Non-surgical correction of cryptotia

Ear Molding in Children-Timing, Technique, and Follow-up: A Systematic Review

Background: Nonsurgical management of congenital ear anomalies using molding devices shows efficacy but lacks standardization of treatment protocols and outcome measures. Learning Objective: To compare ear molding techniques and identify factors related to treatment outcomes. Design Type: Systematic review of the literature (1990-2021). Methods: Studies reporting molding for congenital ear anomalies were assessed. PRISMA guidelines were used. Data extracted included: age at treatment initiation, treatment duration, correction rates, and complications. Data analysis included descriptive statistics and outcomes were compared using the Student t-test. Results: In total, 37 studies with 3,341 patients (mean patients per study, 95; range, 5-488) were included. Infants in whom treatment was initiated at 4.8 weeks (median, 3.7; range, 0.9-8.8 weeks) were treated for 5.1 weeks (median 4.7, range 2.6-7.6 weeks) with 11.0 months follow-up (median 11.4, range 1.4-21.0 months). Individualized devices (physician-customized) were used more (62.2% of studies) than commercial devices. No difference in correction (p = 0.44) or complication rates (p = 0.19) was identified between devices. Totally, 70.3% of studies reported complications and 40.5% of studies included long-term follow-up data. Conclusions: The available evidence supports initiating ear molding in the first weeks of life to be most effective, yet outcome data should be standardized in future studies to improve evidence quality.

Correction of congenital auricle deformities with ear mould: A systematic review and meta-analysis

OBJECTIVE

To assess the effectiveness and safety of ear moulds for congenital auricle deformities.

METHODS

Databases including Medline, EMBASE, Cochrane Library, Chinese BioMedical Literature Database (CBM) and Web of Science were systematically reviewed. Randomised controlled trials (RCT), non-randomised control trials (non-RCT), quasi-randomised control trials (quasi-RCT) and self-controlled before-after trials were also included. Data extraction was independently conducted by two authors. The Risk Of Bias In Non-randomised Studies of Interventions (ROBIN-I) was used to evaluate the risk bias. Heterogeneity was assessed using I2 and chi-square tests. Effective rate, adverse reaction rate and their 95%CI were calculated. Funnel plots, Begg's test as well as sensitivity and subgroup analyses were performed.

RESULTS

The analysis encompassed ten studies, comprising one RCT and nine self-controlled before-after trials, involving 1860 ears (1248 children). The pooled effective rate and adverse reaction rate of ear mould were 91% (95% CI: 0.87-0.94) and 9% (95%CI: 0.02-0.17), respectively. No serious adverse reactions were reported. The effective rate of ear mould intervention showed no significant difference between age at correction≤42 days group (90%, 95%CI: 0.85-0.94) and that >42 days group (93%, 95%CI: 0.83-0.99). Similarly, there was no statistical difference in the correction efficiency between duration of wearing ear mould≤30 days group (90%, 95%CI: 0.85-0.94) and that >30 days group (92%, 95%CI: 0.86-0.96). The effective rate for correcting cryptotia ear (98%, P < 0.001), cup ear (93%, P = 0.004) and prominent ear (90%, P = 0.014) was higher than that of helical rim deformity (66%).

CONCLUSIONS

In the short term, the use of ear moulds is effective and safe in correcting congenital auricle deformities. Notably, the correction efficacy for cryptotia, cup ear and prominent ear deformities surpasses that of helical rim deformities. However, further research is required to ascertain the impact of the duration of wearing on the correction of congenital auricle deformities.

The Treatment Effect of Non-Surgical Ear Molding Correction in Children with Mild Cryptotia Deformity

OBJECTIVE

To investigate the treatment effect of non-surgical ear molding correction in children with mild cryptotia deformity.

METHODS

51 cases were collected from 2016 to 2021. They were divided into four groups (6 months-1 year group, 1-3 years group, 3-6 years group, and ≥6 years group). The effective rate, recurrence rate, complication rate, and treatment duration of non-surgical ear molding correction were analyzed among the four groups.

RESULTS

3 months after the end of corrective treatment, the overall effective rate was 92.2% (47/51), the overall recurrence rate was 7.8% (4/51), and there was statistical significance among the four groups (p = 0.001). The overall complication rate was 2.0% (1/51), and there was no statistical significance among the four groups (p = 1.000). There was statistical significance in the treatment duration among the four groups (p < 0.001), and the mean duration of treatment was positively correlated with the age at treatment (p < 0.001, R = 0.614).

CONCLUSIONS

We first propose and recommend that the treatment time window for non-surgical ear molding correction be maximally extended to 6 years old in children with mild cryptotia deformity. There is a high success rate of non-surgical ear molding correction in children with mild cryptotia deformity. The complication rate is low. There is a positive correlation between the mean treatment duration and the age at treatment, and the treatment duration increases with the growth of months.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2122-2128, 2023.

A Patient With Cryptotia Corrected With Intraoperative Tissue Expansion and Superior Auricular Muscle Transfer Through a Small Hairline Incision

Cryptotia is a relatively common auricular congenital anomaly in Asia. Nonsurgical molding is easy in infancy. However, surgical correction is often necessary after infancy. The authors report a case of cryptotia in which intraoperative tissue expansion and superior auricular muscle transfer were performed through a small incision at the hairline with good results. The patient is a 7-year-old girl. Three years after the operation, successful results were obtained. This method is advantageous as the procedure is simple, risk of relapse can be reduced by also treating the auricular muscle, and scarring is relatively inconspicuous. In addition, it is possible to switch to another technique when the improvement is poor.