Public Perception of Helical Rim Deformities and Their Correction With Ear Molding

Cleft Lip Scar Appearance is Associated With Speech Outcomes After Primary Palatoplasty

OBJECTIVE

This study aims to investigate the correlation between the quality of cleft lip scar and velopharyngeal insufficiency (VPI).

METHODS

Clinical photographs from 56 patients with repaired cleft lip and palate (CLP) were collected and anonymized by cropping the image to the region of interest around the lip and nose. A survey displaying each cleft lip scar image with five associated scar quality features, including scar color, thickness, width, lip shortening, and overall appearance, was distributed. Surveys were distributed using Amazon Mechanical Turk (MTurk), an online crowdsourcing platform, to obtain ratings from 330 laypeople. The same surveys were also distributed to 45 medical students.

MAIN OUTCOME MEASURE

Hypernasality was used as the primary speech outcome measure. Ordinal logistic regression was used to compare the ratings for each of the five scar quality categories with the patients' CAPS-A-AM hypernasality rating for both MTurk and medical student raters. Significance was set at α = 0.05.

RESULTS

For medical student ratings', ordinal logistic regression showed a statistically significant relationship between lip shortening (P=0.019) and overall appearance (P=0.044) with CAPS-A-AM hypernasality score, whereas the other scar categories showed no significant association. There was no statistically significant relationship between MTurk ratings and hypernasality for any of the scar categories.

CONCLUSIONS

The association found between lip shortening and overall scar appearance, thought by the authors to indicate scar contracture, and hypernasality, an indicator of VPI severity, provides an interesting insight into how to potentially identify patients who may be at increased risk for developing VPI.

Nonsurgical Correction of Congenital Auricular Anomalies: Design and Effectiveness of the Ear Splint

Congenital auricular anomaly is a common problem for newborns. In recent years, the correction technology of ear molding has gradually become the mainstream therapy. Therefore, the purpose of this case report is to describe ear molding devices with low-temperature thermoplastic splints, designed by occupational therapists and called the Ear Splint for Taiwan, and to explore its effectiveness in treating newborns with congenital auricular anomalies. The ear splint is made by an occupational therapist based on the theory of corrective mechanics. The molded splint adjusts the ear to normal shape. Patients who received ear treatments at the Mennonite Christian Hospital in 2020 were enrolled as the subjects. A posttest research design was adopted in this case report to conduct a questionnaire survey among parents. The ear splint is a double C-shaped bracket. In this case report, there were two subjects in total, and two different types of malformed ears. According to the questionnaire survey, the average score of auricle shape improvement effectiveness after interventions were 5 and 4 points (5 excellent; 1 bad). The results of this case report indicate that it is feasible for occupational therapists to use the ear splint to mold the congenital auricular anomalies of newborns. Preliminary evidence shows that ear shapes can be corrected. The ear splint provides an early interventional therapy for newborns with congenital auricular anomalies in Taiwan.

Efficacy of Classic Ear Molding for Neonatal Ear Deformity: Case Series and Literature Review

Background: We analyzed an original case series of the classic ear-molding method and evaluated the efficacy and complication rate of the method compared to commercial ear-molding products by meta-analysis to draw conclusions on the efficacy of the classic method. Methods: From January 2019 to March 2022, we selected patients who underwent classic ear molding for newborn ear deformities at our institution and reviewed the patient age, treatment time, efficiency and complications. Additionally, the PubMed, EMBASE, and Scopus databases were searched, and meta-analysis (following the PRISMA guidelines) was performed. Results: In the case study, the success rate (excellent and good outcomes) of the classic ear-molding method was 92.6%. The mean age at application and mean duration of application were 5.81 ± 6.09 days and 32.13 ± 7.90 days, respectively. In the systematic review, the classic method group showed a statistically smaller success rate (proportion of 0.79) and statistically smaller complication rate (proportion of 0.05) than the commercial product group (proportion of 0.83). Conclusions: Compared with commercial products, classic ear molding has remarkable and comparable therapeutic effects on neonatal auricular deformities. Additionally, the classic ear-molding method is more suitable for infants with auricular deformities from socioeconomically vulnerable areas. Thus, the classic ear-molding method could be a better option for congenital ear anomalies than commercial ear-molding products.

Nonsurgical Correction of Congenital Ear Deformities: The Relationship Between Age of Presentation and Regression

PURPOSE

After 3 weeks of age, studies show ear molding to be unsuccessful due to increased regression rates. Studies have not differentiated success rates based on regression severity; partial regressions may be deemed successful and satisfactory by parents. We examined successful ear molding at different ages of presentation by measuring regression severity and parental satisfaction.

METHODS

Patients who presented to [blinded for review] for ear molding from January 2017 to October 2018 were eligible for inclusion. Molds were applied on the initial visit and monitored biweekly. Treatment length was based on age, deformity type, and severity. One month after treatment completion, parents completed a satisfaction survey where they assessed regression on a 3-point severity scale.

RESULTS

A total of 165 patients were included in this study. Sixty-seven were younger than 3 weeks of age and had an overall correction rate of 95%. The complete correction rate was 80% and only 5% saw complete regression. In the remaining 98, the overall correction rate was 94%, with a 63% complete correction rate. Only 6% saw complete regression. There was no statistical significance in parental satisfaction, perceived improvement, or likelihood to recommend ear molding between age groups.

CONCLUSIONS

Regression rates are higher in children older than 3 weeks although not statistically significant. Most regressions were partial and ear molding still significantly corrected most deformities. We suggest that ear molding be offered past 3 weeks of age, with maximum age being dependent on deformity type, as it still leads to high parental satisfaction.

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.

Non-Surgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes

INTRODUCTION

Congenital ear anomalies result from cartilage and skin compression in utero. They can be corrected in infancy before the cartilage hardens and loses its malleability. Caretaker burden of ear molding and its impact on esthetic outcomes has not been studied.

METHODS

Demographic and procedural variables were retrospectively collected for infants who underwent ear molding. Parents were surveyed regarding their experience, caretaker burden, and esthetic outcome. Outside physicians were provided with pre- and post-treatment photographs and asked to rate outcomes. A Likert scale was developed for responses and converted to a numeric score from 1 to 5 with 5 as the most desirable.

RESULTS

Seventy-four patients comprising 121 ears were included. Mean age at treatment was 20.1 ± 21.4 days with treatment duration of 21.1 ± 7.7 days. Parental participation in the survey was 70.1%. Questions that queried parents' experiences revealed a "very positive" experience with minor burden related to bathing and cleaning (Mean Likert Score 4.1, Range 1-5). Favorable parent-reported outcomes were obtained regarding anticipated social distress (4.28, 1-5), satisfaction with results (4.27, 1-5), and perception of final appearance (4.18, 1-5). Physician assessments of esthetic outcomes were slightly lower, but favorable between "somewhat effective" and "very effective" (3.46, 1-5). Earlier treatment trended favorably, but did not reach significance. Ear malformations had higher parent-reported satisfaction than ear deformations (4.75 ± 0.46 vs 4.21 ± 1.25, p = 0.025).

CONCLUSION

Despite the additional obligation for new parents, infant ear molding is rated low in terms of caretaker burden. Esthetic outcomes are excellent as assessed by parents and physicians. However, caretakers reported higher esthetic outcomes than physician evaluations.

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.

Using ear molding to correct auricular helix adhesion deformity

OBJECTIVES

This study examined the effectiveness of Byrd's EarWell system for the treatment of auricular helix adhesion.

METHODS

The newborns with helix adhesion were treated with ear molding. The photos of pinna were taken before, during, and after the treatment. The immediate and long-term outcomes, as well as the complications, were assessed by two independent plastic surgeons.

STUDY DESIGN

A retrospective study. Data on family history, neonatal weight, gestational age, delivery method, laterality, gender, age of initiating treatment, medical comorbidities, duration of treatment, and follow-up time were collected.

STUDY SITE AND PERIOD

From 2019 to 2021, infants treated with the EarWell System in the Eye and ENT Hospital of Fudan University were enrolled in this study.

RESULTS

A total of 46 newborns (66 ears) with helix adhesion were included. The average onset time of treatment was 4.57 ± 3.63 weeks. The average duration of treatment was 7.40 ± 2.05 weeks. 97.0% ears' (64/66) immediate results were excellent or good. During long-term follow-up, 95.5% ears achieved excellent or good outcomes. Age of initiation treatment significantly affected immediate (p = 0.001) and long-term (p = 0.004) outcomes.

CONCLUSIONS

EarWell System was an effective method to correct auricular helix adhesion. Using this approach, patients with helix adhesion could avoid surgeries. Age of initiation treatment was the predictor of successful correction.

Consumer Awareness and Comfort with Resident-run Cosmetic Clinics: A Crowdsourcing Study

Background:

Resident cosmetic clinics (RCCs) are the training modality of choice among both residents and faculty and are a mainstay at most residency programs.^1–4 Despite this, knowledge of RCCs among plastic surgery consumers remains untested. We hypothesize that the public would be aware of and receptive to RCCs.

Methods:

Participants with prior cosmetic procedures or interest in future cosmetic procedures were recruited using Amazon Mechanical Turk and asked to complete a survey in September 2020. First, prior awareness of RCCs was assessed. After a brief description of RCCs, perceptions of safety and preferences for care were assessed.

Results:

After screening for quality, 815 responses were included. Forty-five percent of consumers were aware of RCCs. Seventy-six percent of consumers believed that RCCs were just as safe as attending clinics and 65% were comfortable receiving care from fourth-year residents or higher. Belief in RCC safety was associated with 4.8 times higher odds of feeling comfortable receiving care at an RCC [95% confidence interval (3.3–7.1), P < 0.001]. When given a hypothetical choice between residents and attendings in two scenarios, 46% of consumers chose residents for abdominoplasty and 60% chose residents for Botox injections. Belief in RCC safety was associated with choosing a resident or being indifferent in both scenarios.

Conclusions:

Consumer preference regarding RCCs has largely been untested. This study shows that belief in RCC safety influences consumers’ perceived comfort with receiving care at an RCC. This knowledge can help guide RCC practice and maximize learning opportunities for surgeons-in-training.