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. 2025 Jul 24;13(1):826.
doi: 10.1186/s40359-025-03073-5.

Relationship between ear appearance and psychological function among congenital unilateral microtia after autologous cartilage ear reconstruction: a chain mediation model

Xinyu Li #  1 , Chenlong Li #  1   2   3 , Tianyu Zhang  4   5   6 , Jing Xu  7 , Yaoyao Fu  8   9   10
Affiliations

Relationship between ear appearance and psychological function among congenital unilateral microtia after autologous cartilage ear reconstruction: a chain mediation model

Xinyu Li et al. BMC Psychol. .

Abstract

Background: Congenital microtia significantly impacts children's psychological health, yet there has been limited focus on the effect of ear reconstruction surgery on psychological improvements, especially its pathway. This study aims to explore the role of ear appearance in improving psychological health in individuals with congenital unilateral microtia based on social identity theory, highlighting the limited understanding of the specific pathways involved in this relationship, and investigating how social function and benefit mediate the connection between ear appearance and psychological health in patients who underwent autologous cartilage ear reconstruction.

Methods: A cross-sectional study was conducted, involving 96 patients with congenital unilateral microtia between January and June 2024 at the Eye & ENT Hospital of Fudan University. Sociodemographic and clinical data were collected, along with responses to the EAR-Q and Glasgow Children's Benefit Inventory (GCBI) questionnaires. Data analysis was performed using multiple linear regression and the PROCESS macro in SPSS.

Results: Mediation analysis revealed that social function and emotion mediated the relationship between ear appearance and psychological function (total effect = 0.82; direct effect = 0.21; indirect effect = 0.61). Three mediation pathways were identified: ear appearance influenced psychological function through social function, emotional benefit, and a combined effect of both.

Conclusions: These findings underscore the critical role of social interaction and emotional health in shaping psychological outcomes for individuals with congenital unilateral microtia following reconstruction. The results offer valuable insights for developing targeted interventions to enhance psychological well-being in this population.

Keywords: Chain mediation model; Congenital unilateral microtia; Ear appearance; Psychological function; Social identity theory.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted according to the principles in the declaration of Helsinki-version 2008. All procedures were approved by the Ethics Committee and the Ethics Review Board of Eye & ENT Hospital of Fudan University (No. 2023191). Informed consent was obtained from all participants prior to the initiation of data collection, consent was also provided by a parent/legal guardian for individuals under 16 years of age. Additionally, participants were provided with a detailed explanation of the study’s objectives. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Hypothesized model of mediations
Fig. 2
Fig. 2
Heatmap of correlation analysis
Fig. 3
Fig. 3
Mediation model: Ear appearance on psychology mediated by society and emotion
See this image and copyright information in PMC

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