Socioeconomic and clinical factors influencing treatment selection in microtia and aural atresia

An Overview of the Currently Used Congenital Auricular Anomalies (CAA) Classifications for Surgical Reconstruction: A Scoping Review

CAAs are congenital malformations of the auricle ranging from ear underdevelopment to anotia, lacks standardized classification, impacting our outcome of different reconstruction approaches. This scoping review aimed to explore which CAA classifications are most used in current ear reconstruction practices.

We conducted a scoping review following the PRISMA guidelines, searching MEDLINE and Embase databases on November 1st, 2023. Studies on CAA reconstruction that included clear descriptions of the used classification published in the past 5 years were included. Studies were appraised using the Joanna Briggs Institute checklist.

Out of 293 screened studies, 45 met inclusion criteria, encompassing 19 case series and 5 cohort studies. Findings revealed a predominant use of the Nagata classification across rib cartilage and alloplastic material reconstructions, despite noted application inconsistencies. Other systems like Marx's, Weerda's, and Meurman's remain underutilized.

Most studies used the Nagata's classification. Its widespread use underscores the necessity for an easy to use, but standardized classification to improve surgical outcome reporting and assessment accuracy. Further investigation and standardization efforts regarding the Nagata system are recommended.

Anxiety, Depression, Stress, and Self-Esteem in Turkish Parents of Children with Microtia

OBJECTIVE

To describe factors affecting anxiety, depression, stress, and self-esteem in parents of children with microtia.

DESIGN

Cross-sectional correlational study.

PARTICIPANTS

Parents (N = 117) of children with microtia were recruited nationally through a Turkish craniofacial non-governmental organization's social media.

MAIN OUTCOME MEASURES

Demographics, parental report of microtia experiences and concerns, the Depression Anxiety Stress Scale, and the Rosenberg Self-Esteem Scale.

RESULTS

The mean parental age was 35.61 ± 5.96 years and 74.4% were female. The mean age of their children was 6.08 ± 4.22 years, 69.2% were male, 93.8% had unilateral microtia, and 14.5% had ear reconstruction. Some parents had low self-esteem (24.8%) and were in the severe range for depression (30.7%), anxiety (25.6%), and stress (21.4%). Depression (M = 7.43, SD = 5.35) was associated with worry about child's future (β = 0.25, P = .013), microtia information given around birth (β = -0.20, P = .024), and child no ear surgery (β = -0.23, P = .008), while stress (M = 8.21, SD = 5.37) was associated with worry about the child's future (β = 0.28, P = .008). Parental self-esteem (M = 29.59, SD = 5.10) was related to child having ear surgery (β = 0.19, P = .047) and information about microtia provided around birth (β = 0.22, P = .018). There were no significant associations with Anxiety (M = 6.04, SD = 4.82) identified by multiple regression.

CONCLUSIONS

While most parents were in the average to moderate range for clinical concerns, a fifth to a third of participants were in the severe range for depression, anxiety, and stress and a quarter of participants for low self-esteem. Informing families about the microtia treatment process, having the child have surgery, and interventions for reducing their future concerns may provide psychological relief for them.

Health Disparities Research in Facial Plastic and Reconstructive Surgery: A Scoping Review

OBJECTIVE

Health disparities contribute significantly to disease, health outcomes, and access to care. Little is known about the state of health disparities in facial plastic and reconstructive surgery (FPRS). This scoping review aims to synthesize the existing disparities research in FPRS and guide future disparities-related efforts.

DATA SOURCES

PubMed, Embase, Web of Science.

REVIEW METHODS

We conducted a scoping review in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Our search included all years through March 03, 2023. All peer-reviewed primary literature of any design related to disparities in FPRS was eligible for inclusion.

RESULTS

Of the 12283 unique abstracts identified, 215 studies underwent full-text review, and 108 remained for final review. The most frequently examined topics were cleft lip and palate (40.7%), facial trauma (29.6%), and gender affirmation (9.3%). There was limited coverage of other areas. Consideration of race/ethnicity (68.5%), socioeconomic status (65.7%), and gender/sex (40.7%) were most common. Social capital (0%), religion, occupation, and features of relationships were least discussed (0.01% each). The majority of studies were published after 2018 (59.2%) and were of nonprospective designs (95.4%). Most studies focused on disparity detection (80.6%) and few focused on understanding (13.9%) or reducing disparities (5.6%).

CONCLUSION

This study captures the existing literature on health disparities in FPRS. Studies are concentrated in a few areas of FPRS and are primarily in the detecting phase of public health research. Our review highlights several gaps and opportunities for future disparities-related focus.

Comparison of Transcutaneous and Percutaneous Implantable Hearing Devices for the Management of Congenital Aural Atresia: A Systematic Review and Meta-Analysis

OBJECTIVE

To compare audiometric outcomes, complications, and revisions required for percutaneous (pBCD) versus transcutaneous (tBCD) implantable bone-conduction devices for the treatment of hearing loss associated with congenital aural atresia (CAA).Databases Reviewed.PubMed, Scopus, CINAHL.

METHODS

A systematic review was performed searching for English language articles from inception to December 14, 2022. Studies reporting audiometric outcomes or complications for either pBCDs or tBCDs for the treatment of CAA were selected for inclusion. A meta-analysis of single means and meta-analysis of proportions with comparison (Δ) of weighted proportions was conducted.

RESULTS

A total of 56 articles with 756 patients were selected for inclusion. One hundred ninety patients were implanted with pBCDs, whereas the remaining 566 were implanted with tBCDs. Mean pure-tone audiometry improvement in the pBCD group (39.1 ± 1.1 dB) was significantly higher than in the tBCD group (34.6 ± 1.6 dB; Δ4.5 dB; 95% confidence interval, 4.2-4.7 dB; p < 0.0001). The average improvement in speech reception threshold was 38.6 ± 2.5 dB in the percutaneous group as compared with 32.7 ± 1.6 dB in the transcutaneous group (Δ5.9 dB [5.3-6.5 dB], p < 0.0001). Overall complication rates for patients implanted with pBCDs and tBCDs were 29.0% (15.7-44.4%) and 9.4% (6.5%-13.0%), respectively (Δ19.6% [12.0-27.7%], p < 0.0001).

CONCLUSIONS

Patients with CAA implanted with pBCDs had significantly better audiometric outcomes than those implanted with tBCDs. However, complication rates were significantly higher among the pBCD group.