Congenital malformation of the external middle ear (MA), also known as microtia, is one of the most important birth defects of the face, clinically manifested as: auricular malformation, atresia or stenosis of the external auditory canal; malformation of the middle ear, in addition to affecting the appearance, usually accompanied by conduction-based hearing impairment, partially accompanied by jaw developmental deformities (hemifacial shortness).MA has a negative impact on the child’s appearance and hearing, and the treatment of the malformation of the auricular malformation needs to include both reconstructive plastic surgery as well as hearing reconstruction and rehabilitation. The treatment of MA requires both reconstructive surgery of the deformed otorrhea as well as hearing reconstruction and rehabilitation. Surgical reconstruction of MA is preferred to ossicular reconstruction. Autologous rib cartilage is the most commonly used scaffolding material, with high-density porous polyethylene as a complementary option. Commonly used techniques for total ossicular reconstruction include (1) autologous rib cartilage staged ossicular reconstruction, (2) superficial temporal fascia flap stage I ossicular reconstruction, and (3) mastoid area skin expansion staged (or stage I) ossicular reconstruction. Total ear reconstruction surgery is usually performed around the age of 8. For patients who do not want to use autologous ear cartilage and artificial material scaffolds for total ear reconstruction, or who are not eligible for autologous tissue ear reconstruction, a pseudo-reconstructive (prosthetic) ear repair method can be chosen. MA with conductive hearing impairment caused by atresia or stenosis of the external auditory canal and/or middle ear malformation requires surgical hearing reconstruction. There are two types of methods: atresia/stenosis plasty, including external otoplasty and tympanoplasty and auditory ossicular chain plasty; and implantation of artificial hearing aids, including bone-anchored hearing aids, vibrating acoustic bridges and bone bridges. The timing of surgery should be chosen after the age of 6 years, when pneumatization of the temporal bone is largely complete, the chance of acute otitis media is reduced, accurate audiograms can be obtained for preoperative evaluation, and preoperative and postoperative cooperation is easier, except for those who are found to have a combined cholesteatoma of the external auditory canal before the age of 6 years. The surgical pathway utilizes the anterior pathway of the inner ear nail incision scheme. For atresia reconstruction of the external auditory canal, careful selection is advisable. If otoplasty is required, the procedure may be performed first or staged in a planned manner because the success of otoplasty is dependent on the blood flow of the surrounding skin and flaps, whereas incisions for canal surgery can disrupt the periauricular area.