Ear Abnormalities

Ear splinting for ear anomalies in infants. Is it worth doing and have we missed the boat? A prospective, cohort study

INTRODUCTION

Ear deformities can cause distress to children as they age, especially with ear deformity surgery not routinely available through the NHS. Ear splinting is a non-surgical method that can obviate the need for surgery; however, it is believed that it can only be provided in the first few weeks of life. There is also little evidence in the literature regarding caregiver-reported outcomes of appearance and adherence.

METHOD

Over a 5-year period (2018-2023), pre- and post-splinting questionnaires were provided to caregivers of infants who underwent ear splinting for treatment of congenital ear deformities. Caregiver-reported outcomes assessed the appearance of different anatomical areas of the ear, ease of use, complications and referral pathways.

RESULTS

In total, 123 participants were recruited. Following ear splinting, there was a significant improvement in the ratings of appearance (p<0.001), shape (p<0.001) and projection (p<0.001) of the ear. Caregiver ratings of anatomical regions of the pinna also showed significant improvements for the helical rim (p<0.001) and scaphoid fossa (p<0.001). A small number of caregivers encountered difficulty using the splints (5%), which included application of the splints and keeping them clean and dry. Excellent results were reported regardless of age, with the oldest child being one year old, but the duration of splinting positively correlated with age (p<0.05).

CONCLUSIONS

Ear splinting showed high satisfaction rates in outcomes and adherence, with a low complication rate. It is still preferable to start ear splinting early, but good results were still being found up to one year of age in this study.

Application of decellularized tissues in ear regeneration

More than 5 % of people worldwide suffer from hearing disorders. Ototoxic drugs, aging, exposure to loud sounds, rupture, subperichondrial hematoma, perichondritis, burns and frostbite and infections are the main causes of hearing loss, some of which can destroy the cartilage and lead to deformation. On the other hand, disorders of the external ear are diverse and can range from dangerous neoplasms to defects that are not acceptable from a cosmetic standpoint. These issues include injuries, blockages, dermatoses, and infections, and any or all of them may be bothersome to the busy doctor. Using an implant or hearing aid is one of the treatment strategies for deafness. However, these medical devices are not useful for every eligible patient. With the right therapy, many of these issues are not life-threatening and can be treated with confidence in a positive outcome. As medical research and treatment have advanced dramatically in the past ten years, tissue engineering (TE) has emerged as a promising method to regenerate damaged tissue, raising the prospect of a permanent cure for deafness. Decellularization is now seen as a promising development for regenerative medicine, and an increasing number of applications are being found for acellular matrices. Studies on decellularization show that natural scaffolds made from decellularized tissues can serve as a suitable platform while preserving the main components, and the preparation of such scaffolds will be an important part of future bioscience research. It can have wide applications in regenerative medicine and TE. This review intends to give an overview of the status of research and alternative scaffolds in inner and outer ear regenerative medicine from both a preclinical and clinical perspective for ear disorders in order to show how ongoing TE research has the potential to advance and enhance novel disease treatments.

The Prevalence and Awareness of Congenital External Ear Deformity among the School-Age Group: A Cross-Sectional Study

INTRODUCTION AND PURPOSE

 Congenital outer ear deformities stem from a sequence of disturbances during fetal auricular cartilage embryonic development. A significant gap exists in understanding their prevalence among the school-age group in Saudi Arabia. This cross-sectional study aims to address this knowledge gap to raise awareness about the impact of such disorders.

METHODOLOGY

 This cross-sectional study targeted parents of children in the school-age group. A multistage cluster sampling technique was employed to ensure the representation of schools. A self-administered Google form survey was used. Data were analyzed using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, NY).

RESULTS

 Our study revealed that the majority were males (56.2%), aged 6 to 10 years (49.3%), and attended primary school (69.5%). Chronic illnesses were present in 7.1% of children, with hearing impairment most prevalent (25.9%). Congenital ear deformities affected 2.7% of children, primarily Stahl's ear (35.4%). Limited knowledge about these deformities was observed among respondents (30.3%), yet a significant majority (73.9%) expressed belief in the potential of community awareness to decrease deformity prevalence. The awareness levels were impacted by parental education but showed no significant association with the child's age, gender, or presence of chronic diseases.

CONCLUSION

 Our study underscores the noteworthy occurrence of congenital ear deformities among the school-age group, coupled with a notable lack of awareness. Parental education emerges as a key factor influencing awareness levels. It is imperative to prioritize initiatives to bolster awareness and early detection to promote child health.

Epidemiology of congenital malformations of the external ear in Hunan Province, China, from 2016 to 2020

To describe the epidemiology of congenital malformations of the external ear (CMEE). Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016 to 2020. The prevalence of CMEEs is defined as the number of cases per 1000 fetuses (births and deaths at 28 weeks of gestation and beyond) (unit: ‰). Prevalence and 95% confidence intervals (CI) were calculated by the log-binomial method. Chi-square trend tests (χ2trend) were used to determine trends in prevalence by year. P < .05 was considered statistically significant. Crude odds ratios (ORs) were calculated to examine the association of sex, residence, and maternal age with CMEEs. Our study included 847,755 fetuses, and 14,459 birth defects were identified, including 1227 CMEEs (accounted for 8.49% of birth defects). The prevalences of birth defects and CMEEs were 17.06‰ (95%CI: 16.78-17.33) and 1.45‰ (95%CI: 1.37-1.53), respectively. A total of 185 microtia-anotias were identified, accounting for 15.08% of CMEEs, with a prevalence of 0.22‰ (95%CI: 0.19-0.25). And 1042 other CMEEs were identified, accounting for 84.92% of CMEEs. From 2016 to 2020, the prevalences of birth defects were 18.20‰, 18.00‰, 16.31‰, 16.03‰, and 16.47‰, respectively, showing a downward trend (χ2trend =8.45, P < .01); the prevalences of CMEEs were 1.19‰, 1.62‰, 1.80‰, 1.21‰, and 1.35‰, respectively, with no significant trend (χ2trend =0.09, P = .77). CMEEs were more common in males than females (1.60‰ vs 1.27‰, OR = 1.26, 95%CI: 1.12-1.41), in urban areas than in rural areas (1.77‰ vs 1.23‰, OR = 1.45, 95%CI: 1.29-1.62). The prevalences of CMEEs for maternal age < 20, 20-24, 25-29, 30-34, and ≥ 35 were 1.75‰, 1.27‰, 1.44‰, 1.47‰, and 1.58‰, respectively, with no significant difference (P > .05, reference: 25-29). Most CMEEs were diagnosed by clinical examinations (92.34%), and most CMEEs were diagnosed postpartum (within 7 days) (96.25%). In summary, we have presented the epidemiology of CMEEs in Hunan Province, China. CMEEs were more common in males than females, in urban areas than rural areas, whereas there was no significant difference in prevalence of CMEEs by maternal age. We inferred that CMEEs may be mainly related to genetics, and the mechanism needs to be examined in the future.

Seminars in Plastic Surgery: Pediatric Ear Anomalies and Reconstruction

Congenital ear anomalies affect 15 to 20% of neonates and can be categorized as either auricular deformations or malformations. Deformations involve a fully developed, albeit abnormally shaped, chondrocutaneous framework, which makes them amenable to correction with ear molding within the first few months of life. Malformations involve hypoplastic or fully absent auricular structures that require augmentation with alloplastic and/or autogenous reconstruction. The goal of this article is to outline the various auricular deformities and malformations, followed by a description of the latest clinical management options, both nonsurgical and surgical, by auricular anomaly.

Treatment of congenital auricle malformation with EarWell Ear Correction Kit: A meta-analysis

OBJECTIVE

The effectiveness of EarWell Ear Correction Kit in the treatment of congenital auricle malformation and the incidence of complications are not particularly clear, so we carried out this study to provide a better reference for plastic surgeons to use EarWell Ear Correction Kit in the treatment of congenital auricle malformation.

METHODS

We searched the Chinese and English databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases.

RESULTS

Through this meta-analysis, we found that the effective rate of EarWell Ear Correction Kit was 89.1%. The incidence of complications using EarWell Ear Correction Kit for correction of congenital auricular deformity was 11.4%. In terms of complications, the incidence of skin lesions was 9% and the incidence of dermatitis was 3.4%.

CONCLUSION

EarWell Ear Correction Kit has high efficiency in the correction of congenital auricular deformity and a low incidence of complications. It can be used for the treatment of congenital auricular deformity in patients within 6 months of birth.

Evaluation and Nonsurgical Treatment of Neonatal Ear Anomalies: A Case Report

BACKGROUND

Inspection and evaluation of the neonate's ears are important parts of the neonatal examination. Neonates display a wide variety of ear size and configuration. In many cases, ear molding techniques obviate the need for future surgical correction. This article provides a review of the fetal ear development and describes common physical examination findings of the newborn's external ear. A case report reviews a successful nonsurgical treatment of a minor ear deformity.

CLINICAL FINDINGS

Newborn infant with near absent to very thin bilateral helical rims and otherwise normal bilateral ear shape and structures.

PRIMARY DIAGNOSIS

Bilateral Stahl's ear deformity.

INTERVENTIONS

The EarBuddies product was applied to bilateral ears in an outpatient pediatric plastic surgery clinic. This product remained in place for 8 weeks.

OUTCOMES

The family was pleased with the overall progress and shape of their child's ears. At 18 months of age, the family has no desire to pursue surgical correction of their child's ears.

PRACTICE RECOMMENDATIONS

Assessment of the newborn's external ear is part of a routine admission examination. Careful attention to abnormal or unusual findings allows for prompt evaluation and nonsurgical intervention.

Epidemiological Study of Neonatal Congenital Microtia in Shandong Province, China, 2011-2020

OBJECTIVE

Congenital microtia is a common congenital disease in newborns. The specific cause of congenital microtia is currently unknown. The main objective of this study is to elucidate the epidemiological characteristics of congenital microtia and explore the possible etiology of congenital microtia.

METHODS

Part of the newborn data from 2011 to 2020 in Shandong Province Birth Defects Monitoring Hospitals were randomly selected. The software GraphPad Prism 9 was used to analyze the data and draw figures.

RESULTS

A total of 4247 infants were diagnosed with congenital malformation among 149,525 newborns randomly selected from the Shandong Province Birth Defects Monitoring Hospitals. Among them, a total of 115 infants were diagnosed with congenital microtia. The mean incidence of microtia during 10 years was 76.14±21.93 per 100,000 infants. The mean incidence of microtia in infants with congenital malformation was 2.67±0.75%. The average incidence of male and female infants with microtia during 10 years were 86.93±23.22 and 64.18±32.71 per 100,000 infants, respectively. In terms of maternal age, the older the mother, the higher the incidence of microtia. In terms of the place of residence, rural infants have a higher incidence of microtia than urban infants.

CONCLUSIONS

The average incidence of microtia was 76.14±21.93 per 100,000 infants in Shandong Province, China, 2011-2020. The female-to-male incidence ratio was 1.45:1. The authors recommend that women choose to give birth at the age of 25 to 29. They hope that the government will take measures to improve the medical and health conditions in rural areas and improve parenting knowledge in rural areas. This can effectively reduce the prevalence of microtia in infants.