[tri-med] Low Set Ears

I havent caught up on all my mail but I saw a reference to low set ears and I 
thought it may help everyone if I clarified just what that means because I have 
found that many people don't really understand it and therefore don't see low 
set ears when they are there. I will endeavour to draw a picture and put it up 
on the web but my own artistic skills are not the best.
Understandably many people think that low set ears means that the ears are 
placed low on the side of the head, low being lower than "normal" or to be 
politically correct lower than the average child. While thats true its actually 
not accurate because its also subjective and most people measure it or "see" it 
as being from the bottom of the ear. Thats where the big mistake occurs.

When a doctor determines if ears are low set what he does first is to measure 
the length of the external ear. He will then draw a line (imaginary) from the 
inner canthi of the eye to the parietal apex. The ear is low set (definite) if 
the point WHERE THE EAR JOINS THE HEAD is BELOW that imaginary line. The bottom 
of the ear does NOT come into the equation except in determining if the childs 
ears are smaller than average.

To clarify even further - the inner canthi is the inner corner of the eye - 
right next to the lacrimal duct. The parietal apex is that part of the skull 
thats really prominant in T-18'ers and stops them laying on the back of their 
head, its the "point" at the back of the head.

When a doctor says that the ears are somewhat low set he means that the ear is 
smaller and that the amount of ear above that imaginary line is less than 2 
standard deviations for other children of the same gestational age.

There are tables, but an experienced neonatologist will be able to "eyeball" a 
childs ear and know if its low set or not. And thats why "we" as lay people 
often don't see the "low set" ears that the doctors describe.

Alex is really interesting in that regard and I will try and find an OLD 
picture of it to put up the web so you can see it. But Alex is mosaic and like 
a lot of T-18 mosaicers one side of his face is very different to the other. In 
Alex's case one eye is lower than the other eye. Its not so noticeable when you 
look at his eyes unless you are looking for it, but its really noticeable with 
his ears. 

Both his ears are low set when you draw that imaginary line from the inner 
canthi to the parietal apex but only if its drawn from the eye that is on the 
same side as the ear. I guess what I am saying is that both ears are the same 
if you take the reference point as being his eye, but because one eye is lower 
than the other if you compare the position of each ear to the other ear one is 
a good couple of inches lower than the other these days. Its something that 
they can correct to some degree when the "make" him some new ears, but they 
cant fix it totally and they certainly can't change the position of his eyes 
without reconstructing the bones of his entire face and its not that big a 
problem that I would even consider it (or let him consider it!!!).

What do low set ears mean? In themselves nothing - absolutely nothing. Its a 
very very minor cosmetic anomaly that can be corrected if need be once the 
childs ear stops growing (about age 8). BUT if a child has low set ears and any 
other minor anomaly, such as widely spaced eyes, curved fingers, anything, the 
chances of the child having a major problem as well is very high. 

Additionally any child with low set ears and especially if they are deformed in 
any way, even if its really minor like a thicker "roll" at the top of the ear, 
or even a thinner "roll" then the child should always have a full abdominal 
ultrasound to determine if there are any kidney issues. 

Ears? Kidneys? what the heck do they have in common? I know thats a question 
that I asked when Alex was born and they insisted on a renal ultrasound when he 
was 2 days old because of his funky ears. 

No its not the fact that they are both kidney shaped (though thats interesting) 
Its because in utero the ears develop at the same time as the kidneys and other 
major organs. If there is a problem with the ears (which is easily seen) then 
its reasonable to suspect that whatever caused the ears to be different may 
have also effected the other major organs that were developing at the same time 
(which may not be so easily seen).

A child with low set ears, or if they are deformed in any way should also be 
screened regularly for hearing problems for the first few years of life.

I hope that helps clarify exactly what low set ears are.

Life consists not in holding good cards but in playing those you hold well.
                                            -- Josh Billings

Keep Looking For Rainbows!!
   _--_|\
 /Karen \
 \ _.--._ /
          v Karen, Mum to Alex (11 years, T-18 Mosaic)
http://members.optushome.com.au/karens

                  Building ___ooOOoo__ Rainbows
                       www.trisomyonline.org
                  Families Helping Families On-line

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