Congenital Ear Anomalies Research Articles

Epidemiological Characteristics and Maternal Risk Factors of Microtia and Aural Atresia in Kazakhstan.

Introduction Microtia and aural atresia present congenital ear anomalies that affect external ear and are associated with conductive hearing loss. Both anomalies result from exposure to various prenatal risk factors, most common during the first trimester of pregnancy. Objective This study was aimed at epidemiological analysis of microtia/atresia and associated risk factors in the Kazakhstani population. Methods A retrospective study in two stages. First, a cross-sectional analysis of microtia/ atresia frequencies from 2015 to 2019 on the basis of official statistics obtained from the Republican Centre for E-Health. Then, a case-control study was carried out to elucidate maternal risk factors associated with occurrence of microtia/atresia. We recruited patients presented in Almaty, Kazakhstan, between September 2021 and February 2022. Results There was a substantial regional variation in the rates of both aural atresia and microtia/anotia. Mothers of children with microtia disclosed toxoplasmosis, other agents (including HIV, syphilis, varicella), rubella, cytomegalovirus, herpes simplex (TORCH) infections during pregnancy more often than those of healthy children (45.8 versus 7.3%; p < 0.001). Exposure to different chemicals during pregnancy was mentioned more frequently by mothers of children with microtia when compared with the healthy controls (18.1 versus 8.1%; p = 0.035). Self-reporting of alcohol consumption and intake of antibiotics was also significantly higher in mothers of children with microtia (31.9 and 36.1% respectively). Conclusion Elucidation of microtia/atresia epidemiology is important due to their imposed social and economic burden, associated with treatment and rehabilitation costs.

A Study on the Nonsurgical Correction Treatment Age Window and Long-Term Follow-Up of Infants With Congenital Ear Anomalies in China.

To evaluate the efficacy of ear molding across various initial ages and analyze challenges encountered by infants beyond the optimal treatment age window. A retrospective review of 331 infants (527 ears) treated with EarWell was conducted over 5 years from January 2017 to March 2022 at a single center. The treatment duration of the ear molding, success rate, recurrence rate, and complication rate were analyzed among the 3 age groups. Concentrate on evaluating treatment outcomes for infants with an initial age exceeding 42 days. The mean age at initial treatment was 25±28 days. In addition, it includes a child with cryptotia who is 3.5 years old (1278d). The mean duration of treatment was 7±5 weeks. In the long-term follow-up, the overall treatment success rate was 92%, with 467 ears (88.6%) showing improvement without recurrence, 30 ears (5.7%) experiencing varying degrees of recurrence, and 30 ears (5.7%) showing no improvement or complete recurrence. A total of 20 infants (3%) developed mild skin complications during treatment. Ear molding is a safe and effective option for the treatment of congenital ear anomalies, with a low recurrence rate during long-term follow-up. For infants with congenital auricular anomalies aged over 42 days, ear molding remains a viable option. Treatment success may be influenced by the age at treatment, the subtype of anomalies, and relies on the assessment of a specialized otologist, expert procedural techniques, as well as thorough understanding and cooperation from parents.

Seminars in Plastic Surgery: Pediatric Ear Anomalies and Reconstruction.

Congenital ear anomalies affect 15 to 20% of neonates and can be categorized as either auricular deformations or malformations. Deformations involve a fully developed, albeit abnormally shaped, chondrocutaneous framework, which makes them amenable to correction with ear molding within the first few months of life. Malformations involve hypoplastic or fully absent auricular structures that require augmentation with alloplastic and/or autogenous reconstruction. The goal of this article is to outline the various auricular deformities and malformations, followed by a description of the latest clinical management options, both nonsurgical and surgical, by auricular anomaly.

Ear Molding Therapy of Congenital Ear Anomalies: Long-Term Aesthetic Outcomes and Caretaker Satisfaction.

Ear molding is a safe, non-surgical approach to treat newborns with congenital ear anomalies. In this study, we aimed to investigate long-term aesthetic outcomes and caretaker satisfaction from ear molding therapy. A retrospective chart review from 2018 to 2020 was conducted for infants who underwent ear molding treatment at our institution. Patient demographics and treatment related variables were collected. Caretakers were surveyed regarding their experience, expectations, and aesthetic outcome at 1year (short-term) and 3years (long-term) from treatment. Independent physicians evaluated treatment efficacy. Responses were converted to a Likert scale (1-5), with 5 representing most desirable. Overall, 38 of 42 patients participated in our long-term study (90%) for a total of 62 ears. Average follow-up was 3.31 ± 0.50years after completion of treatment. Mean age at treatment was 23.2 ± 19.7days with a mean treatment duration of 21.7 ± 7.7days. Caretakers' satisfaction regarding auricular appearance remained high (short-term: 4.18 vs. long-term: 4.17, p = 0.54) and anticipated social distress decreased over time. Physician aesthetic evaluations were favorable between "somewhat effective" and "very effective" and remained consistent over time (short term: 3.46 vs. long-term: 3.31, p = 0.31). Furthermore, physician evaluations were higher for deformations than malformations (p = 0.04) and in children who began treatment by 30days old (p = 0.04). Caretaker satisfaction from ear molding therapy remained high after long-term follow up, and social distress from the perception of their child's ears decreased with time. Physician aesthetic ratings confirmed efficacy, with better outcomes seen in deformations than in malformations. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Inheritance analysis and family history for microtia: A hospital-based study in China.

Microtia is a congenital anomaly of the outer ear. Although genetic and environmental factors could play a role, no consensus has been established on the pathogenesis and cause of this condition. In this study, we surveyed the frequency and pattern of family history in patients with microtia in a Chinese specialty clinic population. We evaluated data from 672 patients (mean age=9.2, male-to-female ratio=2.6:1) with microtia admitted to the Department of Auricular Reconstruction at the Plastic Surgery Hospital of Peking Union Medical College from December 2014 to February 2016. Family history of congenital ear anomalies across three generations was recorded. Pearson chi-square test or Fisher exact test was used to test the associations between the characteristics of microtia and hereditary features. A family history of auricle anomalies was identified in 202 patients (30.1%), of whom, 95 families showed vertical transmission, 14 families skipped a generation, and 120 families showed family aggregations. The incidence of family history varied with grades of microtia (P=0.001). Patients with preauricular tags or pits (38.3%) had a higher familial incidence of microtia than those with simple microtia (24.1%) (P<0.001). Patients with a lower grade of microtia demonstrated a higher incidence of family history. Patients with microtia had significantly more relatives with preauricular tags or pits. Microtia and preauricular tags or pits are different manifestations of the same defect, and their significant concurrency among relatives suggests that a considerable proportion of microtia is inherited and could recur with varying degrees of severity in other family members.

Ear Molding for Congenital Auricular Deformities: Efficacy and Factors Affecting Outcomes.

Objective: This study's aim was to assess the effectiveness of ear molding for congenital auricular deformities, analyze the factors affecting prognosis, and provide more clinical data supporting nonsurgical correction for this condition. Methods: A prospective study of a consecutive series of infants treated with ear molding from January 2021 to December 2022 in the department of otolaryngology, Second Affiliated Hospital of Harbin Medical University, was conducted. Demographic and clinical information were collected, and photographs of the ear were taken before and after treatment. Treatment efficacy and the relevant influencing factors were evaluated. Results: Thirty-five patients, including 59 with congenital ear anomalies, underwent noninvasive ear molding. The deformity type, treatment initiation age, and number of treatment cycles affected treatment efficacy. Earlier treatment initiation was associated with a shorter treatment period. Treatments were started earlier if decision-makers were more anxious. Conclusion: The earlier the neonatal auricle deformity is treated, the shorter the treatment time and the more ideal the clinical effect will be. Early noninvasive treatment for microtia is valuable. Early detection and parental awareness and education can help children receive treatment earlier and improve the success rate.

Nonsurgical molding of congenital auricular deformities and analysis of the correction outcomes: A single-center, retrospective study in east China.

Our research was carried out to provide a clinical reference for the application of nonsurgical therapy in newborns with congenital auricular deformities in east China. A retrospective study of consecutive newborns using noninvasive ear molding was conducted in Hangzhou in east China's Zhejiang Province. The demographic and clinical information and photographs of the ear before and after treatment were taken. The diagnosis of each auricular deformity was identified, and the treatment outcome was evaluated. A total of 224 patients including 356 congenital ear anomalies received noninvasive ear molding. The median age of infants to initiate treatment was 39.5 days. The median treatment duration was 42.5 days. The median follow-up time was 137.0 days. The overall treatment effective rate of all infants with nonoperative ear molding was 92.1%, and mild skin irritation and ulceration occurred in 34 ear deformities (9.6%). It confirmed that the treatment efficiency was satisfactory and the complication rate was still acceptable despite the late initiation treatment of neonates in east China. Further analysis of treatment outcomes among three subgroups of infants (the ages to initiate the ear molding were respectively less than or equal to 28, 29-56, and more than 57 days) revealed that initiation treatment was significantly related to the treatment results and the earlier the initiation treatment, the higher the effective rate and the lower the complication incidence. Our study hints that newborns in east China may have a longer period for correction. What is more, although our study affirmed a longer period for noninvasive molding, early diagnosis and treatment are still recommended to improve therapy efficiency and reduce treatment duration and complications.

Development of an interdisciplinary microtia-atresia care model: A single-center 20-year experience.

Microtia and aural atresia are congenital ear anomalies with a wide-ranging spectrum of phenotypes and varied functional and psychosocial consequences for patients. This study seeks to analyze the management of microtia-atresia patients at our center over a 20-year period and to propose recommendations for advancing microtia-atresia care at a national level. We performed a retrospective analysis of data from patients presenting to the Massachusetts Eye and Ear (Boston, MA) for initial otolaryngology consultation for congenital microtia and/or aural atresia between 1999 and 2018. Over the 20-year study period, 229 patients presented to our microtia-atresia center at a median age of 7 years. The severity of microtia was most commonly classified as grade III (n= 87, 38%), 61% (n= 140) of patients had complete atresia, the median Jahrsdoerfer grading scale score was 6 (range 0-10), and 81 patients (35%) underwent surgery for microtia repair. For hearing rehabilitation, 30 patients (64%) underwent bone conduction device implantation and 17 patients (36%) underwent atresiaplasty. The implementation of an interdisciplinary, longitudinal care model resulted in an increase in patient (r=0.819, p< .001) and surgical volume (microtia surgeries, r=0.521, p= .019; otologic surgeries, r=0.767, p< .001) at our center over time. An interdisciplinary team approach to microtia-atresia patient care may result in increased patient volume, which could improve aesthetic and hearing outcomes over time by concentrating care and surgical expertise. Future work should aim to establish standardized clinical consensus recommendations to guide the creation of high-quality microtia-atresia care programs. 4.

ROLE OF HIGH RESOLUTION COMPUTED TOMOGRAPHY IN THE EVALUATION OF TEMPORAL BONE LESIONS

Objectives: The study’s primary goal is to assess inflammatory, traumatic, and neoplastic disorders that impact the temporal bone using high resolution computed tomography (HRCT). The other aim is to comprehend how HRCT can diagnose and detect pathologies of the temporal bone. Methods: The study was conducted at Dr. Patnam Mahender Reddy Institute of Medical Sciences from Jan 2018 to Jan 2020 with a sample size of 60. Written consent for participation in the study was taken before the scan. The study was evaluated with multidetector HRCT-HITACHI 128 SLICE machine. CT images are usually acquired or displayed in axial and coronal planes. Results: Among 60 patients, 44 patients were diagnosed with infections, 11 were diagnosed with tumors, and five patients with anatomical variants. Among 60 patients, 32 (53.3%) were male patients, and 28 (46.6%) were female patients; hence, study shows a male preponderance. Out of 60 patients, the highest number was recorded in those aged 21–30 years 16 (36%). Among 60 patients, 44 suspected of having a middle ear infection were studied. Among these 44 patients, 27 (61.3%) were diagnosed with otomastoiditis, 16 (36%) patients were diagnosed with cholesteatoma, and 1 (2.2%) patient was diagnosed with malignant otitis externa. In our study population of 60 patients, 11 were diagnosed with neoplasms. Among the 11 patients, 7 (67%) were diagnosed with acoustic neuroma in the cerebellopontine angle. Conclusion: The existence of cholesteatoma, changes to the ossicular chain, and erosion of the lateral semicircular canal were all intraoperatively detected in the present study with excellent sensitivity to the clinical and radiographic findings. For correcting any congenital ear anomalies, the HRCT results were helpful for planning and management tools for the surgeon.

National Assessment of Ear Abnormalities as Predictors for Renal Abnormalities

PURPOSE: Ear malformations and renal abnormalities are established to have some level of association. However, there is still ongoing debate regarding the utility, cost-effectiveness, and overall need to screen children with ear malformations for renal abnormalities. Herein, we utilized the 2016 Kids’ Inpatient Database (KID) to examine the association and relationship between different types of ear abnormalities commonly seen in children and renal abnormalities. METHODS: KID is a large national inpatient database that compiles admissions and data regarding diagnosis, race, procedures etc. Patients who had ICD-10 diagnoses of ear abnormalities (Q17) were identified. Those without ear abnormalities served as the control group. Patients with renal malformations (Q60 and Q63) were identified. Logistic regression was then conducted to analyze if patients with ear malformations had significantly different odds of having renal malformations. Statistical analyses were conducted in STATA using an α<0.05 for determining significance of predictors. RESULTS: 8324 patients were identified with ear abnormalities. 5321 patients were identified with congenital renal abnormalities. Those with microtia were found to be 8.83 times more likely to have congenital renal abnormalities compared to those without. Those with an accessory auricle were 3.5 times more likely to have renal abnormalities compared to those without. Those with a diagnosis of other specified ear abnormalities and other unspecified were found to be 5.92 and 7.75 times more likely to have renal abnormalities compared to those without respectively. Those patients with a congenital misplaced ear were 9.66 times more likely to have renal malformations compared to those without. Figure 1 Additionally, we examined renal agenesis as in relation to ear abnormalities. 4784 patients were identified with renal agenesis. Patients with microtia were found to be 18.17 times more likely to have renal agenesis compared to those without. Those with an accessory auricle were 4.01 times more likely to have renal agenesis compared to those without. Patients with a misplaced ear were 14.40 times more likely to have renal agenesis compared to those without. Those with other specified and unspecified ear abnormalities were found to be 8.11 and 8.48 times more likely to have renal agenesis compared to those without respectively. Patients an other mishappen ear were 4.68 times more likely to have renal agenesis compared to those without. Figure 2 CONCLUSIONS: Our results indicate a clear association between specific ear abnormalities and renal abnormalities. As such, there may be clinical value and supportive evidence for conducting screening tests such as renal ultrasounds on pediatric patients who present for ear abnormalities. To our knowledge, this is the first study to evaluate the association of specific ear abnormalities and renal abnormalities using a national database. These associations may aid clinicians in pursuing screening regimens for patients with congenital ear anomalies.

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

Background: We analyzed an original case series of the classic ear-molding method and evaluated the efficacy and complication rate of the method compared to commercial ear-molding products by meta-analysis to draw conclusions on the efficacy of the classic method. Methods: From January 2019 to March 2022, we selected patients who underwent classic ear molding for newborn ear deformities at our institution and reviewed the patient age, treatment time, efficiency and complications. Additionally, the PubMed, EMBASE, and Scopus databases were searched, and meta-analysis (following the PRISMA guidelines) was performed. Results: In the case study, the success rate (excellent and good outcomes) of the classic ear-molding method was 92.6%. The mean age at application and mean duration of application were 5.81 ± 6.09 days and 32.13 ± 7.90 days, respectively. In the systematic review, the classic method group showed a statistically smaller success rate (proportion of 0.79) and statistically smaller complication rate (proportion of 0.05) than the commercial product group (proportion of 0.83). Conclusions: Compared with commercial products, classic ear molding has remarkable and comparable therapeutic effects on neonatal auricular deformities. Additionally, the classic ear-molding method is more suitable for infants with auricular deformities from socioeconomically vulnerable areas. Thus, the classic ear-molding method could be a better option for congenital ear anomalies than commercial ear-molding products.

Anthropometric Study of External Ear: A Comparative Study

Introduction: Ear is the most defining feature of the face and its structure shows the signs of age and sex. The external ears consist of the auricle and the external acoustic meatus. This study was specifically under taken to study the variations in the auricle dimensions, specially height and width, amongst Nepalese medical and nursing students and compare them. Materials and Methods: This study was conducted on medical and nursing students of National Medical College, Birgunj, Nepal, with no evidence of congenital ear anomalies or previous ear surgeries. The study consisted of 110 females and 110 males, aged 18–25 years. Results: The descriptive statistics of the ear variables evaluated and measured on both right and left sides. The ear length ranged from 6.31- 6.30 cm with the right ear length being significantly larger than the left ear length (p=0.010). Similarly, the right ear breadth was significantly wider in comparison to the left ear breadth, range from 3.39- 3. 38 cm (p=0.084). The lobular length range 2.38- 2.36 cm (p=0.001) and the lobular breadth range 1.96- 1.93 cm (p=0.000) which were also larger in the right ear compared with the left ear and the differences reached the level of statistically significant. Conclusion: The ear anthropometric measurements of male students showed higher value when compared to the female nursing students. These results support the findings that the sexual dimorphism does exit and showed the statistically significant differences between the sexes. The length of the ear was found to be higher when compared to the width of the ear in both sexes.

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

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. 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. 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). 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. Therapeutic, IV.

Noninvasive ear molding in the correction of ear anomalies: A systematic review and meta-analysis

ObjectiveEar molding has been used for the treatment of congenital external ear anomalies. The purpose of this study is to systematically review ear molding therapy and perform a meta-analysis to determine its efficacy. MethodsA systematic review and meta-analysis of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed and Embase databases from January 2009 to April 2021 were searched. Individual studies were eligible for inclusion if they evaluated noninvasive ear molding for congenital ear anomalies, featured at least 50 ears, and were published in English. Results15 studies (one RCT and 14 clinical series) with a total of 1729 children undergoing molding of 2508 ears were identified and included in the meta-analysis. Meta-analysis of the eight studies with reported success rates as determined by clinician assessment showed an overall success rate in 87.4% of ears. Meta-analysis of the three studies with reported efficacy as assessed by laypersons showed an overall success rate of 92%.All studies reported a variety of minor skin-related complications in the ear, such as eczema, excoriation, infection, irritation, rash (allergic or nonallergic), and ulceration. Generally, complications were not reported to be serious and were noted to resolve with minimal to no intervention. ConclusionTo the authors’ knowledge, this study represents the largest modern systematic review and meta-analysis analyzing the efficacy of ear molding. A review of the 15 studies included suggests that ear molding is an effective and safe treatment for congenital ear anomalies with a high success rate. However, the strength of this body of evidence is reduced by a lack of comparative studies, heterogeneous patient populations, treatment protocols, and ear assessment scales.

A Novel Nonsurgical Technique for Correcting Congenital Auricular Anomalies.

Congenital ear anomalies are associated with psychological morbidity. Ear deformities can usually be corrected by nonsurgical techniques such as splinting or molding in the neonatal period, initiated before 6 weeks. Without early corrections, many will require otoplasty during childhood. We introduce a novel silicone-based custom mold technique for congenital ear anomalies. The highly malleable silicone was pushed into every part of the auricle, enabling the auricle to remain in the desired shape, with new molds made weekly. Of 31 newborns (18 males, 13 females), 54 ears were treated. Average age at treatment initiation was 26.8 days. The mean treatment duration was 43.2 days, with a median of 28 days. Normal appearance and parent's satisfaction were achieved in 30 patients with 49 deformed ears and also in four newborns older than 6 weeks. Three concha type microtia in two patients achieved great improvements and parents' satisfaction. No complications were reported. Marked aesthetic improvements and normal appearance were achieved for all deformed auricles treated, and improvements in the concha type microtia will partially alleviate future surgical corrections. The results are not inferior to other techniques. The advantages are as follows: cost-effective, time-saving, simple to master, no need for hair shaving, and easy use for parents. Patients older than 6 weeks of age achieved normal auricle appearance, enabling the correction in older newborns. Custom made silicone auricle molding offers a simple nonsurgical technique for correcting congenital ear anomalies, alleviating the need for future surgical corrections.

Nonsurgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes

Nonsurgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes

Non-Surgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes.

Congenital ear anomalies result from cartilage and skin compression in utero. They can be corrected in infancy before the cartilage hardens and loses its malleability. Caretaker burden of ear molding and its impact on esthetic outcomes has not been studied. Demographic and procedural variables were retrospectively collected for infants who underwent ear molding. Parents were surveyed regarding their experience, caretaker burden, and esthetic outcome. Outside physicians were provided with pre- and post-treatment photographs and asked to rate outcomes. A Likert scale was developed for responses and converted to a numeric score from 1 to 5 with 5 as the most desirable. Seventy-four patients comprising 121 ears were included. Mean age at treatment was 20.1±21.4 days with treatment duration of 21.1±7.7 days. Parental participation in the survey was 70.1%. Questions that queried parents' experiences revealed a "very positive" experience with minor burden related to bathing and cleaning (Mean Likert Score 4.1, Range 1-5). Favorable parent-reported outcomes were obtained regarding anticipated social distress (4.28, 1-5), satisfaction with results (4.27, 1-5), and perception of final appearance (4.18, 1-5). Physician assessments of esthetic outcomes were slightly lower, but favorable between "somewhat effective" and "very effective" (3.46, 1-5). Earlier treatment trended favorably, but did not reach significance. Ear malformations had higher parent-reported satisfaction than ear deformations (4.75±0.46 vs 4.21±1.25, p=0.025). Despite the additional obligation for new parents, infant ear molding is rated low in terms of caretaker burden. Esthetic outcomes are excellent as assessed by parents and physicians. However, caretakers reported higher esthetic outcomes than physician evaluations. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The diagnostic utility of clinical exome sequencing in 60 patients with hearing loss disorders: A single-institution experience.

Genetic aetiologies are an important cause of congenital ear anomalies and hearing impairment. Next-generation sequencing (NGS) strategies, such as targeted gene panels or clinical exome sequencing (CES) are effective tools in the diagnosis of patients with inherited hearing impairment, with clear advantages over previous genetic testing approaches. CES in our cohort shows the genetic heterogeneity of syndromic and non-syndromic congenital ear and hearing disorders, highlighting the clinical utility of undergoing genomic investigations. Multidisciplinary decision-making for diagnostic workup and management, including close collaboration between Genetics, Otolaryngology, Audiology and other allied specialties, is key in the investigation of congenital ear and hearing disorders. Timely molecular genetic diagnosis can streamline patient care and potentially improve clinical outcomes.

Overview of Newborn Hearing Screening by transient otoacoustic emissions in Aswan, Egypt: A Hospital-Based preliminary Study

Objectives: One of the most significant risk groups for hearing loss is neonates who spend time in the neonatal intensive care unit (NICU). This study aimed to estimate the prevalence of hearing loss in all neonates admitted to our hospital NICU and evaluate their risk factors. It is a prospective cross-sectional study conducted on all neonates admitted to our hospital in one year. Patients and methods: All Neonates were subjected to history, clinical, Otoscopic examination, and Oto-acoustic emissions test. Neonates with congenital ear anomalies or ear problems that interfere with the screening test were excluded. Results: 90.6% of cases passed the test, and 9.4% had a Refer result in the initial screening. A repeated test for the referral cases showed 6.7% passed and 2.7% had hearing affection (2% bilateral and 0.7 % unilateral). Conclusions: The prevalence of hearing loss was 2.7%, 2 % had bilateral hearing affection, and 0.7 % had unilateral hearing affection. There was a significant correlation between exposures to certain risk factors among the affected neonates; all cases remained more than 5 days in NICU with history of exposure to ototoxic drugs, especially gentamycin, furosemide, vancomycin, and amikacin.

Reply: "Nonsurgical Correction of Congenital Ear Anomalies: A Review of the Literature".

Congenital ear anomalies have been known to cause lasting psychosocial consequences for children. Congenital ear anomalies can generally be divided into malformations (chondro-cutaneous defect) and deformations (misshaped pinna). Operative techniques are the standard for correction at a minimal age of 5-7, exposing the children to teasing and heavy complications. Ear molding is a non-operative technique to treat ear anomalies at a younger age. Having been popularized since the 1980s, its use has increased over the past decades. However, uncertainties about its properties remain. Therefore, this review was conducted to look at what is known and what has been newly discovered in the last decade, comparing different treatment methods and materials. A literature search was performed on PubMed, and 16 articles, published in the last decade, were included. It was found that treatment initiated at an early age showed higher satisfactory outcome rates and a shorter duration of treatment. A shorter duration of treatment also led to higher satisfactory rates, which might be attributable to age at initiation, individual moldability, and treatment compliance. Complications were minor in all articles. Recurrence rate was low and mostly concerned prominent ears, which proved to be the most difficult to correct deformity as well. Malformations, however, were even more difficult to treat than deformations. Our analysis shows ear molding to be a successful treatment method for ear anomalies with a preference for early diagnosis and treatment.