Fixing newborns’ misshapen ears

As a youngster, President Barack Obama was mocked not just for his uncommon name, but also his larger-than-average ears.

“I have to say, with big ears and the name that I have, I wasn’t immune,” he said, kicking off an anti-bullying conference at the White House last year.

Being bullied is no longer accepted as a harmless rite of passage, but children still are mercilessly teased and taunted for having unusually large or protruding ears, says Oren Friedman, director of Facial Plastic Surgery at the Hospital of the University of Pennsylvania and associate professor of otorhinolaryngology: head and neck surgery at Penn. As kids age and the bullying escalates, many will elect to undergo painful and costly corrective surgeries.

Now, Friedman and fellow researchers at the Perelman School of Medicine are proposing a potentially game-changing intervention.

By enlisting newborn hearing screeners to help identify common ear deformities, Penn doctors have been able to reshape the ear and correct several common ear deformities without surgery, all in the first few weeks of a baby’s life. The relatively simple procedure involves applying a splint to bend the ears of newborns with congenital auricular deformities and reshape the impaired cartilage.

Splinting is a medically established procedure for correcting ear deformities like cupped ears. For the reshaping to take hold, doctors must apply the splint within the first three days after birth, when the ears are most malleable due to higher-than-normal estrogen levels post-partum.

The precise frequency of ear abnormalities is not well known—studies suggest between 5 and 30 percent of children may have some type of ear deformity at birth, Friedman says. If left untreated, some of these cases can cause significant functional and social impairment, requiring major surgical intervention.

The major barrier otolaryngologists have faced is identifying patients early enough to begin the splinting process.

“Attention was not always given to this aspect [of treating ear deformities], maybe because people did not realize how important it is,” Friedman says. “But there are numerous studies that speak to the psychosocial impact that various types of deformities of the face, including these, can have on children’s growth and development.”

The key to zeroing in on ear deformities shortly after birth, he says, lies with the hospital hearing screeners, who by law must test the hearing of newborns before they leave the hospital. “It’s not always been the case that the law dictated that hearing screenings be required for infants. This is relatively new over the last 10-15 years,” Friedman says.

The screeners, however, are technicians, Friedman notes. Their primary concern is ear function, not form. So he recently conducted a study where a team of otolaryngologists trained newborn hearing screeners to evaluate congenital auricular deformities. Screeners were given a worksheet of photos and illustrations of the most common ear deformities to consult as they made their rounds.

As they identified infants with suspected congenital auricular deformities, they alerted the infant’s primary care medical team. The primary care team then notified the family that an otolaryngologist would evaluate the infant’s ears.

During the study, 10 infants with 19 affected ears were treated with a simple splint. Researchers documented ear shape prior to splinting and at follow-up visits. All of the patients exhibited improvement from the original deformity after one to four weeks of splinting, with 95 percent showing significant improvement.

“It’s an unfair thing to leave untreated at this age. There is a quicker way, and the fact that it’s not known and not recognized as easily correctable—on a small scale it’s tragic,” Friedman says.

The study results have been published online ahead of print in the International Journal of Pediatric Otorhinolaryngology.

If adopted widely, not only could the protocol help many more children and families, it could reduce health care costs, Friedman says. Increasingly, insurers are declining to cover corrective procedures which, while important for the social and psychological health of children, don’t really affect ear function. Friedman estimates only about half of all cases today are reimbursable.

It’s an unfair thing to leave untreated at this age. There is a quicker way, and the fact that it’s not known and not recognized as easily correctable—on a small scale it’s tragic.”

“What this provides our health care system is a cheap and reliable way to cut down on the need for surgery down the road. In this day and age of cost containment, we are emboldening the people who do this type of work to try and solve problems for these children and their families,” Friedman said.

Cosmetic ear surgery is performed on an outpatient basis but is not without risk. Recovery can be painful and sutures can become infected, which can lead to bleeding in the ear. There’s also the risk the sutures won’t hold and the ear will bend back to its original shape. Most outcomes, though, are positive.

Ultimately, Friedman would like to see pediatricians and neonatologists trained to identify ears suitable for splinting. And he’s developing a questionnaire that parents of newborns can use to make judgments about whether a specialist should be consulted.