A 10-Year Retrospective Review of the Nonsurgical Treatment of Infant Ear Anomalies.

BACKGROUND: A review of a single surgeon's 10-year experience treating congenital ear anomalies using nonsurgical ear molding is presented. This study assesses the efficacy of treating a variety of anomalies in infants with age ranging from younger than 1 week to 22 weeks and identifies potential barriers to care. METHODS: A retrospective chart and photographic review of 246 consecutive infants treated with ear molding between 2010 and 2019 was undertaken. Data regarding patient demographics, anomaly classification, device selection, treatment duration, adverse events, and satisfaction with outcomes were collected. RESULTS: This study included 385 infant ear anomalies in 246 patients. Median age at initiation of treatment was 16 days and median treatment duration was 29.5 days. A median number of three devices was needed to complete bilateral treatment. Treated anomalies included mixed deformity, helical rim, prominent, lidding/lop, Stahl ear, conchal crus, cupping, and cryptotia. Complications occurred in 47 patients, with skin breakdown being the most common [26 patients (55.3 percent)]. Satisfaction rate was 92 percent in 137 surveyed parents. Median patient household income was approximately $112,911, and treatment was covered by insurance for 244 of 246 patients. CONCLUSIONS: The study outcomes demonstrate that ear molding can be effective in patients as old as 22 weeks without compromising treatment duration or complexity. In addition, in the authors' experience, molding is an effective treatment for the majority of infant ear deformities. Despite a steady increase in patient volume over the past 10 years and consistent coverage of treatment by insurance, the authors' catchment area continues to be largely limited to affluent households. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Evolution of Anomaly-Specific Techniques in Infant Ear Molding: A 10-Year Retrospective Study.

BACKGROUND: Congenital ear anomalies occur in at least one-third of the population, and less than one-third of cases self-correct. Ear molding is an alternative to surgery that spares operative morbidity and allows for significantly earlier intervention. In this retrospective study, the senior author (S.B.B.) developed a tailored approach to each specific type of ear deformity. The use of modifications to adapt standard ear molding techniques for each unique ear are described. METHODS: The authors conducted a retrospective, institutional review board-approved study of 246 patients who underwent ear molding performed by a single surgeon. The procedure reports for each case were reviewed to develop stepwise customization protocols for existing EarWell and InfantEar systems. RESULTS: This review included 385 ears in 246 patients. Patient age at presentation ranged from less than 1 week to 22 weeks. Presenting ear deformities were subclassified into mixed (37.4 percent), helical rim (28.5 percent), prominent (10.6 percent), lidding/lop (9.3 percent), Stahl ear (3.6 percent), conchal crus (3.3 percent), and cupping (2.8 percent). Two patients (0.8 percent) had cryptotia. Deformity subclass could not be obtained for 11 patients (4.5 percent). Recommended modifications to existing ear correction systems are deformity-specific: cotton-tip applicator/setting material (Stahl ear), custom dental compound mold (lidding/lop and cupping), scaphal wire (helical rim), cotton-tip applicator/protrusion excision (prominent), and custom dental compound stent (conchal crus). CONCLUSIONS: Presentation of ear anomalies is heterogenous. This 10-year experience demonstrates that the approach to ear molding should be dynamic and customized, using techniques beyond those listed in system manuals to complement each ear and to improve outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Outpatient Posttraumatic Auricle Reconstruction Under Local Anesthesia.

ABSTRACT: We described an outpatient auricle reconstruction in an elderly patient after an accidental facial trauma. The procedure was carried out under local anesthesia given patient's comorbidities and acetylsalicylic acid (ASA) therapy. The patient subsequently underwent to regular follow-up. An excellent healing of the auricle injury was achieved.

Clinical application of intense pulsed light depilation technology in total auricular reconstruction.

Although ear reconstruction technology has been highly developed in recent years, hair growth on the reconstructed ear has plagued both surgeons and patients. In this paper, the authors introduce a clinical application of intense pulsed light depilation in total auricular reconstruction. From August 2012 to August 2013, 27 patients (28 ears) suffering from congenital microtia were treated by intense pulsed light depilation (650-950-nm filter, initial fluence of 14-16 J/cm2 and gradually increased, pulse width of 30-50 ms, spot size of 20 × 30 mm2, intervals of 6-8 weeks, a total of four sessions) either before or after auricular reconstruction. According to the treatment situation at diagnosis, the patients were divided into two groups: the preoperative group and the postoperative group. There were no differences between the two groups in terms of age or initial fluence for hair removal; however, there were less treatments in the former than in the latter group (preoperative group 4.1 ± 0.3, postoperative group 4.7 ± 0.7, F = 9.10, P = 0.006), and the maximum fluence used for hair removal was lower in the former than in the latter group (preoperative group 18-20 J/cm2, postoperative group 19-22 J/cm2, F = 22.31, P < 0.001). After follow-up for ≥4-6 months, the effective rate was 100% in the preoperative group, and the effective rate was 80% in the postoperative group. Intense pulsed light depilation technology is a reasonable complementary approach to total auricular reconstruction. And preoperative depilation is recommended over postoperative depilation. The non-invasive modern photonic technology can resolve the problem of postoperative residual hair on the reconstructed auricle, improving auricular shape and increasing patient satisfaction. In addition, an adequately set preoperative hair removal area can provide surface skin that is most similar to normal auricle skin for auricular reconstruction.

Uso de imanes en el tratamiento de queloides auriculares / Magnets use in the treatment of ear keloids

Introducción y Objetivos. La incidencia de queloides auriculares es cada vez mayor. Su alta frecuencia de recidiva es de gran interés, por ello su extirpación quirúrgica se asocia a otras terapias como radioterapia, corticoides, crioterapia, láser, presoterapia, etc. La presoterapia resulta un método efectivo, sencillo y accesible. Material y Método. Realizamos un estudio prospectivo, experimental, sobre 11 casos de queloides auriculares tratados con resección quirúrgica seguida de presoterapia usando imanes, tomando en cuenta la presión y fuerza magnética ejercida. Llevamos a cabo seguimiento de los casos entre 4 y 6 meses. Empleamos las pruebas de Mann-Whitney y Coeficiente Lineal de Pearson. Determinamos la tasa de recurrencia y realizamos un análisis de regresión para el estudio de la escala de Valor Análoga del Dolor (EVA). Resultados. La tasa libre de recurrencia fue del 90.91%. No hubo ningún tipo de complicación. En cuanto a la EVA, observamos una ascendente tolerancia a la terapia con imanes auriculares a través del tiempo. Conclusiones. El protocolo de uso de imanes que presentamos es un excelente tratamiento coadyuvante. El magnetismo parece cumplir un papel fundamental en la remodelación y organización de las fibras de colágeno de las cicatrices postoperatorias, añadiendo una efectividad mayor a la presoterapia (AU)

Background and Objective. The incidence of keloids in ears is increasing. The high frequency of recurrence is of great interest, so surgical removal is associated with other therapies like radiotherapy, corticosteroids, cryotherapy, laser, acupressure, etc. Pressure therapy is an effective, simple and accessible method. Methods. We conduct a prospective, experimental study, with 11 cases of keloid ears treated with surgical resection followed by pressure therapy using magnets, taking into account the pressure and magnetic force. Follow up between 4 and 6 months was performed. Tests such as Mann-Whitney and Linear Coefficient were used. The recurrence rate was determined and a regression analysis to study the value in Analog Scale of Pain (VAS) was performed. Results. The recurrence free rate was 90,91%. There were no complications. As the EVA, an upward tolerance headset magnet therapy over time was observed. Conclusions. The protocol we present using magnets is an excellent adjuvant treatment. Additionally, magnetism seems to fulfill a key role in the remodeling and organization of the collagen fibers of postoperative scarring, adding more to this type of pressure therapy effectiveness (AU)

Reconstrucción de lóbulo rasgado incompleto mediante media z plastia o colgajo en hamaca / Incomplete cleft earlobe reconstruction using a z-plasty or hammock flap

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Audiologic changes after pinna augmentation.

No studies to date have objectively assessed whether pinna morphology affects sound intensity detected within the external auditory canal (EAC). Commonly performed procedures on the EAC are carried out for acquired and congenital pathology, together with correction of ear deformities. Our aim was to use an experimental model to identify whether a relationship exists between pinna shape and its subsequent effect on the hearing subject. An anatomically accurate and life-size model made of rubber composite was used for this study. Serial sections (small wedge, defect open; small wedge, defect closed; large wedge, defect open; large wedge, defect closed [equivalent to a protruding ear]; and pinnectomy) were undertaken, and the sound intensity changes assessed at the junction between the EAC and middle ear (tympanic membrane position) using an AURICAL Plus (Otometrics; Taastrup, Denmark) sound processor. A statistically significant loss was demonstrated for wedge-excised models, which was greatest at 180° azimuth. This loss was significantly reduced when the wedge defects were closed. A statistically significant improvement was demonstrated in the protruding ("bat") ear model compared with the normal ear at 0° azimuth. In this model, gain in sound intensity is adversely affected by pinna wedge resection. Because this change may be increased in those with protruding ears, this factor is important to consider for all cosmetic and noncosmetic operations to the pinna, and it supports the notion that the pinna is not a simple funnel.

Repairing a non-marginal full-thickness auricular defect using a reversed flap from the postauricular area.

PURPOSE: Different methods for auricular reconstruction have been introduced over time. To minimize stress on the flap and offer an excellent wound control, the anterior pedicled retroauricular flap (APRF) was described in 2012. It offers an excellent alternative for reconstructing different parts of the ear helix. The authors also apply the APRF to repair centrally located perforating defects of the ear. MATERIALS AND METHODS: The APRF was used to reconstruct nonhelical full-thickness defects of the auricle in 11 patients. The operations were performed under local anesthesia and in an ambulatory setting in 3 operative steps. RESULTS: The repair of full-thickness conchal defects was successfully performed in 11 patients, with good esthetic outcome, minimal donor site morbidity, and high patient satisfaction. CONCLUSION: An APRF from the postauricular area is a simple and effective method to reconstruct a full-thickness non-marginal auricular defect.

Modified Antia-Buch flap for the reconstruction of helical rim defects.

BACKGROUND: The Antia-Buch flap is a sophisticated one-stage procedure using two chondrocutaneous flaps to reconstruct the ear helix. Because tissue laxity is largely conferred by the inferior flap, relative to the less mobile superior flap, chondrocutaneous resection of scapha is required for closure. This results in loss of ear height and limits morphologic outcome. We describe a modification of the Antia-Buch flap, which may avoid such drawbacks. PATIENTS AND METHOD: We conducted a retrospective review of patients (n = 15), each undergoing our modified Antia-Buch flap between 2010 and 2014. All procedures were performed under local anesthesia as outpatient procedures. Data on magnitude of resections, procedure durations, related complications, and aesthetic outcomes were collected. RESULTS: The mean size of resection was 25 mm (range, 20-30 mm). The modification improved the mobility of the upper chondrocutaneous flap, eliminating the need to resect the scapha. All wounds healed uneventfully, with no skin necrosis. The morphologic outcome was satisfactory or very satisfactory in all patients, preserving the shape, height, and width of the ear. CONCLUSIONS: Our modification changes the upper flap from an advancement flap to a transposition flap, enhancing its mobility and preempting the resection of the scapha. Thus, anatomic landmarks, aesthetic subunits of the pinna, and ear height are maintained for highly satisfactory morphologic results. LEVEL OF EVIDENCE: 4.

Necrotizing fasciitis of the ear: an unusual case.

We describe a rare case of necrotizing fasciitis of the ear in an otherwise generally healthy 39-year-old man. The ear is rarely involved in this often-fatal disease. The diagnosis was suspected on the basis of clinical examination and confirmed by computed tomography and pathology of a biopsy specimen, which revealed subcutaneous gas formation and dermal infiltration of inflammatory cells, respectively. The patient was promptly treated with surgical debridement, intravenous antibiotics, and hyperbaric oxygen. He recovered well and subsequently underwent otoplastic reconstruction with very satisfactory results. By documenting this case, we aim to heighten awareness of necrotizing fasciitis of the head and neck in an effort to improve survival rates.

Maintaining ear aesthetics in helical rim reconstruction.

BACKGROUND: Wedge resections of the helical rim may result in a significant deformity of the ear with the ear not only smaller but cupped and prominent too. Our technique involves resection of the wedge in the scaphal area without extending into the concha followed by advancement of the helical rim into the defect. This technique is most suitable for peripheral defects of the helical rim, in the middle third. METHODS: Our modified surgical technique was applied to reconstruction of the pinna after resection of the tumor in 12 patients. Free cartilaginous helical rim, length of helical rim to be resected, and projection of the ear from the mastoid was measured. This was then compared with measurements after the operation, and the patient satisfaction assessed with a visual analog scale. RESULTS: The free cartilaginous rim was 91.67 ± 5.61 mm. Of this, 21.92 ± 3.78 mm was resected, which amounted to 23.84% ± 3.35% of the rim. Although this resulted in a mean increase in ear projection of 6.42 ± 1.68 mm, the aesthetic outcome was good (visual analog scale, 9.08 ± 0.9). CONCLUSIONS: This technique reduces cupping and does not make the ear as prominent as it may do after a conventional wedge resection and results in high patient satisfaction.

Blood flow dynamics in reconstructed auricles.

Ear reconstruction with autologous rib cartilage is performed in stages. Restitution of blood flow between the separate stages is crucial to obtain a good result. Laser Doppler perfusion imaging (LDPI) and local temperature were measured in reconstructed and normal ears in response to indirect heating. Ten persons who had had a unilateral ear reconstruction were included in the study. At a minimum, 157 days had passed since the last operation. LDPI showed no difference in blood flow between the reconstructed ear and the normal ear, neither before nor after indirect heating. The upper part of the normal ear was slightly cooler than the corresponding part in the reconstructed ear. Indirect heating caused an increase of LDPI-values and temperatures in the upper, middle, and lower part of the ear both in the reconstructed ear and the normal one. Skin blood flow recovers after 3-stage ear reconstruction and shows normal dynamic response upon indirect heating.

Successful replantation of an amputated earlobe by microvascular anastomosis.

In the microsurgical area, replantation of ear amputation by microvascular anastomosis is considered to be the best method in terms of texture, color, and shape. Only a few cases of successful ear replantation with microvascular anastomosis have been reported because the size of the vessels is very small, and identifying appropriate vessels for anastomosis is difficult. Furthermore, most cases were total or subtotal (upper two thirds of the ear) amputations, and they were successfully reconstructed by replantation.To the best of our knowledge, this is the first case of a patient with ear lobe avulsion who underwent successful replantation by single arterial anastomosis. We report our case with a brief review of the literature.

[Effects of the Nei-Guan acupressure by wrist band on postoperative nausea and vomiting after middle ear surgery].

PURPOSE: This study was to identify the effects of Nei-Guan acupressure using a wrist band on postoperative nausea and vomiting after middle ear surgery. METHODS: The study design was a nonequivalent control group non-synchronized posttest design. Forty patients were assigned into two groups of 20 patients, the wrist band group and the control group. In the wrist band group, acupressure was applied with a wrist band on the P6 point at both wrists from 30 min before to 24 hr after anesthesia. RESULTS: The 1st hypothesis 'Applied wrist band groups will have a greater reduction in the nausea & vomiting grades by INVR than the control group' was accepted (t=2.303, p=.028). The 2nd hypothesis 'The Applied wrist band groups will have a greater reduction in the occurrence of nausea & vomiting than the control group' was partly accepted. The 3rd hypothesis 'The applied wrist band group will have a greater reduction in injection of antiemetics for 24 hr. post anesthesia than the control group' was rejected. CONCLUSION: Acupressure on the P6 point using a wrist band is effective to alleviate nausea for middle ear surgery patients.

Neuro-reflexotherapy for the management of myofascial temporomandibular joint pain: a double-blind, placebo-controlled, randomized clinical trial.

PURPOSE: To assess the efficacy of neuro-reflexotherapy intervention (NRT) for treating temporomandibular joint dysfunction attributed to myofascial pain. Neuro-reflexotherapy intervention consists of the temporary implantation of epidermal devices in trigger points in the back and ear. It has shown efficacy, effectiveness, and cost-effectiveness in treating subacute and chronic common back pain. No study, however, has explored its efficacy in treating myofascial temporomandibular joint pain (MF/TMJP). PATIENTS AND METHODS: This was a randomized, double-blind, placebo-controlled trial. Patients with MF/TMJP for more than 3 months in spite of conservative treatment, and with no evidence of major structural damage in the joint, were recruited at the Maxillofacial Department of the Hospital Clínico Universitario, a teaching hospital in Madrid, Spain. Patients were randomly assigned to an intervention group and to a control group. Patients in the treated group underwent 2 NRTs, immediately after baseline assessment and 45 days later. Sham interventions in the control group consisted of placement of the same number of epidermal devices within a 5-cm radius of the target zones. In both groups, conservative treatment during follow-up was allowed and recorded. Patients underwent clinical evaluations on 4 occasions: 5 minutes before intervention, 5 minutes after intervention, and 45 and 90 days later. The preintervention assessment was performed by the physician at the hospital service who included the patient in the study. The 3 follow-up assessments were performed independently by 1 of 2 physicians who had no connection with the research team, and who were blinded to patients' assignments. The primary outcome variable was level of pain severity during jaw movements at the last assessment (90 days), and the key comparison of interest was change in pain over time (pain levels at baseline and at 90 days). Level of pain was measured using a visual analog scale (VAS). RESULTS: Fifty-one patients with MF/TMJP were recruited into the study. Random assignment allocated 27 patients to the intervention group, and 24 to the control group. Differences in pain severity in favor of the intervention group appeared immediately after the intervention, persisted for 45 days, and increased after the second intervention. Differences at last follow-up were highly clinically and statistically significant (4 to 5 points on the VAS, P = .000), allowing for patients in the intervention group to cease drug treatment (P = .005). There were no differences in the evolution of crepitus or clicking in the joint. There were no clinically relevant side effects associated with the intervention. CONCLUSIONS: For patients in whom conservative treatment has failed, NRT improves the chronic pain associated with MF/TMJP syndrome.

Effects of the Nei-Guan Acupressure by Wrist Band on Postoperative Nausea and Vomiting after Middle Ear Surgery / 간호학회지

PURPOSE: This study was to identify the effects of Nei-Guan accupressure using a wrist band on postoperative nausea and vomiting after middle ear surgery. METHODS: The study design was a nonequivalent control group non-synchronized posttest design. Forty patients were assigned into two groups of 20 patients, the wrist band group and the control group. In the wristband group, acupressure was applied with a wrist band on the P6 point at both wrists from 30 min before to 24 hr after anesthesia. RESULTS: The 1st hypothesis 'Applied wrist band groups will have a greater reduction in the nausea & vomiting grades by INVR than the control group' was accepted (t=2.303, p=.028). The 2nd hypothesis 'The Applied wrist band groups will have a greater reduction in the occurrence of nausea & vomiting than the control group' was partly accepted. The 3rd hypothesis 'The applied wrist band group will have a greater reduction in injection of antiemetics for 24 hr. post anesthesia than the control group' was rejected. CONCLUSION: Acupressure on the P6 point using a wrist band is effective to alleviate nausea for middle ear surgery patients.