Alsmadi et al. (2009) studied a large extended consanguineous Saudi family with Deafness with LAMM. The proband was a 4-year-old girl, who presented with prominent tip of the nose, dysplastic ears, bilateral type 1 microtia, and microdontia with widely spaced teeth. Her ears were low set and anterverted. Dysplastic ear changes were asymmetrical and more pronounced in the upper half. Her both external auditory meatuses were patent with no stenosis. All the affected members (21 individuals) presented with hearing impairment and communicated with sign language. They all had the same facial, auricular, and dental features as of the proband with some intrafamilial variability in the severity of these features. Incisors and canine teeth were small and misaligned with increased space between the teeth. In addition, they had ear abnormalities with asymmetrical involvement and more prominent dysplastic changes in the upper half of the ear and helix. Otoacoustic emissions, indicating outer hair cell dysfunction, and brainstem auditory evoked potentials were absent, indicating profound deafness. On brain imaging, the right side vestibular and cochlear system were not visualized, whereas the left side had a cystic vestibulum. Inner ear structure revealed absent cochlea and no semicircular canals bilaterally. Neural structures also appeared to be absent. All affected family members were descendants of a common ancestor who had lived six generations ago in a geographically isolated small village.