Australian Doctor Australian Doctor 28th July 2017 | Page 25

Therapy Update
Neonatal ear moulding
PLASTIC SURGERY
A simple and effective treatment to correct the
misshapen ears of newborns is available, but the
window of opportunity for treatment is narrow.
A
SIMPLE
treat-
ment is available
to correct the
misshapen ears
of newborns and the criti-
cal time period for its use is
within the first three weeks
of life.
Neonatal ear moulding
has been used to correct
minor deformities of the
ear for many years. How-
ever, due to the lack of
awareness of the technique,
patients are generally not
referred for specialist treat-
ment until it is too late.
Despite having almost no
impact on hearing, abnor-
malities in ear shape and
size are a common source
of teasing and bullying, loss
of self-esteem and signifi-
cant psychosocial distress.
Studies in the UK
National Health Service
(NHS) in 1992 and 2005
have reinforced the sig-
nificant psychosocial mor-
bidity suffered by both

DR JOSEPH DUSSELDORP
children and adults with
auricular deformity. 1,2
The studies showed that
the resultant improvement
in psychosocial functioning
after corrective surgery was
significant, but not univer-
sal.
However, correction of
these deformities in the
newborn period minimises
the risk of this suffering,
and avoids both the pain
and the cost of any future
surgical correction.
Surgery to correct ear
deformities is certainly
available in later life, but
may not be able to pro-
duce results that appear as
natural as those achieved by
moulding. 4
Furthermore, the proce-
dure is cheap, minimally
invasive and well tolerated.
Procedures to correct
auricular deformities are
covered by Medicare.
If the deformity is not
fully corrected using mould-
ing, it is usually improved
making future corrective
surgery more likely to suc-
ceed.
Ear anomalies fall into
two main categories: mal-
formations and deforma-
tions.
Malformations
occur
formed ear is kinked or
compressed during in-utero
development, creating an
abnormal shape (figure 1).
Many parents will be
familiar with mild ear
deformations
occurring
immediately after birth
that often resolve without
THE REASON FOR SUCH A NARROW
WINDOW FOR TREATMENT IS DUE TO
THE DECREASING CONCENTRATION OF
CIRCULATING MATERNAL OESTROGEN
AT AROUND 6-8 WEEKS OF AGE.
when the embryo fails to
fully develop and parts of
the external ear are absent.
This commonly results in a
condition known as micro-
tia (small ear, see figure 2).
Conversely,
deforma-
tions occur when a fully
treatment. However, it is
estimated that one in five
misshapen ears will not
self-correct, becoming per-
manently deformed if left
untreated.
The treatment should be
started before three weeks
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of age and continued for at
least four weeks.
The reason for such a nar-
row window for treatment
is due to the decreasing
concentration of circulat-
ing maternal oestrogen at
around 6-8 weeks of age.
Without the influence of
oestrogen, the soft, new-
born ear cartilage becomes
stiff and the ear effectively
sets in its deformed posi-
tion. Attempts to mould ear
cartilage after three months
of age are prone to fail.
Ear deformities have been
known by many names over
the years: lop ear, cup ear,
constricted ear, Stahl ear
(see figure 3) and cryptotia
to name a few, as well as the
more common bat-wing or
prominent ear deformity.
Many of these deformi-
ties may be treatable with
moulding techniques.
The critical factor to
ascertain is whether the ear
is missing some of its nor-
mal components and is in
fact a microtia, as neonatal
ear moulding is much less
effective and more prone to
complications if this is the
case, though potentially still
useful.
There are many differ-
ent ways of performing ear
moulding.
The simplest technique
consists of the application
of tapes to the ear, often
requiring shaving of a small
amount of hair in the retro-
auricular region (figure 4).
This technique may be
used for the correction of
prominent ears, particularly
when parents have also had
surgery to correct promi-
nent ears and it appears that
the newborn may already
be showing signs of promi-
nence.
For deformities of the
helix (see figure 1), the addi-
tion of a small moulding
wire coated with a silicone
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