Satisfaction and health-related quality of life of patients with microtia following reconstructive surgery using the Nagata technique.

OBJECTIVE: This study aimed to investigate the functional outcomes, satisfaction, and quality of life of patients with microtia following reconstructive surgery. METHODS: This cross-sectional study was conducted using retrospective data of patients with microtia following reconstructive surgery using the Nagata technique. Data were obtained from the medical records of patients who underwent reconstructive surgery at the Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, Dr. Cipto Mangunkusumo Hospital between 2014 and 2018. All eligible patients were referred to participate in this study between November 2018 and March 2019. The hearing function was assessed by a professional audiologist after surgery. Patient satisfaction was evaluated by interview using a previously developed questionnaire, while quality of life was assessed using the EuroQol-5D-Young questionnaire. RESULTS: Thirty-one eligible subjects were included in the study. Pain and discomfort were the most commonly reported factors related to the quality of life following surgery. Approximately 67.7% of the patients were satisfied; 19.4% were very satisfied, and 12.9% reported acceptance of their surgical outcomes. The most common complication was infection (n = 8). Most patients did not experience any problems in their lives after microtia surgery. CONCLUSIONS: The highest rate of satisfactory outcomes was observed for the lobule subunit, which was assumed to be associated with the use of the Z-plasty technique. The most common complication was infection, as environmental hygiene was the most important factor. Thus, further concern for maintaining good hygiene is necessary to improve the quality of reconstructive surgery. The level of satisfaction with microtia reconstructive surgery was adequate. Most patients had a good health-related quality of life without experiencing any problems.

Child and Caregiver Perspectives Towards Facial Appearance in Children With Microtia With or Without Craniofacial Microsomia Using a Newly Developed Likert Scale.

Craniofacial microsomia (CFM) is the second most common congenital craniofacial malformation characterized by asymmetric malformation of the ear and mandible. Numerous studies have reported the importance of child perspective and psychosocial issues in patients with craniofacial abnormalities. However, clinical tools to evaluate child and caregiver perspectives in patients with microtia with or without CFM have been limited or not reported in the literature. The authors aimed to (1) To develop a tool for measuring patient and caregiver evaluation of facial appearance as it relates to microtia and craniofacial microsomia (CFM). (2) To utilize this tool in comparing children, between 7 and 20 years of age, and caregiver perspectives towards facial appearance in patients with microtia with or without craniofacial microsomia (CFM). A prospective single center study conducted from 2016 to 2017 using newly developed 13-item (Microtia) and 27-item (CFM) 5-point Likert scale Likert scale questionnaires given to patients with CFM and caregivers at a craniofacial center. Aged 7 to 20 (N = 25) and their caregivers. A total of 25 patients (13 male, 12 female; mean age at time of survey 13.2 ±â€Š3.7) met criteria for the study. The Likert scale developed and presented in this study may be a useful tool for clinical use in investigating patient and caregiver perspectives for planning surgical timeline. Based on our pilot data it is important to incorporate all voices into decision-making on timing.

Evaluation of appearance-related distress after canaloplasty using the DAS-24 questionnaire.

Background: The main purpose of the canaloplasty is hearing improvement. But there are needs for evaluation of the esthetic or psychosocial effects of canaloplasty.Aims/Objectives: This study investigated the esthetic influence of canaloplasty, with regard to the creation of a patent external auditory canal.Materials and methods: We enrolled 34 patients diagnosed with microtia and congenital aural atresia (CAA). All patients underwent canaloplasty and Derriford Appearance Scale (DAS) questionnaire was used to evaluate patients' distress due to their appearance. A general self-consciousness score (GSC) of DAS was evaluated and compared preoperatively, and postoperatively with the audiological outcomes.Results: Preoperatively, the GSC scores were higher in individuals 12 years or older compared to those of patients less than 12 years of age. One year postoperatively, the GSC score significantly decreased from 27.02(±6.0) to 21.76(±6.0). In detailed item analysis, the postoperative GSC score significantly improved in 8 items. The preoperative mean air-bone gap (ABG) of 49.88 dB decreased to a mean of 28.09 dB at 6 months and to 29.02 dB at 1 year postoperatively.Conclusion and significance: Canaloplasty is a procedure that not only improves hearing in patients with CAA, but also effectively reduces patients' distress due to their appearance.

Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™. DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile. STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates. RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables. CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.

Early Familial Experiences With Microtia: Psychosocial Implications for Pediatric Providers.

This study focuses on early experiences of families with a child with microtia to better inform their ongoing care by pediatric providers. Parents and children (n = 62; mean age of 6.9 ± 3.9 years) with isolated microtia participated in semistructured interviews in Spanish (66.1%) or English (33.9%). Qualitative analysis of responses used open coding to identify themes. Parents reported stressful informing experiences of the diagnosis with multiple negative emotions. Parents and children generally reported not understanding microtia etiology, while some families identified medical, religious, and folk explanations. Parental coping included learning about surgeries, normalization, perspective taking, and support from family, providers, religion, and others with microtia. Family communication centered on surgery and reassurance. Pediatricians of children with microtia need to understand families' formative psychosocial experiences to better promote positive family adjustment through clarifying misinformation, educating families about available treatment options, modeling acceptance, psychosocial screening, and providing resources.

Enfrentando la vida con una malformación congénita craneofacial / Facing life with a craniofacial congenital malformation

Las malformaciones congénitas craneofaciales pueden llegar a tener importantes repercusiones en quienes nacen con estas, sin embargo, son pocos los estudios destinados a indagar sobre el impacto de este tipo de malformaciones en los individuos. Desde esta perspectiva se plantea como objetivo de estudio conocer cómo y de qué manera es el impacto de vivir con una malformación congénita craneofacial. Para alcanzar este objetivo se hizo uso del relato biográfico, para lo cual se siguió la metodología de Amezcua y Hueso y de Hoyos. El análisis de los datos obtenidos permitió establecer unas categorías como son: el desconocimiento del personal de salud sobre la malformación y sobre el síndrome, la forma en la que la sociedad estigmatiza y genera obstáculos, la reacción de los padres frente al recibimiento de un hijo con malformación y, finalmente, la visión de su experiencia como significativa. El participante en su relato demuestra cómo a pesar de los retos que impone el entorno y la sociedad a personas con malformaciones congénitas, los recursos internos permiten transformar la experiencia y resignificarla

Craniofacial congenital malformations may have important effects on those individuals who are born with them; however, there is a short range of studies aimed to query their impact. The objective defined for this study is to know how and in what extension is the impact of living with a craniofacial congenital malformation. In order to reach this objective it was carried out a biographical account following methodology of Amezcua y Hueso and Hoyos. Data analysis allowed the identification of categories such as: lack of information by health professionals about syndrome and malformation, the way society stigmatizes and creates obstacles, parents’ reaction towards birth of a child with malformation and understanding of experience as a significant one. In his account the participant shows how internal sources allow for experience transformation and new signification despite imposed challenges by context and society

Microtia and Social Media: Patient Versus Physician Perspective of Quality of Information.

INTRODUCTION: Previous research demonstrates that patients seek high-quality information on the World Wide Web, especially in rare conditions such as microtia. Social media has overtaken other sources of patient information but quality remains untested. This study quantifies the quality of information for patients with Microtia on social media compared with nonsocial media websites and compares physician and patient scoring on quality using the DISCERN tool. METHODS: In phase 1, quality of the top 100 websites featuring information "Microtia" was ranked according to quality score and position on Google showing the position of social media websites among other nonsocial media websites. Phase 2 involved independent scoring of websites on microtia compared with a patient group with microtia to test whether physicians score differently to patients with t test comparison. RESULTS: Social media websites account for 2% of the scored websites with health providers linking to social media. Social media websites were among the highest ranked on Google. No correlation was found between the quality of information and Google rank. Social media scored higher than nonsocial media websites regarding quality of information on microtia. No significant difference existed between physician and patient quality of information scores on social media and nonsocial media websites (p 1.033). CONCLUSION: Physicians and patients objectively score microtia websites alike. Social media websites have higher use despite being few in number compared with nonsocial media websites. Physicians providing links to social media on information websites on rare conditions such as microtia are engaging in current information-seeking trends.

Teasing in younger and older children with microtia before and after ear reconstruction.

This study prospectively measured teasing and emotional adjustment before and after ear reconstruction in younger and older children with microtia. Participants with isolated microtia (n = 28) were divided into two groups by age at surgery, with a younger group aged 3-5 years (n = 13) with a mean age of 4.0 (0.71) years at the time of surgery and an older group aged 6-10 years old (n = 15) with a mean age of 7.87 (1.30) years. Children and their parents were interviewed preoperatively and a year after surgery about teasing and emotions about their ear(s). Teasing began between the ages of 2.4-4.8 years. A third of the younger group and all of the older group reported preoperative teasing. Before surgery, the older group reported higher rates of negative emotions about their ear(s) and teasing was correlated for all ages with feeling sad, worried, and mad about their ear(s). After surgery, teasing and negative emotions significantly decreased with increased happiness about their ear(s). Postoperative teasing was correlated with trying to hide their ear(s). There were significant interactions from before to after surgery based on surgery age for frequency of teasing, sadness, and feeling mad, with the older group showing relatively greater change postoperatively. Teasing and negative emotions about their ear(s) decreased for all ages after surgery, with a potential protective factor seen in younger surgery age.

Public Perception of the Burden of Microtia.

Microtia is associated with psychosocial burden and stigma. The authors' objective was to determine the potential impact of being born with microtia by using validated health state utility assessment measures. An online utility assessment using visual analogue scale, time tradeoff, and standard gamble was used to determine utilities for microtia with or without ipsilateral deafness, monocular blindness, and binocular blindness from a prospective sample of the general population. Utility scores were compared between health states using Wilcoxon and Kruskal-Wallis tests. Univariate regression was performed using sex, age, race, and education as independent predictors of utility scores. Over a 6-month enrollment period, 104 participants were included in the analysis. Visual analogue scale (median 0.80, interquartile range [0.72-0.85]), time tradeoff (0.88 [0.77-0.91]), and standard gamble (0.91 [0.84-0.97]) scores for microtia with ipsilateral deafness were higher (P <0.01) than those of binocular blindness (visual analogue scale, 0.30 [0.20-0.45]; time tradeoff, 0.42 [0.17-0.67]; and standard gamble, 0.52 [0.36-0.78]). Time trade-off scores for microtia with deafness were not different from monocular blindness (0.83 [0.67-0.91]). Higher level of education was associated with higher time tradeoff and standard gamble scores for microtia with or without deafness (P <0.05). Using objective health state utility scores, the current study demonstrates that the perceived burden of microtia with or without deafness is no different or less than monocular blindness. Given high utility scores for microtia, delaying autologous reconstruction beyond school entrance age may be justified.

Pre and post-operative psychological functioning in younger and older children with microtia.

OBJECTIVES: Microtia ranges from a smaller ear to the absence of the external ear and has been associated with psychosocial distress. Traditional ear reconstruction takes place beginning at age six. Use of an alloplastic implant allows for earlier surgery starting at age three, which may reduce potential negative psychological effects. However, few studies have examined psychosocial outcomes of ear reconstruction with groups that include young children. METHODS: Children (N = 23) with microtia and their parents completed two microtia-related scales, negative emotions and microtia social awareness, and the Behavioral Assessment System for Children - Second Edition (BASC-2) subscales of anxiety, depression, and social skills before surgery and one year after surgery. Participants (74% male) were three to nine years old with a mean age of 6.13 ± 2.10 years and were grouped by age at surgery, three to six years (n = 11) or seven to ten years (n = 12). The sample identified as Latino (96%) or "other" (4%). RESULTS: Pre and postoperative scores by age group were compared using two-way repeated measures analyses of variance. Children and parents reported significantly less negative emotion and microtia social awareness following surgery, with an interaction for parental report of older children showing higher negative emotion preoperatively. Older children also had higher scores of depression and anxiety before surgery and both groups reported significant decreases following surgery, along with improved social skills. Older children showed significantly greater gains in social skills. CONCLUSION: All participants and their parents reported improved psychological functioning postoperatively. However, older children may be at greater risk of psychological concerns given the longer time they have to cope with the impact of microtia on self-image and exposure to social stressors. Undergoing reconstructive surgery earlier may be a protective factor for children with microtia.

[Prospective assessment of quality of life after auricular reconstruction with porous polyethylene]. / Prospektive Erfassung der Lebensqualität nach Ohrmuschelrekonstruktion mit porösem Polyethylen.

BACKGROUND: Microtia is associated with increased psychosocial morbidity. The literature contains three purely retrospective studies using validated tools. These studies show that auricular reconstruction leads to a significant improvement in health-related quality of life in affected children and adults. METHODS: In a prospective approach, the authors assessed 21 consecutive microtia patients (return rate 81 %; 7 children and 10 adults) before and after auricular reconstruction with porous polyethylene using the following validated questionnaires: Glasgow Health Status Inventory (GHSI), Short Form 36 Health Survey Questionnaire (SF-36), Childhood Experiences Questionnaire (CEQ) and Kidscreen-52. RESULTS: An improved health-related quality of life was detected with all applied instruments. CONCLUSION: A subjective benefit of auricular reconstruction with porous polyethylene can be shown using prospective, as well retrospective tools.