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Impact of Accessory Auricular Tissue
Hillary E. Jenny, BS, Benjamin B. Massenburg, BA, E. Hope. Weissler, BA, Paymon Sanati-Mehrizy, BA, Peter J. Taub, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Accessory auricles are common congenital anomalies that range in severity from an accessory appendage of skin alone to a separate pinna composed of skin, subcutaneous tissue, and cartilage. The management varies from immediate suture ligation or titanium clip to inpatient surgical removal and reconstruction; concern for hearing and vestibular impairment also often leads to additional newborn testing. This study aims to assess the current management in newborns with accessory auricles and the impact this diagnosis has on hospital course and patient outcome.
A retrospective cohort study was performed using the 2000- 2012 Kids' Inpatient Database. Newborns were included if they were delivered by normal vaginal births or Caesarean sections. Interventions included audiovestibular testing during admission and/or excision of the accessory tissue. The impact on the hospital course and the health care system was measured by the total charge to the patient and the length of hospital stay. Patient outcome measurements included a diagnosis of hearing or vestibular dysfunction. Data was analyzed using SPSS v20 software.
Of the 19,638,452 births recorded, an accessory ear was identified in 25,802, a prevalence of 0.13%. The ratio of males to females was 53:47, and 36% were born via Caesarean section. A diagnosis of accessory auricular tissue had no significant effect on total charge to the patient or length of hospital stay. However, 11.8% underwent excision or destruction of the accessory auricle during the post-birth admission (n=3033). Compared to uninvolved newborns, significantly more newborns with accessory auricular tissue also received auditory and vestibular testing (5% vs. 4.2%, p<0.001; 5.5% vs. 5%, p<0.001). A significantly greater proportion of newborns with accessory auricle tissue were diagnosed with nonspecific auditory dysfunction (1.2% vs. 0.5%, p<0.001) and hearing loss (0.09% vs. 0.02%, p<0.001). This represented 0.2% of newborns with accessory auricular tissue who underwent auditory testing, compared with the 0.02% of unaffected children who also underwent auditory testing (p<0.001). No children with accessory auricle tissue were diagnosed with a vestibular dysfunction.
Accessory auricular tissue is a common deformity that leads to significantly more frequent auditory and vestibular function testing during a neonate's birth admission, despite having no effect on total charge and length of hospital stay. Almost 1 in 8 newborns underwent definitive management during the birth-admission rather than delaying and utilizing an outpatient option. In addition, more newborns with accessory auricular tissue were diagnosed with nonspecific auditory dysfunction as well as hearing loss. Because a greater proportion of screened neonates were diagnosed with auditory impairment than in the unaffected population, the increased frequency of diagnosis is also not likely to be simply due to lead-time bias. However, despite the increased rate of vestibular screening in newborns with accessory auricular tissue, none of them were diagnosed with vestibular dysfunction, bringing into question the necessity of vestibular function testing in newborns with accessory auricular tissue.
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