Stahl's Ear Research Articles

The self-correction and influence factors of congenital auricular deformity: A prospective cohort study.

To prospectively observe the self-correction of congenital auricular deformity (CAD) and explore the potential factors affecting the self-correction. This study was a multi-center prospective observational study. Newborns aged 0-3 days from 12 Maternal and Child Health Hospitals or Maternity Hospitals were chosen as the participants and prospectively followed up until week 6 after birth. The primary and secondary outcome was the score of deformity, and the secondary outcome was the improvement rate, respectively. A total of 135 newborns diagnosed with CAD (237 ears) were recruited. Boys and girls accounted for 50.37% (117 ears) and 49.63% (120 ears). The top morphological type was the constricted ear (107 ears, 45.15%). The score of deformity at baseline, week 3, and week 6 after enrollment was 4.00, 3.00, and 2.00, decreasing over time (P < 0.05). The higher the severity of deformity, the worse the self-correcting effect (P < 0.05). The scores of deformity of Stahl's ear were lower than those of others after follow-up (P < 0.05). No significant differences among the scores of deformity in different genders (P >0.05). The total improvement rate at week 3 and week 6 was 29.96% (71/237 ears) and 37.13% (88/237), respectively. The improvement rate of the Stahl's ear at week 3 and week 6 after enrollment was higher than that of four other morphological types (P < 0.05). Some CAD tends to self-correction, but for most CADs, there is still a need for early correction. Morphological types and severity of deformity are the main influencing factors on self-correcting effect, whereas sex was not.

The Prevalence and Awareness of Congenital External Ear Deformity among the School-Age Group: A Cross-Sectional Study.

Congenital outer ear deformities stem from a sequence of disturbances during fetal auricular cartilage embryonic development. A significant gap exists in understanding their prevalence among the school-age group in Saudi Arabia. This cross-sectional study aims to address this knowledge gap to raise awareness about the impact of such disorders. This cross-sectional study targeted parents of children in the school-age group. A multistage cluster sampling technique was employed to ensure the representation of schools. A self-administered Google form survey was used. Data were analyzed using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, NY). Our study revealed that the majority were males (56.2%), aged 6 to 10 years (49.3%), and attended primary school (69.5%). Chronic illnesses were present in 7.1% of children, with hearing impairment most prevalent (25.9%). Congenital ear deformities affected 2.7% of children, primarily Stahl's ear (35.4%). Limited knowledge about these deformities was observed among respondents (30.3%), yet a significant majority (73.9%) expressed belief in the potential of community awareness to decrease deformity prevalence. The awareness levels were impacted by parental education but showed no significant association with the child's age, gender, or presence of chronic diseases. Our study underscores the noteworthy occurrence of congenital ear deformities among the school-age group, coupled with a notable lack of awareness. Parental education emerges as a key factor influencing awareness levels. It is imperative to prioritize initiatives to bolster awareness and early detection to promote child health.

Investigation of morphometric features of auricle in newborns and etiology of auricle deformity

ABSTRACTImportanceThe diagnosis of congenital auricular deformity often relies on the clinical experience of clinicians, leading to a high incidence of misdiagnosis and missed diagnosis due to the lack of quantitative diagnostic criteria.ObjectiveTo characterize auricle morphology in newborns from southern China and explore the underlying etiology of congenital auricle deformity.MethodsA total of 636 neonates (1272 ears) with less than seven days old were included. The auricles of each infant were measured and photographed. The relationship between maternal factors and the occurrence of congenital auricle deformity was analyzed.ResultsThe incidence of auricular deformity in southern China was 79.87%. Helical rim deformity and mixed deformity had the highest incidence (17.30% each), while cryptotia had the lowest incidence (0.31%). Among mixed deformities, lop ear with conchal crus ear was the most common (22.73%). Each type of auricle deformity had distinct measurement indicators: the vertical distance of cephalo‐auricular was 73.97% longer and cephalo‐superaurale was 70.00% longer in protruding ears compared to normal auricle; the vertical distance of cephalo‐auricular was 10.96% less in lop ears, 15.07% less in conchal crus ears, and 41.1% longer in cup ears; the distance between helix and antihelix was 22.35% less in constricted ear, 12.94% greater in helical rim deformity, and 43.53% greater in Stahl's ear. Family history of hereditary ear deformity and paternal smoking were significant factors associated with ear deformity in southern China.InterpretationThe incidence of auricle deformities is high in southern China, with significant differences in the morphometric structures of different auricle types.

Auricular Deformational Anomalies Detected in Human Fetal Cadavers.

The aim of the study was to investigate the incidence and diversity of deformational auricular anomalies in human fetuses based on their morphologic appearances. A total of 100 auricles from 56 formalin-fixed fetuses (32 female and 24 male), gestational ages ranging from 17 to 36 weeks, were examined. The auricles were categorized according to the morphologic deformities outlined in existing literature. Of the samples analyzed, 67% exhibited auricular deformities, while the remaining 33% showed no auricle anomalies. Among the auricles with deformities, 73% displayed a single type of deformity: Conchal crus, 22%; Stahl's ear, 13%; inverted conchal bowl, 13%; lidding ear, 12%; cup ear, 7%; and constricted ear, 6%. In addition, 27% of the auricles exhibited 2 different deformities on the same side: Conchal crus with lidding ear, 10%; conchal crus with Stahl's ear, 5%; conchal crus with the antihelix 3rd crus, 3%; constricted ear with lidding ear, 5%; constricted ear with cup ear, 2%; and constricted ear with inverted conchal bowl, 2%. The most prevalent deformity was conchal crus, whereas cup ear was the least. Among the fetuses, 10 had bilaterally normal auricles, 8 had unilaterally normal auricles, 12 exhibited the same deformity bilaterally, and 14 displayed different deformities on each side. Auricular deformational variations can vary in shape and symmetry, even in morphologically normal fetuses. Identifying these deformities can contribute to accurate diagnosis and treatment planning for such anomalies in newborns.

Novel Surgical Procedure of Repair for Stahl's Ear: A Case Report

A pointed-ear defect characterized by an abnormal folding of the skin and cartilage of the pinna, which produce an "elfin ear" or “elf ear” characterized by an ear-rim with a pointed upper-edge, rather than a rounded upper-edge.A 10 year old boy admitted at IGMC Hospital, Shimla during the month of April’ 2022 with the chief complaintsof bilateral abnormal growth of pinna by birth. After the general physical examination, routine blood profile and other Lab investigation, he diagnosed Bilateral Stahl’s Ear (Type I), underwent bilateral otoplasty. Prognosis is good and patient discharged post operatively after a short stay at hospital.

Issue Information

Deformational external ear anomalies in neonates. Conchal crus (A); a leg extending from the middle part of the cavity of concha to its vertical wall, Stahl ear (B); cartilaginous structure starting from the superior crus of antihelix and passing through the fossa scaphoid towards the edge of the helix, Lop ear (C); abnormal downward curving of the upper part of the auricle and absence of the superior crus of antihelix, Rim kink (D); vertical depression in the helix, Prominent ear (E); prominent ear. Further details can be seen in the article by Erdem et al. in this issue. image

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.

Stahl's Ear

Stahl's Ear

Using Ear Molding to Treat Congenital Auricular Deformities.

Objective: To explore the utility of ear molding in the treatment of congenital auricular deformations.Study Design: A retrospective chart/photograph review of a consecutive series of infants treated with the EarWell System from 2017 to 2020 was performed. Data on type of auricular deformity, treatment side, and auricular length and width were collected weekly for all study participants.Result: A total of 173 patients (274 ears) with congenital auricular anomalies were included. The treatment duration for lop ears and Stahl's ears was shorter than for other deformations. The mean treatment EarWell duration of participants who started ear molding within 14 days of birth was shorter than that of those who started treatment more than 14 days after birth with the same ear deformation. For participants with unilateral ear deformities, the length and width of both the affected and healthy ears increased over the course of treatment, equalizing after 3 weeks. For participants with bilateral ear deformities, the length and width of both ears increased rapidly over the first 3 weeks of treatment, and the length and width of both ears gradually equalized after treatment.Conclusion: Ear molding is an important intervention for treating congenital auricular deformations, and can increase auricular length and width. Early identification and initiation of treatment is crucial in the management of congenital auricular deformation.

Ear Abnormalities.

Congenital ear abnormalities present an aesthetic and psychosocial concern for pediatric patients and their parents. Diagnosis of external ear deformities is based on clinical examination and is facilitated by an understanding of normal ear anatomy. Ear anomalies can be categorized as malformations or deformations. Malformations are characterized by absent anatomical structures of the ear (or absence of the ear itself), as exemplified by microtia and anotia. Ear deformations are characterized by ear anatomical landmarks that are present but are distorted or abnormal, with Stahl ear, constricted ear, and prominent ear being common presentations. Ear malformations will not improve with growth of the patient and uniformly require surgical intervention to recreate an anatomically typical ear. Although a small percentage of ear deformations can self-resolve, most patients with ear deformations will require nonsurgical or surgical reconstruction to achieve a normal or more aesthetic ear. In recent decades the use of nonsurgical ear splinting or molding has been recognized as a highly effective method in correcting a variety of congenital ear deformations when treatment is initiated in the first 8 weeks of life. The urgency in initiating nonsurgical treatment of ear deformations at an early age makes prompt recognition of these ear deformations essential because surgical correction remains the only viable reconstructive option in older infants and children.

Management of Congenital Auricular Anomalies.

After studying this article, the participant should be able to: 1. Describe normal ear anatomy and development, and evaluate the patient's ears for differences in shape, size, prominence, and symmetry. 2. Identify common congenital ear deformities, including prominent ear, macrotia, Stahl ear, cryptotia, constricted ear, and lobule anomalies. 3. Describe both early nonoperative management and operative techniques for correction of these ear deformities. 4. Be aware of advantages and disadvantages of common and emerging techniques for correction of pediatric ear deformities. Whereas severe ear malformations such as microtia/anotia are rare, other ear deformities, such as prominent ear, Stahl ear, and cryptotia, are common. Although these ear deformities result in minimal physiologic morbidity, their psychological and cosmetic impact can be significant. Identifying these common deformities and understanding how they differ from normal ear anatomy is critical to their management. In cases where a deformity is identified in neonatal life, ear molding may obviate the need for surgery. Although various surgical techniques have been described for correction of common ear deformities, the surgeon should follow a careful stepwise approach to address the auricular deformity or deformities present. By using such an approach, complications may be minimized and predictable aesthetic outcomes achieved.

Titanium Mesh for Correction of Stahl's Ear Deformity

Abstract Background: Stahl's bar is a rare auricular malformation that can bring social stigma to the patient. Stahl's deformity is congenital anomaly, characterized by an accessory third crus in the ear cartilage, giving rise to an irregular helical rim and paradoxically bent scaphoid fossa along its two axes [1]. Correction of such ear deformity can be a challenging task for the surgeons. There are no standard techniques for correcting this deformity [2]. Several different techniques are described in literature which yield unpredictable results. The conventional techniques of correcting this deformity include either excision of the cartilage, repositioning of the cartilage, or scoring techniques, also correction using internal sutures [3]. We studied a new technique for correction of this deformity using titanium mesh. The technical details of the surgery are described along with a review of literature on correcting similar anomalies. Aim of Study: Our aim is to evaluate and discuss the efficacy and safety of using titanium mesh to correct Stahl's ear deformity. Subjects and Methods: A prospective randomized study conducted from June 2017 to March 2019. In all, 7 patients having the Stahl's bar deformity, two bilateral and five unilat-eral (9 ears) included. All patients have been presented and managed at the Department of Otolaryngology, Hearing and Speech Institute. Patients have been managed surgically to correct the deformity. Surgery was by implanting a piece of titanium mesh which has been shaped and tailored to reverse the paradoxically bent scaphoid fossa. The titanium mesh with its new curve was put inside a small sub-perichondrial pocket along the long axis of the deformed bar. Regular follow-up visits were done every month for at least 6 months. Results: The operative time ranged from, 45 to 70 minutes with a mean of 62 minutes. Surgery was easy straight forward, Blood loss was minimal. As regards the final outcome, the affected auricles regained its normal appearance with fine scaphoid fossa and helical rim intraoperatively. The ears that were operated were of normal size and shape. All patients and their families were satisfied with the final result. There were no complications.Summary: Correction of Stahl's bar deformity can be accomplished easily and safely by implanting a pre shaped titanium mesh forcing the abnormally curved cartilage to regain its normal curvature.

The Double-reverse Wedge Excision Technique: A Novel Approach to Reconstruction of Stahl’s Ear Deformity

Stahl's ear deformity presents with an abnormal third crus of the antihelix and varying degrees of severity. This paper aims to describe a novel technique for reconstruction of Stahl's ear involving a double-reverse wedge excision of the third crus cartilage and skin, as well as use of Mustardé sutures to recreate the superior crus and Furnas sutures to complete the auricular setback. This novel technique for correction of Stahl's ear deformity produces a more stable aesthetic result versus classic otoplasty with desired auricular setback, minimal reduction in the size of the ear, and limited scarring on the anterior auricular surface. Reconstruction of Stahl's ear deformity can be accomplished using this double-reverse wedge excision technique of the third crus cartilage and skin with Mustardé and Furnas sutures to recreate the superior crus and complete auricular setback, effectively restoring anatomic harmony to the ear.

Oreja de Stahl y su manejo quirúrgico

Oreja de Stahl y su manejo quirúrgico

Review of Microtia : A Focus on Current Surgical Approaches

A wide spectrum of anomalies may involve the auditory system. As a visible structure, auricular malformations constitute a great burden. A wide set of anomalies may affect the ear including the microtia spectrum, protruding ears (bat ear), constricted ear (Lop and Cup ears), Stahl ear, and cryptotia.In plastic surgery practice protruding ears and microtia are common presentations. Microtia literally means small ears. Microtia is a spectrum of anomalies of the auricle that range from disorganized remnant of cartilage attached to soft tissue lobule to complete absence of the ear (anotia). Ear reconstructive procedures has made in impact in the lives of these patients. The early attempts to surgically restore the ear in microtia was in 1920 using a rib cartilage. Up to 49% of microtia cases are associated with other anomalies or a known syndrome. The most common syndromic associations are hemifacial microsomia, Towens Brocks syndrome, Treacher Collins, Goldenhar and Nager syndrome. Oculo-auriculo-vertebral spectrum (OAVS). Generally, the ear can be retrieved by two possible methods: Surgical reconstruction using autologous or alloplastic cartilage and the use of prosthesis which could be adhesive or implant retained. Surgical reconstruction proved to be superior to other methods due to its longevity and less complications. The only limitation is the skill of the surgeon. Ear prosthesis are reserved for special cases including traumatic anotia in adults.

The treatment efficiency of a new ear moding device in the infants with congenital ear abnormalities

Objective:To observe the nonsurgical treatment effciency of a new ear moding device on congenital auricle deformities in order to promote clinical application. Method:Twenty-nine patients (38 ears) from Beijing Tongren Hospital Outpatient received ear molding treatment using the EarWell Infant Ear Correction System. We keep regular follow-up and close observation during the moding period. The treatment effciency was judged by the otologist, plastic surgeons and parents based on the preprocedure and postprocedure photographs and divided into 3 grades: excellent, good and poor. Result:Twenty-nine patients (38 ears) including prominent ear, 2 ears; cup ear,7 ears; lidding/lop ear deformities, 4 ears; Stahl's ear, 4 ears; helical rim abnormalities, 4 ears; conchal crus ear, 3 ears, mixed ear deformities 4 ears; cryptotia, 5 ears; ear malformation, 5 ears, 2 patients (2 ears) stop moding after 3 days treatment due to the low compliance of the infants, the remaining 36 ears received ear molding all have improved. The success rate of the EarWell Infant Ear Correction System is more than 94% (good to excellent). Conclusion:EarWell Infant Ear Correction System have a significant moding effect and can achieve satisfactory results in early time. EarWell system has a high success rate in the treatment of neonatal auricle deformations and mild auricle malformations, depending on the severity of the deformations and the initiation of treatment time. The sooner the noninvasive moding begins (especially within one week after birth), the better effect and the shorter treatment time the patients will achieve.

Management of Stahl's ear: a case report

Management of Stahl's ear: a case report

Correction of Congenital Auricular Deformities Using the Ear-Molding Technique.

BackgroundStudies of the ear-molding technique have emphasized the importance of initiating molding early to achieve the best results. In the present study, we describe the immediate effects and long-term outcomes of this technique, focusing on children who were older than the ideal age of treatment initiation.MethodsPatients who visited our institution from July 2014 to November 2015 were included. Medical charts were reviewed to collect data on demographics, the duration of treatment, the types of deformities, and the manner of recognition of the deformity and referral to our institution. Parents were surveyed to assess the degree of improvement, the level of procedural discomfort at the end of treatment, any changes in the shape of the molded auricle, and overall satisfaction 12 months after their last follow-up visits.ResultsA review of 28 ears in 18 patients was conducted, including the following types of deformities: constricted ear (64.2%), Stahl ear (21.4%), prominent ear (7.1%), and cryptotia (7.1%). The average score for the degree of improvement, rated on a 5-point scale (1, very poor; 5, excellent), was 3.5 at the end of treatment, with a score of 2.6 for procedural discomfort (1, very mild; 5, very severe). After 12 months, the shapes of all ears were well maintained. The average overall satisfaction score was 3.6 (1, very dissatisfied; 5, very satisfied).ConclusionsWe had reasonable outcomes in older patients. After 1 year of follow-up, these outcomes were well maintained. Patients past the ideal age at presentation can still be candidates for the molding technique.

Innovative method to correct Stahl ear that involves full thickness scoring incisions and an onlay graft of cymba conchal cartilage

We successfully corrected Stahl ear with a combination of scoring incisions and a conchal cartilage graft. The cymba concha was used as an onlay graft, to serve as an anatomical splint. This technique maintains the original size of the ear without an irregular contour or visible scars, and it makes it possible to reshape stiff cartilage.

“Intra Scaphal Opposing Sutures” for Stahl’s ear correction

Stahl’s ear deformity is a rare congenital abnormality and is characterized with the presence of an abnormal third crus in the upper pole of the auricle. Although various techniques are advised, there is no standard surgical correction option. In this study, we have tried to show a new suture method to able to correct Stahl’s ear deformity as a more practical and less invasive way. This study includes 4 patients and 4 ears having Stahl ear deformity that was corrected by “Intra Scaphal Opposing Sutures”. The patients were followed up for 12 months with clinical examination and photography. Patient satisfaction was good with favorable results. Suturing techniques are common procedure for Stahl’s ear correction. They can be used alone or in combination with excision, scoring and/or reshaping techniques. The main advantages of our technique are: using a smaller posterior incision, limited dissection and less destruction without performing any excision. Stahl’s ear correction with Intra Scaphal Opposing Sutures may offer a practical and stable solution in selected cases, especially with minor presence of aberrant third crus.