A Retrospective Review of Outcomes and Complications after Infant Ear Molding at a Single Institution

Abstract

Background: The purpose of this study was to evaluate outcomes and complications associated with infant ear molding at a single institution.

Methods: We conducted a retrospective chart review of all infants who underwent ear molding using the EarWell Infant Ear Correction System with pediatric plastic surgery from October 2010 to March 2021. Types of ear anomalies, age at initiation, duration of treatment, gaps in treatment, comorbidities, and complications were extracted for included patients. The primary outcomes assessed were degree of ear anomaly correction and incidence of skin complications. Parents were also sent a questionnaire regarding their long-term satisfaction with the ear molding treatment process.

Results: A total of 184 ears of 114 patients meeting inclusion criteria were treated during the study period. Mean age at treatment initiation was 21 days, and average duration of treatment was 40 days. Helical rim deformities (N = 50 ears) and lop ear (N = 40 ears) were the most common anomalies. A total of 181 ears (98.4%) achieved either a complete (N = 125 ears, 67.9%) or partial correction (N = 56 ears, 30.4%). The most common complications were eczematous dermatitis (N = 27 occurrences among 25 ears, 13.6%) and pressure ulcers (N = 23 occurrences among 21 ears, 12.5%). Infants who experienced a complication were 3.36 times more likely to achieve partial relative to complete correction (P < 0.001; 95% confidence interval 1.66-6.81).

Conclusion: Ear molding is an effective treatment strategy for infant ear anomalies, with most patients achieving complete correction.

Fig. 1.

EarWell infant ear molding device. The ear molding device consists of a series of retractors that grip onto the helical rim, an anterior shell that adheres to the face, a posterior cradle that holds the overall apparatus together (left), a conchal bowl former, and an optional foam piece that may overlay the conchal bowl former for additional pressure.

Fig. 2.

Age at treatment initiation. Age (d) upon initiation of infant ear molding treatment. The mean age of treatment initiation was 21 days.

Fig. 3.

Complete correction of helical rim deformity. A, Helical rim deformity before treatment. B, Complete correction of deformity following infant ear molding.

Fig. 4.

Complications. Eczematous dermatitis (A) and pressure ulcer (B) were the most encountered complications during infant ear molding.

Fig. 5.

Ear molding questionnaire long-term satisfaction and outcomes. Questionnaire responses from parents of treated patients regarding their satisfaction with duration of treatment, ease of use, clinical team communication about the treatment process, skin reactions, and whether any social issues have occurred with their children due to ear appearance since treatment.

Fig. 6.

Cumulative appearance scores. Cumulative appearance score was significantly higher among parents who reported their child’s treatment was a success (n = 21) when compared with parents who did not believe the treatment was a success (n = 3).

Fig. 7.

Modifications to the EarWell device. The device may be modified by trimming down the antihelix-shaping post (red circle) of the posterior shell. The removed piece is depicted in the photograph (black circle). Red arrows indicate full-thickness cuts in between lid insertion slots to improve cradle flexibility and reduce tension to prevent loosening of the adhesive backing from the skin.