Aesth. Plast. Surg.

31:372 379, 2007

DOI: 10.1007/s00266-006-0231-4

Original Article

Anthropometry of the Normal Human Auricle: A Study of Adult Indian Men

Ruma Purkait, M.Sc., Ph.D., and Priyanka Singh, M.Sc.

Department of Anthropology, Saugor University, 470 003, Saugor, M.P., India

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

Correspondence to R. Purkait, M.Sc., Ph.D.; email: r.purkait@

gmail.com

lengths, although their respective widths are comparable

with those of others.
Key words: AnthropometryCross-sectional
Indian malesNormal human auricle

study-

The auricle plays an important role in the clinical

diagnosis of congenital anomalies and syndromes.
For a physician, a deformation in auricular shape
and size or spatial dislocation of the auricle on the
face can point toward a possible anomaly in the patient. Trisomy 13 and 18 syndromes, for example, are
reported to have low-set and deformed auricles,
whereas Downs syndrome patients have smaller
auricles than normal [24]. Several studies on the
auricle involving various syndromes and anomalies
have been reported [3,6 10,20].
Auricular appearance and symmetry contribute
enormously to the facial aesthesis. Any auricular
defect in the form of disproportionate size, abnormal
elongation of the auricular lobe, or a missing part is
corrected by surgery. Cosmetic surgery and facial
rejuvenation have become quite popular not only in
the West, but also in many developing countries.
For rectifying such abnormalities, a plastic surgeon
requires information about normal auricular dimensions, the auricles bilateral position on the face, and
general conformation. But these auricular data vary
in dierent ethnic groups.
Few studies on this aspect have been undertaken
[1,2,4,5,9,11,12,13,16,17] in various populations.
Farkas [9] reported a study on the auricular growth
of normal West German and North American whites
and on the anthropometry of auricles in facial syndromes. To date, his study is considered the most
comprehensive report on the measurements and
general morphology of the auricle.

R. Purkait and P. Singh

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).

Studies have followed on other populations of the

world. To quote a few, Kalcioglu et al. [16,17], Bozkir
et al. [4], and Barut and Aktunc [2] measured the
auricle of Turkish subjects. Ferrario et al. [12] and
Gualdi-Russo [13] investigated the Italian population, and Brucker et al. [5] studied Americans. Azaria
et al. [1] made a detailed study of the ear lobe and the
various factors aecting its length. Yet, studies of
other ethnic groups are urgently required, especially
in parts of the world inhabited by diverse ethnic
groups. India is one such multiracial country that
deserves more attention in this direction from
researchers because standards based on one part of
the country may not suit others. To date, very few
studies on auricular dimensions have been reported
from India. Frugal data on the auricle have been
presented by Lakshminarayana et al. [19] in their
report on the facial growth of south Indian children
(from newborns to 11 year-olds). Hence, the current
study attempted to provide anthropometric data on
normal adult male auricles from central India.

Subjects and Methods

The data were collected from a total of 415 males
categorized into ve age groups. The ages of the
males ranged from 18 to 70 years. Each age group
consisted of 60 or more males. All the subjects were
normal healthy residents of central India. None had
any auricular (congenital or traumatic) or maxillofacial abnormality, and none were genetically related
to one another.
All linear measurements were taken with a sliding calliper (Dial calliper; Mitutoyo Corporation,

Fig. 2. Measurement of the ear inclination angle with the

goniometer xed on the sliding calliper. The arrow shows
the reading on the goniometer as 14
.

Kawasaki, Kanagawa, Japan, accuracy 0.01 mm)

(Fig. 1a). For all the measurements, the subject sat
upright with his head in the Frankfurt horizontal
plane. The locations of the landmarks were marked
on the auricle and the face.
A total of nine anthropometric measurements were
taken directly on the auricle. Measurements 1 to 3 and
6 were taken following the Knumann [18] method.
Measurement 7 followed the Farkas [9] method, and
measurements 8 and 9 followed the method of Kalcioglu et al. [16]. Measurements 4 and 5 were dened by
the rst author (R.P.) of the current study. These
measurements, shown in Figs. 1 to 3, are as follows:
 Measurement 1. Length of the auricle (1 2)
(Fig. 1b).

374

Anthropometry of Normal Adult Auricle

Fig. 3. Measurement of the ear

protrusion at the (a) superaurale
and (b) tragal levels with a geometric set square. The arrows
show the protrusion of the ear
from the mastoid bone.

 Measurement 2. Width of the auricle (3 4).

 Measurement 3. Lobular length (6 2).
 Measurement 4. Lobular width (9 10). This is
the distance between the anterior and posterior
lobules. The measurement was taken at the
midpoint of the lobular length. Care was taken
to keep the limbs of the caliper parallel to the
medial longitudinal axis of the auricle.
 Measurement 5. Conchal length (5 6). This is
the straight distance between the concha superior and the incisura intertragica inferior.
 Measurement 6. Conchal width (7 8).
 Measurement 7. Auricular inclination angle. The
angle is read on the protractor of the goniometer
xed on the immovable limb of the sliding
caliper (Fig. 2).
 Measurement 8. Protrusion at the superaurale
level.
 Measurement 9. Protrusion at the tragal level.
The heights of auricular protrusion were measured
using a geometric set square with its base touching
the mastoid area. The vertical limb of the set square
thus measured the perpendicular distance between
the posterior helical border at the superaurale/tragal
level and the mastoid area (Fig. 3).
The width and length of the auricle, concha, and
lobule were incorporated into their respective indices
for assessment of their proportion in the various age
groups:
 Auricular index: the width of the auricle 100/
length of the auricle
 Lobular index: the lobular width 100/lobular
length
 Conchal index: the conchal width 100/conchal
length.

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

Protrusion at the tragal level

Protrusion at the superaurale level

Auricular Inclination angle (degrees)

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)

Age groups (years)

Table 1. Auricular dimensions in ve age groups

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)

R. Purkait and P. Singh

375

376

Anthropometry of Normal Adult Auricle

Table 2. Auricular, lobular, and conchal indices in ve age groups

Index

Age groups (years)

18 30

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

The width and length of the auricle, lobule, and

concha were incorporated into indices for examination of the changes in their proportion with progression of age (Table 2). Auricular and conchal
indices exhibited a minor variation, with the mean
value ranging from 56.0 to 58.5 and from 70.3 to
73.7, respectively. Unlike them, the lobular index
exhibited a large variation (105 117.4 for the right
ear and 107 122.6 for the left ear) across the age
groups. The auricular and lobular indices showed a
general decreasing trend with advancing age.
Table 3 describes the auricular features. Oval
(57.3%) followed by triangular (30.7% right and left
combined) shapes of the auricle were found to be the
most common. Normally rolled helices accounted for
more than 88% of the helix forms. The preauricular
area was generally clean, with appendage cases at the
rate of 0.4%. Of the lobules, 65.5% were bilaterally
free and of proportionate size (48.7% for left and
right combined). The free lobules were generally
tongue shaped, and the attached lobules were gener-

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

ally bow shaped. Hypoplasia of the ear lobes was

registered for 6% of the left ears and 7.7% of the right
ears.
Discussion
The ear, an important component of the facial complex, gives a subtle impression of its bearers age and
sex. Its size, shape, and spatial location on the face
are important from an aesthetic point of view. Any
abnormality is an indication of a possible anomaly in
the subject. Knowledge of normal ear dimensions
may be useful as a guideline for the plastic surgeon
rectifying possible defects. The dimensions vary in
dierent ethnic groups, which necessitates that surgeons base their observation on the data specic to
the ethnic group. Initiating a step in this direction, the
current study attempted to furnish data for normal
males from central India, which forms a major part of
the Indian subcontinent.

R. Purkait and P. Singh

377

Table 4. Comparsion of male auricle measurements in various ethnic groups

Author

Population studied

Gualdi-Russo [13] North Italian

Ferrario et al. [12] North Italian white

Age group Auricle

Auricle
Lobular
Lobular
Protrusion at
(years)
length (mm) width (mm) length (mm) width (mm) the tragal
level (mm)
31 40
41 50
51 60
>60
18 30
31 56

Azaria et al. [1]

Ashkenazi & Sephardi 20 40

Jews of Israel
40 60
>60

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

The dimensions of the lobule are dependent on its

shape and attachment to the cheek. Hence, caution
should be exercised when the results are interpreted.
In the current study, the length remained almost
unchanged for the 50- to 60-year-olds, as compared
with that of the 40- to 50-year-olds, although the
width increased (Table 1). Further investigation
showed that the group contained an unusually large
proportion (47%) of attached and bow-shaped lobules. This explained the shortness of the length and
the greater width. Farkas [9] also found attached
earlobes to be hypoplastic in his data on white North
Americans. Great intra- and intergroup variation in
the shape and attachment of the lobule also may
account for the discrepancy exhibited by the lobular
index, as reected in the 50- to 60-year-olds (Table 2).
In the data, 28% of the lobules were either slightly
free at the lower end or adherent to the cheek (Table 3). It is an already established fact that free earlobes elongate more than their attached counterpart
[1]. Hence, during rectication of earlobe ptosis, an
attempt is made to render it adherent to the cheek to
stall its further elongation.
Table 4 presents comparative auricular data for a
few populations. A signicant variation is seen in
their size. Indian auricular length is shorter than that
of any ethnic group depicted in the Table 4. The
auricular length of Indian elders (age 50 70 years) is
comparable with that of young Turkish (age 18 25
years) [4] and Italian ears [12,13]. Interestingly, the
ear width is similar to that exhibited by Turkish males
[4] of the same age group.
In our sample, although the lobular length was
comparable with Jewish [1] data for the younger
group, in older groups, there was great disparity because, in contrast to Indians, the elongation continues at a greater pace among Jews. As such, it seems
that the lobular length is shorter among Indians, although its width is comparable with that of American
[5] and Turkish [4] males. This is further supported by

378

data on auricular features, which classied 7.7% right

and 6% left lobules as hypoplastic and 31.2% right
and 28.6% left lobules as small (Table 3).
Exceptionally large auricular inclination also is an
indication of a possible anomaly. Among patients
with cleft lip and cleft palate anomaly, for example,
the ear is set with greater inclination of the longitudinal axis [9]. Therefore, it may help a clinician to be
acquainted with the normal range of auricular inclination, which usually falls within a range of 9
to 29
.
In the current population, the mean varied between
14.2 degrees and 16.8 degrees.
Knowledge of auricle protrusion has two advantages. First, it oers a possible indication of a
prominent ear when the superaurale distance from
scalp is greater than 20 mm [16]. Its incidence is quite
common in the general population, ranging from
5.5% to 38.7% [22]. In the current study, the prominent ear was observed in 11.4% of right and 10.2% of
left auricles, a little more than reported in the Turkish
population (9.8% in the right ear) [16].
Second, measurement of auricular protrusion also
nds its use in the designing of hearing aid instruments. The aid may be tted behind the ear or surgically anchored to the mastoid bone. With the boneanchored hearing aid, a small abutment is exposed
outside the skin for transmission of sound vibrations
to the bone. Whatever the form of aid instrument,
knowledge of ear projection from the skull, both in
the superior and inferior aspects, is essential for
designing it. Surgeons also nd it crucial for planning
the surgery. Among Indians, the mean superaurale
protrusion ranges from 10.5 to 16.1 mm, and at the
tragal level from 18.8 to 24.8 mm. The dimensions of
the concha also can be helpful in designing hearing
aid instruments that t into it.
It is essential to remember the statement of Rubin
et al. [23] that there is no ear which can be designated
as standard. Even in the same ethnic group, great
diversity exists in the shape and size of the external
ear [11]. Grouping such diverse ears together into
various age groups in a cross-sectional study gives
only a crude estimate of their average dimensions.
Hence, it is necessary to reiterate that it may not be
the best method for studying changes in ear dimensions with progression of age.
The study was undertaken with a sincere eort to
generate more interest and consequently more research on this aspect, especially in this part of the
world where such data are scarce. The current study
has generated metric data for Indian male auricles,
which will be useful to plastic surgeons as a guideline
for correcting auricular deformity. It also will furnish
information to the hearing aid instrument industries
for the production of anatomically correct products
for the populations they serve.
A perusal of the auricular data leads to the conclusion that although various parts of the auricle do
exhibit changes with the progression of age, the
elongation of the lobule contributes the most to the

Anthropometry of Normal Adult Auricle

overall increase in auricular length. Besides providing

standards, the report stresses the need for an objective approach to the diagnosis of syndromes or any
anomaly by actual measurement of the features rather than reliance on ones impression of physical
features. Sometimes in a routine visual examination a
physician may miss minor defects of the auricle,
which will be visible in a metric analysis [11].
Acknowledgments. The authors are grateful to the subjects
for their cooperation during the study, and to the University
Grants Commission, New Delhi, for sponsoring the current
study, which is part of the Research Award project. (Sponsored by the University Grant Commission, New Delhi).

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