Increased posterior angulation of the ears

Page most recently updated 7 September 2026

This page focuses on increased posterior angulation of the ears as a morphologic feature of conditions that may also be associated with psychiatric manifestations, such as psychosis, mania, autism spectrum disorder, ADHD, OCD, and self-injurious behaviours. The page begins with a clinical definition of increased posterior angulation of the ears based on the standardized Elements of Morphology terminology, together with visual examples from the same source. This is followed by a list of conditions in which increased posterior angulation of the ears has been described in association with psychiatric manifestations.

Of note, to optimize clinical utility, the list does not include conditions associated with intellectual disability in the absence of other psychiatric features.

Each condition listed below is linked to a dedicated page within this resource. These pages describe the psychiatric manifestations associated with each condition, as well as other morphologic and broader clinical features, allowing the differential diagnosis to be considered from multiple perspectives.

Measurement of posterior angulation of the ear

Angle * is used to determine the degree of angulation.

Image credit: National Human Genome Research Institute (NHGRI), Elements of Morphology.

Definition

Objective: Angle formed by the line perpendicular to the Frankfurt plane and the medial longitudinal axis of the ear (the two most remote points of the ear) greater than 2 SD above the mean for age.

Note: Use of the Frankfurt plane is compromised if the ear is also low-set. Abnormalities of ear shape may make it difficult to reliably determine the medial longitudinal axis of the ear. In such cases, it is probably unwise to make an assessment of the rotational status of the ear.

Synonyms: Posteriorly Rotated Ear.

Selected references and further reading — Morphologic lens

Allanson JE, Biesecker LG, Carey JC, Hennekam RCM. Elements of morphology: introduction. Am J Med Genet A. 2009;149A(1):2-5.

Hennekam RCM, Biesecker LG, Allanson JE, Hall JG, Opitz JM, Temple IK, Carey JC; Elements of Morphology Consortium. Elements of morphology: general terms for congenital anomalies. Am J Med Genet A. 2013;161A(11):2726-2733.

Jones KL, Jones MC, del Campo M. Smith's recognizable patterns of human malformation. 8th ed. Philadelphia: Elsevier; 2021.

Reardon W. The bedside dysmorphologist: a guide to identifying and assessing congenital malformations. 2nd ed. Oxford: Oxford University Press; 2016.