Patient factors associated with novel EAR-Q appearance, psychosocial, and social scales: A cross-sectional study and regression analysis.

INTRODUCTION: The EAR-Q is a rigorously validated patient-reported outcome measure, which evaluates ear appearance and health-related quality of life (HRQL) in patients with congenital or acquired ear conditions. The aim of this study was to conduct an exploratory analysis to examine the factors associated with EAR-Q appearance and HRQL scale scores. METHODS: In this study, 862 participants, aged 8-29 years, with congenital or acquired ear conditions, completed the EAR-Q as part of an international field-test study. Patients responded to demographic and clinical questions as well as the EAR-Q. Univariable and multivariable linear regression analyses were used to determine factors that were significant predictors for the scores on the EAR-Q Appearance, Psychological, and Social scales. RESULTS: Most participants were men (57.4%), awaiting treatment (55.0%), and had a microtia diagnosis (70.4%), with a mean age of 13 (±4) years. Worse ear appearance scores (p < 0.02) were associated with male gender, microtia, no history of treatment, ear surgery within 6 months, unilateral involvement, and greater self-reported ear asymmetry. Decreased psychological scores (p < 0.01) were associated with increasing participant age, no treatment history, recent ear surgery, and dissatisfaction with ears matching or overall dissatisfaction. Lower social scores (p ≤ 0.04) were associated with no treatment history, those awaiting surgery, ear surgery within the last 6 months, bilateral involvement, and self-reported ears matching or overall appearance. CONCLUSION: This analysis identified patient factors that may influence ear appearance and HRQL scale scores. These findings provide evidence of patient factors that should be adjusted for when undertaking future observational research designs using the EAR-Q in this patient population.

Lobe of sound: prosthetic rehabilitation of partial auriculectomy defect.

Loss of facial organs in an individual may be due to congenital anomalies or acquired causes. The missing parts of the face like ear, eyes and nose are considered as maxillofacial defects that can be rehabilitated by a prosthesis and/or cosmetic surgeries. This frontier of science has developed into a more reliable and predictable process due to the ever-increasing development of materials and equipments used in this procedure. The fabrication of an ear prosthesis is considered by many prosthetists to be one of the most difficult replacements in maxillofacial reconstruction. The severe undercuts and pronounced convolutions of the ear present a challenge in simulating a naturally proportioned prosthesis. Proper assessment of the disfigured facial organs and a feasible approach to rehabilitating them has for long been the target of clinical maxillofacial prosthodontics. This report describes a simple and engrossing technique to rehabilitate a patient with a partial auricular defect in the most aesthetic and economical manner using medical-grade room temperature vulcanising silicone.

Clinical results and health-related quality of life in otoplasty patients using cartilage resection and suturing methods.

In this study, we evaluated clinical results and health-related quality of life in our otoplasty patients in whom we used cartilage resection method (CRM) and suturing method (SM). A total of 132 ears of 77 patients (36 males, 41 females; mean age 14.6 ± 6.4) between January 2006 and February 2013 were included in this study. Patients were divided into two groups according to the type of surgery performed: Group 1 was the cartilage resection group (CRG) and Group 2 was the suturing group (SG). CRM was performed on 64 ears of 37 patients (unilateral in 10 cases and bilateral in 27 cases), and SM was performed on 68 ears of 40 patients (unilateral in 12 cases and bilateral in 28 cases). The parameters of the groups, including operation time, measurements of the auriculocephalic distances, complication rates, postoperative satisfaction rates, and health-related quality of life were compared. Mean operation time was 53.7 ± 7.8 min in the CRG and 44.9 ± 4.2 min in the SG (P ≤ 0.05). Mean postoperative auriculocephalic measurements were similar in both groups. The complications were more frequent in the CRG (10/37 patients, 27.02 %) than in the SG (3/40 patients, 7.54 %) with statistically significant difference (P < 0.05). Three months after the surgery, visual analog scale increased from 25 (preoperatively) to 70 in the CRG and from 30 to 90 in the SG, with a statistically significant difference (P < 0.05). Patients' health-related quality of life showed a statistically significant increase after the operation in both groups (P < 0.05). CRM and SM are effective treatment methods with high success rates for patients with prominent ears. In the selected cases, SM seems to represent a better option for otoplasty than CRM because clinical results, cosmetic outcomes, patient satisfaction, and health-related quality of life scores were better than CRM.

The psychosocial consequences of reconstruction of severe ear defects or third-degree microtia with rib cartilage.

BACKGROUND: There are few data focusing on the improvement of psychosocial functioning and self-esteem in patients with congenital or acquired severe auricular defects. OBJECTIVE: We investigated the satisfaction of patients following auricular reconstruction with rib cartilage. METHODS: One hundred patients treated for reconstruction with rib cartilage for congenital or traumatic auricular defects have been evaluated retrospectively for changes in self-esteem, performance ability, and psychosocial attitude using a clinically established questionnaire, Frankfurter Selbstkonzeptskalen (FSKN). In addition, patients were asked to judge the new auricle and the thoracic scar using a new questionnaire. RESULTS: Of 68 patients who took part in this study, almost 90% could integrate the new ear into their body concept. If faced with the same decision for surgery again, 75% would again choose a reconstruction with rib cartilage. More than three-quarters rated the thoracic scar as acceptable in relation to the benefits of the new ear, although one-third felt uncomfortable with the pain and cosmetic appearance of the thoracic scar. According to the results of the FSKN questionnaire, values in psychosocial abilities improved postoperatively. There was no clear change in either self-esteem or performance ability. CONCLUSIONS: Ear reconstruction with rib cartilage remains, under most circumstances, the procedure of choice for repairing auricular defects. There is a high acceptance of this method among patients, although the impact of the thoracic scar needs to be discussed extensively before surgery. The importance of the surgeon's experience cannot be underestimated, because it determines the aesthetic results and the patient's satisfaction in this challenging area of plastic surgery.

Post traumatic ear reconstruction.

This is a review of 249 patients who have suffered ear trauma and who have presented for reconstruction over the last eighteen years. All were born with normal ears and had lost one or both ears or a major segment of the ear. Congenital ear problems including microtia are not included.

Ear reconstruction following severe complications of otoplasty.

BACKGROUND: Correction of prominent ears is one of the most common operations performed in congenital deformity. Many appropriate corrective techniques have been described. While rare, severe complications destroying ear contours can occur and their correction should follow the established principles of ear reconstruction. METHODS: A retrospective review of the notes of all patients who presented to Clinique George Bizet (1981-2007) in Paris, for correction of complications after undergoing prominent ear surgery at another facility, was performed. Each patient's age, gender, diagnosis, number of previous operations and final outcome were noted as available. Patients were included in this study if they had undergone one or more operations for prominent ears, leading to severe destructive complications, prior to consultation with the senior author and then underwent surgical repair with either an auricular (conchal) cartilage graft or with autogenous costal cartilage. RESULTS: A total of 49 (25 female, 24 male) patients met the inclusion criteria. The mean age at presentation was 23 years (range of 10-59 years of age). The mean number of previous attempts to correct the ear deformity was 1.3 (1-12) times. Eight patients underwent reconstruction with a conchal cartilage graft and 41 with costal cartilage. CONCLUSIONS: While more minor contour deformities are correctable with a contralateral conchal cartilage graft, when more than a quarter of the ear or more than two planes of its complex folds are deformed, costal cartilage is recommended for surgical repair. The principles of ear reconstruction should be well understood prior to attempting a repair of severe complications after otoplasty.

Psychosocial outcome of patients after ear reconstruction: a retrospective study of 62 patients.

This was a retrospective study examining the psychosocial morbidity of patients before and after ear reconstruction. Semistructured questionnaires were sent to 90 patents with significant congenital or acquired auricular deformity 2.2 years (range 3 months to 5 years) following autogenous or osteointegrated reconstruction. Sixty-two patients (69%) responded. Twenty-two of the patients below 12 years, who had undergone reconstructive surgery, also completed the Childhood Experience Questionnaire. These were compared with a cohort of 362 normal patients. There was significant psychosocial morbidity in both children and adults with auricular deformity. Seventy-one percent of patients reported reduced self-confidence that affected both social life and leisure activity. Teasing was a prominent symptom in both children (88%) and adults (85%) but was a motivational factor for surgery in children only. Dissatisfaction with the appearance (73.1%), on the other hand, was the main reason for treatment in adults. Following ear reconstruction, 74% of adults and 91% of children reported an improvement in self-confidence resulting in enhanced social life and leisure activities in both adults and children. There was no difference between osteointegrated and autogenous reconstruction. Sixty percent of patients reported their result as excellent. The patients scored their result better than the surgeon. We conclude that auricular reconstruction has significant psychosocial benefit in the majority of children and adults despite donor-site morbidity and a range of technical result.

[Evaluation of deformation after auricular cartilage collection].

We studied the occurrence of deformation after collection of auricular cartilage. Subjects numbered 28 (15 with auricular cartilage collection and 12 without serving as a control group). We measured ear length, ear width, ear attachment length, auricular cartilage length, auricular lobe length, and auricle height, evaluating questionnaires given to subjects. Results showed that the collection of auricular cartilage does not result in deformation. In conclusion, the collection of auricular cartilage has few risks in view of cosmetics.