Neonatal Ear Molding: Timing and Technique

Double-Layer Traction Method for Treating Severe Upper Auricular Adhesion Malformation in Infants: A Prospective Randomized Controlled Study

BACKGROUND

Severe upper auricular adhesion malformation poses a significant challenge for complete correction through ear molding. This prospective randomized controlled study aimed to assess the efficacy of a new method in addressing severe upper auricular adhesions.

METHODS

In this non-blinded randomized controlled study, we enrolled 72 infants with severe upper auricular adhesion malformation who underwent treatment with the EarWell system. They were randomly assigned to either the double-layer traction (DLT) group or the control group. We compared the effectiveness of treatment, treatment duration, and potential complications between the two groups.

RESULTS

All 72 infants completed the treatment and follow-up, with 38 (52.8%) in the DLT group and 34 (47.2%) in the control group. The DLT group exhibited significantly shorter treatment times and a lower incidence of pressure sores than the control group. The DLT method, along with unilateral malformation, independently predicted positive long-term outcomes.

CONCLUSIONS

The DLT method demonstrated superior effectiveness, shorter treatment duration, and lower complication rates than traditional methods when treating severe upper auricular adhesion malformation in infants. The DLT method is safe and effective and merits broader adoption in clinical practice.

LEVEL OF EVIDENCE II

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.

The Prevalence and Awareness of Congenital External Ear Deformity among the School-Age Group: A Cross-Sectional Study

INTRODUCTION AND PURPOSE

 Congenital outer ear deformities stem from a sequence of disturbances during fetal auricular cartilage embryonic development. A significant gap exists in understanding their prevalence among the school-age group in Saudi Arabia. This cross-sectional study aims to address this knowledge gap to raise awareness about the impact of such disorders.

METHODOLOGY

 This cross-sectional study targeted parents of children in the school-age group. A multistage cluster sampling technique was employed to ensure the representation of schools. A self-administered Google form survey was used. Data were analyzed using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, NY).

RESULTS

 Our study revealed that the majority were males (56.2%), aged 6 to 10 years (49.3%), and attended primary school (69.5%). Chronic illnesses were present in 7.1% of children, with hearing impairment most prevalent (25.9%). Congenital ear deformities affected 2.7% of children, primarily Stahl's ear (35.4%). Limited knowledge about these deformities was observed among respondents (30.3%), yet a significant majority (73.9%) expressed belief in the potential of community awareness to decrease deformity prevalence. The awareness levels were impacted by parental education but showed no significant association with the child's age, gender, or presence of chronic diseases.

CONCLUSION

 Our study underscores the noteworthy occurrence of congenital ear deformities among the school-age group, coupled with a notable lack of awareness. Parental education emerges as a key factor influencing awareness levels. It is imperative to prioritize initiatives to bolster awareness and early detection to promote child health.

The non-operative correction of ear anomalies in infants using the EarWell infant corrective system in the Netherlands

BACKGROUND

Congenital ear anomalies are regular but often overlooked occurrences. The golden standard of treatment has been to surgically correct these anomalies at a minimum age of 5 to 7 years. As of the last century, ear molding has developed to be a safe, reliable, and effective treatment method. Different treatment methods are still under investigation. This study aims to investigate the use of the EarWell Infant Corrective System in the Dutch population.

METHODS

Children aged 0-12 weeks were included in the Zuyderland Medical Center to be treated with the EarWell Infant Corrective System in case of ear deformations. Every 2 weeks, the system was replaced and correction was evaluated by both physician and parents.

RESULTS

Seventy-three participants were included, of whom 123 ears in total were treated. Age at initiation was 35.5 days on average; treatment lasted an average of 59 days. Parents and physicians both reported an amelioration of all ear anomalies after treatment, scoring the correction grade an 8.8. Overall satisfaction with the treatment method was 9 or higher for both groups.

CONCLUSIONS

The EarWell Infant Corrective System is a safe, reliable, and effective treatment method for the correction of ear anomalies in infants.

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.

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.

Ear Molding for Congenital Auricular Deformities: Efficacy and Factors Affecting Outcomes

Objective: This study's aim was to assess the effectiveness of ear molding for congenital auricular deformities, analyze the factors affecting prognosis, and provide more clinical data supporting nonsurgical correction for this condition. Methods: A prospective study of a consecutive series of infants treated with ear molding from January 2021 to December 2022 in the department of otolaryngology, Second Affiliated Hospital of Harbin Medical University, was conducted. Demographic and clinical information were collected, and photographs of the ear were taken before and after treatment. Treatment efficacy and the relevant influencing factors were evaluated. Results: Thirty-five patients, including 59 with congenital ear anomalies, underwent noninvasive ear molding. The deformity type, treatment initiation age, and number of treatment cycles affected treatment efficacy. Earlier treatment initiation was associated with a shorter treatment period. Treatments were started earlier if decision-makers were more anxious. Conclusion: The earlier the neonatal auricle deformity is treated, the shorter the treatment time and the more ideal the clinical effect will be. Early noninvasive treatment for microtia is valuable. Early detection and parental awareness and education can help children receive treatment earlier and improve the success rate.

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.

Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain

OBJECTIVE

This study compares patients undergoing early cleft lip repair (ECLR) (<3-months) and traditional lip repair (TLR) (3-6 months) with/without nasoalveolar molding (NAM) to evaluate the effects of surgical timing on weight gain in hopes of guiding future treatment paradigms.

DESIGN

Retrospective review.

SETTING

Children's Hospital of Los Angeles, California.

PATIENT, PARTICIPANTS

A retrospective chart review evaluated patients who underwent ECLR or TLR ± NAM from November 2009 through January 2020.

INTERVENTIONS

No intervention was performed.

MAIN OUTCOME MEASURE(S)

Patient demographics, birth and medical history, perioperative variables, and complications were collected. Infant weights and age-based percentiles were recorded at birth, surgery, 8-weeks, 6-months, 12-months, and 24-months postoperatively. The main outcomes were weight change and weight percentile amongst ECLR and TLR ± NAM groups.

RESULTS

107 patients met inclusion criteria: ECLR, n = 51 (47.6%); TLR + NAM, n = 35 (32.7%); and TLR-NAM, n = 21 (19.6%). ECLR patients had significantly greater changes in weight from surgery to 8-weeks and from surgery to 24-months postoperatively compared with both TLR ± NAM (P < .05). Age-matched weights in the ECLR group were significantly greater than TLR ± NAM at multiple time points postoperatively (P < .05).

CONCLUSIONS

ECLR significantly increased patient weights 24-months postoperatively when compared to TLR ± NAM. Specifically compared to TLR-NAM, ECLR weights were significantly greater at all time points past 6-months postoperatively. The results of this study demonstrate that ECLR can mitigate feeding difficulties and malnutrition traditionally seen in patients with cleft lip.

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.

Nonsurgical Correction of Stahl's Ear in Neonates: A Case Study

Stahl’s ear deformity is a congenital auricular anomaly characterized by a third crus in the auricular cartilage, giving rise to an irregular helical rim and a bent scaphoid fossa. This deformity is mainly treated surgically during childhood. However, studies regarding ear-molding techniques show that postpartum splinting offers a safer and more effective permanent correction, and that happens because of the high circulating levels of estrogen that neonates receive from their mothers right after birth, making the cartilage more malleable. We present a case that shows a newborn with unilateral Stahl’s ear deformity, in which we used a molding device (EarBuddies) to permanently correct the ear’s shape. After 3 weeks of treatment, the affected auricle regained its normal appearance. There were no complications. Long-term follow-up showed no recurrence. Splinting of this ear deformity seems to be a nonpainful, stress-free and, most importantly, effective nonoperative treatment. Postpartum clinical examination of the ears is crucial, as the sooner the nonsurgical correction of the deformity begins, the better the results are. A clinical screening for ear deformities should be established immediately after every child’s birth to eliminate the risk for surgical intervention later in childhood.

Treatment of congenital auricle malformation with EarWell Ear Correction Kit: A meta-analysis

OBJECTIVE

The effectiveness of EarWell Ear Correction Kit in the treatment of congenital auricle malformation and the incidence of complications are not particularly clear, so we carried out this study to provide a better reference for plastic surgeons to use EarWell Ear Correction Kit in the treatment of congenital auricle malformation.

METHODS

We searched the Chinese and English databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases.

RESULTS

Through this meta-analysis, we found that the effective rate of EarWell Ear Correction Kit was 89.1%. The incidence of complications using EarWell Ear Correction Kit for correction of congenital auricular deformity was 11.4%. In terms of complications, the incidence of skin lesions was 9% and the incidence of dermatitis was 3.4%.

CONCLUSION

EarWell Ear Correction Kit has high efficiency in the correction of congenital auricular deformity and a low incidence of complications. It can be used for the treatment of congenital auricular deformity in patients within 6 months of birth.

Evaluation and Nonsurgical Treatment of Neonatal Ear Anomalies: A Case Report

BACKGROUND

Inspection and evaluation of the neonate's ears are important parts of the neonatal examination. Neonates display a wide variety of ear size and configuration. In many cases, ear molding techniques obviate the need for future surgical correction. This article provides a review of the fetal ear development and describes common physical examination findings of the newborn's external ear. A case report reviews a successful nonsurgical treatment of a minor ear deformity.

CLINICAL FINDINGS

Newborn infant with near absent to very thin bilateral helical rims and otherwise normal bilateral ear shape and structures.

PRIMARY DIAGNOSIS

Bilateral Stahl's ear deformity.

INTERVENTIONS

The EarBuddies product was applied to bilateral ears in an outpatient pediatric plastic surgery clinic. This product remained in place for 8 weeks.

OUTCOMES

The family was pleased with the overall progress and shape of their child's ears. At 18 months of age, the family has no desire to pursue surgical correction of their child's ears.

PRACTICE RECOMMENDATIONS

Assessment of the newborn's external ear is part of a routine admission examination. Careful attention to abnormal or unusual findings allows for prompt evaluation and nonsurgical intervention.

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.

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.

The Outward Curved Concha, an Unfamiliar Congenital Auricular Deformation: A Novel Protocol for Nonsurgical Management

ABSTRACT

Anomalies present in about 30% of newborn ears; 15% to 20% of them are permanent. Malformations can be treated solely surgically; however, deformations, when promptly diagnosed, can be treated with nonsurgical methods, such as splinting and molding. The deformity of an outward curved concha is not only an aesthetic issue, but may confer functional problems that impair hearing and hearing aid usage. The goal of this report was to present this unique anomaly and our novel noninvasive treatment protocol for its management. Our cohort comprised 10 newborns treated for outward curved concha during 2018 and 2019. The patients underwent nonsurgical treatment using the EarWell system. In some patients, the management was followed by molding and taping to achieve the best effect. Treatment for all the patients began before age 3 weeks (mean, 2 weeks). Treatment duration was 5.2 weeks, on average. Nine patients did not show any adverse effects. The majority of parents expressed satisfaction with the aesthetic result; 70% were extremely pleased. Early initiation of the treatment-protocol for outward curved concha deformation yielded excellent and timely results in the infants, without the necessity of an invasive procedure.

Assessing outcomes of ear molding therapy by health care providers and convolutional neural network

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.

Long-Term Effectiveness of Ear Molding in Infants Using the EarWell Infant Correction System in China

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.

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.

Correction of neonatal auricular deformities with DuoDERM: A simple technique

Ear moulding in neonates has been shown to successfully correct congenital auricular anomalies. There are several available moulding techniques. However, commercially available moulding devices (e.g., EarWell and Ear Buddy) can be costly, and their alternatives have limited customizability. We present a technique using cost-effective and customizable materials for moulding common anomalies (Stahl's ear, constricted ear, and prominent ear). DuoDERM Extra-thin, Steri-strips, and 3M Kind Removal Silicone tape are used to splint the ear in a preferred position. The DuoDERM is rolled into a putty, placed in the ear, and secured with tapes. This treatment is initiated in the clinic, with weekly splint changes carried out at home by caregivers, and intermittent follow-up appointments. DuoDERM moulding is a safe, inexpensive, highly customizable, and simple way to correct auricular deformities. Primary physicians/paediatricians should embed moulding into their practice, starting treatment as early as possible in the neonatal period.

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.

Efficacy and Timing of Neonatal Ear Correction Molding

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.

Comparison of 2 Ear Molding Systems for Nonsurgical Management of Newborn Auricular Deformities

BACKGROUND

Congenital auricular deformities are common diseases in newborn infants. We compared the efficacy of 2 ear molding systems in the nonsurgical management of newborn auricular deformities in Chinese infants.

METHODS

A total of 462 newborns with auricular deformities were treated with either the EarWell or the LiangEar ear molding systems. The posttreatment outcome was graded as excellent, fair, and poor. The differences in effectiveness between the 2 ear molding systems and factors that may affect the posttreatment outcome were analyzed.

RESULTS

Both ear molding systems showed substantial efficacy in the treatment of newborn auricular deformities. The effective rate was comparable between the EarWell and the LiangEar systems for 4 types of auricular deformities (cryptotia, prominent ear, helical rim abnormality, and cup ear), while the costs for the LiangEar systems were half as much as that for the EarWell systems. Multivariate regression analysis showed that earlier time points at treatment initiation, less severe auricular deformities, treatment duration, and breastfeeding were the most significant predictive factors for a better outcome.

CONCLUSION

Our findings demonstrate that using the EarWell and the LiangEar systems are both optimal nonsurgical approaches for treatment of most newborn auricular deformities.

Identifying Ear Abnormality from 2D Photographs Using Convolutional Neural Networks

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.

[Non-invasive correction of congenital ear deformities with the EarWell Correction System: a prospective study]

BACKGROUND

Congenital ear deformities occur in 5 % of all newborns. Molding of the ear is possible during the first six weeks of life because of the maternal hormones which are still circulating in the newborns. For several years we have been using the EarWell™ Correction System, which allows us to correct ear deformities within the first weeks of life.

PATIENTS AND METHODS

This prospective study included 19 newborns. The following ear deformities were treated: cup ear, lop ear, steel ear, helical rim abnormalities, antihelical rim abnormalities. The results of the EarWell™ system were reevaluated two years after the procedure. Two independent examiners evaluated the clinical results on the basis of preand postprocedural pictures. In addition, the following parameters were evaluated: time of application, complications, satisfaction of parents, cost comparison between the EarWell™ system and otoplasty.

RESULTS

In all, 32 ears were treated with the EarWell™ system. 63 % were male and 37 % female. The system was placed in the first three weeks of life. The average treatment time was 12-28 days. The rate of complications was 1.3 %. The clinical results were rated as follows: 23 % very satisfactory, 35 % fully satisfactory, 30 % satisfactory, 3 % less satisfactory and 9 % not satisfactory. 95 % of the parents would use the EarWell™ system again. The costs of the EarWell™ system are EUR 660, those of otoplasty EUR 2826.

CONCLUSION

Ear deformities are easily treated with the EarWell™ system during the first weeks of life. It reduces the need for surgical correction at a later age and prevents children from further stress. Another advantage is the low costs compared with the costs of otoplasty.

The role of Nasoalveolar molding: A 3D Prospective analysis

Nasoalveolar molding (NAM) is commonly employed to reduce the alveolar segments into proper alignment and to improve nasal symmetry in patients with cleft lip and palate. This study examines the periodical progression of NAM treatment over time. 20 patients with complete unilateral cleft lip and palate were prospectively recruited. A 2 stage NAM treatment protocol was applied. Stage 1 involved adjustment of the alveolar segments (mean age 15.6 days), while Stage 2 added nasal stents and started average 43 days after stage 1. 3D images (n = 241) were obtained prior to NAM initiation and weekly until the end of treatment. The cleft lip area, bilateral nostril areas, and the nostril height and width were measured. Treatment was assessed in the Cleft (C) side and the Non-cleft (N). There was significant difference in the C/N ratio of the nostril area, width, and height at pre-treatment (0.9 ± 0.3, 4.1 ± 1.1, and 0.5 ± 0.2), at the end of stage 1 (1.1 ± 0.3, 2.2 ± 0.6, and 0.8 ± 0.2), and at the end of stage 2 treatment (1.8 ± 0.3, 1.8 ± 0.4, and 1.2 ± 0.1); p < 0.05. Comparative 3D analysis with dense sampling offers a precise methodology for showing effects of NAM treatment. The morphological changes achieved with NAM therapy occur in early treatment phase.