Timing of otoplasty in children: what age?

Abstract

Sir, The timing of otoplasty is controversial; there are no guidelines to direct surgeons to recommend an age at which this procedure is most appropriately undertaken. Very little research has been published addressing this question. Members of the American Association of Plastic Surgeons have been surveyed regarding this issue: the majority of respondents performed surgery when the age of the child was greater than 5 years [1]. We endeavoured to identify common practice in the UK among surgeons performing this procedure and to identify their reasons for selecting a particular age at which to oVer the procedure. The same questions were asked of parents and educational psychologists to explore the opinions held by these groups, who have regular close contact with children of school age. We conducted a postal survey of 200 each of plastic surgeons, drawn randomly from the list of membership of the British Association of Plastic Surgeons, 200 child psychologists, from the British Psychological Society and 200 parents whose children had undergone otoplasty in the previous 3 years in the Royal Hospital of Sick Children, Edinburgh. We received 120 replies from surgeons (65%), 95 parents (48%) and 69 psychologists (35%). The most commonly quoted ideal age range for prominent ear correction was 6–8 years (42%). 79% of both surgeons and parents and 63% of psychologists believed a child should be older than 6 years before undergoing otoplasty, as demonstrated in Fig. 1. Parents, surgeons and psychologists agreed on the most important factors inXuencing the decision to undergo otoplasty: the child’s awareness of prominent ears, the child suVering bullying and school absence due to embarrassment were all ranked highly. Parental request and future ear growth were ranked lowly by all groups. Many parents commented that they waited until their child declared himself/herself unhappy with their ears and only then did they request otoplasty. There was consensus amongst surgeons that one should only proceed when the child had gained enough maturity to request the procedure. The ability of a child to voice concern about a physical characteristic and agree to surgery requires a degree of maturity, uncommon