The cartilage of the newborn ear is extremely soft and pliable, possibly due to the influence of oestrogen present in a breastfeeding mother's mlik. If there is a normal amount of skin and cartilage, most abnormally shaped or prominent ears can be corrected by splintage with EarBuddies™ splints . The technique will treat prominent ears, Stahl’s bars, lop ears, cryptotia and kinks of the rim. Some cup ears can also be improved.
About two thirds (61%) of prominent ears are noticeable soon after birth. The remaining third become obvious around three months of age, as baby’s head shape changes and as the cartilage framework of the ear hardens during early life.
Parents are often falsely reassured by Health Professionals that their child’s ears will look more normal with age, but this is rarely the case. An ear which is easily pushed forward when baby sleeps, feeds or turns its head is likely to become more prominent until, at least, the age of six months. The condition is not viewed as a deformity in all cultures; in some Eastern cultures, ears which stick out are thought to catch good luck.
It is several weeks before the ear cartilage begins to harden and ideally splintage should be started in the first few days of life. At this stage the cartilage is easily remoulded, the sweat and sebaceous glands are poorly developed so that the tapes which hold the splint in place stick well, and the child moves its head little, and does not reach up to the ears to dislodge or pick at the splints.
For prominent (stick-out) ears, rim kinks, Stahl’s bar, lop and cup ear, EarBuddies™ splints are taped close to the rim of the ear and then the ear is taped back to the side of the head. The splint exerts pressure on the scaphal hollow of the ear, reforming, then emphasising the antihelical fold and the helical rim. Simply taping the ear back without the splint in situ does not effect a permanent improvement and distortion of the rim of the ear can develop later in life. To correct cryptotia, the ear should be pulled out from the side of the head, and the splint taped into position in the groove above and around the ear.
In the newborn, splintage for one to two weeks is all that is necessary. Perseverance is required once the “golden” period shortly after birth is missed. It was previously thought that splintage was only effective in babies of up to six months but nevertheless, some persistent parents achieve a worthwhile correction in children as old as four years.
Early splintage may improve ear shape without the need for later surgery or anaesthetic. Splintage has the additional advantage of preventing pre-surgery teasing. It is not yet a widespread practice, despite a number of reports which show neonatal splintage of misshapen ears to be of benefit, cheap and safe. Nevertheless, it is clear that the future of treatment of such deformities lies in this direction. In 2015, a network of EarPerfect centres was conceived to give parents access to professional help in fitting the splints.
To avoid teasing and otoplasty in later years, splintage using EarBuddies™ is now recognised as the treatment of choice for stick-out or deformed ears. Babies move their heads very little in the first few weeks of life, the skin hardly sweats and once the birth coating has been cleaned off, the tapes used to fix the splints in place usually stick for long enough - about two weeks - to ensure a good correction. Sticking back the ears with tape alone can cause flattening or notching of the rim or antihelix which may not become apparent until much later.
Ear Buddies™ are best used at birth, or as soon as the ears start to stick out. A third of prominent ears don’t begin to stick out until about three months of age but by then, splintage takes longer. Unsplinted, about one in twenty people will have prominent ears by the age of 5. With persistence, splintage with Ear Buddies’ can still be effective up to the age of two years, but the process is much more difficult as the infant is by then able to reach up to the ears and potentially interfere with the splints.
Surgery to correct stick-out or bat ears is currently the most common paediatric plastic surgery undertaken in the UK. Splinting the stick-out or deformed ears of a baby at birth can save the need for surgery at a later date. The greater the delay, the more difficult it is likely to be and the more persistence is needed if it is to be effective. As the use of splintage becomes widespread, it is anticipated that pinnaplasty (otoplasty) surgery in the UK, North America and Australia would become unusual by 2030.
“It is vital that neonatal paediatricians, obstetricians, general practitioners, and midwives are
educated about early detection [of ear deformity] and how to initiate treatment themselves.”
“If successful, an effective splinting programme could consign the surgical correction of all but the
most severe ear deformities to the past.”
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