By Poon Chian Hui

The ear is so visible that a slight anomaly will stand out.

Protruding ears, oddly-shaped ears and even absent ears are deformities that can cause much distress, especially to a child. Being teased can seriously dent one's self-esteem in the long run.

With its many curves and ridges, the ear is a complicated structure to recreate.

However, such reconstruction surgery is available and can greatly improve the appearance of deformed ears.

One of the few places in Singapore that offers this is KK Women's and Children's Hospital (KKH).

Dr Tan Ying Chien, a plastic surgeon at KKH who performs surgery for those with deformed ears, comments on three cases.

1 Piercing gone awry

Sarah's "cauliflower" ear was the result of a severe infection from a ear cartilage piercing gone wrong. The patient's rib cartilage was used to reconstruct a new part of the ear.

As a typical trendy teen, Sarah (not her real name) had decided, on an impulse, to have her right upper ear pierced at a mall. However, things went wrong, putting the then 15-year-old on a traumatic roller coaster ride for the next three years.

A minor infection set in one week after her ear cartilage piercing.

'My right ear became red and swollen,' recalled Sarah, now 18 and studying in a polytechnic. 'At first, I wasn't too concerned as I thought it was normal.'

However, it got worse and she was eventually referred to Tan Tock Seng Hospital. An operation was needed to remove the accumulated pus. By then, her right ear had ballooned to 11/2 times thicker than normal.

There was more bad news. During the operation, doctors had to remove part of the ear cartilage due to the severity of the infection. This caused the ear to become deformed, giving her what doctors call a 'cauliflower ear'.

It came as a shock to Sarah. 'I didn't expect such a thing to happen,' she said. 'My friend had the same piercing done on that day, but nothing happened to her.'

However, it was not the physical pain that was the hardest to bear, but the scrutiny of others around her. 'I became conscious of what people might think if they saw my ear,' she said.

To prevent people from seeing her deformed ear, she would flip her long hair to one side to cover it. 'I was really stressed during a stint at a part-time job because I had to tie up my hair,' she recalled.

Although her family was supportive, Sarah admitted keeping her feelings from them. 'When I got extremely upset, I just cried alone,' she said. 'I felt that what had happened to me was unfair.'

A chance for something to be done about it came last year when Sarah heard about ear reconstruction surgery.

'In ear reconstruction, the patient's own rib cartilage is used to create a new part of the ear,' said Dr Tan Ying Chien, a plastic surgeon at KK Women's and Children's Hospital, who performed the operation on Sarah this January. During surgery, which lasted more than five hours, rib cartilage was extracted and the ear reconstructed immediately.

Dr Tan said the shape of the new ear had to be carefully carved from the cartilage, using precise measurements taken from Sarah's other ear as reference.

It is a tricky process as the rib cartilage is not very malleable, he said, adding that the new part also had to blend in with the rest of the deformed ear as well as match the other ear.

Although severe cases like Sarah's are rare, Dr Tan said infections - the cause of such ear deformities - are common among people who have their ear cartilage pierced. 'Compared to the earlobe, the ear cartilage takes longer to heal and is more prone to infection,' he said, adding that multiple cartilage piercings will increase this risk.

While Dr Tan saw only two such cases in the past six months, he felt that it was still two cases too many.

His advice for those who still want to get their ear cartilage pierced is to be cautious.

'Always make sure that it is done in a sanitary environment,' he said. 'Monitor the ear closely afterwards and seek immediate medical help if there is pain, redness, swelling or pus discharge.'

[Go to page 2: Creating an ear]