Nonsurgical correction of congenital ear abnormalities in the newborn: Case series

The non-operative correction of ear anomalies in infants using the EarWell infant corrective system in the Netherlands

BACKGROUND

Congenital ear anomalies are regular but often overlooked occurrences. The golden standard of treatment has been to surgically correct these anomalies at a minimum age of 5 to 7 years. As of the last century, ear molding has developed to be a safe, reliable, and effective treatment method. Different treatment methods are still under investigation. This study aims to investigate the use of the EarWell Infant Corrective System in the Dutch population.

METHODS

Children aged 0-12 weeks were included in the Zuyderland Medical Center to be treated with the EarWell Infant Corrective System in case of ear deformations. Every 2 weeks, the system was replaced and correction was evaluated by both physician and parents.

RESULTS

Seventy-three participants were included, of whom 123 ears in total were treated. Age at initiation was 35.5 days on average; treatment lasted an average of 59 days. Parents and physicians both reported an amelioration of all ear anomalies after treatment, scoring the correction grade an 8.8. Overall satisfaction with the treatment method was 9 or higher for both groups.

CONCLUSIONS

The EarWell Infant Corrective System is a safe, reliable, and effective treatment method for the correction of ear anomalies in infants.

Ear Molding Therapy of Congenital Ear Anomalies: Long-Term Aesthetic Outcomes and Caretaker Satisfaction

INTRODUCTION

Ear molding is a safe, non-surgical approach to treat newborns with congenital ear anomalies. In this study, we aimed to investigate long-term aesthetic outcomes and caretaker satisfaction from ear molding therapy.

METHODS

A retrospective chart review from 2018 to 2020 was conducted for infants who underwent ear molding treatment at our institution. Patient demographics and treatment related variables were collected. Caretakers were surveyed regarding their experience, expectations, and aesthetic outcome at 1 year (short-term) and 3 years (long-term) from treatment. Independent physicians evaluated treatment efficacy. Responses were converted to a Likert scale (1-5), with 5 representing most desirable.

RESULTS

Overall, 38 of 42 patients participated in our long-term study (90%) for a total of 62 ears. Average follow-up was 3.31 ± 0.50 years after completion of treatment. Mean age at treatment was 23.2 ± 19.7 days with a mean treatment duration of 21.7 ± 7.7 days. Caretakers' satisfaction regarding auricular appearance remained high (short-term: 4.18 vs. long-term: 4.17, p = 0.54) and anticipated social distress decreased over time. Physician aesthetic evaluations were favorable between "somewhat effective" and "very effective" and remained consistent over time (short term: 3.46 vs. long-term: 3.31, p = 0.31). Furthermore, physician evaluations were higher for deformations than malformations (p = 0.04) and in children who began treatment by 30 days old (p = 0.04).

CONCLUSION

Caretaker satisfaction from ear molding therapy remained high after long-term follow up, and social distress from the perception of their child's ears decreased with time. Physician aesthetic ratings confirmed efficacy, with better outcomes seen in deformations than in malformations.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The advantages of domestic ear molding system in molding bilateral neonatal congenital auricular deformities

BACKGROUND

There are different types of ear molding devices on the market. However, due to high cost, the wide application of the ear molding is hindered, especially for children with bilateral congenital auricular deformities (CAD). This study is designed to correct the bilateral CAD with the flexible use of Chinese domestic ear molding system.

METHODS

Newborns diagnosed with bilateral CAD were recruited in our hospital from September 2020 to October 2021. For each subject, one ear wore a set of domestic ear molding system, while the contralateral ear used only matching Retractor and Antihelix Former. Medical charts were reviewed to collect data on the types of CAD, the incidence of complications, the initiation and duration of treatment, as well as the satisfaction after treatment. Treatment outcomes were graded into three levels: excellent, good, and poor, according to the improvement of auricular morphology evaluated by both doctors and parents, respectively.

RESULTS

A total of 16 infants (32 ears) were treated with the Chinese domestic ear molding system, which contains 4 cases with Stahl's ear (8 ears), 5 cases with Helical rim deformity (10 ears), 3 cases with Cup ear (6 ears), 4 cases with Lop ear (8 ears). All infants accomplished the correction completely. Both parents and doctors were satisfied with the outcomes. No obvious complication was observed.

CONCLUSIONS

Ear molding is an effective nonsurgical treatment for CAD. Molding with Retractor and Antihelix Former is simple and effective. Domestic ear molding system can be flexibly used in correcting bilateral CAD. With this approach, infants with bilateral CAD will benefit more in the near future.

Functional Pathway and Process Enrichment Analysis of Genes Associated With Morphological Abnormalities of the Outer Ear

Congenital anomalies of the outer ear are common birth defects, including a variety of congenital deformities or malformations ranging from mild structural anomalies to total absence of the ear. Despite its high incidence and detrimental impact on patients, the etiology of outer ear abnormalities remains poorly understood. The goal of this study was to summarize the related genes and improve our understanding of the genetic etiology of morphological abnormalities of the outer ear. Human Phenotype Ontology (HPO) database, Mouse Genome Informatics (MGI) database, and PubMed search engine were used to acquire the genes associated with abnormal human or mouse outer ear. Metascape was employed on the genes above to conduct functional annotation, pathway and process enrichment analysis, protein-protein interaction network analysis, and MCODE component analysis. After a comprehensive review of the databases and literature, we identified 394 human genes and 148 mouse genes that have been associated with abnormal phenotypes of the outer ear, and we identified several biological pathways for human and mouse respectively. Especially, the analysis of common genes shared by human and mouse emphasized the importance of certain genes ( PAX6 , PBX1 , HOXA1 , HOXA2 , TBX1 , TBX15 , PRRX1 , and HMX1 ) in the embryonic development of the external ear. Through our analysis of genes associated with morphological abnormalities of the outer ear, the authors have shown that embryonic development pathways take important roles in the morphogenesis of abnormal external ear and highlighted some potential genetic drivers.

One-Year Outcomes of Ear Molding for Infants with Constricted Ear

BACKGROUND

Ear molding is a noninvasive treatment that shows promising results for neonatal ear deformations. Little research has been reported evaluating 1-year outcomes or relapse after ear molding for ear malformations.

METHODS

One-year molding efficacy for constricted ear, a common malformation that affects the aesthetic appearance of the auricle, was assessed during a single-center, prospective study conducted over a 3-year period (from May of 2017 to April of 2020). Infants with constricted ears were recruited and treated with the EarWell Infant Ear Correction System. Constricted ear classification, age at treatment application, duration of treatment, complications, and parental satisfaction were analyzed. Photographic documentation of the ears was performed before treatment, at treatment termination, and 12 months after treatment to evaluate treatment efficacy and relapse.

RESULTS

Sixty patients with 91 constricted ears were recruited. The EarWell Infant Ear Correction System was initiated before 2 weeks of age for 75.0% of these patients. Successful correction was achieved in 85.8% of patients. Early molding initiation (before 14 days of age) resulted in a significantly higher success rate ( P = 0.017). Class 1 and class 2 deformities achieved better outcomes than class 3 deformities ( P = 0.001). Among the 91 auricles, 37 ears (40.7%) relapsed: 36.3% had mild relapse, 4.4% had moderate relapse, and 0% had severe relapse. The treatment duration for patients with relapse was shorter than for patients without relapse ( P = 0.035).

CONCLUSION

Early ear molding is an effective treatment for constricted ear. Sufficient molding duration and consolidation periods are crucial in maintaining treatment effects.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Nonsurgical Correction of Stahl's Ear in Neonates: A Case Study

Stahl’s ear deformity is a congenital auricular anomaly characterized by a third crus in the auricular cartilage, giving rise to an irregular helical rim and a bent scaphoid fossa. This deformity is mainly treated surgically during childhood. However, studies regarding ear-molding techniques show that postpartum splinting offers a safer and more effective permanent correction, and that happens because of the high circulating levels of estrogen that neonates receive from their mothers right after birth, making the cartilage more malleable. We present a case that shows a newborn with unilateral Stahl’s ear deformity, in which we used a molding device (EarBuddies) to permanently correct the ear’s shape. After 3 weeks of treatment, the affected auricle regained its normal appearance. There were no complications. Long-term follow-up showed no recurrence. Splinting of this ear deformity seems to be a nonpainful, stress-free and, most importantly, effective nonoperative treatment. Postpartum clinical examination of the ears is crucial, as the sooner the nonsurgical correction of the deformity begins, the better the results are. A clinical screening for ear deformities should be established immediately after every child’s birth to eliminate the risk for surgical intervention later in childhood.

Evolution of Anomaly-Specific Techniques in Infant Ear Molding: A Ten-Year Retrospective Study

BACKGROUND

Congenital ear anomalies occur in at least one-third of the population, and less than one-third of cases self-correct. Ear molding is a nonoperative alternative to surgery that spares operative morbidity and allows for significantly earlier intervention. In this retrospective study, the senior author developed a tailored approach to each specific type of ear deformity. The use of modifications to adapt standard ear molding techniques for each unique ear are described.

METHODS

The authors conducted a retrospective, institutional review board-approved study of 246 patients who underwent ear molding by a single surgeon. The procedure reports for each case were reviewed to develop step-wise customization protocols for existing EarWellTM and InfantEarTM systems.

RESULTS

This review included 385 ears in 246 patients. Patient age at presentation ranged from less than 1 week to 22 weeks. Presenting ear deformities were subclassified into mixed (37.4%), helical rim (28.5%), prominent (10.6%), lidding/lop (9.3%), Stahl's ear (3.6%), conchal crus (3.3%), and cupping (2.8%). Two patients (0.8%) had cryptotia. Deformity subclass could not be obtained for 11 patients (4.5%). Recommended modifications to existing ear correction systems are deformity-specific: cotton tip applicator (CTA)/setting material (Stahl's ear), custom dental compound mold (lidding/lop and cupping), scaphal wire (helical rim), CTA/protrusion excision (prominent), and custom dental compound stent (conchal crus).

CONCLUSIONS

Presentation of ear anomalies is heterogenous. This ten-year experience demonstrates that the approach to ear molding should be dynamic and customized, using techniques beyond those listed in system manuals to complement each ear and to improve outcomes.

Non-Surgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes

INTRODUCTION

Congenital ear anomalies result from cartilage and skin compression in utero. They can be corrected in infancy before the cartilage hardens and loses its malleability. Caretaker burden of ear molding and its impact on esthetic outcomes has not been studied.

METHODS

Demographic and procedural variables were retrospectively collected for infants who underwent ear molding. Parents were surveyed regarding their experience, caretaker burden, and esthetic outcome. Outside physicians were provided with pre- and post-treatment photographs and asked to rate outcomes. A Likert scale was developed for responses and converted to a numeric score from 1 to 5 with 5 as the most desirable.

RESULTS

Seventy-four patients comprising 121 ears were included. Mean age at treatment was 20.1 ± 21.4 days with treatment duration of 21.1 ± 7.7 days. Parental participation in the survey was 70.1%. Questions that queried parents' experiences revealed a "very positive" experience with minor burden related to bathing and cleaning (Mean Likert Score 4.1, Range 1-5). Favorable parent-reported outcomes were obtained regarding anticipated social distress (4.28, 1-5), satisfaction with results (4.27, 1-5), and perception of final appearance (4.18, 1-5). Physician assessments of esthetic outcomes were slightly lower, but favorable between "somewhat effective" and "very effective" (3.46, 1-5). Earlier treatment trended favorably, but did not reach significance. Ear malformations had higher parent-reported satisfaction than ear deformations (4.75 ± 0.46 vs 4.21 ± 1.25, p = 0.025).

CONCLUSION

Despite the additional obligation for new parents, infant ear molding is rated low in terms of caretaker burden. Esthetic outcomes are excellent as assessed by parents and physicians. However, caretakers reported higher esthetic outcomes than physician evaluations.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Spontaneous Resolution of Ear Lidding in Newborns: A Prospective Observational Cohort Study

ABSTRACT

Ear lidding is a cosmetic outer ear shape deformity commonly observed in newborns. Although lidding is considered a benign condition, psychological concerns such as bullying and depression have been observed in older children supporting correction of the condition. Nonsurgical correction of lidding using molding and splinting techniques has become increasingly popular, achieving successful outcomes in the majority of cases. Spontaneous resolution of the condition has also been reported in the literature however there is minimal prospective data available on the natural progression of ear lidding. In our case series of 11 closely followed newborns, we aimed to characterize the natural progression and resolution of lidding. Ten consecutive newborns participated in the observation plan and all 10 had complete spontaneous resolution of lidding within an average of 40 days. One other newborn's parents self-selected to have molding and splinting treatment. These results suggest that cosmetic treatment for less severe cases of ear lidding may be unnecessary as they have the potential to resolve on their own. Future research in this area could include controlled study designs and more work is needed to identify, which infants will require treatment. Our study may provide helpful reassurance to families and physicians that many newborns may see complete resolution of lidding without intervention.

Long-Term Effectiveness of Ear Molding in Infants Using the EarWell Infant Correction System in China

BACKGROUND

Ear molding is a safe and effective way to treat babies born with ear deformities. In this study, the authors explored the long-term effectiveness of ear molding and determined the factors that relate to recurrence.

METHODS

A retrospective review of 200 consecutive infants treated with the EarWell System from March of 2018 to August of 2019 was performed. Immediate and long-term effectiveness was evaluated and compared.

RESULTS

A total of 190 children (314 ears) were included. The mean age at presentation was 16.2 days (range, 0 to 100 days). The most common deformity was constricted ear [172 ears (54.8 percent)], and the rarest deformity was cryptotia [four ears (1.3 percent)]. At the completion of treatment, 10 constricted ears were evaluated to be unsuccessful. The immediate success rates of mild and severe constricted ears were 95.7 percent and 93.1 percent, respectively. The average long-term follow-up was 336 days (range, 180 to 660 days) after completion of treatment. Twenty-two ears (7.2 percent) reverted to their original shape. The long-term success rates of severe constricted ears and prominent ears decreased most significantly, 83.3 percent (p = 0.030) and 66.7 percent (p = 0.042), respectively. Family history led to a decrease of long-term effectiveness of prominent ears. Age at application, sex, duration of molding, and retention taping were not correlated to the long-term outcome.

CONCLUSIONS

Long-term follow-up demonstrated that in a percentage of babies, the ear deformities did recur after an initially successful treatment. Severe constricted ears and prominent ears are most likely to relapse.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Ear Abnormalities

Congenital ear abnormalities present an aesthetic and psychosocial concern for pediatric patients and their parents. Diagnosis of external ear deformities is based on clinical examination and is facilitated by an understanding of normal ear anatomy. Ear anomalies can be categorized as malformations or deformations. Malformations are characterized by absent anatomical structures of the ear (or absence of the ear itself), as exemplified by microtia and anotia. Ear deformations are characterized by ear anatomical landmarks that are present but are distorted or abnormal, with Stahl ear, constricted ear, and prominent ear being common presentations. Ear malformations will not improve with growth of the patient and uniformly require surgical intervention to recreate an anatomically typical ear. Although a small percentage of ear deformations can self-resolve, most patients with ear deformations will require nonsurgical or surgical reconstruction to achieve a normal or more aesthetic ear. In recent decades the use of nonsurgical ear splinting or molding has been recognized as a highly effective method in correcting a variety of congenital ear deformations when treatment is initiated in the first 8 weeks of life. The urgency in initiating nonsurgical treatment of ear deformations at an early age makes prompt recognition of these ear deformations essential because surgical correction remains the only viable reconstructive option in older infants and children.

Correction of neonatal auricular deformities with DuoDERM: A simple technique

Ear moulding in neonates has been shown to successfully correct congenital auricular anomalies. There are several available moulding techniques. However, commercially available moulding devices (e.g., EarWell and Ear Buddy) can be costly, and their alternatives have limited customizability. We present a technique using cost-effective and customizable materials for moulding common anomalies (Stahl's ear, constricted ear, and prominent ear). DuoDERM Extra-thin, Steri-strips, and 3M Kind Removal Silicone tape are used to splint the ear in a preferred position. The DuoDERM is rolled into a putty, placed in the ear, and secured with tapes. This treatment is initiated in the clinic, with weekly splint changes carried out at home by caregivers, and intermittent follow-up appointments. DuoDERM moulding is a safe, inexpensive, highly customizable, and simple way to correct auricular deformities. Primary physicians/paediatricians should embed moulding into their practice, starting treatment as early as possible in the neonatal period.

Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature

Congenital ear anomalies have been known to cause lasting psychosocial consequences for children. Congenital ear anomalies can generally be divided into malformations (chondro-cutaneous defect) and deformations (misshaped pinna). Operative techniques are the standard for correction at a minimal age of 5–7, exposing the children to teasing and heavy complications. Ear molding is a non-operative technique to treat ear anomalies at a younger age. Having been popularized since the 1980s, its use has increased over the past decades. However, uncertainties about its properties remain. Therefore, this review was conducted to look at what is known and what has been newly discovered in the last decade, comparing different treatment methods and materials. A literature search was performed on PubMed, and 16 articles, published in the last decade, were included. It was found that treatment initiated at an early age showed higher satisfactory outcome rates and a shorter duration of treatment. A shorter duration of treatment also led to higher satisfactory rates, which might be attributable to age at initiation, individual moldability, and treatment compliance. Complications were minor in all articles. Recurrence rate was low and mostly concerned prominent ears, which proved to be the most difficult to correct deformity as well. Malformations, however, were even more difficult to treat than deformations. Our analysis shows ear molding to be a successful treatment method for ear anomalies with a preference for early diagnosis and treatment.

Public Perception of Helical Rim Deformities and Their Correction With Ear Molding

BACKGROUND

Among congenital ear deformities, helical rim deformities are most common. Non-surgical ear molding has emerged as an effective option to treat helical rim deformities and could reduce the need for surgery later in a child's life. Despite this, there has never been a study examining how the general public rates corrections after ear molding.

METHODS

A retrospective chart review was conducted of all consecutive patients with helical rim deformities treated with InfantEar TM Molding System. Amazon Mechanical Turk (MTurk) was used to survey blinded respondents using photographs of patients' ears to determine the degree of normalcy on a scale of 1 (not normal) to 10 (completely normal) before and after molding. Ratings of ears were compared using a paired t test and percent improvement from baseline.

RESULTS

A total of 59 ears met criteria for evaluation by 497 MTurk respondents. Average age of patients at the time of treatment was 34.2 ± 16.8 days and mean therapy duration was 31.3 ± 13.1 days. A paired t test analysis found that MTurk respondents identified significant improvement in 91.5% of ears (n = 54) (P < 0.05). The percent improvement in observed helical rim change was on average 82.7 ± 61.1%.

CONCLUSION

Ear molding is an effective and safe way to address helical rim deformities early in the neonatal period. The general public is able to recognize ears with rim deformities as abnormal, and appreciate the difference in architecture after molding. Crowdsourcing technology offers an opportunity to measure laypeople's perceptions regarding outcomes after ear molding.

Neonatal ear splinting for congenital ear deformities✰

Splinting of ears in neonates to correct the congenital auricular deformities has been well described. Despite being a non-invasive technique and having a potential to prevent need for correctional surgery, it's up-take across the UK has been poor. This study evaluates the outcomes of neonatal ear splinting for congenital ear deformities from a regional ear splinting service. The retrospective study of patients undergoing neonatal ear splinting from 2009- 2015 was conducted at the Welsh Centre for Burns and Plastic Surgery. A total of 82 (n = 123 ears) neonates were treated. At the cessation of treatment 93% were reported as improved/excellent by a clinician. Longer-term parent evaluation showed improved/excellent result in 78.89%. Neonatal ear splinting is relatively inexpensive and has a high rate of success for a variety of neonatal ear deformities. Promoting awareness, identifying patients early and commencing treatment may reduce surgical correction of auricular deformities.

Implementation of auricular malformation screenings in the newborn population

BACKGROUND AND OBJECTIVE

Research has shown that it is important to initiate ear molding early for children with auricular malformations in order to achieve the best results. Currently our institute relies on the traditional primary care physician (PCP) referral system, which does not recognize the time sensitivity of the visit in patients with auricular malformations. The purpose of the current research is to implement a new screening protocol for identifying auricular malformations in the newborn population and thus expedite the clinic visit and necessary intervention.

METHODS

The hearing screen technicians (HSTs) were trained to identify some of the most common auricular malformations. A picture guide of 11 types of auricular malformations were given to the HSTs to use as a reference. At the time of the newborn hearing screen, the HSTs examined the pinnas of each baby. When an auricular malformation was identified, the auricular malformation team was immediately alerted and a bedside consultation with ENT occurred.

RESULTS

Comparison was made of the referral rate between pre- and post-implementation of the protocol which showed an increased rate of identification (five referrals in the 12-month period pre-implementation versus eighteen referrals in the 15-month period post-implementation).

CONCLUSION

We successfully implemented an auricular malformation screening protocol that was linked to newborn hearing screenings. The frequency of identification has increased with the implementation of the new screening protocol and has resulted in earlier initial ENT consultations for ear molding with the goal of improving patient satisfaction and results.

Efficacy and Timing of Neonatal Ear Correction Molding

BACKGROUND AND AIM

Given the incidence of congenital auricular anomalies varies racially, this study aimed to investigate the efficacy and timing of ear correction molding in infants with auricular anomalies.

MATERIALS AND METHODS

A total of 141 auricular anomalies of 100 infants less than 4 months of age were treated using the Earlimn molding system. Treatment outcomes were graded (three categories) in terms of auricular morphology. The efficacies and outcomes of modeling were evaluated in infants according to age and anomaly type.

RESULTS

The mean age at which correction was initiated was 35.13 days of life, and the average treatment duration was 17.81 days. Of all anomalies, 86% were corrected. Both deformations and certain malformations were satisfactorily corrected. The outcomes of children with conchal crura and mixed anomalies were relatively poor. Although no differences in treatment efficiency were evident among the three age groups, infants < 3 weeks old required shorter treatment courses than those > 6 weeks old. The only complications were mild skin ulcers.

CONCLUSIONS

Ear correction molding is remarkably effective for infants with auricular deformations/malformations. Molding efficacy depends on the type of anomaly. Initiation of molding at less than 6 weeks of age is essential to minimize treatment duration.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Classification of the concha-type microtia and their new suitable treatment strategies without autogenous costal cartilage grafting

OBJECTIVE

Numerous corrective methods have been successfully applied in concha-type microtia reconstruction over the past several decades, and autogenous rib cartilage grafting has become a routine technique in a two or three-stage operation. However, it still remains a challenge due to the effective use of the large volume of the remnant cartilage and skin involved. The objective of this study was to clarify how this remnant cartilage and skin could be manipulated for new suitable treatment strategies without autogenous costal cartilage grafting.

METHODS

A total of 424 patients with concha-type microtia operated at our Center from January of 2012 to June of 2019 have been reviewed and analyzed cases. At the same time, a classification system for grading the severity of concha-type microtia was created on the basis of anatomical findings and ear size.

RESULTS

A total of 436 ear cases (involving 424 patients), showing concha-type microtia, were included in our study and reviewed through medical records, photographs, analysis of surgical methods, and postoperative outcomes. The concha-type microtia were classified into four graded types: Grade I (n = 151), Grade II (n = 101), Grade III (n = 93), and Grade IV (n = 79). A total of 352 ears in 345 patients with Grade I to III concha-type microtia were followed up for 1 month to 7 years (average, 14.7 months). 329 patients (95.4%) were satisfied with the aesthetic outcomes of the corrected ear.

CONCLUSIONS

Individual corrective methods and aesthetic outcomes for patients with Grade I to III of deformity were described in this study. The authors present new suitable approaches according to a progressive classification system which provide conservative and individualized methods of treatment in early stages of life.

Deformations of the Ear and Their Nonsurgical Correction

The incidence of congenital ear deformities has been documented to be as high as 58% of all newborns. Unfortunately, the majority of these deformations do not spontaneously self-correct, leaving the child with a permanent deformity that can only be corrected through surgery. With the evolving simplicity of ear molding that can be done in the office, this can obviate the need for unnecessary surgery that comes with its own set of complications and a higher cost. Early detection and early treatment is key for successful ear molding. The purpose of this article is to review the types of deformational ear deformities and the most up-to-date literature on ear molding, increase awareness to this topic, and ultimately increase patient and parental satisfaction with their overall care.

Effectiveness of Ear Splint Therapy for Ear Deformities

OBJECTIVE

To present our experience with ear splint therapy for babies with ear deformities, and thereby demonstrate that this therapy is an effective and safe intervention without significant complications.

METHODS

This was a retrospective study of 54 babies (35 boys and 19 girls; 80 ears; age ≤3 months) with ear deformities who had received ear splint therapy at the Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University Hospital between December 2014 and February 2016. Before the initiation of ear splint therapy, ear deformities were classified with reference to the standard terminology. We compared the severity of ear deformity before and after ear splint therapy by using the physician's ratings. We also compared the physician's ratings and the caregiver's ratings on completion of ear splint therapy.

RESULTS

Among these 54 babies, 41 children (58 ears, 72.5%) completed the ear splint therapy. The mean age at initiation of therapy was 52.91±18.26 days and the treatment duration was 44.27±32.06 days. Satyr ear, forward-facing ear lobe, Darwinian notch, overfolded ear, and cupped ear were the five most common ear deformities. At the completion of therapy, the final physician's ratings of ear deformities were significantly improved compared to the initial ratings (8.28±1.44 vs. 2.51±0.92; p<0.001). There was no significant difference between the physician's ratings and the caregiver's ratings at the completion of ear splint therapy (8.28±1.44 vs. 8.0±1.61; p=0.297).

CONCLUSION

We demonstrated that ear splint therapy significantly improved ear deformities in babies, as measured by quantitative rating scales. Ear splint therapy is an effective and safe intervention for babies with ear deformities.

A Simplified Nonsurgical Method for the Correction of Neonatal Deformational Auricular Anomalies

Despite reported success of early nonsurgical splinting of congenital ear deformities, the technique has not been widely utilized due to difficulty with application and positional maintenance of these devices. Delay in treatment can result in unnecessary surgery for the child later in life. In response to this need, we developed a simplified system consisting of Velcro, conformers, and polysiloxane gel that can be applied in 3 steps. Before and after photos after application of the device were graded by a plastic surgeon independent of the study. A total of 33 ear deformities were treated. In all, 92.3% of ears achieved significant improvement and normalization of their ears after therapy. This device allows for a more straightforward and individualized application than current products available. Our hope is that practitioners involved early in the infant's care will utilize this technology resulting in improved outcomes and avoiding unnecessary surgery.

Correction of Congenital Auricular Deformities Using the Ear-Molding Technique

Background

Studies of the ear-molding technique have emphasized the importance of initiating molding early to achieve the best results. In the present study, we describe the immediate effects and long-term outcomes of this technique, focusing on children who were older than the ideal age of treatment initiation.

Methods

Patients who visited our institution from July 2014 to November 2015 were included. Medical charts were reviewed to collect data on demographics, the duration of treatment, the types of deformities, and the manner of recognition of the deformity and referral to our institution. Parents were surveyed to assess the degree of improvement, the level of procedural discomfort at the end of treatment, any changes in the shape of the molded auricle, and overall satisfaction 12 months after their last follow-up visits.

Results

A review of 28 ears in 18 patients was conducted, including the following types of deformities: constricted ear (64.2%), Stahl ear (21.4%), prominent ear (7.1%), and cryptotia (7.1%). The average score for the degree of improvement, rated on a 5-point scale (1, very poor; 5, excellent), was 3.5 at the end of treatment, with a score of 2.6 for procedural discomfort (1, very mild; 5, very severe). After 12 months, the shapes of all ears were well maintained. The average overall satisfaction score was 3.6 (1, very dissatisfied; 5, very satisfied).

Conclusions

We had reasonable outcomes in older patients. After 1 year of follow-up, these outcomes were well maintained. Patients past the ideal age at presentation can still be candidates for the molding technique.

Non-surgical Management of Congenital Auricular Deformities

BACKGROUND

Unlike congenital auricular malformations which are identified by underdevelopment of dermal and cartilaginous tissues, deformed ears are less sever congenital anomalies characterized only by a misshaped pinna structure and can be improved with acceptable cosmetic results and minimal cost through ear molding if treated in early neonatal period. In this study, authors present the first report of using splinting techniques for treatment of deformational auricular anomalies in Iranian children.

METHODS

Our case load consisted of a series of 29 patients (Male=16, Female=13) who were referred to Plastic Surgery Unit of Shiraz University of Medical Sciences from September 2011 to December 2014. Children aged more than 6 moths were excluded. Twenty-nine children affected by various deformities including prominent ears (n=11), lop ears (n=8) and constricted ears (n=10) were treated by splintage as a nonsurgical technique. The mean time of treatment was 13.33±2 weeks.

RESULTS

Eight (27.6%) patients did not complete the treatment. Splinting resulted in excellent or satisfactory results in 12 (57.14%) of treated cases. No improvement was observed at the end of the molding treatment in 9 patients. No complication was observed during the treatment in any of the patients.

CONCLUSION

The nonsurgical molding can be used as an effective approach for achieving natural outcomes and correcting cosmetic abnormalities. Rate of satisfaction is dependent on type of deformity, the neonatal age in which treatment started and also parents' adherence to treatment methods and principals. Concerning the low rate of complications and high satisfactory results the method can be used instead of surgery in appropriate cases.

Developmental disorders of the ear in children and adolescents: conservative and surgical treatment options

BACKGROUND

Developmental disorders of the ear can impair hearing and cause cosmetic deformities. In recent years, new surgical treatments have become established, above all in audiological rehabilitation.

METHOD

We selectively searched the PubMed database up to May 2013 for publications in English and Germanabout the therapeutic options.

RESULTS

No randomized trials have been performed, for both ethical and practical reasons (inadmissibility of placebo surgery, specialization of surgeons for individual techniques). To correct prominent ears, cartilage-sparing suture techniques are preferred, as they lead less often than scoring and incisional techniques to the formation of persistent, incompletely correctable ridges and scaffolding defects. The successful esthetic rehabilitation of severe deformities of the external ear is achievable through pinna reconstruction with costal cartilage (main risks: tissue defect at donor site, scaffolding resorption) or porous polyethylene (main risk: implant extrusion). The functional rehabilitation of conductive or mixed hearing impairment due to ear-canal atresia and major middle-ear deformities is preferably achieved with active middle-ear implants or bone-conduction hearing aids. Functional rehabilitation should be provided even when the hearing impairment is unilateral, in order to improve directional hearing and hearing with ambient noise. In cases of purely cochlear, unilateral, severe hearing impairment or deafness, a boneconduction hearing aid can be tried, and the individual indication for a cochlear implant can be considered.

CONCLUSION

The treatment options described here enable the affected children to benefit from complete functional and esthetic rehabilitation before they start school.

Identification of congenital auricular deformities during newborn hearing screening allows for non-surgical correction: a Mayo Clinic pilot study

OBJECTIVE

To introduce a Mayo Clinic pilot study in which newborn hearing screeners are trained to identify congenital auricular deformities, allowing for non-surgical correction with a simple splint initiated in the immediate neonatal period.

METHODS

Newborn hearing screeners received education on evaluation of congenital auricular deformities. Ten infants with 19 affected ears amenable to treatment with a simple splint were enrolled between June 15 and December 10, 2009. Splinting was initiated prior to the infant's discharge from the hospital.

RESULTS

Congenital auricular deformities amenable to correction with splinting included cup ear, Stahl's ear, and prominent ear. All ears were assessed by physical examination and photographic documentation prior to splinting and at follow-up visits. All exhibited improvement from the original deformity after 1-4 weeks of splinting. There were no instances of skin irritation or breakdown.

CONCLUSION

Splinting therapy of congenital auricular deformities is very effective when initiated within the first 3 days of life while cartilage is quite malleable. Newborn hearing screening is performed within 24-48 h of birth and is an ideal opportunity to identify auricular deformities. This pilot study shows that early identification of auricular deformities by properly educated newborn hearing screeners is feasible, allowing for successful initiation of splinting therapy.

A prospective study on non-surgical correction of protruding ears: the importance of early treatment

OBJECTIVES

Splinting is an elegant method to correct ear deformities in the newborn. However evidence is lacking on the relation between age and efficacy and duration of the treatment. We prospectively studied these questions on protruding ears in 132 babies.

METHODS

A splint in the scaphal hollow was used in combination with tape (Earbuddies(®)). Treatment continued until the desired shape persisted. Results were judged from photographs and mastoid-helical distance was measured.

RESULTS

In 132 babies 209 ears were treated. Twenty-four patients had no follow-up, 27 stopped therapy for skin irritation and fixation problems. In the remaining patients results were good in 28%, fair in 36%, poor in 36%. Efficacy deteriorates with age; with fair or good results in 66.7% if therapy started before the sixth week. Older children needed to be splinted longer. The anti-helical fold was easier corrected than a deep concha (correction in 69.8% versus 26.8%).

CONCLUSIONS

Considering splinting therapy for protruding ears, a reasonable chance of success can only be offered to parents of children up to six weeks of age. It is favorable if the deformity is mainly due to a flat antihelix.

A new method to correct Stahl's ear

OBJECTIVE

Stahl's ear is a rare congenital auricular malformation in which an abnormal 'third crus' traverses the upper pole of the scapha. A number of different treatment options have been published to correct Stahl's ear deformity; however, none of them corrects all the variations perfectly. In this article, we describe our new method to correct this deformity.

METHODS

To correct Stahl's ear and acquire a natural-looking appearance, a technique of cartilage scoring and a folding cartilage flap was used. The entire layer of the cartilage was cut through and the anterior skin covering the cartilage was dissected to the external border of the desired superior crus and antehelix to form a fan-shape flap. After scoring of the posterior surface of the cartilage, the cartilage flap was folded and sutured to the cartilage below to build the superior crus.

RESULTS

Seventeen patients ranging in age from 9 to 46 years were operated upon using this technique. The ears that were created were of normal size and shape. All patients and their families were satisfied with the final result. There were no complications.

CONCLUSION

We have developed a new method to correct Stahl's ear deformity. Outcomes of this technique on 17 patients suggest that our method is simple, effective and successful.

Prospective study of a noninvasive treatment for two common congenital toe abnormalities (curly/varus/underlapping toes and overlapping toes)

OBJECTIVE

To assess, in the newborn, the efficacy of a standard taping treatment used in children for two selected congenital toe abnormalities (curly/varus/underlapping toes and overlapping toes), and compare the outcome with the available world literature.

METHODS

All children referred by their family physician between January 2004 and January 2006 were included. The newborns were reviewed by one author (WGS) within 10 days of birth, assessed for severity, and the toes were taped in a standard manner if the abnormalities met the study criteria. After one and two months, the same author reviewed the children, and retaped the toes. The children's toes were photographed before the taping and then after three months when the tape was removed permanently. After six months, the children, with their pictures, were sent to a second author (JTS), and were scored for the grade of severity and improvement using standard criteria.

RESULTS

The world literature and standard textbooks indicate a 25% spontaneous improvement of these abnormalities. The recommendation is for surgical correction at a later date because intervention with taping has not shown success after the newborn period. No prior studies have been undertaken in the newborn. In the present study of 84 toes, the abnormality occurred in 2.8% of newborns, and 94% of the toes were improved or cured with no complications related to the technique.

CONCLUSION

A simple, office-friendly technique of taping underlapping and overlapping toes in the newborn proved successful in 94% of the toes.