It is said that everyone is an apple that God has bitten, and the bigger the defect, the more God loves his fragrance and leaves him a special mark! They are such a group of children with a “special mark”, a group of “unusual” children who are born with one or both ears missing. The medical term for this condition is congenital microtia, also known as congenital microtia syndrome. It is an auricular deformity caused by congenital dysplasia of the ear, often accompanied by external auditory atresia, middle ear deformity and maxillofacial deformity. Why does microtia occur? Although many studies have been conducted on the etiology of microtia, it is still not very clear and no definite causative factors have been identified. There are many factors that are associated with the development of microtia, mainly environmental and genetic. Environmental factors include biological, physicochemical and psychological factors, among which infection with pathogenic viruses in early pregnancy, radiation and environmental pollution, and the use of certain drugs in early pregnancy can lead to the development of the disease, and frequent exposure of the pregnant mother to alcohol and tobacco, and mental stimulation in early pregnancy are also predisposing factors. For example, in 1968, a study concluded that the disease is chromosomally recessive. In 2008, scholars in China reported a case of a family cluster of patients with a right-sided ear deformity, which was a first-degree relative of a father and daughter, and considered heredity to be an important factor. In conclusion, the cause of microtia is not clear, and there is no effective prevention method. So what can be done to treat it? Children with microtia require two types of treatment: outer ear reconstruction and hearing reconstruction surgery. In patients with unilateral microtia with external atresia, the middle ear is often deformed, but they still have partial hearing, and the healthy ear has normal hearing, so the hearing of patients with unilateral microtia is basically normal and does not affect life and learning. Patients with unilateral microtia and bilateral microtia with external atresia can undergo external canal and middle ear surgery if they have hearing impairment. Surgery on the external ear canal and middle ear often disrupts the local anatomy, making a reconstructive auricular surgery very difficult, so auricular reconstruction is recommended before hearing reconstruction surgery. When is the best time to have surgery for my child? Parents want to have surgery as soon as possible to give their child a normal ear. It is generally accepted that autologous rib cartilage is the best scaffold material for ear reconstruction, which is then placed under the expanded skin to complete the auricular reconstruction. If the surgery is performed too early it can be limited by the development of the rib cartilage and the healthy side of the ear. Surgery is generally best around the age of 6, when it is technically and psychologically more appropriate. Physiologically, the size and softness of the rib cartilage in children around 6 years old is suitable for sculpting the ear scaffold. If the surgery is performed too early, the rib cartilage will be small and not strong enough, and the ear scaffold will be easily deformed. Around the age of 6 the child’s ear size has developed to 90-95% of the adult size, after that the ear size will not change significantly. We have observed that ears made from their own rib cartilage can grow in parallel. Therefore, auricular reconstruction surgery around the age of 6 according to the size of the healthy ear will result in symmetrical ears, and the child will not have major changes as an adult. 2. Psychologically, before the age of 6, children are not particularly concerned about their abnormal ears, thus they do not cause serious psychological trauma and are not very cooperative with post-operative care. This will minimize the psychological impact of the deformity on the child. Parents of children with microtia do not need to be overly anxious or self-critical, but rather spend more time and effort to give their children the best possible care and treatment.