Nonsurgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes

INTRODUCTION: Congenital ear anomalies result from ear cartilage and skin compression in utero. Nonsurgical correction through molding therapy can be performed in infancy before the cartilage hardens and loses its malleability. A study of caretaker burden of ear molding and its impact on aesthetic outcomes has not been performed. METHODS: Demographic and procedural variables were retrospectively collected for infants who underwent ear molding. Parents were surveyed regarding their experience, caretaker burden, and final aesthetic outcome. Outside physicians were provided with pre- and post-treatment photos and asked to rate outcomes. A Likert scale was developed for responses and converted to a numeric score from one to five, with five as the most desirable. Additionally, infant ears were divided by dysmorphology (deformation versus malformation), age at treatment (≤ 30 days, 31–60 days, and >60 days), and length of treatment (≤ 14 days, 15–30 days, and >30 days). Subgroup analyses based on these divisions used ANOVA tests to evaluate both parent and physician responses based on these treatment variables. RESULTS: Seventy-four patients comprising 121 ears were included. Mean age at treatment was 20.1 ± 21.4 days with treatment a duration of 21.1 ± 7.7 days. Parental participation in the survey was 70.1%. Questions that queried parents’ experiences revealed an overall “very positive” experience, with minor caretaker burden related to bathing and cleaning (mean Likert score 4.1, range 1–5). Favorable parent-reported outcomes were obtained for areas including anticipated social distress (4.28, 1–5), satisfaction with results (4.27, 1–5), and perception of final appearance (4.18, 1–5). Mean Likert scores of questions assessing the caretaker’s experience had a moderate correlation with anticipated social distress (r = 0.404, P = 0.005), satisfaction with results (r = 0.477, P = 0.001), and perception of final appearance (r = 0.473, P = 0.001). Physician assessments of aesthetic outcomes were slightly lower, but favorable between “somewhat effective” and “very effective” (3.46, 1–5). Interestingly, there was no correlation between physician responses and parental responses for anticipated social distress, satisfaction with results and perception of final auricular appearance. Earlier time to treatment trended favorably, but did not reach significance; total duration of treatment was not a significant predictor of outcomes. Ear malformations had higher parent-reported satisfaction than ear deformations (4.75 ± 0.46 versus 4.21 ± 1.25, P = 0.025). CONCLUSIONS: Ear molding therapy is an effective treatment for congenital auricular deformities, allowing for less invasive and earlier improvement of auricular architecture than otoplasty. The treatment process creates a low burden of care for parents and provides the added benefit of increasing parents’ confidence in caring for the child. Malformations can be significantly improved with molding and lead to satisfaction rates higher than deformations among parents. Through an interdisciplinary approach, neonates should be identified early to allow for optimal results. Higher satisfaction trended toward significance for earlier intervention.