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Vella JB. Pediatric Otoplasty and Auricular Molding. Facial Plast Surg Clin North Am 2024; 32:95-103. [PMID: 37981420 DOI: 10.1016/j.fsc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
With the advent of widespread use of commercial ear molding products, the literature addressing the indications for and timing of perinatal intervention in auricular deformations and malformations has increased significantly. Although the rationale for perinatal ear molding seems to be hormonally mediated, the common assertion that breastfeeding may prolong the window of effective intervention remains without convincing evidence. The common auricular anomalies as well as indications, timing, and methodology of effective intervention including ear molding or surgical otoplasty are reviewed herein.
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Affiliation(s)
- Joseph B Vella
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Rutgers Cleft and Craniofacial Center, Rutgers-Robert Wood Johnson Medical School, 10 Plum Street, 5th Floor, New Brunswick, NJ 08901, USA.
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Xiao F, Wu B, Dong C, Cheng G, Cao Y, Wang L, Dong X, Lu Y, Yang L, Chen L, Li L, Pan X, Wei Q, Zhuang D, Chen D, Yin Z, Ni Q, Liu R, Xu S, Li G, Zhang P, Qian Y, Li X, Peng X, Wang Y, Wang H, Zhou W. Genetic spectrums and clinical profiles of critically ill neonates with congenital auricular deformity in the China Neonatal Genomes Project. Hum Genet 2023; 142:1737-1745. [PMID: 37938362 DOI: 10.1007/s00439-023-02612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
Congenital auricular deformity (CAD) is a complex phenotype that may occur as a single malformation or part of a congenital syndrome. The genetic architecture and utility of next-generation sequencing (NGS) in a sizable cross-sectional study of critically ill neonates with CAD have not yet been systematically investigated. This cross-sectional study investigated the genetic spectrum in critically ill neonates with CADs. Critically ill neonates with CADs (n = 251) were enrolled between August 8, 2016 and October 1, 2022. All neonates underwent NGS. The outcomes were molecular diagnostic yield, spectrum of genetic events, and clinical findings. Genetic findings were obtained in 107 neonates (42.6%), of which 67.3% (72/107) had pathogenic/likely pathogenic/variants of uncertain significance (P/LP/VUS) gene variations and 32.7% (35/107) had P/LP/VUS copy number variations (CNVs). The diagnostic rates of clinical exome sequencing were similar to those of exome sequencing. The logistic regression model revealed that CAD neonates with craniofacial abnormalities (OR = 4.15, 95% CI 2.29-7.53) or cardiovascular malformation (OR = 2.09, 95% CI 1.14-3.84) are more likely to be attributed to genetic causes. Follow-up analysis revealed that, compared to those in the undiagnosed group, the number of neonates whose care was withdrawn or who died was higher in the genetically diagnosed group (P < 0.05). This study identified a high incidence of genetic causes in critically ill neonates with CADs, with a combination of single-nucleotide variations and CNVs among the genetic causes of CAD. These findings highlight potential of NGS in the genetic testing of critically ill neonates with CADs.
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Affiliation(s)
- Feifan Xiao
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Bingbing Wu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Chenbin Dong
- Department of Plastic Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Guoqiang Cheng
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, 201102, China
| | - Yun Cao
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, 201102, China
| | - Laishuan Wang
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, 201102, China
| | - Xinran Dong
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yulan Lu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Lin Yang
- Department of Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Liping Chen
- Department of Neonatology, Jiangxi Provincial Children's Hospital, Nanchang, 330029, Jiangxi, China
| | - Long Li
- Department of Neonatology, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, 830001, Xinjiang, China
| | - Xinnian Pan
- Department of Neonatology, Maternal and Child, Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, Guangxi, China
| | - Qiufen Wei
- Department of Neonatology, Maternal and Child, Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, Guangxi, China
| | - Deyi Zhuang
- Department of Pediatrics, Xiamen Children's Hospital, Xiamen, 361006, Fujian, China
| | - Dongmei Chen
- Department of Neonatal Intensive Care Unit, Quanzhou Maternity and Children's Hospital, Quanzhou, 362000, Fujian, China
| | - Zhaoqing Yin
- Department of Neonatology, The People's Hospital of Dehong, Dehong, 678400, Yunnan, China
| | - Qi Ni
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Rencao Liu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Suzhen Xu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Gang Li
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Ping Zhang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yanyan Qian
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xu Li
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xiaomin Peng
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yao Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Huijun Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Wenhao Zhou
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, 201102, China.
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Burns HR, Dinis J, Ding Y, Buchanan EP. Seminars in Plastic Surgery: Pediatric Ear Anomalies and Reconstruction. Semin Plast Surg 2023; 37:287-298. [PMID: 38098685 PMCID: PMC10718655 DOI: 10.1055/s-0043-1775888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
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.
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Affiliation(s)
- Heather R. Burns
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jacob Dinis
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Yang Ding
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P. Buchanan
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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Uyar I, Aksam E, Kopal C, Kapı E. Comparison of Transcutaneous Fixation-Assisted Method with Classical Needle-Assisted Method in Prominent Ear Surgery. Aesthetic Plast Surg 2023; 47:189-198. [PMID: 35332407 DOI: 10.1007/s00266-022-02838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prominent ear deformity is an autosomal dominant inherited deformity. Surgery is the most effective treatment method for prominent ear patients. Different prominent ear operations have been described in the literature. In this study, it is aimed to compare the transcutaneous fixation-assisted method that we described in prominent ear repair with the classical needle-assisted method. METHODS Patients who were operated for bilateral prominent ear deformity between January 2017 and January 2020 were included in the study. Two different approaches were used in the operations. In the first group, conventional needles were used to adjust the position of the concha-scaphal sutures. In the second group, transcutaneous suturing was used to adjust the position of the concha-scaphal sutures. The duration of the operation was recorded. Patients were called for controls in 1-3-6 and 12th months; photographs were taken. Measurements were made in the preoperative period, in the intraoperative and at the postoperative 12th month. SPSS program was used for statistical analysis. RESULTS A total of 52 patients were included in the study. There were 27 patients in Group 1and 25 patients in Group 2. There was no significant difference between the groups in terms of demographic characteristics (p>0.05). While the average operation time was 80.37 minutes in Group 1, the average operation time was 60.40 minutes in Group 2. The operative times between the groups were statistically significant (p<0.05). There was no statistically significant difference between the groups in preoperative, intraoperative and postoperative measurements (p>0.05). CONCLUSIONS As a result, transcutaneous fixation-assisted method is performed faster than the classical needle-assisted method and the results are understood right at the beginning of the operation. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Ilker Uyar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Izmir Katip Celebi University Medical Faculty, İzmir, Turkey. .,Izmir Katip Celebi University Ataturk Training and Research Hospital, Basın Sitesi, Atatürk Eğitim ve Araştırma Hastanesi, Karabağlar, 35360, İzmir, Turkey.
| | - Ersin Aksam
- Department of Plastic, Reconstructive and Aesthetic Surgery, Izmir Katip Celebi University Medical Faculty, İzmir, Turkey
| | - Can Kopal
- Private Practice, Kultur Mah. Sair Esref Bul. No:61 Bahar Apartmanı K:2 D:5, Alsancak, İzmir, Turkey
| | - Emin Kapı
- Adana Medical Faculty, Health Application and Research Center, Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences, Adana, Turkey
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Noninvasive ear molding in the correction of ear anomalies: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2022; 159:111189. [PMID: 35716418 DOI: 10.1016/j.ijporl.2022.111189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/10/2022] [Accepted: 05/22/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Ear molding has been used for the treatment of congenital external ear anomalies. The purpose of this study is to systematically review ear molding therapy and perform a meta-analysis to determine its efficacy. METHODS A systematic review and meta-analysis of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed and Embase databases from January 2009 to April 2021 were searched. Individual studies were eligible for inclusion if they evaluated noninvasive ear molding for congenital ear anomalies, featured at least 50 ears, and were published in English. RESULTS 15 studies (one RCT and 14 clinical series) with a total of 1729 children undergoing molding of 2508 ears were identified and included in the meta-analysis. Meta-analysis of the eight studies with reported success rates as determined by clinician assessment showed an overall success rate in 87.4% of ears. Meta-analysis of the three studies with reported efficacy as assessed by laypersons showed an overall success rate of 92%. All studies reported a variety of minor skin-related complications in the ear, such as eczema, excoriation, infection, irritation, rash (allergic or nonallergic), and ulceration. Generally, complications were not reported to be serious and were noted to resolve with minimal to no intervention. CONCLUSION To the authors' knowledge, this study represents the largest modern systematic review and meta-analysis analyzing the efficacy of ear molding. A review of the 15 studies included suggests that ear molding is an effective and safe treatment for congenital ear anomalies with a high success rate. However, the strength of this body of evidence is reduced by a lack of comparative studies, heterogeneous patient populations, treatment protocols, and ear assessment scales.
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Wu H, Niu Z, Li G, Li Y, Wang B, Qian J, Wang Y, Jiang H, Chen Y, Han Y. Nonsurgical Treatment for Congenital Auricular Deformities: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2022; 46:173-182. [PMID: 34231021 DOI: 10.1007/s00266-021-02427-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effectiveness and safety of non-surgical correction for congenital auricular deformities (CADs) remain unclear owing to a lack of high-level evidence. This systematic review and meta-analysis aimed to estimate the overall success and complication rates of the non-surgical correction for CAD. METHODS We searched PubMed, Medline, and Cochrane Library for eligible studies. The pooled success and complication rates of non-surgical correction were estimated using a random effects model. Subgroup analyses were performed to compare the success rates between patients treated with splints and molding systems, between those younger and older than 6-weeks, and among those with different types of CADs. RESULTS The review yielded 14 studies. The pooled success rate of non-surgical treatment was 93% (95% CI: 88%-97%). The success rates with splints and commercialized molding systems were 94% and 92%, respectively. The success rate was higher if non-surgical correction was initiated before age 6 weeks (96% vs. 82%). Prominent ears showed a lower success rate (85%) than other types of CADs (all > 90%). The pooled complication rate was 18% (95% CI: 10%-29%). Complications, including skin wound, irritation, and rash, were mild and easily treatable. CONCLUSION The non-surgical correction of CADs is highly effective and safe. Splints and molding systems offer similar effectiveness. Non-surgical correction is more beneficial if applied within 6 weeks of birth. Prominent ears have a lower, but still acceptable, success rate compared to other types of CAD. We recommend the early use of non-surgical correction to achieve favorable outcomes. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Huanhuan Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China
| | - Zehao Niu
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Guo Li
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan Li
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Bingqing Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China
| | - Jing Qian
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China
| | - Yue Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China
| | - Hanyi Jiang
- Graduate School of North, China University of Science and Technology, Tangshan, 063210, China
| | - Youbai Chen
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Yan Han
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Liu C, Wo P, Zhang J, Li J. Nonsurgical molding of congenital auricular deformities and analysis of the correction outcomes: A single-center, retrospective study in east China. Front Pediatr 2022; 10:1031575. [PMID: 36589152 PMCID: PMC9800832 DOI: 10.3389/fped.2022.1031575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Our research was carried out to provide a clinical reference for the application of nonsurgical therapy in newborns with congenital auricular deformities in east China. METHODS A retrospective study of consecutive newborns using noninvasive ear molding was conducted in Hangzhou in east China's Zhejiang Province. The demographic and clinical information and photographs of the ear before and after treatment were taken. The diagnosis of each auricular deformity was identified, and the treatment outcome was evaluated. RESULTS A total of 224 patients including 356 congenital ear anomalies received noninvasive ear molding. The median age of infants to initiate treatment was 39.5 days. The median treatment duration was 42.5 days. The median follow-up time was 137.0 days. The overall treatment effective rate of all infants with nonoperative ear molding was 92.1%, and mild skin irritation and ulceration occurred in 34 ear deformities (9.6%). It confirmed that the treatment efficiency was satisfactory and the complication rate was still acceptable despite the late initiation treatment of neonates in east China. Further analysis of treatment outcomes among three subgroups of infants (the ages to initiate the ear molding were respectively less than or equal to 28, 29-56, and more than 57 days) revealed that initiation treatment was significantly related to the treatment results and the earlier the initiation treatment, the higher the effective rate and the lower the complication incidence. CONCLUSION Our study hints that newborns in east China may have a longer period for correction. What is more, although our study affirmed a longer period for noninvasive molding, early diagnosis and treatment are still recommended to improve therapy efficiency and reduce treatment duration and complications.
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Affiliation(s)
- Chuanbo Liu
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peibin Wo
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jufang Zhang
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinsheng Li
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Hallac RR, Jackson SA, Grant J, Fisher K, Scheiwe S, Wetz E, Perez J, Lee J, Chitta K, Seaward JR, Kane AA. Assessing outcomes of ear molding therapy by health care providers and convolutional neural network. Sci Rep 2021; 11:17875. [PMID: 34504194 PMCID: PMC8429730 DOI: 10.1038/s41598-021-97310-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/17/2021] [Indexed: 12/05/2022] Open
Abstract
Ear molding therapy is a nonsurgical technique to correct certain congenital auricular deformities. While the advantages of nonsurgical treatments over otoplasty are well-described, few studies have assessed aesthetic outcomes. In this study, we compared assessments of outcomes of ear molding therapy for 283 ears by experienced healthcare providers and a previously developed deep learning CNN model. 2D photographs of ears were obtained as a standard of care in our onsite photography studio. Physician assistants (PAs) rated the photographs using a 5-point Likert scale ranging from 1(poor) to 5(excellent) and the CNN assessment was categorical, classifying each photo as either “normal” or “deformed”. On average, the PAs classified 75.6% of photographs as good to excellent outcomes (scores 4 and 5). Similarly, the CNN classified 75.3% of the photographs as normal. The inter-rater agreement between the PAs ranged between 72 and 81%, while there was a 69.6% agreement between the machine model and the inter-rater majority agreement between at least two PAs (i.e., when at least two PAs gave a simultaneous score < 4 or ≥ 4). This study shows that noninvasive ear molding therapy has excellent outcomes in general. In addition, it indicates that with further training and validation, machine learning techniques, like CNN, have the capability to accurately mimic provider assessment while removing the subjectivity of human evaluation making it a robust tool for ear deformity identification and outcome evaluation.
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Affiliation(s)
- Rami R Hallac
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA. .,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, 1935 Medical District Dr., Dallas, TX, 75235, USA.
| | - Sarah A Jackson
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Jessica Grant
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Kaylyn Fisher
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Sarah Scheiwe
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Elizabeth Wetz
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Jeyna Perez
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Jeon Lee
- Department of Bioinformatics, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Krishna Chitta
- Department of Bioinformatics, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - James R Seaward
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Alex A Kane
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, 1935 Medical District Dr., Dallas, TX, 75235, USA
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Long-Term Effectiveness of Ear Molding in Infants Using the EarWell Infant Correction System in China. Plast Reconstr Surg 2021; 148:616-623. [PMID: 34432691 DOI: 10.1097/prs.0000000000008293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3250. [PMID: 33299713 PMCID: PMC7722567 DOI: 10.1097/gox.0000000000003250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Abstract
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.
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11
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Surgical correction of Stahl ear using cartilage-cutting and -sparing techniques. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zou K, Fan Y, Jiang L, Huang J, Miao Y, Yang C, Yang M, Zhao L. Ear mold for congenital ear malformation: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e21313. [PMID: 32791720 PMCID: PMC7387052 DOI: 10.1097/md.0000000000021313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Congenital auricular deformities (CAD) are prevalent worldwide. The objective of this study is to investigate the effectiveness and safety of ear molding for children with CAD at their early days. METHODS One hundred and nighty children (under 3 days) with CAD will be included in the study. Participants will be randomly allocated to treatment or waiting list group (n = 95). The treatment group will receive ear molding within 3 days after birth for 2 weeks. The control group will receive usual care and receive the same ear molding at 6th week if spontaneously recover is not occur. Physician and parent assessment of improvement, parent's anxiety, depression, and quality of life and adverse events will be measured at baseline, 3rd and 6th week of initial treatment. The primary outcome recovery rate will be compared between groups using Chi square test. Secondary continuous outcomes will be compared using analysis of variance. DISCUSSION This study is the first randomized controlled trial to examine the effectiveness, safety and cost-effectiveness of ear molding for CAD comparing with waiting list, to inform clinical decision of CAD treatments and relevant guideline development.
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Affiliation(s)
- Kun Zou
- Department of Health Policy and Management
- West China Research Centre for Rural Health Development, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
| | - Yanjun Fan
- National Center for Women and Children's Health, China Center for Disease Control and Prevention, Beijing
| | - Lihua Jiang
- Department of Health-Related Social and Behavioral Sciences
| | - Jincheng Huang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Yunqi Miao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Chunsong Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
- Department of Pharmacy, West China Second Hospital, Sichuan University
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Yang
- Department of Health Policy and Management
- West China Research Centre for Rural Health Development, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
- Faculty of Health, Art and Design, Swinbune Technology University, Melbourne, Australia
| | - Li Zhao
- Department of Health Policy and Management
- West China Research Centre for Rural Health Development, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan
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Ear Molding Therapy: Laypersons' Perceptions, Preferences, and Satisfaction with Treatment Outcome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2902. [PMID: 32802642 PMCID: PMC7413762 DOI: 10.1097/gox.0000000000002902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. This study investigates laypersons’ perceptions of congenital ear deformities and preferences for treatment, particularly with ear molding therapy—an effective, noninvasive, yet time-sensitive treatment.
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14
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Gulati RD, Faraci N, Butts SC. Neonatal Ear Molding. Laryngoscope 2020; 131:E423-E427. [PMID: 32619285 DOI: 10.1002/lary.28842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Rahul D Gulati
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Nick Faraci
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York, U.S.A
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Liu YCC, Kini S, Barton G, Pham T, Marcet-Gonzalez J, Novak B. Implementation of auricular malformation screenings in the newborn population. Int J Pediatr Otorhinolaryngol 2020; 133:109999. [PMID: 32224391 DOI: 10.1016/j.ijporl.2020.109999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Yi-Chun Carol Liu
- Baylor College of Medicine, Department of Otolaryngology - Head and Neck Surgery, One Baylor Plaza Suite NA-102, Houston, TX, 77030, USA; Texas Children's Hospital, Department of Pediatric Otolaryngology, 6701 Fannin St, Suite 640, Houston, TX, 77030, USA.
| | - Sameer Kini
- Baylor College of Medicine, Department of Otolaryngology - Head and Neck Surgery, One Baylor Plaza Suite NA-102, Houston, TX, 77030, USA.
| | - Geran Barton
- Texas Children's Hospital, Department of Surgery, 6621 Fannin Street, Suite B320, Houston, TX, 77030, USA
| | - Tien Pham
- Texas Children's Hospital, Department of Surgery, 6621 Fannin Street, Suite B320, Houston, TX, 77030, USA
| | - Jessie Marcet-Gonzalez
- Texas Children's Hospital, Department of Surgery, 6621 Fannin Street, Suite B320, Houston, TX, 77030, USA
| | - Barbra Novak
- Texas Children's Hospital, Department of Audiology, 6701 Fannin Street, MC 520.30, Houston, TX, 77030, USA
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Zhuang Q, Wei N, Zhou Q, Wang H, Wu Y, Chen Z, Yu D, Wang P, Shi H. Efficacy and Timing of Neonatal Ear Correction Molding. Aesthetic Plast Surg 2020; 44:872-878. [PMID: 31965228 DOI: 10.1007/s00266-019-01596-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Qianger Zhuang
- Department of Otorhinolaryngology-Head and Neck Surgery, Wuxi Children's Hospital, Wuxi, Jiangsu, China
- Department of Otorhinolaryngology-Head and Neck Surgery, the Sixth People's Hospital affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China
| | - Ning Wei
- Department of Otorhinolaryngology-Head and Neck Surgery, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Qi Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Hui Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, the Sixth People's Hospital affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China
| | - Yaqin Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, the Sixth People's Hospital affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China
| | - Zhengnong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, the Sixth People's Hospital affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China.
| | - Dongzhen Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, the Sixth People's Hospital affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China.
| | - Pengjun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, the Sixth People's Hospital affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China.
| | - Haibo Shi
- Department of Otorhinolaryngology-Head and Neck Surgery, the Sixth People's Hospital affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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Pediatric Otoplasty: Does Surgical Specialty Training Affect Safety and Rates of Adverse Perioperative Events? J Craniofac Surg 2020; 31:1739-1742. [PMID: 32433130 DOI: 10.1097/scs.0000000000006533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Otoplasty remains an overlapping clinical domain of plastic surgery and otolaryngology. The purpose of this study is to objectively analyze the safety of otoplasty and determine if there are any risk factors, such as surgical training, associated with increased patient morbidity. METHODS Retrospective cohort study was conducted of otoplasty procedures performed in North America by plastic surgeons and otolaryngologists between 2012 and 2017 using the American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset. Statistical analysis was performed to analyze the relationships between comorbidities, congenital malformations, and postoperative complications. RESULTS There were 777 otoplasty procedures performed during the study period. Median age at time of surgery was 8.3 years (95% CI 7.9-8.7 years). Plastic surgeons performed 75.8% (n = 589) procedures and otolaryngologists performed 23.4% (n = 182). No significant (P = 0.952) difference in the occurrence of postoperative complications between surgical specialties was appreciated despite the fact that operative time was significantly longer in procedures performed by otolaryngologists (121 minutes versus 94 minutes, P < 0.001). Overall, 1.3% (n = 10 of 777) children experienced a complication, with the most common complication being superficial surgical site infection, occurring in 0.9% (n = 7 of 777) patients. There was no association of comorbidities (P all > 0.324) or congenital malformations (P all > 0.382) contributing to postoperative complications. Reoperation (0.8%, n = 6 of 777) and readmission (0.4%, n = 3 of 777) were uncommon; nevertheless, these adverse events were significantly associated with multiple inherent patient risk factors on multivariate regression. CONCLUSIONS Otoplasty is a relatively safe surgical procedure with similarly low complication and readmission rates when performed by plastic surgeons and otolaryngologists. Surgical site infection remains the most prevalent complication after otoplasty. Readmission and reoperation after otoplasty were significantly correlated to prematurity, structural pulmonary abnormality, alimentary tract disease, and seizure disorder.
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Hallac RR, Lee J, Pressler M, Seaward JR, Kane AA. Identifying Ear Abnormality from 2D Photographs Using Convolutional Neural Networks. Sci Rep 2019; 9:18198. [PMID: 31796839 PMCID: PMC6890688 DOI: 10.1038/s41598-019-54779-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 11/19/2019] [Indexed: 01/22/2023] Open
Abstract
Quantifying ear deformity using linear measurements and mathematical modeling is difficult due to the ear's complex shape. Machine learning techniques, such as convolutional neural networks (CNNs), are well-suited for this role. CNNs are deep learning methods capable of finding complex patterns from medical images, automatically building solution models capable of machine diagnosis. In this study, we applied CNN to automatically identify ear deformity from 2D photographs. Institutional review board (IRB) approval was obtained for this retrospective study to train and test the CNNs. Photographs of patients with and without ear deformity were obtained as standard of care in our photography studio. Profile photographs were obtained for one or both ears. A total of 671 profile pictures were used in this study including: 457 photographs of patients with ear deformity and 214 photographs of patients with normal ears. Photographs were cropped to the ear boundary and randomly divided into training (60%), validation (20%), and testing (20%) datasets. We modified the softmax classifier in the last layer in GoogLeNet, a deep CNN, to generate an ear deformity detection model in Matlab. All images were deemed of high quality and usable for training and testing. It took about 2 hours to train the system and the training accuracy reached almost 100%. The test accuracy was about 94.1%. We demonstrate that deep learning has a great potential in identifying ear deformity. These machine learning techniques hold the promise in being used in the future to evaluate treatment outcomes.
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Affiliation(s)
- Rami R Hallac
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States. .,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, 1935 Medical District Dr., Dallas, Texas, 75235, United States.
| | - Jeon Lee
- Department of Bioinformatics, UT Southwestern, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Mark Pressler
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - James R Seaward
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Alex A Kane
- Department of Plastic Surgery, UT Southwestern, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, 1935 Medical District Dr., Dallas, Texas, 75235, United States
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Lu DYD, Pauwels J, Jin L, Kozak FK, Chadha NK. Detection of abnormally shaped ears by a trained non-specialist allows for early non-surgical intervention. Int J Pediatr Otorhinolaryngol 2018; 110:22-26. [PMID: 29859580 DOI: 10.1016/j.ijporl.2018.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Many children are born with abnormally-shaped ears, including protruding ears or unusually-shaped outer ears. While the majority are benign, these may cause significant issues with self-esteem and bullying in childhood. Early molding can resolve some of these abnormalities, avoiding the need for future corrective surgery. However, newborns with these abnormalities are rarely identified early, within the first few days of life, when molding is most effective. In this study, we investigate whether a trained non-specialist can correctly identify ear shape abnormalities in newborns. METHODS A non-specialist (medical student) was trained on normal and abnormal ear anatomy using photographs and descriptions. Newborns <72 h of age were recruited from maternity wards. Newborns' ears were photographed and these images were assessed independently by two specialists and the non-specialist. External ear shape was classified as either normal or abnormal based on pre-determined criteria. RESULTS A total of 661 ears of 334 newborns were photographed and assessed. High inter-rater agreement was achieved with a kappa statistic of 0.863 (SE 0.078). The non-specialist detected abnormally-shaped ears with a sensitivity and specificity of 90.9% and 91.1% respectively. CONCLUSIONS Our study illustrates that non-specialist can be trained to accurately detect newborn ear abnormalities, providing a cost-effective means of ensuring that these children's health care needs are met in a timely fashion. Specifically, we recommend the integration of ear shape assessment into currently established programs such as the newborn hearing screening program.
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Affiliation(s)
- Daphne Y D Lu
- Faculty of Medicine, University of British Columbia, Canada; Division of Pediatric Otolaryngology-Head & Neck Surgery, B.C. Children's Hospital, Vancouver, Canada
| | - Julie Pauwels
- Division of Pediatric Otolaryngology-Head & Neck Surgery, B.C. Children's Hospital, Vancouver, Canada
| | - Lisa Jin
- Faculty of Medicine, University of British Columbia, Canada; Division of Pediatric Otolaryngology-Head & Neck Surgery, B.C. Children's Hospital, Vancouver, Canada
| | - Frederick K Kozak
- Faculty of Medicine, University of British Columbia, Canada; Division of Pediatric Otolaryngology-Head & Neck Surgery, B.C. Children's Hospital, Vancouver, Canada
| | - Neil K Chadha
- Faculty of Medicine, University of British Columbia, Canada; Division of Pediatric Otolaryngology-Head & Neck Surgery, B.C. Children's Hospital, Vancouver, Canada.
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Schultz K, Guillen D, Maricevich RS. Newborn Ear Deformities: Early Recognition and Novel Nonoperative Techniques. Semin Plast Surg 2017; 31:141-145. [PMID: 28798548 DOI: 10.1055/s-0037-1603958] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Congenital auricular anomalies are common sources of aesthetic concern and psychosocial distress for both children and their parents. Only one-third of these anomalies self-correct, leaving a large need for acceptable corrective methods. Otoplasty is often the standard treatment; however, newer nonsurgical methods, including splinting and molding in the neonatal period, have shown favorable results without the complications of surgical intervention and with the advantage of early intervention. These treatment options have not yet been widely adopted in Western countries due to delayed diagnosis of auricular deformities and confusion regarding treatment indications and technique.
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Affiliation(s)
- Kelly Schultz
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Diana Guillen
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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22
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Woo JE, Park YH, Park EJ, Park KY, Kim SH, Yim SY. Effectiveness of Ear Splint Therapy for Ear Deformities. Ann Rehabil Med 2017; 41:138-147. [PMID: 28289646 PMCID: PMC5344815 DOI: 10.5535/arm.2017.41.1.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/26/2016] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Ji Eun Woo
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Yul-Hyun Park
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Eun Ji Park
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Kyu Yong Park
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Sun Hee Kim
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Shin-Young Yim
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
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Fraser L, Starritt N, Melia L, Kubba H. Development of a screening service for neonatal ear deformity using neonatal hearing screeners and an information leaflet. Int J Pediatr Otorhinolaryngol 2013; 77:538-43. [PMID: 23411133 DOI: 10.1016/j.ijporl.2012.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/15/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Early splinting of neonatal ear deformities has been proven to be successful but the opportunity to splint is frequently missed due to lack of awareness amongst healthcare personnel. We aimed to develop a regional screening service using neonatal hearing screeners and an information leaflet to allow for the early detection and treatment of such children. METHODS We created an information leaflet that was distributed by hearing screeners to all parents in Greater Glasgow at the time of the child's neonatal hearing assessment, with a contact number allowing parents to self refer. All neonates referred were seen at a dedicated clinic within a week and suitability for splints determined. We aimed to assess acceptability of the service, splinting result as rated by parents and otolaryngologist and also costs involved. RESULTS Over a 15 month period, 13,403 leaflets were distributed. 88 babies were referred (0.7%) and 54 were found suitable for splinting. 78% of parents rated the efficacy of splints as either excellent or very good and 96% said they would recommend the service to a friend. Median age at first review was 4 days. We found a weak but statistically significant correlation between age at first review and the surgeon rated outcome from splinting (Spearman's rho=-0.321, p=0.038), with those babies commencing treatment early generally having a better splinting result. We also found that age at first review correlated with duration of splinting required (Spearman's rho=0.357, p=0.008), with younger babies generally requiring shorter splinting times. Cost analysis revealed a saving of £482.76 per child when comparing splint treatment to potential later corrective ear surgery costs. CONCLUSIONS Our screening service is both acceptable to parents and efficient in allowing for early correction of ear deformity in the majority of cases. By detecting treatable children early, we propose that the introduction of routine screening and splinting on a wider basis will avoid the psychological burden of ear deformity in childhood and also avoid the need for later corrective surgery.
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Affiliation(s)
- Lyndsay Fraser
- Department of Otolaryngology, Royal Hospital for Sick Children, Dalnair Street, Glasgow G3 8SJ, United Kingdom.
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