Non-surgical correction of cryptotia and the analysis of treatment time and other influence factors

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 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.

[Nonsurgical correction of cryptotia in children older than early neonates]

Objective:To study the clinical application of nonsurgical correction of cryptotia in children older than 6 months. Methods:The children with cryptotia deformity treated in Guangzhou Women and Children's Medical Center from January 2017 to January 2021 were divided into two groups according to their ages. The study group was over 6 months old and the control group was under 6 months old. They were treated with a Earwell auricle correction system, the follow-up was continued for 3-6 months, and the correction effects, complications and recurrence after the treatment were calculated in the two groups. Results:The average time of the treatment start stage and consolidation stage in the study group was（20.29±7.14） days and（31.82±9.65） days, and respectively the control group was（7.5±3.21） days and（16.64±6.53） days, the difference in treatment time between the two groups was statistically significant（P=0.001）. The effective rate in the study group was 90.91%（20/22）, and the effective rate in the control group was 96.43%（27/28）, there was no statistically significant difference between the two groups（P=0.576）. The recovery rate in the study group was 31.82%（7/22）, and the recovery rate in the control group was 85.71%（24/28）, the cure rate of the control group was higher than that of the study group（P=0.002）. Complications occurred in both groups. The most common complications in the study group were skin redness and swelling 18 cases（81.82%） and stent shedding 16 cases（72.73%）, pressure ulcers followed by 12 cases（54.55%）. The most common complication in the control group was skin eczema 9 cases（32.14%）, pressure ulcers 6 cases（21.43%）, stent shedding 5 cases（17.86%）. There was a statistical difference in the incidence of complications between the two groups（P<0.05）. Conclusion:For older children with cryptotia, Earwell correction systems can still be actively tried to correct hidden ears, but only the hidden auricle can be pulled out. Other combined malformations such as helix adhesion, dysplasia of the upper helix, etc. cannot be improved. Before treatment, it is necessary to fully communicate with the parents about possible complications during the treatment process. Encouraging children and parents to insist on wearing the correction system is the key to successful treatment.