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

Abstract

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.

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

“…Congenital ear deformities occur in 5% to 15% of infants [ 14 , 16 ]. Patients with congenital ear deformities tend to suffer psychological distress manifesting as anxiety, low self-esteem, and behavioral problems [ 12 ].…”

“… A forest plot of the success rate [ 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. The classic ear-molding method showed substantial efficacy in the treatment of newborn auricular deformities.…”

Evaluation and Nonsurgical Treatment of Neonatal Ear Anomalies

“…Communicating with empathy, using consistent and simple language, and providing written and visual information are important considerations for healthcare professionals when interacting with families. It is also important to set realistic expectations to help limit discrepancies between expectation and outcome 18…”

“…Retrospective reviews have shown auricular outcomes to be superior and parents to be satisfied with the outcome 97% of the time, as compared with a satisfaction rate of 85% when treatment was initiated more than 3 weeks after birth. 18 Additional studies have shown that initiating treatment after 6 weeks of life may require prolonged treatment duration due to lower levels of circulating maternal estrogen and resulting firmness of the auricle. 17 Infants with a prominent (or protruding) ear have an increased concha-mastoid angle and/or a flattened antihelical fold (Figure 2).…”

“…It is also important to set realistic expectations to help limit discrepancies between expectation and outcome. 18…”