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Lessons learned in ear molding: a single surgeon's experience of 175 consecutive patients
Vikas S. Kotha, Manas Nigam, M.D., Emily Lai, Stephen B. Baker, M.D., D.D.S..
Georgetown University, Washington, DC, USA.

Background: Ear molding can improve almost any congenital ear deformity when employed within the first three weeks of life. The senior author has been using this technique since 2007 and this paper presents an evolution of his technique over the past 12 years.
Methods: Medical charts were reviewed consecutively for patients undergoing ear molding. Ears were stratified according to molding initiation > 3 weeks of birth. P<0.05 indicated significance.
Results: 272 ears (175 patients) were identified (mean follow-up 0.5 mo). The mean age significantly differed in group I (n=176) (11.2 5.2 d) and II (n=92) (37.4 20.7 d) (P=0). Table 1 describes the deformities, 71% of which presented bilaterally. The length of treatment was 30.9 days overall (34.7 d vs. 32.4 d, P=0.4). EarWell (Becon Medical Ltd., Tuscon, AZ) devices were used for all but three ears. The number of devices used was similar (2.3 vs. 2.5). Fallouts (1.04 1.1 vs. 0.69 1, P=0.02) and replacements (0.9 1.1 vs. 0.56 0.7, P=0.004) were more common with delayed molding. The most common complication was minor skin breakdown in 18 (6.6%) ears. Complications did not correlate with age. Two (0.7%) ears underwent follow-up surgery. Overall satisfaction was 85%.
Conclusions: Ear molding is ideally advocated for the treatment of congenital ear deformities within 3 weeks of birth. Uncommon complications include allergy, skin breakdown, and failure to meet expectation. From our experience, setting realistic expectations helps limit discrepancies between expectation and outcome. As such, we have had success as late as 5 weeks of birth. Proper ear molding requires dynamic care; it not a single quick application of the device. Although molding kits are useful for basic anomalies, the senior author has readily achieved optimal results using adjunct techniques like scaphal molding and impression-material encasement of molding devices. Obtaining the ideal result requires 4-6 weeks of continuous reassessment. Finally, we have seen greater patient satisfaction when bilateral molding is applied to not only normalize the more abnormal but to obtain symmetry between the opposing ears.
Figures/Tables
Table 1. The types of auricular deformities treated with nonoperative ear molding (N=272). The type of deformity did not influence when molding began.

DeformityEars (N=272)Molding Initiation
(days from birth)
P-value
<3 weeks (n=176)> 3 weeks (n=96)
Stahl23 (8.4%)15 (8.5%)8 (8.3%)0.742
Lidding‎/Lop24 (8.8%)17 (9.7%)7 (7.3%)
Helical Rim39 (14.3%)24 (13.6%)15 (15.6%)
Prominent63 (23.1%)42 (23.9%)21 (21.9%)
Cupping21 (7.7%)15 (8.5%)6 (6.3%)
Conchal Crus6 (2.2%)2 (1.1%)4 (4.2%)
Mixed96 (35.2%)60 (34.1%)35 (36.5%)


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