Evolution of Anomaly-Specific Techniques in Infant Ear Molding: A 10-Year Retrospective Study

Abstract

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 an alternative to surgery that spares operative morbidity and allows for significantly earlier intervention. In this retrospective study, the senior author (S.B.B.) 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 performed by a single surgeon. The procedure reports for each case were reviewed to develop stepwise customization protocols for existing EarWell and InfantEar 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 percent), helical rim (28.5 percent), prominent (10.6 percent), lidding/lop (9.3 percent), Stahl ear (3.6 percent), conchal crus (3.3 percent), and cupping (2.8 percent). Two patients (0.8 percent) had cryptotia. Deformity subclass could not be obtained for 11 patients (4.5 percent). Recommended modifications to existing ear correction systems are deformity-specific: cotton-tip applicator/setting material (Stahl ear), custom dental compound mold (lidding/lop and cupping), scaphal wire (helical rim), cotton-tip applicator/protrusion excision (prominent), and custom dental compound stent (conchal crus). Conclusions: Presentation of ear anomalies is heterogenous. This 10-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. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

A Ten-Year Retrospective Review of the Nonsurgical Treatment of Infant Ear Anomalies

“…Table 2 demonstrates a significant trend toward choosing the InfantEar for older-presenting patients because of the better fit of the device for larger ears. 19 This finding suggests that although parental expectations must be taken into account, our ability to plan treatment based on patient age and presentation may have an independent positive effect on outcomes.…”

“…By the end of the study period, it is estimated that prefabricated systems were modified for at least 30 percent of patients. 19 The use of additional supplies or modification of technique improved fit of the device for each unique ear, especially in older patients. These modifications assisted with offloading pressure, minimizing rates of skin breakdown and ulceration to 11 percent and 2 percent, respectively (Table 4).…”