A few days ago a concerned parent visited my office with Zoe*, their beautiful little 4 month old baby girl. She has bat ears. “We don’t want her to be teased at school. We want her to be able to tie her hair back without being conscious of her abnormal ears” her parents told me. The problem is that Zoe will have to wait until she is old enough to safely undergo otoplasty surgery to correct her ears because she is already too old for us to use ear-moulding.(*name changed)
So the thing is that close to 5% of children are born with some kind of ear abnormality. Ear deformity is one of the most commonly overlooked and downplayed birth abnormalities. When an ear deformity is identified, some health care workers are loathed to a raise a “cosmetic concern” about an otherwise healthy newborn baby, especially during such a joyous time of parenthood.
All too often parents are reassured that the deformity will self correct or that the child will “grow into their ears”.
The truth is that only 30% self-correct. That means that 70% of ear abnormalities stay unchanged. We have all heard about the ruthlessness of school children on the playing field and ear deformities can put a child at risk of peer ridicule and teasing which can result in low self esteem, anxiety or social isolation.
The most recognisable deformity is bat ears (prominent ears). Some other common deformities include lop ear, cup ear, buried ear and Mr Spock ear. They have traditionally required a surgical operation to correct the appearance. This is usually performed at 5 or 6 years old, before school-going age, and costs upwards of R30000. It is rarely, if ever, covered by medical aid.
Ear moulding is something I am very excited about because it offers a non-surgical alternative. Quite a number of years ago medical science realised that during the early weeks of infancy, ear cartilage is unusually soft and malleable. This is attributed to the circulating maternal hormone, oestrogen. Which peaks at 3 days after birth and returns to normal levels at 6 weeks. Oestrogen effects a constituent in infant ear cartilage called hyaluronic acid, which increases its flexibility and “mould-ability”.
HOW EAR MOULDING WORKS
During this period of increased malleability, ear deformities can be moulded into the correct shape. A lot of home-made rather ingenious taping and headband techniques have been tried by well-meaning parents and plastic surgeons alike, but more recently a rigid silicone cup-like splint has shown great promise. A 2010 clinical trial by Byrd et al, published in the Journal of Plastic and Reconstructive Surgery had a remarkable 90% correction rate using the EarWell ear correction device.
Ear moulding using the EarWell system is non-surgical and painless. No anaesthesia is needed for the treatment. The moulding uses specially designed splints which are placed over the ear and are replaced weekly. The process is takes about 4-6 weeks and gives the best results when started in the first weeks after birth. Doft et al published a study in 2015 showing that starting treatment as early as day 3 of life will shorten the treatment to 2 weeks. In the same study, ninety-nine percent of parents said that they would have the procedure repeated. And successful correction was seen in an astounding 96%.
Although the best results are seen when staring early, Woo et al published encouraging results in babies who started treatment at the age of one month. This is similar to my experience with older babies, especially those with helical rim deformities.
The biggest risk for parents in South Africa, is missing out on this special privileged period of cartilage plasticity because of the lack of awareness of this treatment. My practice offers this treatment in Cape Town. If you want to know more about ear moulding feel free to get in touch with me.