In clinical work, there are often patients with congenital ear deformities whose first (or even multiple) surgeries at outside hospitals are unsuccessful, some of which are really distressing and regrettable. The same goes for hearing reconstruction. Once the surgery fails, the difficulty and risk of reoperation (e.g., facial paralysis) increases dramatically, so it is important for the patient to complete the first surgery well. Based on our experience, here are some considerations that we hope will be helpful in the preparation and selection of surgery for these patients. Generally speaking, patients with congenital malformations of the outer and middle ears have to solve 2 problems: 1) appearance: auricular reconstruction; 2) hearing improvement: outer ear canal and tympanic chamber reconstruction, or hearing solutions such as bone conduction hearing aids, BAHA, or sound bridge implants. For unilateral deformity with good hearing on the opposite side, we will first solve the problem of appearance and perform auricular reconstruction, and for those who require hearing improvement, we will perform external canal and tympanoplasty or other hearing solutions as mentioned above at the same time as the auricular reconstruction and revision. For patients with bilateral deformities, it is more urgent to solve the hearing problem first. If the patient is under 6 years old, he or she should wear a bone-conduction hearing aid or BAHA to help improve hearing and then have surgery after 6 years old; if the patient is over 6 years old, he or she should have surgery in stages 1 and 2 according to the 3-stage auricular reconstruction method, and in stage 3, external canal and tympanoplasty or other hearing solutions as mentioned above should be performed at the same time. In terms of the choice of surgical method, at present, auricular reconstruction is still more effective after skin expansion and ear reconstruction with autologous rib cartilage stent implantation, while external auditory canal and tympanic chamber reconstruction require higher technical level of the operator and hospital surgical conditions (such as CT examination, microscope, facial nerve monitoring), and need to be done better in larger hospitals with experienced otologists. Therefore, the basic steps for patients before deciding to have surgery are: 1. Patients assess their condition: for example, unilateral or bilateral? Small ear deformity first for hearing or appearance? 2. Choose the right hospital and doctor for you: Determine based on your needs and what the hospital/doctor can offer. 3. Develop a surgical plan: According to the patient’s situation, discuss with the doctor you have chosen, such as when to start the first surgery? Do hearing or appearance first? How to reserve the location of the reconstructed ear canal opening. 4. Start the surgery: Ear reconstruction.