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Original Article
Abstract.
Background: To treat auricular deformities or to perform
facial rejuvenation, a plastic surgeon requires normative
data for auricular dimensions. The metric standards vary in
various ethnic groups, and such data are especially scarce
from in India. This study aimed to provide anthropometric
information about the normal dimensions of the adult male
auricle in central India.
Methods: A cross-sectional study was undertaken in central
India with 415 males categorized in ve age groups. Six
linear dimensions including the length and width of the
auricle, lobule, and concha and the heights of the auricular
protrusion at the superaurale and tragal levels were measured. Auricular, lobular, and conchal indices were calculated. The inclination of the auricle relative to its vertical
axis was measured. Descriptions of various auricle parts
including its shape, preauricular area, form of the helical
fold, lobular shape, size, and type of attachment to the
cheek were recorded.
Results: Almost all the linear measurements showed a steady
increase in size with age. The dimensions of the lobule were
dependent on its shape and attachment to the cheek. The
mean lobular and auricular indices were found to decrease
with increasing age, indicating more elongation than widening of the structures. On the average, bilateral asymmetry
was observed in all measurements, although only auricular
length, width, and conchal length in a few age groups were
found to be statistically signicant. The frequency distribution of forms of various auricular features is presented.
Conclusions: The human ear continues to grow throughout
life. The lobule contributes the most to the overall elongation
of the auricle. This study furnishes the rst set of metric data
of auricular dimensions for normal Indian males 18 to 70
years of age. In comparison with other ethnic groups, Indian
males seem to have the smallest auricular and lobular
study-
373
Fig. 1. (A) Sliding calliper with an accuracy of 0.01 mm. (B) The landmarks of the auricle are (1) superaurale, (2) subaurale,
(3) preaurale, (4) postaurale, (5) concha superior (the crossover of the lower edge of the anterior end of the crus antihelicis
inferius and the posterior border of the crus helicus), (6) incisura intertragica inferior (the deepest point in the incisura
intertragica), (7) incisura anterior auris posterior (the most posterior point on the edge of the incisura anterior auris), (8) the
strongest anthelical curvature, (9) lobule anterior (the ear attachment line is drawn joining the otobasion superior and inferior;
the point on this line at the midpoint of the lobular length is the landmark), and (10) lobule posterior (the most posterior point
on the margin of the lobule at the midpoint of the lobular length).
374
Simple statistical analysis (mean standard deviation) was performed for each age group. A two-tailed
distribution t test at the 95% condence interval was
undertaken to study the bilateral variation using the
SPSS 8.0 (SPSS for Windows Release 8.0.0 (1997))
software package.
To minimize the error likely to creep into prolonged
measurement sessions and with the hope that participation rates would be higher, the details of auricular
features were observed on images of the subject.
Bilateral prole images of the face were captured with
a Kodak Easy Share CX7330 (Eastman Kodak
Company, Rochester, New York), 3.2 mega pixel
digital camera at a distance of 0.9 to 1.1 m from the
subject using a 3 optical zoom. The descriptions for
various parts of the auricle were recorded.
Results
The anthropometric data of 415 males are depicted in
Table 1. All the linear dimensions show a steady increase in size from lower to higher age groups. Lobular
width also follows this trend except in the oldest group,
in which the width tends to decrease. Generally, the
linear measurements, except for lobular length, show a
6% to 11% increase in size, as compared with the
youngest and oldest groups. This increase is comparatively larger (23%) for lobular length. Across the entire cohort, lobular length constituted 30.7% of the
total auricular length. Bilateral asymmetry was
apparent for all ages for all measurements, but except
for auricular length and width and conchal length,
none could reach a statistically signicant level.
The auricular inclination angle and the protrusion
at the super aurale and tragal levels were quite variable across the age groups and did not show any
denite trend. Auricular protrusion was found to
increase inferiorly.
R: right; L: left
a
p < 0.05 for bilateral dierence
Conchal width
Conchal length
Lobular width
Lobular length
Width of auricle
Length of auricle
Measurements (mm)
58.2
1.8
34.0a
1.6
16.9
2.4
19.6
2.4
26.8a
2.4
18.7
2.0
14.7
4.5
15.7a
4.8
24.8
4.9
57.7
2.2
33.1
1.8
16.7
2.7
20.0
2.9
26.4
1.9
18.8
2.0
14.6
4.5
16.1
4.4
24.8
4.9
59.1
1.9
33.9a
2.1
18.1
2.9
20.2
2.5
27.2a
2.5
19.8
1.7
17.1a
4.0
15.4
4.6
24.6
4.7
58.4
2.5
33.1
1.8
18.3
2.7
20.9
2.7
26.7
2.1
19.6
1.6
16.3
3.5
15.5
4.5
24.0
5.3
R
a
30 40 (n = 82)
18 30 (n=121)
60.4
2.4
34.6a
2.4
18.8
1.9
21.1
2.9
26.9a
2.1
18.9
1.9
14.2
5.2
10.5
3.8
18.8
4.2
R
59.7
3.4
33.4
2.4
19.1
2.1
21.6
2.4
26.4
2.0
18.7
2.2
14.8
4.5
11.2
3.8
18.9
4.5
40 50 (n=68)
62.7
3.3
35.5
2.0
18.9
1.4
21.8
3.0
28.0
2.6
20.1
1.9
16.8
3.0
13.5
2.9
21.8
3.6
R
62.7
3.1
35.0
2.0
18.6
2.8
22.0
3.4
28.2
2.3
20.3
2.0
16.5
3.1
13.3
2.6
21.3
3.6
50 60 (n = 74)
64.9
5.4
36.4a
2.7
20.9
4.2
21.3
2.1
28.7
2.4
20.2
1.4
16.7
4.1
13.5
4.4
22.2
5.1
64.2
5.1
35.6a
2.6
20.6
3.5
21.5
1.9
28.6
2.0
20.1
1.7
16.0
2.9
15.5
4.5
22.8
4.6
60 70 (n =70)
376
Auricular
Lobular
Conchal
30 40
40 50
50 60
60 70
58.5
3.0
117.4
9.8
70.3
4.9
57.3
3.2
122.6
11.3
71.5
4.9
57.3
3.6
115.0
12.4
73.1
8.0
56.9
3.7
117.1
12.5
73.7
7.5
57.3
3.9
113.4
8.9
71.1
10.8
56.0
3.4
116.6
10.2
71.4
11.3
56.7
3.8
115.7
10.1
72.3
8.1
56.0
4.1
122.6
12.3
72.5
8.8
57.2
4.6
105.0
10.4
70.6
6.3
56.4
4.6
107.0
9.2
70.9
6.3
R: right; L: left
Table 3. Description of auricular features
Features
Classication
Shape of auricle
Normal
Preauricular region
Abnormal
Clear skin
Presence of appendages
Helix
Subclassication
Oval
Round
Rectangular
Triangular
Skin appendage
Pits
Fistula
Normally rolled
Wide but not covering the scapha
Wide, thin, and collapsed above scapha
Flat and unfolded
Wide with a concave marginal
impression on the junction of
the middle and upper segments
of the auricle
Frequency (%)
Right
Left
57.3
6.5
5.4
30.8
100
88.3
11.4
0.3
57.3
6.5
5.6
30.6
99.6
0.4
88.3
11.4
0.3
377
Population studied
62.4
62.5
65.9
68.9
R: 62.92
L: 63.16
R: 64.41
L: 65.31
35.3
35.1
36.6
38.2
R: 38.8
L: 38.17
R: 40.44
L: 39.78
The auricular size continues to increase even during adulthood [14]. This increase is attributable to
reduced resilience and elasticity of skin [21], the
diminutive tensile strength of the connective tissue
[15], and gravitational forces. The data of the current
study reiterate this observation in almost all linear
measurements (Table 1). The conchal length and
width, which had not been reported to date, also increase in size with age. The auricular index in general
exhibits a decrease with age, indicating a faster increase in length than in width with aging (Table 2).
Farkas [9] reported that the auricular index for 18year-old North American white males as 56.7. In the
current study, although the index was not calculated
age wise, the values were 58.5 for the right ear and
57.3 for the left ear in 18 to 30 year-olds.
According to Farkas and Lindsay [10] and Farkas
[8], the auricular length and width can be useful in
diagnosing syndromes including microtia or craniofacial syndromes that may present with disproportionately wide or narrow ears. Wide ears are observed
in Apert and Crouzon syndromes, and narrow ears
are seen in patients with a cleft lip and palate.
The results show that the ear lobule continues to
elongate with age (Table 1). The maximum progression of growth was found to be after the age of 60
years. The lobular index (Table 2) also supports the
preceding observation, exhibiting a decreasing trend
with advancing age. This decrease is much more than
that observed in the auricular index and also supports
the observation of Brucker et al. [5] that the lobule is
the only ear structure that changes signicantly with
age.
Brucker et al. [5] reported a decrease in lobular
width with age in their mixed American data (89 females and 34 males), but when males alone were
considered, the measurement failed to show a statistical dierence across age groups. The current data
do not show any decrease in lobular width with age
except in the oldest group.
R: 17.5
L: 17.3
R: 20.4
L: 20.4
R: 23.6
L: 23.4
378
References
1. Azaria R, Adler N, Silfen R, Regev D, Hauben DJ:
Morphometry of the adult human earlobe: A study of
547 subjects and clinical application. Plast Reconstr
Surg 111:2398 2402, 2003
2. Barut C, Aktunc E: Anthropometric measurements of
the external ear in a group of Turkish primary school
students. Aesth Plast Surg 30:255 259, 2006
3. Beahm EK, Walton RL: Auricular reconstruction for
microtia: Part 1. Anatomy, embryology, and clinical
evaluation. Plast Reconstr Surg 109:2473 2482, 2002
4. Bozkir MG, Karakas P, Yavuz M, Dere F: Morphometry of the external ear in our adult population.
Aesth Plast Surg 30:81 85, 2006
5. Brucker MJ, Patel J, Sullivan PK: A morphometric
study of the external ear: Age and sex-related dierences. Plast Reconstr Surg 112:647 652, 2003
6. Chou CT, Tseng YC, Tsai FJ, Lin CC, Liu CS, Peng
CT, Tsai CH: Measurement of ear length in neonates,
infants, and preschool children in Taiwan. Acta Paediatr Taiwan 43:40 42, 2002
7. Della Croce FJ, Green S, Aquilar EF: Framework
growth after reconstruction for microtia: Is it real and
what are the implications? Plast Reconstr Surg
108:1479 1484, 2001
8. Farkas LG: Ear morphology in Treacher Collins,
Aperts, and Crouzons syndromes. Arch Otorhinolaryngol 220:153 157, 1978
9. Farkas LG: Anthropometry of normal and anomalous
ears. Clin Plast Surg 5:401 412, 1978
10. Farkas LG, Lindsay WK: Ear morphology in cleft lip
and palate anomaly. Arch Otorhinolaryngol 206:57 68,
1973
11. Farkas LG, Posnick JC, Hreczko TM: Anthropometric
growth study of the ear. Cleft Palate Craniofac J
29:324 329, 1992
12. Ferrario VF, Sforza C, Ciusa V, Serrao G, Tartaglia
GM: Morphometry of normal human ear: A crosssectional study from adolescence to mid-adulthood.
J Craniofac Genet Dev Biol 19:226 233, 1999
13. Gualdi-Russo E: Longitudinal study of anthropometric
changes with ageing in an urban Italian population.
Homo 49:241 259, 1998
14. Heathcote JA: Why do old men have big ears? BMJ
311:1668, 1995
15. Ito I, Imada M: A morphological study of age changes
in adult auricular cartilage with special emphasis on
elastic bres. Laryngoscope 111:881 886, 2001
379