Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, 41e47

A morphometric study of the human ear*

K. Skaria Alexander a,*, David J. Stott b, Branavan Sivakumar a,
Norbert Kang a
a
b

Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK
Department of Medical Statistics, University of Hertfordshire, Hatfield, UK

Received 22 January 2010; accepted 1 April 2010

KEYWORDS
Ear
Ear
Ear
Ear

morphometry;
ethnic variation;
sex variation;
prominence

Summary Aims: We examined variations in the shape of the human ear according to age, sex
and ethnic group with particular attention to ear prominence.
Methods: 420 volunteers were recruited. Measurements included; head height and length, ear
height and axis, antihelix taken off angle, earlobe length and width, ear width at the helical
root and tragus. Prominence was measured at the helical root and tragus (conchomastoid
angle, conchal bowl depth and helicalemastoid distance).
Results: Good symmetry was shown for all measurements. Ethnically Indian volunteers had the
largest ears (both length and width), followed by Caucasians, and Afro-Caribbeans. This trend
was significant in males (p < 0.001), but not significant in females (p Z 0.087). Ears increased
in size throughout life. Subjectively, only 2% of volunteers felt their ears were prominent
compared to 10% in the opinion of the principal investigator. No objective measurements were
identified that accurately predicted subjective perceptions of prominence.
Conclusions: We found consistent trends in ear morphology depending on ethnic group, age
and sex. Our study was unable to define an objective method for assessing ear prominence.
Decisions about what constitutes a prominent ear should be left to personal and aesthetic
choice.
2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by
Elsevier Ltd. All rights reserved.

The pinna is a defining feature of the face. Its shape and

size is influenced by age, sex and ethnic origin. Ear
appearance and symmetry contribute to facial aesthetics
and otoplasty surgery increases in popularity with each
successive year.1 However, before changing the shape of an
*
This study has been presented at BAPRAS Summer Scientific
Meeting 2010 and at BAAPS meeting 2010.
* Corresponding author. Tel.: 44 7900 392238.
E-mail address: ksalexander@doctors.org.uk (K.S. Alexander).

ear, plastic surgeons should have data available to define

the limits of normal ear shape, size and orientation. These
data may also be important to surgeons treating congenital
abnormalities of the pinna.
There are many studies of ear morphometry in the
literature. The shape, size and orientation of each pinna is
as individual as a fingerprint but it is possible to make some
generalisations; men have larger ears than women, ears
increase in both length and width with increasing age, and
overall ear size differs according to ethnic group. However,

1748-6815/$ - see front matter 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjps.2010.04.005

42

K.S. Alexander et al.

there have been no recent studies of these parameters in

the ethnically diverse United Kingdom (UK) population.
Moreover, there is no consensus in the literature over
definitions of ear prominence.

Methods
420 volunteers (patients or staff) were recruited. Exclusion
criteria included; congenital deformity, tumour, trauma or
previous surgery to the pinna. The age, sex and ethnic origin
of each volunteer were recorded. Volunteers were asked to
describe their ears as normal or prominent. The principal
author also made a subjective assessment of ear prominence.
All measurements were made by the principal author.
Objective measurements were made in the sitting position
with the head in the Frankfort horizontal plane. Measurements of head height (vertex to menton) and head length
(occiputemalar prominence) were recorded. The following
data were also recorded (Figure 1):

7) Conchal bowl depth

8) Helical-mastoid distance
Measurement 4a was taken vertically. Measurements 4b
and 5 were measured perpendicular to the ear axis.
Measurements 5e8 were measured at a) the level of the
tragus and b) the helical root.
Measurements 1, 4, 5 and 8 were made using a Vernier
calliper. Angles 2, 3 and 6 were measured with a goniometer. Conchal bowl depth (measurements 7a and 7b) was
measured using a simple device made from an insulin
syringe (with the plunger removed). A sliding K wire was
inserted transversely through the barrel of the syringe. The
barrel was rested on the antihelix and the tragus. The Kwire tip was then advanced, to rest on the conchal bowl.
The length of K wire was measured with callipers.
All measurements of length were recorded in milli
metres. Angles were measured in 5 increments.

Statistical methods
1) Ear length e the most dependant part of the lobule to
the most distant part of the auricle.
2) Ear axis e the angle between measurement 1 and the
vertical.
3) Antihelical take off angle.
4) Lobule
a) Length
b) Width
5) Auricle width
6) Concho-mastoid angle

All the data followed normal or approximately normal

distributions. The exception was measurement two where
the spread of the data were insufficient to justify parametric analysis. Mean (SD) are given in the tables. Parametric methods were used for correlation and regression
analyses. Significance of ethnic differences was assessed
using one-way-ANOVA. A p-value < 0.05 was considered
statistically significant.

5a
5b
5

Figure 1 Schematic drawing of measurements recorded. Measurements 6-8 were taken at levels 5a and 5b as indicated on
illustration 5. Therefore, there are two measurements of the conchoemastoid angle (6a and 6b), two measurements of conchal
bowl depth (7a and 7b) and two measurements of the helical-mastoid distance (8a and 8b). In all a total of 13 separate
measurements were recorded.

A morphometric study of the human ear

Table 1

43

Demographics of the study population

Age groups

Caucasian

Afro-Caribbean

Indian Subcontinent

Oriental/Mixed

Total

Male

Male

Female

Male

Female

Male

Male

Female

Female

Female

<15
15e29
30e44
45e59
60e74
75e89

0
36
35
30
21
15

3
32
39
39
26
12

1
10
11
5
3
0

0
5
16
8
3
0

1
10
13
7
1
0

0
14
7
2
1
0

0
3
1
0
0
0

1
3
4
2
0
0

2
59
60
42
25
15

4
54
66
51
30
12

Total

137

151

30

32

32

24

10

203

217

Results

Ear position and shape

Demographics

The mean axis of the pinna (measurement 2) was 25 in males




and 27 in females (range 15e35 and 15e40 respectively). No
significant difference was noted between ethnic groups (age
15e59). There was evidence of a change in the take-off angle
of the anti-helix (measurement three) comparing Indian,
Caucasian and Afro-Caribbean males and females aged 30e44
years. This result was significant in males (p < 0.018), but not
in women (p Z 0.860). No apparent difference was seen
amongst younger subjects (aged 15e29 years).
A significant decline in anti-helical take-off angle
(measurement three) was observed with increasing age for
both genders and for Caucasians but not the other ethnic
groups.

Patient demographics are summarised in Table 1. There

were six patients below the age of 15; these were excluded
from further analysis, leaving 414 subjects (828 pinnas).
The majority of volunteers were from three ethnic groups;
Caucasian 69% (n Z 288), Afro-Caribbean 15% (n Z 62), and
Indian subcontinent 13% (n Z 56). Eight volunteers were of
mixed race, and six of Oriental origin; due to these small
numbers, they were not included in any analysis of the
effects of ethnic origin. To reduce age bias, we restricted
our analysis of the effect of ethnic origin to volunteers aged
15e44 (115 males, 113 females).

Symmetry
The majority of measurements between left and right ears
were highly symmetrical (Table 2). Symmetry was greatest
for linear measurements (height and width), but less for
conchal fossa depth and conchoemastoid angle. The
degree of correlation was sufficiently high that analyses of
the parameters of the left ear are presented unless
otherwise specified.

Table 2

Symmetry of measurements

Measurements

1
2a
3
4a
4b
5a
5b
6a
6b
7i
7ii
8i
8ii
a

Kendalls Tau.

Correlation (parametric)
M (n Z 201)

F (n Z 213)

0.96
0.76
0.76
0.90
0.73
0.71
0.77
0.72
0.79
0.60
0.65
0.75
0.74

0.94
0.81
0.80
0.83
0.68
0.71
0.81
0.78
0.55
0.72
0.69
0.73
0.71

Males
Females

b(slope)

0.255
0.222

0.136
0.120

0.003
0.007

Ear length
There was no significant correlation between head size
(height/width) and ear size (length/width). Volunteers
from India had the longest ears, followed by Caucasians and
Afro-Caribbeans respectively (Table 3). This relationship
was significant for males. A trend was seen but did not
achieve significance for females.
Length of the ear (measurement one) increased with age
for all ethnic groups. The best fit, least squares, regression
line for Caucasians took the following form:
Male ear height mmZ59:17
0:239Age rZ0:732; pZ< 0:001
Female ear height mmZ56:97
0:172 Age rZ0:613; pZ< 0:001
Lengthening of the earlobe accounted for much, but not
all, of the increasing length of the ear with age.

Ear width
The width of the ear (measurements 5a and b) varied with
age and sex. There was a significant difference with ethnic

44
Table 3

K.S. Alexander et al.

Mean (SD) ear length by ethnicity and gender: ages 15e44

Ethnic group

Age 15e29

Indian Subcontinent
Caucasian
African/Afro-Caribbean
One Way ANOVA sign.

Age 30e44

Males

Females

Males

Females

68.9(3.9)
65.2 (4.2)
62.7 (2.8)
0.004

60.9 (3.7)
60.4 (3.2)
60.4 (2.1)
0.875

70.5 (4.0)
68.0 (4.5)
62.7 (4.0)
<0.001

64.7 (4.3)
63.5 (4.6)
60.8 (4.4)
0.079

origin for men (i.e. Indian ears were wider than Caucasian
which were wider than Afro-Caribbean ears). A similar
relationship was seen for females but the relationship did
not achieve significance. Correlation between ear length
and width was moderate (r Z 0.532).

Prominence
There are no published data to suggest that ear prominence
occurs more frequently in any particular ethnic group.
Therefore volunteers of all ethnic groups were initially
included in analysis of ear prominence. Measurements from
both ears were included.
Based on the subjects self-assessment, 2% of volunteers
had ear prominence compared to 10% as assessed by the
lead author (Table 4). The lead researcher agreed with the
self-assessment of all volunteers who said they had prominent ears. The researchers assessment included two
subjects with a telephone ear deformity (prominence of the
upper pole and lobe). There was an even distribution in the
self-assessment of prominence comparing males and
females. However, there was a 5-fold difference in prevalence based on the opinion of the researcher and a 6-fold
difference for males in particular.
Of the 42 subjects with prominent ears as determined by
the researcher, 26 had bilaterally prominent ears with the
remaining 16 having only unilateral prominence (11 left, 5
right). Thirty-three subjects had whole ear prominence,
whereas 9 had upper pole prominence only. Three of the 42
volunteers with at least one ear assessed by the researcher as
prominent were aged under 15. The measurements from the
remaining 39 (63 prominent ears) volunteers are summarised
in Table 5 and compared to ears subjectively assessed as nonprominent by the lead researcher (765 ears).
From our data, volunteers assessed by the researcher as
having whole ear prominence had larger measurements of

prominence (measurements 6e8), compared to other

volunteers or subjects with upper pole prominence alone
(Table 5). However, the data for conchal fossa depth
(measurements 7a andb) show that the difference between
prominent and non-prominent ears was slight. By comparison, the relative contribution of unfolding of the anti-helical
fold to overall prominence of the ear was 73% (measured at
the tragus) in patients with whole ear prominence.
There was no difference in prominence between Indian
and Caucasian volunteers, although there was a trend for
less prominent ears amongst Afro-Caribbean volunteers.
This reached significance (ANOVA p < 0.05) for the helicalemastoid distance in both genders when measured at
the helical root, and for concho-mastoid angle in females
when measured at the level of the tragus.
Ear width had no effect on ear prominence. The data for
conchoemastoid angle, conchal bowl depth and helicalmastoid distance show evidence of a normal distribution
(data not shown). At point 6a the mean concho-mastoid


angle was 46 , and at point 6b the mean was 32 . Conchal
bowl depth was very weakly associated with age (data not
shown).

Discussion
In 1978, Farkas presented his method of measuring ear
parameters.2 We used many of Farkas measurements for
this study, but adapted some to improve precision and
reproducibility. Specifically, Farkas measured ear width
from the helical root to the post-aurale. With any change in
ear axis, the position of the post-aurale changes (Figure 2).
Measuring width of the ear at the helical root and the tragus
improves reproducibility (Figure 1). Farkas also measured
the concho-mastoid angle between the posterior aspect of
the ear in its upper portion and the mastoid plane. The


concho-mastoid angle can vary by 10 -15 in the same ear

Table 4 Assessment of prominence. Researchers opinion compared with subjects own opinion. Numbers indicate the number
of subjects not the number of pinnas
Researchers opinion on prominence

Subjects opinion on prominence

Prominent

Normal

Total

Females

Prominent
Normal
Total

5
0
5

5
207
212

10
207
217

Males

Prominent
Normal
Total

3
0
3

29
171
200

32
171
203

A morphometric study of the human ear

45

Table 5 Patients assessed as having prominent ears by the researcher compared to the normal population in this study.
Measurements of prominence are grouped by site of prominence for all ethnic groups (Indian, Caucasian, Afro-Caribbean,
Oriental and Mixed-race), both genders and age >14 years (total Z 828 pinnas). n Z number of pinnas not number of subjects
All measurements:
mean (SD)

Conchoemastoid
angle (degrees)

Conchal bowl
depth (millimetres)

Helicalemastoid
distance (millimetres)

Site of prominence

6a

6b

7a

7b

8a

8b

Whole ear
Superior pole only
Normal (for comparison)

47
16
765

58.1 (10.6)
46.9 (10.6)
45.0 (10.4)

47.9 (13.2)
36.9 (5.1)
31.1 (7.1)

19.5 (2.5)
18.3 (1.9)
18.0 (2.2)

20.9 (2.6)
18.9 (2.1)
18.5 (2.4)

23.2 (2.5)
20.7 (2.7)
18.9 (2.7)

27.5 (3.2)
24.9 (3.0)
20.0 (3.1)

depending on the exact position at which it is measured

(Table 5). We defined the points at which prominence was
assessed (measurements 6e8) with greater precision.

Goniometer measurements of 5 interval were considered
sufficient to identify any differences due to age, sex or
ethnic origin.

Ethnic group
Ear size varies according to ethnic group.3-8 We have
compared our data with previous studies (Table 6). No
similar values are available for Afro-Caribbean people,
although Adamson found no differences between the white
and Negro populations in their study of an American population.9 Our data are broadly similar to those of previous
studies.
In our study, people from the Indian subcontinent had
the longest ears, followed by Caucasians, with Afro-Caribbeans having the smallest ears. This contradicts Purkait.
This trend was observed amongst men (p < 0.01) and
women (p > 0.05) of each ethnic group. The evolutionary/
functional significance of such differences is unclear.
Azaria (547 subjects) found that Ashkenazi and Sephardi
Jews had larger earlobes when compared with other Jews and
Arabs in Israel. Azaria also noticed that the lobule is smaller
amongst black Africans compared with other ethnic groups.10
Our data concur with Azaria, showing that Afro-Caribbean
people have small earlobes but contradict Sharma,11 who
found that Indian men also had small earlobes.
These discrepancies may be explained by differences in
measurement technique or may represent true differences
between our diverse sample of Indian subcontinent volunteers and the Northwest Indians examined by Purkait and
Sharma. Our data for Caucasians concur with the results of

Figure 2

studies on similar ethnic groups,4,5 although how this

information might be relevant to surgical correction of ear
deformities is unclear.

Symmetry
Farkas noted asymmetry between left and right ears in
a paediatric population.5,12 By adulthood, the discrepancies had diminished.5 Barut noted significantly larger left
ears for all parameters in children.13 Our data are mainly
from an adult population and show generally good
symmetry between left and right ears which concurs with
previous studies.10,14 Linear measurements were more
symmetrical than angular measurements although the
correlations for angular measurements were still moderate
(Table 2), concurring with Ferrarios findings.7 Taken
together, the data suggest that the main determinants for
success in achieving symmetry after any reconstruction are
to ensure that linear measurements correlate. However
significant variations in the appearance of the left and right
pinnas are still expected.

Ear position and shape

The mean angle of the long axis of the ear in our study was


25 in males and 27 in females. Pham15 reported an angle




of 15 e20 and Farkas2 reported an angle of 9 e29 . The
angle of the long axis did not vary by ethnic group. Sforza
measured ear parameters amongst 843 white Italians using
a computerised electromagnetic digitiser14 and noted an
increase in linear measurements (length more than width)
and a reduction in the angle of the longitudinal axis with
increasing age.

Schematic diagram showing changing position for postaurale with regard to ear axis.

46

K.S. Alexander et al.

Table 6 summary of various ear morphometry studies. Data are shown where available for the adult (age 18) left ear.
Numbers represent distances in millimetres. Ear width shown from our study at helical root level
Study

Population

Male ear length

Male ear width

Female ear length

Female ear width

Purkait3
Alexander

Northwest Indian
Indian subcontinent

57.7
68.9

33.1
36.0

60.9

31.2

British Caucasian
American Caucasian
Turkish Caucasian
Italian Caucasian
Caucasian

59.9
62.4
63.1
63.1
65.2

35.4
33.3
38.1
34.4

58.5
59.7
57.3
60.4

33.5
31.3
35.0
31.3

33.8

60.4

32.3

Heathcote
Farkas5
Bozkir6
Ferrario7
Alexander

Alexander

Afro-Caribbean

62.7

Asai8

Japanese

64.1

The take-off angle of the antihelical fold (measurement 3)

did not vary with ethnic group. However, we observed
a statistically significant decrease in this angle with

increasing age in both males (-0.198 /yr) and females

(-0.180 /yr). This may be an effect of lengthening of the ear.
There was a great degree of variability in this parameter,
regardless of ethnic group, age and gender suggesting that
the antihelical take-off angle plays little role in defining
the normal ear.

Ear length
In 1978, Farkas stated that the full length of the ear was
reached by age 15 in males and age 13 in females.2 Kalciolglu (1552 Turkish children) stated that ear length was
complete in girls at 11 and boys at 12 whilst ear width
measured at the tragus was complete at 6.16 However,
looking at their data, it is probably more accurate to
conclude that there is continued growth of the ear, albeit
at a slower rate. In a longitudinal study of 44 Belgian men,
Susanne noted an increase in ear length of 5.89 mm over
a 22 year period.17 Cross-sectional studies from Ito (1958
Japanese subjects) and Meijerman (1353 Dutch subjects)
showed an increase in all ear measurements for both
genders throughout life.18,19 Meijerman observed that
auricular length increased by 0.18 mm/year in men and
0.16 mm/year in women but found no difference in earlobe
length, although the data for this study were obtained from
measurements of ears in photographs and not direct
measurements of the ear.
We found that ear size was independent of head size,
which concurs with Ferrario.7 Our data show increased ear
length and width with increasing age. Caucasian male ears
lengthened by 0.243 mm/yr, and female ears by 0.172 mm/
yr. This is similar to Heathcotes4 study of British men
showing lengthening of 0.22 mm/yr. Brucker20 concluded
that earlobe lengthening was the sole cause of the increase
in length. In contrast, we found an increase in the length of
both the earlobe and the cartilaginous parts of the ear.

Ear width
Kalciolglu16 found no significant difference in ear width
comparing males and females. In contrast, we found that
ear width showed a significant trend for males (Indian>

Caucasian> Afro-Caribbean) but not for females. These

data concur with the observations of Farkas, Barut and
Sforza.2,13,14 In our study, ears continued to grow in width
throughout life, reaching a plateau after 74 years of age.
The same was true for earlobe width which also continued
to increase throughout life in contrast to Brucker.20 The
functional significance of such growth was unclear.
Conchal bowl depth was very weakly associated with age
(data not shown) suggesting that the widening of the ear
that occurs with age is due to an increase in other parts of
the ear (e.g. helical rim) but not widening of the conchal
fossa.

Prominence
Farkas defined ear prominence as a concho-mastoid angle

>40 , but gave no justification for selecting this cut-off.2
Using this un-validated measure, Farkas then stated that
prominence was present in 4.3% of men and 4.7% of women.
Adamson (2300 ears) defined the upper limit of helix to
scalp distance as 2 cm.9 Adamson did not define a fixed
point on the ear, and gave no justification for this cut-off
other than after measuring hundreds of ears it became
apparent that this was normal. Adamson also found no
difference in the frequency of prominence between
genders or between Caucasian and black African races. In
Turkey, Bozkir (341 young adults) found that female ears
were slightly more prominent than mens measured at the
level of the tragus.6 Purkait used Adamsons criteria for ear
prominence (2 cm) and noted a prevalence of 11.4% (right
ear) and 10.2% (left ear)3 while Kalciolglu noted a prevalence of 9.8%, when measuring helicalemastoid distance at
both the superaurale and tragus.16 Rubin measured the ears
of 100 adults and 50 children21 and stated that, on average,
the helical rim was 1.8 cm from the mastoid process. An ear
was described as prominent if the distance was >2.5 cm or

the cephaloauricular angle was greater than 30 although
no justification was given for selecting these cut-offs.
Tolleth stated that a normal ear had a helical-mastoid
distance of 1.5e2.0 cm.22 However, it would appear that
these were merely his subjective observations and no
measurements of any ears were actually performed.
In our study, conchoemastoid angle (measurements 6a
and b) conchal-bowl depth (measurements 7a and b) and
helical-mastoid distance (measurements 8a and b) all

A morphometric study of the human ear

followed continuous normal distributions. Therefore, it was
not possible to assign a cut-off at which an ear became
prominent. Nor was it possible to understand how other
authors selected their particular cut-offs to define ear
prominence since there was an obvious and wide discrepancy between the volunteers perception of prominence and
that of the researcher (Table 4).
In the absence of any validated measures of prominence, the subjective assessment of the lead researcher
appears to have been as valid as any other. Previous
studies23 have suggested that ear prominence is the result
of an increase in the depth of the conchal bowl and/or
unfolding of the antihelix. Our data (Table 5) concurs with
this opinion. However, our data also suggest that even for
subjects with whole ear prominence, unfolding of the
antihelix contributes up to 73% to the overall prominence.
This suggests that, for whole ear prominence, correction of
an absent or poorly developed anti-helical fold will still
have a significant effect on prominence without the need to
alter the conchal fossa.
Our review of the literature suggests that none of the
widely used definitions of ear prominence have been validated. Applying these definitions to our data, there was
a large discrepancy in the prevalence of ear prominence.
This was not entirely surprising given that the perception of
prominence is essentially a personal and aesthetic consideration. However, it has led us to conclude that attempts to
define ear prominence with any objective measures are
fruitless and the most accurate definition is; an ear is
prominent when the patient says it is.

Conflict of interest statement

There are no financial and personal relationships with other
people or organisations that could inappropriately influence (bias) our work.

Funding
No funding was required for this study.

Ethical approval
Ethical Approval was granted from our local ethical
committee.

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