A Morphometric Study of the Newborn Ear and an Analysis of Factors Related to Congenital Auricular Deformities:

Efficiency of ear molding for treating constricted ears of different severity

PURPOSE

To investigate the treatment time and efficiency of constricted ears of different severity after correction.

MATERIALS AND METHODS

We included the patients with constricted ear presented to our hospital for treatment between December 2021 and December 2023 in this retrospective analysis. The patients were divided into class I, II and III groups based on the severity of the constriction. Then we collected the data on classification of severity from each patient, together with sex, family history, age at initial correction, being informed upon diagnosis after birth, as well as utilization of auricle correction system. Logistic regression analysis was performed to identify the factors associated with the treatment time and efficiency.

RESULTS

The correction system yielded a high effective rate in the constricted ears. The treatment time in class II was significantly longer compared with those of class I after adjusting these parameters. Compared with the cases of class I, those with a class III showed significant attenuation in the symptoms and conditions (95 % CI: 0.034, 0.365; P < 0.001), after adjusting the age at initial correction, being informed upon diagnosis after birth, and utilization of auricle correction system. There were no statistical differences between class II and III in the treatment efficiency after correction.

CONCLUSIONS

The Amazing Ear Correction System was effective in treating constricted ear, yielding satisfactory treatment efficiency. Patients with class II constriction required longer treatment time compared with those of class I. The treatment outcome in the class I constriction was better than that of class III.

Auricular Deformational Anomalies Detected in Human Fetal Cadavers

The aim of the study was to investigate the incidence and diversity of deformational auricular anomalies in human fetuses based on their morphologic appearances. A total of 100 auricles from 56 formalin-fixed fetuses (32 female and 24 male), gestational ages ranging from 17 to 36 weeks, were examined. The auricles were categorized according to the morphologic deformities outlined in existing literature. Of the samples analyzed, 67% exhibited auricular deformities, while the remaining 33% showed no auricle anomalies. Among the auricles with deformities, 73% displayed a single type of deformity: Conchal crus, 22%; Stahl's ear, 13%; inverted conchal bowl, 13%; lidding ear, 12%; cup ear, 7%; and constricted ear, 6%. In addition, 27% of the auricles exhibited 2 different deformities on the same side: Conchal crus with lidding ear, 10%; conchal crus with Stahl's ear, 5%; conchal crus with the antihelix 3rd crus, 3%; constricted ear with lidding ear, 5%; constricted ear with cup ear, 2%; and constricted ear with inverted conchal bowl, 2%. The most prevalent deformity was conchal crus, whereas cup ear was the least. Among the fetuses, 10 had bilaterally normal auricles, 8 had unilaterally normal auricles, 12 exhibited the same deformity bilaterally, and 14 displayed different deformities on each side. Auricular deformational variations can vary in shape and symmetry, even in morphologically normal fetuses. Identifying these deformities can contribute to accurate diagnosis and treatment planning for such anomalies in newborns.

The Ideal Proportion of the Auricle Exposure via a Morphometric Analysis in Asian Women

BACKGROUND

Ears are an important aesthetic feature that is vital to the overall attractiveness of the face. Although there have been many studies on the aesthetics of the auricle, there is currently a lack of consensus on the ideal proportion of auricle exposure for Asian women in frontal view.

OBJECTIVES

This study aimed to investigate ideal proportion of auricle exposure in Asian women.

METHODS

An observational study was carried out on the photographs of 84 women on the list of the 100 most beautiful faces in Asia (published by TCC Asia in 2020). The proportion of the distance between the outer canthus and the outermost point of auricle to the distance between the inner canthus and the outermost point of auricle was calculated as the auricle exposure proportion. Evaluators were asked to rank a set of photographs of the volunteer with varying auricle exposure proportions from most attractive to least attractive.

RESULTS

Measurements of the photographs of the 84 women showed a mean ear exposure proportion of 0.600. With 487 questionnaire responses received, the proportion of auricle exposure that the evaluators considered most attractive was 0.600. People with aesthetic experience considered 0.625 the most attractive proportion, while the general group considered 0.600 the most attractive.

CONCLUSIONS

The ideal proportion of the auricle exposure for Asian women is in the range of 0.60-0.625, which may help surgeons reconstruct aesthetically pleasing ears.

LEVEL OF EVIDENCE V

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 .

Customized Orthosis for Nonsurgical Correction of Congenital Auricle Deformities in Newborns

SUMMARY

A misshaped pinna, caused by extrinsic pressures such as birth canal extrusion or incorrect position, is a common congenital auricular deformity in newborns. Surgery is a routine option to address this deformity, but it is traumatic and may lead to unacceptable aesthetic outcomes. Commercial ear mold orthoses with uniform size have been used for nonsurgical orthotic treatment, but are not applicable in all cases, depending on the auricle morphology. The authors used computer-aided design and three-dimensional (3D) printing technology to develop a novel customized orthosis for congenital auricular deformities. 3D ear models were constructed using computer-aided design software and a novel customized orthosis model was established after a process of correction, adjustment, and construction, with precise matching to allow tight attachment to the outer ear free from uneven skin pressing. After 3D-printing a customized orthosis injection mold, medical silicone injection molding was used to produce customized orthoses. Clinical application was conducted in 3 newborns and achieved satisfactory results. This novel customized auricle orthosis is an effective option for nonsurgical correction of a misshaped pinna.

Evaluation of the Reproducibility of Auricular Subunit Markers Based on Three-Dimensional Computed Tomography

BACKGROUND

As a facial feature, the auricle plays an important role in the integrity and aesthetics of the whole face. Auricular subunits are associated with patient satisfaction in auricular reconstruction, but there are few studies on auricular subunits. We want to evaluate the reproducibility of auricular subunits by measuring the coordinates of the marker points of auricular subunits, accordingly provide a reference for the improvement of auricular reconstruction and the aesthetics of auricular injection.

METHODS

Mimics 19.0 was used to carry out three-dimensional (3D) reconstruction of the computed tomography (CT) scan data of patients' brains; measure the three-dimensional coordinates of the 13 auricular subunit markers, the morphological auricle length and width, and the physiological auricle length and width; and analyze the reproducibility as well as the differences between group.

RESULTS

Reproducibility of auricle subunit markers: There are 1124 (58.82%) high reproducibility, 580 (30.35%) moderate reproducibility, and 207 (10.83%) low reproducibility. The superior tragus notch, tragus, and antitragus had the highest reproducibility. There was no significant difference between the groups in the marking points on the helix, and there were no statistically significant differences in the measurement values of the auricles on the two sides. The physiological ear length and width and the morphological ear length of males were larger than those of females. These showed significant differences between the age groups.

CONCLUSION

Most auricular subunit markers have high reproducibility. The subunits with higher reproducibility are the structures that need to be optimized during auricle reconstruction surgery or auricle injection in the future.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

A three-dimensional algorithm for precise measurement of human auricle parameters

Measurement of auricle parameters for planning and post-operative evaluation presents substantial challenges due to the complex 3D structure of the human auricle. Traditional measurement methods rely on manual techniques, resulting in limited precision. This study introduces a novel automated surface-based three-dimensional measurement method for quantifying human auricle parameters. The method was applied to virtual auricles reconstructed from Computed Tomography (CT) scans of a cadaver head and subsequent measurement of important clinically relevant aesthetical auricular parameters (length, width, protrusion, position, auriculocephalic angle, and inclination angle). Reference measurements were done manually (using a caliper and using a 3D landmarking method) and measurement precision was compared to the automated method. The CT scans were performed using both a contemporary high-end and a low-end CT scanner. Scans were conducted at a standard scanning dose, and at half the dose. The automatic method demonstrated significantly higher precision in measuring auricle parameters compared to manual methods. Compared to traditional manual measurements, precision improved for auricle length (9×), width (5×), protrusion (5×), Auriculocephalic Angle (5-54×) and posteroanterior position (23×). Concerning parameters without comparison with a manual method, the precision level of supero-inferior position was 0.489 mm; and the precisions of the inclination angle measurements were 1.365 mm and 0.237 mm for the two automated methods investigated. Improved precision of measuring auricle parameters was associated with using the high-end scanner. A higher dose was only associated with a higher precision for the left auricle length. The findings of this study emphasize the advantage of automated surface-based auricle measurements, showcasing improved precision compared to traditional methods. This novel algorithm has the potential to enhance auricle reconstruction and other applications in plastic surgery, offering a promising avenue for future research and clinical application.

Analysis of the effect and influencing factors of EarWell auricle orthosis in the treatment of congenital auricle deformity in children

OBJECTIVE

To observe the efficacy of EarWell ear orthosis in treating children with different types of ear deformities.

METHODS

We selected 80 children aged <6 weeks with ear deformities (110 ears: 15, 30, 21, 25, and 19 ears with prominent ear, lop ear, cup ear, cryptotia, and helical rim deformity, respectively). Differences in effectiveness rate, treatment time, and incidence of complications among children with different types of auricular deformities were compared. Recurrence rates at 1 and 3 months after the treatment were compared.

RESULTS

The overall success rate was 92.73 %, and the treatment effectiveness rate did not differ significantly among the children with different types of auricular malformations (P > 0.05). The correction time of the helical rim deformity was the shortest, and the correction times of the prominent and cup ears were significantly longer than those of the other groups (P < 0.05). The incidence of complications associated with helical rim deformity and lop ear was lower, and the incidence of prominent and cup ear complications was significantly higher than that in the other groups (P < 0.05). The recurrence rate in children with prominent and cup ears was higher at 1 and 3 months after correction, and children with a lop ear and cryptotia showed no recurrence at 1 and 3 months after treatment, which correlated with the correction time, incidence of complications, and recurrence rate (P < 0.05) CONCLUSION: The EarWell auricle orthosis is an effective treatment in children with auricular morphological malformations. Correction time, complication rate, and recurrence rate were related to the malformation type.

A publicly available newborn ear shape dataset for medical diagnosis of auricular deformities

Early and accurate diagnosis of ear deformities in newborns is crucial for an effective non-surgical correction treatment, since this commonly seen ear anomalies would affect aesthetics and cause mental problems if untreated. It is not easy even for experienced physicians to diagnose the auricular deformities of newborns and the classification of the sub-types, because of the rich bio-metric features embedded in the ear shape. Machine learning has already been introduced to analyze the auricular shape. However, there is little publicly available datasets of ear images from newborns. We released a dataset that contains quality-controlled photos of 3,852 ears from 1,926 newborns. The dataset also contains medical diagnosis of the ear shape, and the health data of each newborn and its mother. Our aim is to provide a freely accessible dataset, which would facilitate researches related with ear anatomies, such as the AI-aided detection and classification of auricular deformities and medical risk analysis.

The application of the strip-shaped cymba conchae orthosis in the nonsurgical correction of complex auricular deformity

Objective

This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities.

Methods

Clinical data were collected from 2020 to 2021 for 6 patients who underwent correction using a strip-shaped cymba conchae orthosis. The indications, corrective effects, and complications associated with use of the orthosis were analyzed.

Results

There were four indications for treatment: cryptotia with helix adhesion; cryptotia with grade I microtia; cryptotia with excessive helix thickness; and auricular deformity beyond the treatment time window (≥6 months). Excellent corrective effects were observed in all 6 patients. Complications occurred in one patient, who recovered after symptomatic treatment.

Conclusion

The use of a strip-shaped cymba conchae orthosis alone or combined with a U-shaped helix orthosis presents a feasible approach for correcting complex auricular deformities or deformities beyond the treatment time window in pediatric patients.

Congenital ear malformation (CEM)

BACKGROUND

At present, there are not international unified standards and reports on Congenital Ear Malformation (CEM) in the world, which makes it difficult to transfer information and compare the literature.

AIMS/OBJECTIVES

Through the statistical analysis of a large sample of CEM, a unified standard of all aspects of CEM is proposed and the data are provided for reference, which is convenient for the international work and literature comparison in this field.

MATERIALS AND METHODS

Based on the author's 30 years of clinical and scientific research work on CEM and the relevant cases of 3231 (4714 ears) in our hospital, and combined with literature, statistical analysis was made.

RESULTS

This paper summarizes the classification, definition, epidemiology, embryonic development, pathogenic factors of CEM and elaborates on the clinical manifestations, examination and sequence therapy of representative Congenital Malformation of the Middle and Outer Ear (CMMOE). We also introduce malformation of the auricle and inner ear, so as to cover the outer, middle and inner ear. At the same time, we introduce our achievements and contributions in this field.

CONCLUSIONS AND SIGNIFICANCE

This study provides reference to the international unified standard and treatment principle of the CEM.

Changes of Age-related Auricular Cartilage Plasticity and Biomechanical Property in a Rabbit Model

OBJECTIVES

Ear molding is an emerging technique that can correct auricular deformities. Treatment initiation time is the most important prognostic determinant of ear molding. Here, we aimed to examine why auricular cartilage plasticity appeared to diminish with age. Thus, we characterized age-related changes in the biomechanical, biochemical, and morphological properties of auricular cartilage.

METHODS

New Zealand rabbits were used as the experimental animal. We examined immature [postnatal 0 day (P0), 5 days (P5), 15 days (P15)], young [2 months (2M)], and mature [6 months (6M)] rabbits. Rabbits' ears were splinted and folded using adhesive fixation strips. Folding duration ranged from 1 day to 5 days to 10 days. Photographs were taken to calculate the retained fold angle. Cartilage morphology and extracellular matrix (ECM) content were examined histologically (using hematoxylin-eosin, Safranin O, elastic Van Gieson, and Masson's trichrome). Water content, DNA content, and cell density were also analyzed. Biomechanical properties were measured using a Nano indenter.

RESULTS

Immature ears had smaller angles after strip removal, and the angled deformation lasted a longer time. Cartilage matrix compositions, including glycosaminoglycan (GAG), elastin fiber, and collagen, increased over development. The water content, DNA content, and cell density decreased with age. Young's modulus was significantly higher in mature cartilage.

CONCLUSIONS

Here, we successfully established an animal model of ear molding and demonstrated that immature cartilage was associated with better plasticity. We also found that the cartilage's biomechanical property increased with the accumulation of ECM. The biomechanical change could underlie age-related shape plasticity.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:88-94, 2023.

External ear anatomy and variations in neonates

It is aesthetically important that the auricle has a natural and beautiful shape. The sizes, position and symmetry of normal auricle are used for different purposes in different disciplines. A deformation in the auricle of neonates and its size or location on the face may indicate a possible anomaly. The aim of this study is to investigate the normal sizes, anomaly types, anomaly rates and the relationship between hearing screening test results and auricular anomaly of the neonatal auricle. The length, width, angle, and distance measurements of the auricle were made in neonates (n = 550). Anomaly types of auricle were observed. Goniometer was used to measure angles; digital caliper and ruler were used to measure lengths. Anomalies were detected by the method of observation. In the morphometric data of the neonatal auricle, differences were determined in length and width values in terms of gender. Various types of anomalies were observed in the right ear of 96 participants and in the left ear of 103 participants. Normal auricle size, position and symmetry are important for surgical reconstructions, hearing aid design, producing data banks on gender, age and ethnicity, and providing reference information for multiple diagnostic and forensic procedures. Recognition and early detection of auricular anomalies play an essential role in clinical diagnosis and their correction with special devices.

Noninvasive ear molding in the correction of ear anomalies: A systematic review and meta-analysis

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.

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.

Nonsurgical molding of congenital auricular deformities and analysis of the correction outcomes: A single-center, retrospective study in east China

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.

Ear Deformations in Preterm Newborns: Non-Surgical Treatment

ABSTRACT

Approximately 30% of newborns have some degree of congenital ear anomalies, the minority will resolve spontaneously. Deformations can be treated non-surgically, when diagnosed early, whereas malformations surgically only. The authors use the EarWell system proven to achieve excellent results in treating deformations. Although prematurity might raise the risk of ear-deformations compared to term infants, in our experience, there is a longer time frame until effective treatment is initiated due to the cartilage malleability.Treatment included splinting with retractors and taping or a custom-made silicone ear-mold if necessary. Patients were examined weekly, and treatment continued until appropriate ear shape was achieved (6-14 weeks).The authors treated 8 preterm infants during 2018 to 2020 with the above method. Average age of application was 9.25 weeks; treatment was initiated in all patients before the age of 12 weeks. 5/8 had a right-side, 2/8 a left-side, and one a bilateral deformation. Average treatment duration was 10 ± 2.9 weeks. Assessment of satisfaction was made by parents via phone questionnaires; most were pleased with the overall result, while 62% were extremely satisfied.The authors observed higher compliance and longer-lasting malleability of the cartilage in preterm compared to term-infants. They also had fewer complications than in the term group, maybe due to their older (actual age), and more resistant and durable skin compared to a term-infant of the same age. The authors recommend initiating treatment in preterm infants later than accepted practice as results were excellent, and despite the longer treatment duration, this is a better treatment option than surgery.

A longitudinal study of changes of congenital auricular deformity regarding self-correction

This study aimed to investigate the factors associated with congenital auricular deformities and evaluate the long-term frequency of their self-correction. Ninety newborns were enrolled in the study, and data were collected within 2 weeks after birth and at 1 year. The shape of the auricle was classified into seven categories using a digital image. At 2 weeks after birth, several birth-related factors were evaluated in the auricular deformity and normal groups. At 1 year after birth, the images of auricles were compared with the images at birth, and the changes in the auricle shape were investigated. Congenital auricular deformities were observed in 139 out of 180 ears, and the major type noted was helix rim deformity (47 ears), followed by normal ears (41 ears), and cup ears (33 ears). Male sex was found to have a statistically significant association with the occurrence of auricular deformity. In the longitudinal study, among 43 neonates (86 ears) followed-up 12 months later, the self-correction rate was approximately 50%. The normal auricle and prominent ear increased, helix rim deformity and cup ear decreased significantly. The prognosis of deformity varied depending on the type of deformity. Considering the low self-correction rate in the prominent and cup ears, newborns with these deformities might be recommended to undergo management such as auricle molding technique, as required.

3D Technique-Based Nonsurgical Correction of Deformational Congenital Auricular Deformities

INTRODUCTION

Congenital auricular deformity (CAD) is a common postpartum deformity, and nonsurgical correction of CAD has been recognized as a safe and effective approach. Three-dimensional (3D) technique has been used in surgical reconstruction of unilateral microtia; however, 3D technique used in nonsurgical correction for deformational CAD has not been reported.

METHODS

In this study, 12 CAD patients aged from 0.6 to 7 months with 16 deformational CAD were treated with 3D technique-based personalized nonsurgical correction (3D-NSC). Patients' CAD was photographed pre- and post-correction, and clinical outcome was evaluated as poor, fair, good, and excellent by comparing pre- and post-correction pictures. Different kinds of tests were used to analyze the data.

RESULTS

All patients got an improved auricle shape (10 excellent, 2 good, and 4 fair). Multivariate regression analysis showed that CAD type was significantly associated with correction outcome, sex and age were significantly associated with correction outcome for the 11 constructed types of CAD, and age was significantly associated with the correction outcome when we focused on the male constructed auricles.

CONCLUSION

3D-NSC provided a significant nonsurgical clinical treatment for CAD patients, with younger patients getting better clinical outcomes with shorter correction time.

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.

Nonoperative Molding of Congenital Ear Deformities: The Impact of Birth-Initiation Delay on Correction Outcome

Ear molding can improve the majority congenital ear deformities when employed early after birth. However, the best time to initiate treatment remains debated. In describing one surgeon's experience over the past near decade, this study aims to highlight differences conferred by treatment timing. The authors hypothesize that auricular outcomes are superior when deformities are molded beginning in the first 3 weeks of life. A retrospective review (2010-2018) of 272 cases was performed to compare early initiation of molding (<3 weeks of birth) and delayed initiation (>3 weeks). The mean patient age was 20.4 days and the mean follow-up was 0.5 months. The overall treatment was approximately 31 days. The number of devices required was similar (2.3 versus 2.5) between early and delayed molding cases, but fall-outs (1.0 versus 0.7, P = 0.02) and replacements (0.9 versus 0.6, P = 0.004) were more common after delayed molding. Skin complications developed in 13.6% (37) of ears overall and did not differ by treatment timing. Follow-up surgery was reported in 2 (0.7%) ears. The 85% of families reported subjective satisfaction with the final outcome; satisfaction was significantly higher for early cases (97% versus 79%, P = 0.03). Ear molding of congenital ear deformities should begin within 3 weeks of birth. From our experience, setting realistic expectations helps limit discrepancies between expectation and outcome.

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.