Health-related quality of life outcome of children with prominent ears after otoplasty

Results of Modified Stenströms Technique Otoplasty and Patients' Satisfaction at King Fahad Armed Forces Hospital (KFAFH)

Background Globally, the prevalence of protruding ears is relatively frequent. Ear deformities manifest due to underdevelopment of the antihelical fold, conchal hypertrophy, and/or an obtuse conchoscaphal angle. The availability of multiple approaches proves that there isn't a single optimal accepted procedure. The Modified Stenström otoplasty technique supports the surgeon in the management of underdeveloped antihelix fold, conchal hypertrophy, and obtuse conchoscaphal angle among other deformities. We are the first to evaluate the clinical effects and measure the satisfaction rate post-otoplasty using the modified Stenström technique with a case series study. Methods Six patients were included in the study with a total of 12 ears operated on between February 2021 and July 2022. Utilizing the modified Stenström technique for bilateral protruding ears. All patients had six postoperative follow-up visits with fixed intervals; one week, three weeks, six weeks, three months, six months, and one year. During their one-year postoperative follow-up appointment, all patients completed the satisfaction survey questions. Results Six individuals were studied, three males and three females with a mean age of 23.1 (range, 7-53 years old). There were no complications or recurrences observed. Based on the responses we collected, all patients reported a high satisfaction rate at one-year postoperative follow-up. Conclusion The modified Stenström technique yields good naturally appearing ears. It is an easy and safe technique to apply. It has a short recovery period, and no hospital stay is required. All contribute to a high satisfaction rate among studied patients.

Complications of Cartilage Sparing Otoplasty: A Systematic Review and Meta-Analysis

OBJECTIVE

To study the prevalence of complications in patients who have undergone cartilage sparing otoplasty.

METHODS

On December 26, 2021, the authors searched 8 databases using the search term "(otoplasty) AND (cartilage sparing OR cartilage sparing)" for collecting the most appropriate studies. The authors used R software version 4.1.2 for conducting the meta-analysis.

RESULTS

Of the 414 records screened, the authors included 14 studies. Recurrence/reoperation was the most common reported complication with a prevalence of 4.27% (95% CI: 2.93-6.22), followed by suture erosion 2.46% (95% CI: 0.86-7.07) and hematoma/hemorrhage 1.34% (95% CI: 0.79-2.27). The authors did not find any significant difference between cartilage sparing and cartilage scoring in terms of recurrence/reoperation [odds ratio (OR): 0.92; 95% CI: 0.53-1.60; P = 0.766], hematoma/hemorrhage (OR: 1.39; 95% CI: 0.28-7.01; P = 0.688), and wound infection (OR: 0.37; 95% CI: 0.06-2.24; P = 0.279).

CONCLUSION

Various complications have been reported, including recurrence and reoperation, hematoma, wound infections, suture erosions, keloid formation, and skin necrosis. However, the prevalence of these events is not high, although significant heterogeneity was reported for some outcomes. Therefore, it can be concluded that cartilage sparing otoplasty is a safe and reproducible technique.

Minimally Invasive Technique for Correction of Prominent Ear

OBJECTIVES

Prominent ear is not an uncommon deformity with 5% prevalence in population worldwide. Although there is no physiological handicap in this deformity, it affects the psychology and social integration, especially in children. Many surgical techniques are performed to correct this deformity. In this study, we illustrate a minimally invasive technique in cases of prominent ear and evaluate its efficacy.

MATERIALS AND METHODS

A total of 16 patients were operated by incisionless otoplasty in both ears simultaneously. Therefore, 32 ears were included in the study. Postoperative follow-up was carried out for 6 months to determine the efficacy of this technique, complications, and recurrence of the abnormal shape.

RESULTS

Two ears (2/32) were presented with slight protrusion three months postoperatively Three ears had postoperatively exposed sutures that needed to be embedded again under local anesthesia. The satisfaction rate was found to be 88% by the visual analog scale. No perichondritis or other complications occurred postoperatively. The technique results in correction of the deformity without any visible evidence of surgery.

CONCLUSION

This technique is effective and safe for correction of prominent ear with negligible rate of complications and rapid recovery time.

The ideal auricular protrusion - An interactive perceptual pilot study

PURPOSE

Excessive ear protrusion (prominauris) can negatively affect facial appearance. Because the concept of an ideal auriculocephalic angle is controversial, however, it is difficult to define when an obtrusive auricle requires surgical intervention. It is often assumed that angles exceeding 30° require corrective surgery. However, little is known about public perception of ear protrusion. This study aimed to assess perceptions of different degrees of auricular protrusion.

MATERIALS AND METHODS

We conducted an interactive panel survey. Male and female evaluators assessed digitally processed cloned images of a male and female model that depicted various ear protrusions ranging from 0° to 90°. Predictor variables were the sex of the evaluator, the sex of the clone and the extent of auricular protrusion. The outcome variable was the overall attractiveness of auricular appearance.

RESULTS

Forty-four evaluators (students of dental medicine, mean age 25.43 years) participated in the study: 22 women and 22 men. The study results revealed sexual dimorphism, with the attractiveness of corresponding male and female clones rated differently. Male evaluators favoured female ear positions that fitted closer to the head; preferred alignments for female clones were: 18° (Mean) ± 9.38° (SD), p = 0.006; for male clones: 30° ± 7.94°, p = 0.003. Ear protrusion starts to negatively affect aesthetic appearance for male evaluators at positions of 42° ± 4.87° (female clone) and 54° ± 8.22° (male clone), p = 0.001. The panel of evaluators agreed to perceive angles of 21-24° ± 8.10° (female clones), ± 8.33° (male clones), as the ideal degree of protrusion in both sexes (p = 0.158).

CONCLUSION

In this study, perception of ear appearance depended on the sex of both the evaluator and the clone being assessed. Obtrusive ears were more readily accepted in male faces than in female ones. Nevertheless, the overall panel perception shows a preference for rather close fitting, unobtrusive ear alignments. For planning of corrective ear surgery, a target angle of approximately 22° can be considered as a desirable result.

Development of a New Patient-reported Outcome Measure for Ear Conditions: The EAR-Q

Background:

Patient-reported outcome measures are widely used to improve health services and patient outcomes. The aim of our study was to describe the development of 2 ear-specific scales designed to measure outcomes important to children and young adults with ear conditions, such as microtia and prominent ears.

Methods:

We used an interpretive description qualitative approach. Semi-structured qualitative and cognitive interviews were performed with participants with any type of ear condition recruited from plastic surgery clinics in Canada, Australia, United States, and United Kingdom. Participants were interviewed to elicit new concepts. Interviews were audio-recorded, transcribed, and coded using the constant comparison approach. Experts in ear reconstruction were invited to provide input via an online Research Electronic Data Capture survey.

Results:

Participants included 25 patients aged 8–21 years with prominent ears (n = 9), microtia (n = 14), or another condition that affected ear appearance (n = 2). Analysis of participant qualitative data, followed by cognitive interviews and expert input, led to the development and refinement of an 18-item ear appearance scale (eg, size, shape, look up close, look in photographs) and a 12-item adverse effects scale (eg, itchy, painful, numb).

Conclusions:

The EAR-Q in currently being field-tested internationally. Once finalized, we anticipate the EAR-Q will be used in clinical practice and research to understand the patient’s perspective of outcomes following ear surgery.

Clinical Outcome and Patients' Satisfaction Study After Otoplasty Using Hybrid Techniques in Adult Patients

OBJECTIVES

There are limited data on the effect of otoplasty on health-related quality of life (HRQoL) in prominent ears. There are no data on the effect of otoplasty on Glasgow Benefit Inventory (GBI) of otoplasty using hybrid techniques in adult patients.

METHODS

This study involved 28 patients who underwent otoplasty using combined procedures. We chose the GBI because it is a sensitive tool for detecting changes in health status following an intervention. Patients older than 13 years received the GBI, being retrospective well-validated questionnaires for measuring the effect of otorhinolaryngologic interventions, and particularly plastic surgery procedures, on HRQoL. An individual questionnaire was created by the standard GBI. We combined posterior auricular skin excision, Mustarde suture technique, and conchomastoid suture techniques for maximizing the cosmetic improvements.

RESULTS

According to the results of this study, good outcomes with patient satisfaction were achieved with this hybrid procedure. We found a conspicuous improvement in GBI total score as well as in the general health subscale after otoplasty. This indicates the beneficial impact on the healthy self-perception of this surgical procedure with prominent ears.

CONCLUSIONS

In our retrospective assessment, GBI turned out to be a very useful and valuable tool in the evaluation of otoplasty. We demonstrated a long-lasting improvement in HRQoL after otoplasty for the prominent ears. Hybrid techniques are effective and satisfying treatment methods with high success rates for patients with prominent ears.

Audit of 117 otoplasties for prominent ear by one surgeon using a cartilage-cutting procedure

BACKGROUND

The plethora of surgical procedures for prominent ear correction reflects lack of satisfaction with outcomes achieved. This paper describes a cartilage-cutting otoplasty procedure and reports an audit of its outcomes.

METHODS

Discharge coding was used to retrospectively identify patients who had undergone the otoplasty of interest at Middlemore Hospital, Auckland, during the 5 years from March 2010 to the end of February 2015. Hospital records were accessed. Demographic, procedure and patient satisfaction data were recorded and analysed (PASW/SPSS Statistics 18.0). Chi-square test and t-test were used to assess associations, with significance accepted at two-sided P < 0.05.

RESULTS

Sixty-four patients underwent the specified otoplasty (54.7% females: mean age 9.5 years (standard deviation, SD: 4.2; range: 4-20)), of whom 93.8% had bilateral procedures with mean surgical time of 61 min (SD: 14; range: 34-94). This was significantly shorter (P < 0.001) than for bilateral surgeries by all other techniques and surgeons in the review period. None of the 117 procedures of interest subsequently had suture extrusion or revision surgery. Mean time from surgery to satisfaction determination was 993 days (SD: 521; range: 111-1850) for 43 (67.2%) patients. 23.3% believed that there had been aesthetically insignificant partial recurrence of prominence, typically of one ear only. This was insufficient for all but one patient to consider repeat otoplasty. Surgery outcome was rated 'very satisfactory' and 'satisfactory' by 90.7% and 9.3% of patients/parents, respectively. All would recommend the surgery to others.

CONCLUSION

With infrequent complications and recurrence requiring revision, and without long-term reliance on sutures, the otoplasty reported is time-efficient, safe and generates high patient satisfaction.

A novel approach for classifying protruding ears is easy to calculate and implement in daily clinical practice

AIM

Protruding ears are a prevalent deformity, with a reported incidence of 5% in the paediatric population, but it lacks a simple digital classification. The aim of this study was to find a parameter that would objectively allow the photographic classification of protrusion, by comparing frontal facial images of patients with protruding ears with aged-matched controls.

METHODS

This prospective cohort study compared the frontal facial images of 105 patients with protruding ears with 112 aged-matched controls without protruding ears. A rectangle was drawn on the image for each ear, encompassing its full visible anatomy. The width of each rectangle was divided by its height to create an index. The mean value of both ears was defined as the Frontal Aesthetics Translation Index for Measurement of Amplitude of the Ears (FATIMAE).

RESULTS

The calculated values for group with protruding ears were significantly higher than for the controls. No gender differences were found. However, the FATIMAE values decreased with age, establishing different classification criteria for separate age groups.

CONCLUSION

The FATIMAE is easy to calculate and implement in daily clinical practice and establishes a practical approach for classification of protrusion, as well as for referral criteria for a specialised surgical consultation.

A retrospective study of patient outcomes and satisfaction following pinnaplasty

INTRODUCTION

Up to 5% of all children have prominent ears. Psychological distress and bullying adversely affect these children and can cause significant social exclusion. In times of austerity, cosmetic procedures such as surgical correction of prominent ears are felt to be an unnecessary cost to the health service.

MATERIALS AND METHODS

A retrospective case note review of all patients undergoing pinnaplasty was undertaken. Postoperative outcomes were compared against the Royal College of Surgeons of England standards. The Glasgow Benefit Inventory, a validated post-intervention questionnaire, was then posted out to all patients.

RESULTS

A total of 72 patients were identified. Average age at procedure was 13 years. Eleven patients were above the age of 19 years. Twenty-eight patients were male and forty-four female. Sixty-two cases underwent bilateral pinnaplasty. No patients developed hematoma, and there were no readmissions within 30 days of surgery. Twenty-nine patients responded to the questionnaire (40%), of whom 27 reported a positive impact on their psychosocial well-being with a mean score of 36.

CONCLUSION

Pinnaplasty offers patients an opportunity to alleviate the psychological distress of bullying and harassment secondary to the appearance of prominent ears.