Q: My baby was born with one ear and no hole is seen from outside. When I approached a nearby ENT doctor, he suggested for BERA and OAE tests. Is it safe to do a BERA test in a one day old baby? Can this be cured with plastic surgery?

A:Abnormality in the development of the ear may affect any one or a combination of the outer ear, the middle ear or the inner ear. In any child who is born with abnormality in the development of the outer ear (no ear, small ear, absent ear canal, etc.) it is mandatory to check the level of hearing in that child - both in the apparently normal ear, and if possible in the abnormal ear. In a small child, this is done by performing tests such as BERA (brain stem evoked audiometry), OAE (oto-acoustic emissions testing) and ASSR (auditory steady-state response). These tests are perfectly safe to perform, do not have any side effects and can be, and are, routinely performed in newborns. It is important to test the hearing so that we can ensure that at least one ear is functioning normally. If this can be confirmed, then there is no urgency in treating the abnormal ear as regards hearing. If there is a hearing problem in both the ears, this would need to be attended to early, so that the child hears sounds and develops normal hearing and speech. The treatment would depend on the nature and the site of the hearing loss. This often involves the use of some form of hearing device in the initial period. Any surgical reconstruction is reserved till the child is a bit older. You would also be advised to get a CT scan of the head and ear at a later stage. As regards plastic (or cosmetic) surgery to form the outer ear, this is not usually done before the age of 5 years, and maybe even later. Ensuring normal hearing in at least one ear is the priority. The next would be to consider options for improving hearing in the abnormal ear - by either surgical reconstruction or use of a bone conduction hearing aid or BAHA (bone anchored hearing aid) implant. Cosmetic improvement is usually considered later.