We often have anxious parents coming to the clinic, “Doctor, take a look at your baby’s ears and ear piercings! What should we do in the future? In fact, it is because the baby has congenital malformation of the outer and middle ears, which is a common malformation in otology. Because auricular malformations are often combined with middle ear malformations, they are collectively referred to as congenital microtia. Because of the cosmetic deficit and hearing impairment, the physical and mental health of children is seriously affected. The auricular deformity can be divided into three levels according to the degree of the deformity: Level I has a normal auricular shape, but the overall size is smaller than the opposite side; Level II has a partially missing structure and an obvious deformity of the auricle, but a part of the anatomical structure is normal; and Level III has no obvious auricular structure. For congenital middle ear deformity, we must first determine whether the deformity is monaural or binaural. For monaural deformity, we must also determine whether the hearing in the normal ear is normal, generally the hearing in the normal ear is also normal. The timing of auricular surgery for monaural deformities is generally considered to be around 6 years of age, as this is the age when it is advantageous for the child to cooperate with the surgery and for the child’s psychological development. As for the external auditory canal and hearing reconstruction, it is advisable to do so after 8 to 10 years of age depending on the situation. Unilateral hearing impairment caused by monaural malformation does not have a significant impact on hearing and language development, and hearing aids are not usually needed. However, it is still necessary to communicate with the school teacher to monitor the child’s hearing and learning. It is important to note that children with monaural malformations can still suffer from acute otitis media even though the ear hole is not visible. Bone conduction ABR can be performed around 3 months after birth in children with binaural malformations to generally assess hearing and the cochlear nerve. It is best to wear bone-conduction hearing aids in both ears by 6 months after birth to benefit the auditory nerve and future language development, and to perform otoplasty at 6 years of age. As for CT examination of the temporal bone to evaluate the external auditory canal and middle ear, it is recommended after 6 months of age. For some children with bilateral microtia who may not be able to undergo external canal and middle ear surgery, Baha (bone-anchored hearing aid) and vibroacoustic bridge, which have emerged in recent years, are also better options.