Do Not Stahl: Analyzing 10-Year Trends of Nonsurgical Ear Molding as Early Intervention for Congenital Ear Anomalies

Abstract

BACKGROUND: The senior author has employed ear molding as a treatment for infant ear anomalies for over 12 years, and it is now his preferred approach to almost all ear anomalies. During this period, we have observed trends in our treatment approach secondary to our experiences. The purpose of this study is to evaluate the classification of presenting anomalies, duration of treatment, timing of treatment, parent satisfaction, complications, and any identifiable barriers to care. METHODS: The authors conducted a retrospective review of infants who underwent ear molding with the EarWell or Infant Ear systems by a single surgeon over a 10-year period. Each case was evaluated for key patient demographics, presenting anomalies, treatment duration, device reapplication, complications, outcome satisfaction, and need for adjunct treatment. RESULTS: Two hundred forty-six infants with a total of 385 ears were evaluated. Of these patients, 107 underwent unilateral treatment and 139 underwent bilateral treatment. Presenting anomalies included Stahl’s ear (n = 9), lidding/lop (n = 23), helical rim (n = 70), prominent (n = 26), cupping (n = 7), conchal crus (n = 8), and mixed (n = 92). Age at the start of treatment ranged from 3 to 156 days with 61.8% of patients presenting before 3 weeks. Average duration of treatment was 30.5 days and did not vary significantly with age at presentation (P = 0.653) or laterality (P = 0.630). Duration of treatment was shortest for ears exhibiting lidding/lop anomalies (22.8 days) and significantly longer for ears exhibiting a combination of at least 2 anomalies (32.4 days; P < 0.01). Unilateral treatment required an average of 0.96 device replacements compared with 1.49 for bilateral treatment. Adverse events occurred in only 19.1% of cases with skin breakdown (n = 26) under the device being the most common. The senior author performed approximately 12.4 cases per year between January 2010 and December 2016 and 53.0 cases per year between January 2017 and December 2019. Average income for treated patients based on zip code was estimated to be $113,087 and treatment was covered by insurance in 244 of 246 cases. At least 1 parent expressed satisfaction with outcomes in 92.0% of cases. CONCLUSIONS: This study shows that ear molding achieves successful outcomes with high satisfaction and low complication rates across a wide range of presenting anomalies and ages. Treatment of older-presenting infants does not vary significantly in complexity or duration compared with younger infants. There has been a rise in the number of ear molding cases performed by the senior author over the last 10 years, indicating increasing interest in nonsurgical correction of auricular anomalies. The overwhelming majority of patients in this study were insured and of high socioeconomic status, suggesting need for broadening awareness and access to ear molding as a treatment option.