Effect of Protruding Ears on Visual Fixation Time and Perception of Personality

Abstract

rotruding ears continue to be perceived as a negative physical attribute in many cultural settings, with affected children frequently being ridiculed and adolescents experiencing reduced self-esteem. 1 Protruding ears have been associated with inferior cognitive performance at school, immaturity, less favorable personality traits, diminished selfconfidence, and social avoidance. 2,3 Media often select a person with large, prominent, or oddly shaped ears when wishing to depict an odd character or a less-intelligent individual. Few, if any, features are believed to elicit such negative responses as prominent or overly large ears. Prominent ears have been found to be significantly larger than normal ears. 4 From this perspective, protruding ears may be perceived as a stigma, defined as "an attribute or characteristic that conveys a social identity that is devalued in a particular social context," which includes "being the target of negative stereotypes, being rejected socially, being discriminated against, and being economically disadvantaged." 5(p505) Facial stigmata, such as scars, acne, strabismus, nasal deformities, and protruding ears are the most common reasons for a request for surgical revision. Persons with these facial stigmata provoke a negative reaction in the observer, with facial deformities having a negative effect on the perception of honesty, trustworthiness, and employability and, thereby, social functionality. 6 The relationship between visual deformities and high psychological distress was demonstrated to be close. 7 Several studies have IMPORTANCE Protruding ears are often thought to be a stigma, supposedly drawing attention and negatively influencing the perception of personality. These purported negative effects that may indicate corrective aesthetic otoplasty in patients too young to provide informed consent have not been quantified. OBJECTIVE To quantify attention directed toward protruding ears and its effect on the perception of selected personality traits. DESIGN, SETTING, AND PARTICIPANTS In this observational study conducted from August 1, 2013, to October 31, 2013, visual scan paths were recorded of 20 lay observers looking at photographs of faces of 20 children (age range, 5-19 years) with either protruding ears or ears morphed via computer software to appear nonprotruding. Subsequently, the observers rated 10 perceived personality traits based on the same photographs. MAIN OUTCOMES MEASURES Visual fixation time on protruding vs nonprotruding ears was compared and correlated with observers' scores for personality traits. RESULTS Fixation time on protruding ears was significantly longer compared with that for morphed nonprotruding ears (mean [SD], 9.6% [5.6%] vs 5.8% [3.2%] of total fixation time, P = .04). The difference between the overall personality questionnaire scores and between individual scores for assiduousness, intelligence, and likeability was not significant for protruding and nonprotruding ears. Faces in which the protruding auricles received the highest percentage of vis...

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