Ear molding to correct deformations in newborns can obviate the need for surgery, provided that molding takes place within the first six weeks of life. After this narrow golden window of opportunity has passed, the molding method becomes less or not effective. Corrective surgery will be the likely recourse, which can only be carried out after four years of age.
Thus, identification of congenital ear deformities and prompt referral for assessment and intervention is extremely time-critical, as the effectiveness of the molding method plummets with age.
COMMON CHILDHOOD EAR DEFORMITIES
Ear deformities can be broadly divided into two categories: deformations and malformations. Deformations form the majority of ear deformities, and are typically misshapen ears with minimal deficiency in ear cartilage and skin. Common types of ear deformations include cup ears, lidding and helical deformities, which are outlined in Table 1a and Table 1b. Ear deformations are
amenable to molding.
Ear malformations are more severe deformities where there is a deficiency of ear cartilage and/or skin. The most severe forms are microtia – where the child has a rudimentary ear appendage, and anotia – where the child has no ear at all.
Ear malformations cannot be fully corrected with molding, and reconstructive surgery is the recommended treatment. The age indicated for surgery to correct ear malformations depends on the type of deformity.
While ear deformations do not affect a child’s hearing, studies have shown that children and adults with ear deformities experience significantly more psychological distress, anxiety, self-consciousness, behavioural problems and social avoidance.
NON-SURGICAL EAR SHAPING
Ear molding can be highly effective in correcting ear deformations without surgery when initiated between the second or third day to six weeks of a newborn’s life, during which the cartilage is pliable and moldable due to high levels of maternal oestrogen present in the child’s circulation.
Beyond this period of time, splinting becomes less or no longer effective, and the child can only undergo corrective surgery after four years of age, when the ears have grown to nearly their full size.
The process of ear molding involves wearing a customised splint continuously for a period of time to correct and maintain the shape of the ear, and the patient is reviewed weekly to monitor the progress of the correction.
If initiated early, the duration of molding ranges from two to six weeks, depending on the severity of the deformation. The pliability of the newborn’s cartilage allows the deformity to be corrected, and the results – after a period of molding or splinting – are permanent.
Possible complications can include minor skin irritation and excoriations from splints and adhesive tapes used during molding. These are self-limiting and often resolve within a few days. Recurrence of the ear deformity after termination of splinting can be a late complication; this is more common in babies who commenced molding later in life.
Ear molding must be carried out by a medical practitioner trained in correcting ear deformities, as it is crucial to identify the abnormality accurately and customise the splint accordingly. Babies born in KK Women’s and Children’s Hospital (KKH) who have ear deformities are referred to the Department of Plastic, Reconstructive and Aesthetic Surgery for assessment and diagnosis as early as possible after birth.
For babies diagnosed with ear deformations, when molding is initiated at day two to three of life, the rate of successful ear correction is more than 90 per cent.
At KKH, molding techniques are also increasingly being used to improve ear malformations. Patients who undergo this form of non-surgical correction can expect to require less invasive surgery in future to reconstruct their ear form, or no surgery if they find the improved ear form acceptable.
EARLY INTERVENTION CRUCIAL FOR SUCCESSFUL EAR MOLDING
At present, KKH performs ear molding for an average of 50 newborns each year. However, the number of children undergoing ear molding remains low compared to the incidence of childhood ear deformations in Singapore. This may be due to the lack of public awareness of ear molding as a viable and non-invasive corrective measure, as well as the late presentation of patients beyond the optimal age for successful molding.
As some ear deformations in newborns can be subtle and easily missed, caregivers and community healthcare practitioners are encouraged to examine the ears of newborns using the three-step approach outlined in Table 2, to identify less obvious deformations.
Generally, the earlier a child receives intervention, the better their projected outcomes. Thus, should an infant be suspected to have an ear deformity, they should be promptly referred for tertiary assessment and diagnosis.