Mirror Ear: A Rare Case of Polyotia.

Polyotia is an anomaly of the external auricle in which the accessory auricle is large enough to closely resemble an additional pinna rather than a skin remnant and cartilage. Polyotia, also known as mirror ear or accessory ear, is a type of ear anomaly in the tragus area, but the term refers to substantial anomalies which resemble an accessory ear, unlike a pre-auricular tag. It is an extremely rare condition and to date, less than 30 cases of polyotia have been reported according to a review of the literature. A variety of theories has been proposed for development of such abnormal external auricle. We report two cases of polyotia which presented to Dhulikhel Hospital ENT OPD that was successfully corrected surgically. An 8-year-old boy and a 14-year-old boy presented with a large accessory anomalous auricle on left and right ear respectively. The accessory auricle was composed of an elastic cartilaginous component covered with skin and was positioned anteriorly to the original auricle in both the cases. The anomaly was not as large as the patient's external auricle, rather it mirrored the external auricle. On the opposite ear both the cases presented with preauricular skin tag. Surgical correction was done by dissecting the skin free from the duplicated cartilage via an incision along the free edge of the helix the duplicated cartilage was contoured to fill the pre-tragal hollow and the tragus reconstructed with a free cartilage graft.

Research Note: Metabolomics revealed the causes of the formation of chicken structural blue earlobes.

The earlobes of chickens exhibit a range of colors, but there has been relatively little research on the formation of structural blue earlobes. Previous results showed that the structural color earlobes were related to the interplay between melanin and collagen in light reflection. To investigate the metabolic differences in these earlobe colors, we conducted nontargeted liquid chromatograph mass spectrometer (LC-MS) for metabolomic sequencing on structural blue (Green and Blue groups) and nonstructural color (Black group) earlobes tissue of Jiangshan black-bone chickens. The content detection in earlobe tissues of different groups shows that there were significant differences in melanin and collagen content between the Black and Green group. The metabolome identified a total of 6,102 mass spectroscopic peaks and ultimately identified 919 annotated metabolites. Variable importance in the projection (VIP) analysis identified the common differential expressed metabolites (DMs) "Tyr Thr Ala Glu" among the 3 groups. By combining those DMs with differentially expressed genes (DEGs) in our previous transcriptome data from the same sample, and associated with KEGG pathway analysis, multiple pathways related to melanogenesis and collagen metabolism were enriched across the 3 groups. By analyzing the metabolites and genes in these pathways, as well as the interaction network diagram of DEGs, we identified some key genes, Wnt Family Member 6 (WNT6), Transcription Factor 7 (TCF7), Proopiomelanocortin (POMC) and Calcium/Calmodulin Dependent Protein Kinase II Alpha (CAMK2A), and some key DMs like DG (11M3/9M5/0:0) and gentisic acid. The differential gene expression and metabolic levels affect the production of melanin and collagen, leading to differences in the content in melanin and the thickness of the collagen layer between earlobe colors, while the thickness of the collagen layer could affect light scattering, ultimately resulting in different colored earlobes in Jiangshan black-bone chickens.

Auricular spoon-shaped crus malformation including variants: Clinical features and a novel surgical approach.

BACKGROUND: Certain auricular malformations are uncommon and lack generally accepted diagnostic names. This study investigates an uncommon complex auricular malformation known as auricular spoon-shaped crus malformation providing a detailed description of its external characteristics. Additionally, an effective surgical approach is proposed. METHODS: Between 1991 and 2023, 12 auricles in 11 patients with auricular spoon-shaped crus malformation including variants were surgically treated at our center. Patient medical records and photographic data were retrospectively reviewed. RESULTS: Each auricle exhibited 2 to 4 major structural deformities within the 5 areas of the superior crus, inferior crus, and stem of the antihelix, helical crus, and earlobe. These deformities resulted in depression between the antihelix and antitragus, vertical shortening, horizontal elongation of the auricle, and/or drooping of the ear. Three patients displayed a low positioning of the malformed ear, and 8 patients exhibited mild to moderate hemifacial microsomia. In corrections we conducted earlier, we utilized various methods with variable aesthetic outcomes. Recently, an improved corrective method we implemented yielded consistently promising aesthetic results. We have confidence that adopting the surgical approach we suggest can lead to promising aesthetic results when addressing this malformation. Furthermore, we hope that the presented malformation will be recognized as a primary auricular malformation by auricular surgeons in the future.

A new corrective method for the Tanzer's group IIB constricted ear: Helical expansion using V-Y advancement flap combined with concha cartilage graft.

BACKGROUND: The complexity of a constricted ear shape renders the aim of establishing a uniform surgical method unattainable, thus posing an ongoing challenge in its correction. The Tanzer's group IIB constricted ear is characterized by a prominent downward folding, an underdeveloped antihelix, and the absence of sacpha. The present study used a V-Y advancement flap combined with concha cartilage for the repair of Tanzer's group IIB constricted ear. METHOD: A total of 16 patients diagnosed with type IIB ear constriction from September 2016 to September 2022 were enrolled in this retrospective study. The correction procedure for the constricted ear involved the utilization of a V-Y advancement flap combined with concha cartilage graft. The auricle shape data of the patients, their visual analog scale (VAS) satisfaction scores, and aesthetic outcomes scale (AOS) aesthetic scores were examined preoperatively and 12 months post-operatively. RESULT: The mean duration of follow-up in this study was 18 months. The post-operative measurements of ear length, ear width, bilateral differences in ear length, and bilateral differences in ear width exhibited significant improvement compared to the preoperative values. The mean preoperative AOS score was 1.12 ± 0.34, and the mean post-operative AOS score increased to 3.81 ± 0.40. The preoperative VAS satisfaction score was 2.31 ± 0.70, whereas the post-operative VAS score significantly increased to 8.00 ± 0.89. The follow-up period did not present any cases of flap necrosis, hematoma, infection, or wound dehiscence. CONCLUSION: The combination of V-Y advancement flap and concha cartilage transplantation for the correction of Tanzer's group IIB constricted ear can achieve a natural and aesthetically pleasing auricle shape, resulting in high patient satisfaction.

Auricular growth potential of patients with concha-type microtia after auricular cartilage stretching surgery: A prospective study.

BACKGROUNDS: For patients with concha-type microtia, surgical intervention and the degree of deformity may affect the growth rate of the auricular cartilage, which is different at different ages. This study aimed to explore the auricular growth potential of patients with concha-type microtia at different ages after auricular cartilage stretching surgery. METHODS: A total of 66 patients with unilateral grade II and III concha-type microtia were involved in this prospective cohort study. All patients underwent auricular cartilage stretching surgery. Relevant data were collected before surgery, immediately after surgery, and at the last follow-up. RESULTS: The perimeter, width, and length of auricle, between each follow-up, was statistically significant, which supported the effect of surgery and auricular development. For patients in the grade II group, no statistical significance was found in the difference in the perimeter, width, and length between the affected and normal auricle. For the patients in the grade III group, the difference in the relevant indexes of the affected auricle was significantly different from those of the normal auricle. Between subgroups divided according to their age, the growth potential of affected auricle with the same degree of deformity was statistically significant. CONCLUSIONS: Growth potential of the affected auricle of the grade II group was consistent with that of the normal auricle, which was significantly higher than that of the grade III group. For patients at different ages, auricles grew faster before 3 years of age. Surgical intervention improved the auricular aesthetics and released the auricular growth potential. Thus, surgical intervention should be recommend as early as possible.

Perichondritis of the auricle: bacterial or fungal? (A case series).

BACKGROUND: Suppurative perichondritis of the auricle is a common disease that can easily cause malformations if it develops into an uncontrolled infection. In nearly half of the cases, otolaryngologists cannot identify the pathogens involved. CASE PRESENTATION: In the present work, we described two cases of pyogenic perichondritis, with negative on conventional culture. However, using metagenomic next-generation sequencing (mNGS), we detected fungal infections in the patients and after the patients were given anti-fungal treatment, the patients achieved a good prognosis. CONCLUSIONS: These cases highlighted the possibility that fungi might be the involved pathogens in patients who have had multiple negative bacterial cultures, and mNGS should be applied in these cases. mNGS could be used as a supplement to traditional culture methods.

Effectiveness of postoperative superficial radiotherapy following the keloid-cross-flap surgery for auricular keloid: A prospective cohort study.

BACKGROUND AND PURPOSE: Retaining partial keloid skin to make cross flaps (keloid-cross-flap surgery) is a modification of the core excision. This study aimed to compare the effectiveness of superficial radiotherapy versus compression therapy after keloid-cross-flap surgery. MATERIALS AND METHODS: In this prospective cohort study, auricular keloid patients were consecutively screened from January 2019 to December 2021. They underwent keloid-cross-flap surgery and then enter either the superficial radiotherapy or the compression treatment group. The primary outcome was the one-year keloid recurrence rate. Secondary outcomes included: non-completion rate of adjuvant treatment; Patient and Observer Scar Assessment Scale (POSAS) scores and auricular aesthetics scores, evaluated by a four-point Likert scale (1 = poor to 4 = excellent) of non-recurring patients. Propensity score matching (PSM) was used to eliminate potential confounding factors. RESULTS: 123 patients were included in the superficial radiotherapy group and 128 in the compression treatment group. Non-completion rate was significantly higher in the compression treatment group (17.97 %), while the loss rate was comparable between the two groups. Overall, 13 patients (13.54 %) relapsed in superficial radiotherapy group, while 22 patients (25.58 %) in compression group (p < 0.05). After PSM, 59 patients in each group were analyzed, and the recurrence rate was lower in the superficial radiotherapy group (13.56 %). Of relapse-free patients, no significant difference was found in PSAS scores, OSAS scores or aesthetic scores between the two groups. CONCLUSION: Keloid-cross-flap surgery could provide favorable morphologic repair of the auricular keloid, and postoperative superficial radiotherapy shows higher compliance and lower recurrence rate comparing to compression treatment.

Efficiency of ear molding for treating constricted ears of different severity.

PURPOSE: To investigate the treatment time and efficiency of constricted ears of different severity after correction. MATERIALS AND METHODS: We included the patients with constricted ear presented to our hospital for treatment between December 2021 and December 2023 in this retrospective analysis. The patients were divided into class I, II and III groups based on the severity of the constriction. Then we collected the data on classification of severity from each patient, together with sex, family history, age at initial correction, being informed upon diagnosis after birth, as well as utilization of auricle correction system. Logistic regression analysis was performed to identify the factors associated with the treatment time and efficiency. RESULTS: The correction system yielded a high effective rate in the constricted ears. The treatment time in class II was significantly longer compared with those of class I after adjusting these parameters. Compared with the cases of class I, those with a class III showed significant attenuation in the symptoms and conditions (95 % CI: 0.034, 0.365; P < 0.001), after adjusting the age at initial correction, being informed upon diagnosis after birth, and utilization of auricle correction system. There were no statistical differences between class II and III in the treatment efficiency after correction. CONCLUSIONS: The Amazing Ear Correction System was effective in treating constricted ear, yielding satisfactory treatment efficiency. Patients with class II constriction required longer treatment time compared with those of class I. The treatment outcome in the class I constriction was better than that of class III.