon as possible. To confirm the diagnosis, your doctor will use an otoscope, a device with a light on the end, to look inside you ear. Usually, the hole or tear is visible. In order to test if the ruptured eardrum has affected your hearing, our doctor will also perform some hearing tests.

The treatment for a tear in the eardrum is minimal; usually they will heal on their own within three months. To prevent ear infections you may be prescribed antibiotic drops and to prevent pain, over-the-counter pain medication can be taken. If the eardrum is slow to heal or the perforation is too large, surgery may be needed. Your doctor will use a piece of your own tissue to mend the tear in a simple, outpatient procedure.

Ear Tubes
Insight into causes and treatment options
Painful ear infections are common for children. By the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own. Some require treatment with antibiotics. But sometimes, ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues such as hearing loss, behavior, and speech problems. In these cases, insertion of an ear tube by an ENT specialist may be considered.
What are ear tubes?
Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes.
These tubes can be made out of plastic, metal, or Teflon and may have a coating intended to reduce the possibility of infection. There are two basic types of ear tubes: short-term and long-term. Short- term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long-term tubes may fall out on their own, but removal by an otolaryngologist is often necessary.
Who needs ear tubes and why?
Ear tubes are often recommended when a person experiences repeated middle ear infections (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes such as flying and scuba diving).
Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia. The average age for ear tube insertion is one to three years old. Inserting ear tubes may:
Reduce the risk of future ear infection;
Restore hearing loss caused by middle ear fluid;
Improve speech problems and balance problems; and
Improve behavior and sleep problems caused by chronic ear infections.
How are ear tubes inserted in the ear?
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision in the ear drum. This is most often done under a surgical microscope with a small scalpel (tiny knife). If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space.
What happens during surgery?
A light general anesthetic is administered for young children. Some older children and adults may be able to tolerate the procedure without general anesthetic. A myringotomy is performed and the fluid behind the ear drum is suctioned out. The ear tube is then placed in the incision. The procedure usually lasts less than 15 minutes and patients awaken quickly.
Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when a repeat tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infection and the need for repeat surgery.
What happens after surgery?
After surgery, the patient is monitored in the recovery room and will usually go home within an hour. Patients usually experience little or no postoperative pain but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily.
Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery. Sometimes children can hear so much better that they complain that normal sounds seem too loud.
The otolaryngologist will provide specific postoperative instructions, including when to seek immediate attention and to set follow-up appointments. He may also prescribe antibiotic ear drops for a few days.
To avoid the possibility of bacteria entering the middle ear through the ventilation tube, physicians may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing, swimming, and water activities. However, recent research suggests that protecting the ear may not be necessary, except when diving or engaging in water activities in unclean water such as lakes and rivers. Parents should consult with the treating physician about ear protection after surgery.Possible complications
Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:
Perforation- this can happen when a tube comes out or a long-term tube is removed and the hole in the ear drum does not close. The hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty.
Scarring- any irritation of the ear drum (recurrent ear infections), including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problem with hearing.
Infection- ear infections can still occur in the middle ear or around the ear tube. However, these infections are usually less frequent, result in less hearing loss, and are easier to treat-often only with ear drops. Sometimes an oral antibiotic is still needed.
Ear tubes come out too early or stay in too long- if an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by an otolaryngologist.

Ear Wax Removal

Earwax, also known as cerumen, is the waxy substance produced by the glands within the lining of the ear canal. Earwax protects the skin within the ear canal, helps the ear stay clean and lubricated and protects it from bacteria, debris and water. Normally, older earwax dries up and falls out of the ear taking with it any trapped particles. The problems arise when something prevents the earwax from falling out of the ear, such as a blockage or impaction.

The most common cause of impacted earwax is incorrect cleaning of the ear, usually done with a cotton swab. Instead of cleaning out the earwax, the earwax is just pushed further into the ear canal. Hearing aids and earplugs can also cause the earwax to be pushed further into the ear canal. If you have a small or oddly shaped ear canal this can also make it difficult for the earwax to fall out of the ear on its own. A growth or an injury to the ear canal can also create a blockage.

Ear pain, a decrease in hearing, a sensation of fullness in the ear or dizziness can all be symptoms of impacted earwax. Since these symptoms can also be a sign of multiple conditions, it is important to visit your doctor to confirm the cause.

Once at the doctor’s office, your doctor will look into your ear with a lighted instrument called an otoscope in order to determine the best method for removing the impacted earwax. The irrigation method is the easiest and most popular method. It involves softening the earwax with drops and then using a syringe-like tool to push water into the ear canal. The water is able to flush out all the impacted earwax. The suction method, which should only be performed by an audiologist or ENT doctor, involves a low pressure suction device and a video otoscope. The third method of removal is use of a curette, a small cured instrument. After looking into your ear, the curette is inserted and used to scrape out the earwax.

There are multiple home remedies, many of which are recommended by your doctor after the earwax has been removed. Earwax can be softened by using over-the-counter drops, hydrogen peroxide or mineral oil. A bulb can be used to push warm water into the ear, to help remove the wax. This may need to be repeated several times.

Cholesteatoma

A cholesteatoma is a noncancerous skin growth in the middle ear, behind the eardrum.

The Eustachian tube, which connects the middle ear to the back of the nose, is responsible for equalizing the pressure within the middle ear. If the Eustachian tube becomes blocked, usually because of an ear infection, a cold or a sinus infection, it can create a negative pressure buildup within the middle ear. This can cause the eardrum to pull apart, creating a pocket. This pocket can fill with waste material (such as old skin cells) and become bigger and bigger. If this pocket gets too big, it can begin causing serious damage to the structure of the ear.

The symptoms of a cholesteatoma typically start out mild and get worse as it grows larger. Symptoms will begin with a foul-smelling discharge from the ear and then move on to feelings of pressure, dizziness and hearing loss. It is important to see your doctor as soon as you are beginning to experience these symptoms; if left untreated the cholesteatoma will just continue to grow larger and cause more damage to the ear.

A review of your medical history and a physical exam using an otoscope, a lighted device used to examine the inside of the ear, is usually all that is needed to diagnose a cholesteatoma. If the cholesteatoma cannot be seen, a CT scan may be ordered.

The first method of treatment to control the growth, treat any infections, reduce inflammation and drain the ear is through an ear cleaning, antibiotics and ear drops. The only way to completely remove the cholesteatoma is through surgery. Usually performed as an outpatient procedure, the first surgical procedure will only remove the growth. A second surgery may be necessary to repair any damage the cholesteatoma caused in the middle ear. Follow up visits will also be needed to make sure the cholesteatoma is not growing back.

Acoustic Neuromas

An acoustic neuroma is a noncancerous tumor on the nerve leading from the inner ear to the brain. This type of tumor can lead to problems with hearing loss, ringing in the ear and trouble balancing. The only known cause of this rare type of tumor is a gene mutation on chromosome 22. Normally, this gene is responsible for the growth of Schwann cells which cover the nerve.The symptoms of an acoustic neuromas depend on the tumor’s effect on the nerve or from pressure the tumor places on adjacent nerves or blood vessels. Symptoms usually appear gradually as the tumor develops. Hearing loss, ringing in the ear, loss of balance and dizziness are all common symptoms. Early diagnosis is key, as the larger the tumor gets the more likely it is to do serious damage.

In order to diagnose an acoustic neuroma, your doctor will review your medical history, perform a hearing test and order a scan, such as an MRI or CT.

The treatment for an acoustic neuroma depends entirely on the size. If the tumor is small, it can simply be monitored through regular imaging and hearing tests. Larger tumors may require stereotactic radiosurgery to stop their growth. Stopping the growth of the tumor helps preserve the nerve’s function and prevent hearing loss. This procedure directs radiation to the precise spot of the tumor without having to make any incisions. Surgery is needed for tumors that cannot benefit from radiation. The goal of surgery is to remove the entire tumor but due to the placement or size of the tumor it may not be possible to remove it all. As with any surgery there are risks, including hearing loss, facial weakness, infection of the cerebrospinal fluid or a stroke.

Reconstructive Ear Surgery

Reconstructive ear surgery may be needed for a few reasons: congenital defect, an injury or trauma to the ears or simply if you are unhappy with the shape and would like a change. This surgery is called an otoplasty and can be performed on patients as young as four years old.The most popular type of reconstructive surgery is called ear pinning. This procedure can change the shape of the ear and bring it closer to the head. For children, this procedure is done under general anesthesia; adults can usually get by with just a sedative and a local anesthetic. An incision is made behind the ear to expose the cartilage, which is reshaped, and any excess skin is removed. The ear can then be repositioned so it sits closer to the head. Finally, the incision is closed with stitches. This procedure typically takes one to two hours.

Ear pinning can be performed with two different techniques, cartilage sparing or cartilage scoring. The cartilage sparing technique involves creating an incision in the cartilage itself; this is a more invasive procedure and can lead to scarring. The cartilage sparing technique uses only stiches and sutures to change the shape and position of the ear, creating a smoother and more natural-looking ear.

Reconstructive ear surgery is commonly used to treat a congenital defect called Microtia. Microtia occurs in three out of every 10,000 births and results in small and underdeveloped ears. Burns and injuries from torn piercings can also be treated with reconstructive ear surgery. If the ears need to be built back up, cartilage from the ribs and skin from the upper buttocks area are used.

Ear reduction surgery is performed if a patient is unhappy with the size and shape of their ears. The doctor will cut into the cartilage and skin to reshape and create a smaller looking ear. Often, ear pinning will be performed at the same time.