A Single-institution, Retrospective Chart Review of Outcomes and Complications Following Infant Ear Molding with the EarWell System

Abstract

PURPOSE: Approximately one-third of infants are born with ear anomalies, more than two-thirds of which do not self-correct.1 Ear molding is the mainstay of nonsurgical correction and is commonly initiated as soon as possible after birth while cartilage remains malleable due to high concentrations of circulating maternal estrogens in the infant bloodstream.1 The purpose of this study was to examine the outcomes and complications associated with infant ear molding using the EarWell system at a single institution. METHOD: We conducted a retrospective chart review of all infants who underwent ear molding with pediatric plastic surgery from October 2010 to March 2021. Ear anomalies were classified as deformations, malformations, or multiple anomalies. Age at initiation, duration of treatment, temporal gaps in treatment, comorbidities, and details regarding any complications were also extracted for included patients. The primary outcomes assessed were degree of ear anomaly correction, incidence of skin complications, and unanticipated cessation of treatment. Parents of included patients were also sent a questionnaire regarding their children’s experiences with the ear molding process in which four outcomes regarding ear appearance (overall appearance, ‘natural’ look, symmetry, prominence) were rated on a 4-point Likert scale and cumulatively scored out of 16. RESULTS: A total of 184 ears of 113 patients were treated during the 11-year study period. Mean age at treatment initiation was 21 days, and average duration of treatment was 40 days. Helical rim deformities (N=50 ears) and lop ear (N=40 ears) were the most common anomalies present. Nine ears possessed characteristics consistent with two different anomalies. A total of 181 ears (98.4%) achieved either a complete (N=125 ears, 67.9%) or partial correction (N= 56 ears, 30.4%) upon treatment completion. There was no statistically significant association between age at initiation (p = 0.314), duration of application (p = 0.198), or type of anomaly (p = 0.192) and partial vs. complete correction. The most common complications were eczematous flares (N=27 occurrences among 25 ears, 13.6%) and pressure ulcers (N=23 occurrences among 21 ears, 12.5%). Incidence of complications was not significantly associated with age at application (p = 0.269), duration of application (p = 0.238), or type of anomaly (p = 0.106). Infants who experienced a complication were 3.36 times more likely to achieve partial correction (p < 0.001; 95% CI 1.66-6.81) relative to complete correction. Questionnaire responses were received for 24 out of 113 patients (21.2%) and were categorized into ‘Successful’ (N=21, 87.5%) and ‘Unsuccessful’ groups (N=3, 12.5%) depending on whether respondents denoted the ear molding process as successful or unsuccessful, respectively. The average cumulative appearance score for the ‘Unsuccessful’ and ‘Successful’ groups was 11 ± 2.6 and 15.4 ± 1.6, respectively, with a statistically significant difference between groups (p = 0.002). CONCLUSION: The EarWell system is an effective treatment strategy for infant ear anomalies, with most patients achieving complete correction. Addressing complications early may help providers optimize outcomes. REFERENCES: 1. Byrd HS, Langevin CJ, Ghidoni LA. Ear Molding in Newborn Infants with Auricular Deformities. Plastic and Reconstructive Surgery. 2010;126(4):1191-1200. doi:10.1097/PRS.0b013e3181e617bb