A major threat to the declining European hedgehog (Erinaceus europaeus) is road traffic. Devising methods to reduce the number of collisions would increase hedgehog welfare in an urbanized world and serve to protect this flagship species, and this goal might be advanced by an understanding of their hearing. This study investigates the auditory capabilities and anatomy of the ear of the European hedgehog. Using auditory brainstem response testing on 20 live hedgehogs from Danish wildlife rescue centres, we measured hearing thresholds across 4-85 kHz and found a peak sensitivity around 40 kHz, revealing that European hedgehogs can hear sound frequencies of at least 4-85 kHz. Complementary postmortem micro-CT scans enabled a detailed three-dimensional reconstruction of the inner ear, revealing small middle ear bones with a cochlear spiral of approximately 1.7 turns. Results show that hedgehogs can perceive a broad ultrasonic range, which provides important cues for directional hearing and may additionally function in prey detection and communication. These findings provide critical insights into hedgehog sensory biology and inform the potential development of ultrasonic repellents to mitigate traffic collisions and habitat disturbances, contributing to conservation strategies for this declining species.

Objective This study aimed to investigate the experiences of children/young people and families living with microtia and hearing loss. Design Interviews and focus groups were conducted with children and young people (n = 11) with microtia and parents (n = 12). A constant comparative approach consistent with Grounded Theory was used. Study sample Participants included children and young people with microtia aged 7 to 20, recruited from across England, UK. They engaged in individual semi-structured interviews, whilst parents participated across five online Focus Groups. All participants spoke English and received care from the National Health Service (NHS). Results Children, young people and parents actively assess the child’s hearing needs. Other microtia considerations change over time, and ongoing information-seeking is important. This information is drawn from multiple sources, contributing to an understanding of microtia as an integral aspect of the individual’s identity. Conclusions This study highlights the evolving information needs of children and young people with microtia, including hearing support, ear reconstruction options, managing daily challenges such as school and social situations, and learning about the experiences of peers with similar conditions. The findings show how these needs change over time, emphasising the value of accessible, age-appropriate information to support children as they grow and navigate these experiences.

Partial ear reconstruction of large defects challenges surgeons to blend native and reconstructive auricular structural and soft tissue segments while preserving natural ear contours, accommodating variable etiologies and anatomical involvement. For pediatric patients, consideration of skin coloration, scar location and visibility, readiness for surgery, and compliance with postsurgical care contribute heavily to what is considered a successful outcome. This study reviews our institutional experience with techniques to manage large partial auricular defects in pediatric patients who did not elect for total ear reconstruction. This is the largest reported cohort of any-cause pediatric partial ear defects in the literature. A retrospective review was conducted of pediatric patients who underwent partial ear reconstruction of large or structurally significant defects between 2009 and 2024. Patients were categorized based on etiology (acquired or congenital). Demographics, operative details, and outcomes were collected. Eighteen ears from 17 patients were included, comprising 9 acquired (50%) and 9 congenital defects (50%). The average time from injury to surgery was 2.9 ± 3.2 years. Most defects involved the upper third of the ear (n = 14, 77.8%). All ears underwent autologous costal cartilage reconstruction. Seven cases had inadequate local tissue (acquired = 5; congenital = 2); of those, 6 underwent temporoparietal fascia flap (TPFF) coverage (acquired = 4; congenital = 2), and 1 underwent tissue expansion due to concurrent injury to the ipsilateral temporoparietal fascia region (acquired). Local tissue was used for coverage in 12 cases (acquired = 5; congenital = 7). One framework exposure and one explantation occurred in the acquired cohort. The average follow-up duration was 2.5 ± 2.0 years. At our institution, large partial ear defects require comprehensive discussions with patients and families regarding optimal approaches while addressing individual priorities and limitations. Our evolved structural approach using autologous costal cartilage reconstruction demonstrated reliable outcomes in large pediatric partial ear defects of any indication (congenital or acquired). We consider TPFF early in traumatic scenarios that have missing or poor-quality skin, or congenital presentations where skin is tethered, fixed, or unable to fully unfurl.

Abstract Traumatic ear amputation secondary to human ear-bite is one of the common emergencies. If left untreated, it results in a deformity that causes social embarrassment and stigmatizes the victim. This case study documents primary ear reconstruction with “spare-part” amputated cartilage in a middle-aged, diabetic male after 24 hours of amputation. This reconstruction was performed using modified Mladick's Pocket technique in three stages over 90 days. There was complete cartilage take. Partial flap necrosis was managed conservatively. Over 18 months, the ear settled well and was nearly symmetrical to the opposite ear. There was a good skin match and minimal donor site morbidity. In favorable circumstances, primary non-microsurgical reconstruction using amputated cartilage of the ear in human bite is a feasible option even after 24 hours of amputation in patients with comorbidities. Primary ear reconstruction has the technical advantage of having unscarred tissues for repair.

ABSTRACT Functional elastic cartilage remains an unmet challenge in regenerative medicine, limiting reconstructive options for children born with microtia, the congenital malformation of the auricle. The current gold standard treatment relies on harvesting rib cartilage, an invasive procedure associated with donor site morbidity, impaired aesthetics, and unnaturally stiff ears due to the use of hyaline cartilage. Here, we engineered primary human auricular chondrocytes to generate functional elastic cartilage with near‐native tissue properties. This was achieved through the synergistic integration of growth factor‐controlled chondrogenesis, stress‐relaxing biomaterials that promote elastic cartilage formation, and a bioreactor platform enabling homogeneous tissue maturation. The engineered grafts exhibited a uniform extracellular matrix composition with elastin, glycosaminoglycans, and collagen II comparable to native auricular cartilage, while lacking the fibrocartilage marker collagen I. The resulting tissue achieved a compressive modulus of 1.1 ± 0.03 MPa, matching native cartilage (1.0 ± 0.1 MPa), and maintained its structural integrity and elasticity in vivo for 6 weeks in a subcutaneous rat model. These grafts represent the closest replication of native human elastic cartilage achieved ex vivo to date, establishing a foundation for clinically viable, functional auricular grafts.

Since Tanzer's seminal work introducing costal cartilage for ear reconstruction, subsequent advances by Brent, Nagata, and Firmin have refined surgical techniques and aesthetic outcomes. However, fundamental aspects of the procedure-such as planning incisions, achieving accurate ear positioning, and guiding chest wall incisions for rib harvest-have seen limited innovation. The current standard practice of using projection paper or transparent templates to replicate the contralateral ear position remains imprecise. Similarly, autologous cartilage harvest can be particularly challenging in patients with higher BMI, due to difficulty in accurate rib palpation and visualization. Misplaced chest wall incisions can result in suboptimal rib harvest, longer operative times, and increased morbidity. In this study, we introduce patient-specific, three-dimensional (3D) printed masks, termed hEARo masks, as a novel and user-friendly tool for ear framework positioning. Furthermore, we present the integration of augmented reality (AR) technology to enhance preoperative planning and intraoperative guidance during microtia repair, enabling more precise incision placement for rib harvest. The combined use of 3D printing and AR facilitates complex ear reconstruction, offering increased surgical precision, reduced operative time, and potentially improved patient outcomes. These innovations represent a significant advancement in the personalization and accuracy of auricular reconstruction.

Bipolar Remodeling Aneurysmorrhaphy and Bookend Clip Reconstruction of Complex Middle Cerebral Artery Aneurysm: 2-Dimensinal Operative Video and Technical Nuances.

Loss of mastoid skin and temporoparietal fascia after complete scalp avulsion precludes conventional ear reconstruction. We report a total auricular reconstruction using a remote, prelaminated radial-forearm flap. A 42-year-old woman with prior scalp avulsion and right ear amputation underwent (1) 200-mL forearm expansion, (2) autogenous costal-cartilage framework insertion and maturation, and (3) free transfer to the mastoid area anastomosed to the preserved proximal superficial temporal vessels. At 6 months the neo-auricle showed symmetric contour, color match, and defined helix/anti-helix; the donor forearm retained full wrist motion. No infection, minimal exposure, or cartilage resorption occurred. Remote, prelaminated radial-forearm flap auricular reconstruction provides a reliable benchmark for ear restoration when all local options have been exhausted.

3D Ear Reconstruction with Neural-Powell Optimized SOP and Curvature Guidance

A modified two-stage ear reconstruction with integrated correction: Reduced cartilage harvest and operative time for bilateral microtia.

PRS Journal Club: Novel Techniques in Autologous Ear Reconstruction and a New Grading System for Unilateral Cleft Severity and Presurgical Orthopedic Outcomes.

Objective: To explore the clinical efficacy of two-stage ear reconstruction using autologous rib cartilage in the correction of congenital microtia. Methods: The study was a retrospective cohort study. From January 2000 to February 2025, 3 050 patients (1 992 males and 1 058 females, aged 6 to 52 years) with congenital microtia who met the inclusion criteria were admitted to the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine. All of them were corrected by the two-stage ear reconstruction. The first stage operation involved harvesting of the 6th to 8th autologous rib cartilages (the 9th autologous rib cartilage was harvested if necessary) for ear framework fabrication. Depending on the amount and location of residual ear tissue, the transverse, longitudinal, "V"-shaped, "U"-shaped, or "W"-shaped incisions were designed, and then fabricated frameworks were implanted, and the wounds were closed. The second stage operation was performed 3 to 6 months after operation. The reconstructed ear was first lifted, the reserved cartilage or titanium plate was used as supporting material to construct the cranio-auricular angle, and then the wound was closed with retroauricular fascial flap and split-thickness scalp skin graft. The wound at the donor site of the skin graft was packaged and fixed. After operation, the incidence of complications was recorded, and the occurrence rate was calculated. During the follow-up, the appearance of the reconstructed ear was observed, and the patients' satisfaction or reasons for dissatisfaction were counted. Results: The complications, such as venous congestion, flap necrosis, and cartilage exposure, etc. occurred in the first stage operation, and the occurrence rate was 6.59% (201/3 050); partial skin graft necrosis, fascial flap necrosis, and cartilage exposure, etc. occurred in the second stage operation, and the occurrence rate was 9.18% (280/3 050). The complications were all controlled effectively after adopting treatment measures such as acupuncture and bloodletting combined with wet compress using gauze soaked in heparin solution, debridement and drainage, hyperbaric oxygen therapy, rational application of antibiotics, and repair with fascial flaps and skin grafts. During the follow-up of 6 months to 15 years after the second stage operation, the morphology of each sub-unit of the reconstructed ear appeared, the proportion was coordinated, and the structure was soft and natural. 89.02% (2 715/3 050) of the patients and their families were satisfied with the shape contour, position, and size of the reconstructed ear. The reasons for the dissatisfaction of the remaining patients were local structural defects of the reconstructed ear caused by postoperative complications, asymmetry in the position of the reconstructed ear due to factors such as hemifacial microsomia and ectopic auditory meatus. Conclusions: Two-stage ear reconstruction using autologous rib cartilage in the correction of congenital microtia is a reliable surgical technique, characterized by a low incidence of postoperative complications, natural anatomical structure of the reconstructed ear, and high patient satisfaction.

Costal cartilage tissue regeneration after the modified first-stage autologous ear reconstruction for microtia: A retrospective study.

The temporoparietal fascia flap (TPFF) is an extremely versatile and reliable option in reconstructive surgery, particularly for the head and neck region. It is most often utilized in the pediatric population as a pedicled flap for ear reconstruction in congenital microtia. While its use in adult patients and congenital microtia pediatric patients is well established, there are no current reports in the literature of utilization of a TPFF in patients under the age of 3 years. We present a case of full thickness burns to the ear in a 3 month old in which a pedicled TPFF was utilized to salvage the patient’s native ear cartilage. This case highlights the versatility of the flap and expands the age in which this can be safely and successfully performed.

Microtia is a congenital malformation characterized by abnormal development of the external ear. Auricular reconstruction is the primary treatment for microtia. Because of the unique 3-dimensional anatomical structure of the auricle, the fabrication of patient-specific scaffolds remains one of the most technically demanding aspects of the reconstruction process. This review summarizes the literature and provides a comprehensive guide of the latest advances and breakthroughs in traditional autologous cartilage procedures and tissue-engineered ear scaffold technologies. Although traditional techniques often fail to meet the growing aesthetic needs of patients, recent advancements in autologous costal cartilage grafting have led to substantial improvements, particularly in the areas of skin expander selection and placement, cartilage carving skills, and framework stabilization. Meanwhile, tissue engineering, particularly 3D bioprinting, has emerged as a promising alternative. Advances in bioinks, seed cells, and imaging technologies have further refined the fabrication of ear scaffolds, although clinical validation remains limited. While traditional methods continue to evolve, tissue engineering and 3D printing holds significant promise for the future. This review aims to guide future research and contribute to intelligent ear reconstruction.

Background: Creating a tragus in microtia reconstruction is technically difficult, and its importance as a visual landmark is uncertain. Objective: To compare the attention given to ears in photographs with and without a tragus, as measured by eye tracking of gaze patterns. Methods: Participant eye movements were tracked (Tobii Pro) while viewing photographs of a profile face and close-up view of the ear. The tragus was absent in half of the images. Gaze patterns were visualized as heat maps, and t-tests compared areas of interest on the face and ear. Results: Fifty adults (27 female, ages 21-83) without medical training participated. While viewing a profile face for 10 s, participants looked at a normal ear for 2.19 s (1.5-2.9) (mean, 95% CI) and an ear without a tragus for 2.25 s (1.6-2.9) (p = 0.81). On close-up view, the tragus received the least attention (0.19 s, 0-0.19), while gaze at the canal increased from 0.82 s (0.39-1.3) to 1.39 s (0.96-1.8) when the tragus was absent (p = 0.02). Conclusion: When the tragus was absent, gaze patterns of the profile face were not impacted; however, the ear canal was more exposed and received more attention on close-up view of the ear. This may influence aesthetic goals in auricular reconstruction.

Introduction and Purpose. Middle ear paraganglioma (glomus tympanicum) is a rare, benign, highly vascular neuroendocrine tumor arising on the cochlear promontory. Despite its benign nature, it may cause local destruction and symptoms such as pulsatile tinnitus, conductive hearing loss, or a retrotympanic mass. Computed tomography (CT) and magnetic resonance imaging (MRI) are essential for diagnosis. The aim of this study is to present a clinical case and underline the role of imaging, embolization, and surgery. Materials and Methods. A single case was analyzed, including clinical data, otoscopic findings, CT, angiography, details of embolization and surgery, and histopathological results. High-resolution CT was used to assess bony involvement, while angiography defined vascular supply and enabled preoperative embolization. The tumor was surgically removed, and histopathology confirmed paraganglioma. Results. The patient presented with pulsatile tinnitus, progressive hearing loss, and intermittent otorrhea. Otoscopy revealed a pink, pulsatile mass within the external auditory canal. CT showed a well-defined with limited bony erosion. Angiography demonstrated marked vascularity arising from branches of the middle meningeal artery. Embolization effectively reduced tumor perfusion. The mass was completely removed surgically, requiring resection of a diseased incus and reconstruction of the middle ear. Recovery was uneventful. Conclusion. Middle ear paraganglioma should be considered in patients with pulsatile tinnitus and vascular retrotympanic masses. CT and MRI are essential for evaluating lesion extent, while angiography and embolization reduce intraoperative bleeding and facilitate safer surgery. Surgical excision remains the treatment of choice for class A/B tumors. The present case supports the effectiveness of a multistep approach incorporating imaging, vascular control, and precise surgical technique.

Auricular microtia commonly presents with conductive hearing loss, imparting appearance and functional differences. Single-stage microtia reconstruction with porous polyethylene implant and vascularized temporoparietal fascia flap is frequently employed at our center. Bone conduction hearing devices (BCHD) have gained popularity to treat conductive hearing loss with increasing device sophistication. BCHD placement is typically done in a delayed fashion, but with recent FDA approval for children as young as 5 years old, it is possible at the time of external ear reconstruction. We present a novel technique modification allowing for concurrent single-stage ear reconstruction with BCHD placement and compare early outcomes between a series of five patients who underwent concurrent reconstruction and five who underwent staged reconstruction. All patients in both groups achieved adequate tissue healing with similar time course of recovery, with average follow-up of 4.3±2.4 months. One patient in the concurrent cohort experienced polyethylene exposure post-operatively, requiring debridement and secondary tissue-transposition revision but without effect on the BCHD. When comparing procedural length, concurrent procedure length was significantly shorter than total time for staged reconstruction and implant placement (304±61 vs. 459±51 minutes, p=0.002). Further, time from index procedure to BCHD activation was significantly shorter in the concurrent cohort as compared to the staged cohort (59±45 vs. 403±220 days, p=0.024). Overall, these preliminary findings suggest that performing concurrent single-stage polyethylene ear reconstruction and BCHD placement is feasible, reduces operative time, and did not result in excessive complications in this small series.

Tissue Engineering (TE) is a newer technology with ongoing development across various areas of healthcare. For microtia patients, TE holds promise as a viable option for ear reconstruction, making it essential to understand the perspectives of patients and guardians. This study aimed to evaluate the perspectives of microtia patients and guardians, specifically investigating levels of awareness, comprehension, and interest in TE. A survey and educational material were distributed to microtia patients and guardians. Surveyors were assessed on a Likert scale, and comparative analyses, including two-sample t-testing and multivariate analysis with logistic regression, were used to observe trends in responses. A total of 40 surveys were recorded. White patients reported greater familiarity with TE. More than half of the respondents expressed an interest in TE as a reconstructive option. Having a doctor provide TE information positively correlated with willingness to adopt TE reconstruction. Understanding of TE positively correlated with willingness to pursue TE for reconstruction. Patients with more severe grade microtia and white patients were more likely to travel to a hospital that offered TE. We found that TE is an unfamiliar concept for most patients. Demographic, socioeconomic, cost, and trust in a doctor played an essential role in patients' and guardians' willingness to choose TE for microtia reconstruction. As TE for reconstruction approaches clinical use, these key considerations from a patient and family-centered lens about TE-based reconstruction is critical for application.

BackgroundTissue Engineering (TE) is a newer technology with ongoing development across various areas of healthcare. For microtia patients, TE holds promise as a viable option for ear reconstruction, making it essential to understand the perspectives of patients and guardians. This study aimed to evaluate the perspectives of microtia patients and guardians, specifically investigating levels of awareness, comprehension, and interest in TE.MethodsA survey and educational material were distributed to microtia patients and guardians. Surveyors were assessed on a Likert scale, and comparative analyses, including two-sample t-testing and multivariate analysis with logistic regression, were used to observe trends in responses.ResultsA total of 40 surveys were recorded. White patients reported greater familiarity with TE. More than half of the respondents expressed an interest in TE as a reconstructive option. Having a doctor provide TE information positively correlated with willingness to adopt TE reconstruction. Understanding of TE positively correlated with willingness to pursue TE for reconstruction. Patients with more severe grade microtia and white patients were more likely to travel to a hospital that offered TE.ConclusionsWe found that TE is an unfamiliar concept for most patients. Demographic, socioeconomic, cost, and trust in a doctor played an essential role in patients’ and guardians’ willingness to choose TE for microtia reconstruction. As TE for reconstruction approaches clinical use, these key considerations from a patient and family-centered lens about TE-based reconstruction is critical for application.