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Ear pits (preauricular pits) are often a rather subtle finding on physical exam. They are located at the superior attachment of the pinna to the face and may be unilateral or bilateral. Up to 10% of Asian infants will have pits -- they are less common among caucasians and African Americans. There is a rare association between ear pits and Brachio-Oto-Renal Syndrome so audiologic testing of these infants is recommended, but otherwise this is considered a benign finding. With an isolated pit, renal ultrasounds are not generally recommended. Screening for associated renal anomalies becomes more important when other anomalies are present, when there is a positive family history of deafness, renal pathology or auricular malformations, or when the mother has a history of gestational diabetes.

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Here, the low set position of the ear (also hypoplastic) can be appreciated. If an imaginary line is drawn from the outer canthus of the eye straight back to the occiput (here the occiput is just where the edge of the blanket meets the head), a low set ear will fall completely below the line. An ear with normal set will cross or touch the same line. This infant had trisomy 18 as an underlying etiology.

Many variations in size and shape exist within the label of "normal ear", but in general, the normal ear is one is which all the structures (helix, antiehelix, tragus, antitragus, scaphoid/triangular fossa, and external auditory canal) are all present and well formed.

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In contrast to the previous photos, this pinna is not well-formed and is smaller than a normal ear. This is microtia, class II. Hearing evaluation is mandatory in these infants and referral to a pediatric ENT specialist is recommended. Fortunately, this infant was found to have normal hearing. Elective cosmetic repair was planned for a later date.

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This pinna deformity, where the superior edge of the helix is folded down, is known as lop ear. Again, it is typically an isolated finding. This is another deformity that may be improved with splinting.

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Also known as Satyr ear, Spock ear, or Vulcan ear, this deformity of the pinna is characterized by a flat helix at the superior pole, a third crus extending into the helix, and a flattened scaphoid fossa. When this deformity is severe enough to be of cosmetic concern, molding or splinting can be initiated by a plastic surgeon (within the first week of life for the best cosmetic results). As an isolated finding, cosmesis is the only concern, but the appearance will not improve with time. Exact etiology is unknown.

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This is the same ear as in the previous photo, viewed from the front. From this angle, the prominence of the auricle can be better seen. As an isolated finding, this ear shape does not require any further evaluation.

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Here is another infant with auricle malformation. The ear is hypoplastic and low set. Again, because genetic syndromes are frequently associated with abnormal ear shapes, a careful physical examination should be performed. Even in the absence of other findings, referral to a pediatric ENT specialist may be indicated, as an abnormal pinna may be an indicator of internal ear abnormalities.