By Danielle Crull, ABOM

One of the very challenging fits that I have the opportunity to do are kids with a microtia (my-CROW-she-a) or Anotia (an-know-she-a). Microtia is when the external part of the ear is underdeveloped and can have varying degrees of malformation, from mild structural differences to more severe. Anotia is when the external ear does not develop at all. According to the CDC, approximately 1 in every 3,800 babies in the United States are born with this condition. Because children can present with varying degrees of malformation, they always require expert fitting.

I have found a good methodology for fitting and great success using it.

When fitting a microtia ear or anotia, it’s important to remember the fitting triangle. The weight of the frame is distributed on 3 points, the nose, the left ear, and the right ear. When a pair of glasses rests on the face, approximately 90% of the weight will be on the nose and the remaining 10% distributed evenly on each of the ears. In a standard fitting, the ears help by keeping the bulk of the weight in place at the top of the nose. When a child has an external ear that isn’t formed completely or missing entirely, the weight distribution is disrupted and standard fitting becomes problematic. Basically, if one ear cannot hold the weight, the glasses are off balance. So we need to find a different way for the microtia/anotia side to hold its weight.

You might find it hard to believe that I do not resort to straps or headbands, but I don’t! I have found that straps don’t stay put and slip down the back of the head, causing the glasses to fall forward and off. The head band can be helpful, but it’s definitely not the most comfortable, and certainly doesn’t allow the best fit. Let's be honest, it also has that “medical '' feel to it, drawing attention where parents and older children don’t want it to be. I’ve fit many elementary school aged kids who are very self-conscious about the attention a medical head band brings.

I use a “multi-fit” approach to solve the un-triangle fitting issue.

Meet “Little Buddy.” LIttle Buddy is 15 months old and I’m grateful that mom is allowing me to use his pictures for educational purposes. “Little Buddy” has one fully formed ear and one that is not able to support the glasses weight at all, due to microtia ear.

Here is the process:
Start with a lightweight frame that fits really well on the bridge of the nose. This is important, because if the bridge isn’t supporting well enough, it will make the rest of the fit even more difficult.

Next fit the fully formed ear first. Fit it WELL! Make sure that the temple is curved and touching the back of the ear all the way down. No gaps. It’s important to use this ear to the best of its fitting ability.

Now move on to the microtia ear. Fitting this side with an occipital fit is the best option. I use what I call a “topographical occipital fit.” View the child’s head as if you are looking at a topographical map. Then bend and shape the temple, gently resting it around the natural curves of the head. It’s generally quite bumpy! These bumps and curves provide a nice resting place for the temple and will hold the remaining weight of the frame, keeping it in place.

There is a lot of trial and error, putting the frame on, adjusting, then readjusting until perfect. It takes time, but it’s worth it. With, “Little Buddy,” we also added rubber shrink tubing on the end of the temple to provide a little bit of a grip. This is an additional aid that can be used if needed to secure that temple in place on the head.

If you’re doing this fit on a young toddler, give them plenty of time to crawl around to make sure the glasses stay in place. “Little Buddy” crawled around our office and played for quite a while giving his new fit a good workout! This multi-fit approach is beautiful, just like “Little Buddy.” It’s basic old-school knowledge applied expertly. And it is oh-so-satisfying to see glasses fitting so well and little kiddos comfortable and happy. If you get the opportunity to fit microtia or anotia ear (adult or child), give this multi-fit a try.