Dear Readers:

During this holiday season, the editors at Hearing Health & Technology Matters (HHTM) are taking some time off. However, we are not leaving you without anything to read on our blog this week. Instead, we are publishing a special holiday edition filled with what we call our Readers’ Choices.

HHTM has had more than half a million page views in 2014, and the Readers’ Choices featured this week are the posts published on each of our individual blogs that drew the largest number of viewers during the year.

Whether or not you have read these Readers’ Choice posts before, we think you will enjoy them.  And be sure to return next week when all of us editors, our batteries recharged, will publish a New Year’s Eve issue filled with fascinating new posts to get 2015, HHTM’s fifth year, off to a great start.

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The protrusion of ears can be a significant problem.  We can all relate to the teasing that results from being  different, especially as teenagers.  Protruding ears  affect about 5% of the general population worldwide and  is the most frequent deformity of the head and neck area.  This week’s Hearing International will review the problem and present a new surgical implant procedure for its treatment.  While not yet cleared by the Food and Drug Administration (FDA)  for use in the US, the procedure has been approved in the UK, South Africa, Canada, Mexico, Australia, and countries across Europe and Asia.  Basically, it takes a relatively painful Otoplasty surgical procedure performed under general anesthesia and turns it into an incision-less 20-minute procedure. 

The Problem: Protruding Ears

Prominent/protruding ears are found in both genders equally and are not associated with other abnormalities or syndromes.  However, they can be esthetically displeasing, a source of psychological distress, and, in some instances, dysfunctional. Most often the patient is a child whose parents seek a plastic surgery evaluation due to their child’s distress over ridicule by other children. While most patients are children,  it is not just a problem of schoolyard teasing. Adults with an uncorrected prominent ear deformity usually seek treatment due to life long struggle with insecurities about their ears. 

What causes Prominent or Protruding ears?

For the most part, genetics play a large role. People who have protruding or prominent ears often share this with others in the family. While the specific etiology remains unknown,  approximately 8% of patients with prominent/protruding ears have a family history of the abnormality.   The “cause” of this is generally a defect in the Auricular cartilage of the ear.  It is very rare that a person’s ears protrude because of an injury or accident.  The most common causes of prominent/protruding ears are an underdeveloped, effaced, or absent antihelical fold or an overdeveloped and/or excessively deep conchal bowl.  Additionally, a prominent mastoid process may also contribute to the protrusion. The condition may be unilateral or bilateral. There may be minor defects in the lower portion of the auricle that may also be a factor in the overall defect, although these minor defects are often overlooked.  The external ear develops more rapidly than other components of the craniofacial anatomy. Different portions of the ear grow at different rates. By age three, ear width will reach approximately 90 percent of adult dimensions. By the end of the first year of life, about 75 percent of the ear length will occur. Elastic properties of ear cartilage are normally age dependent. Before age 6 years, cartilage is malleable, and suture repositioning is maintained with a low incidence of recurrence.  Adolescent and adult populations have stiffer, less pliable cartilage.

Traditional Treatment Techniques

For babies under 6 months of age with their pliable cartilage, non-surgical treatment can be effective.   Taping or splinting of the auricle has been successful.  Some physicians have also used molding devices made of plastic ora wire wrapped with micro-foam tape, contoured to fit the ear, conforming the deformed areas into a normal shape.  The time needed to correct the deformity varies from a few days to several months.

For older children and adults, the specific surgical technique is determined by the anatomic deformity and performed under general anesthesia. Procedures performed include a postaricular incision and the excision of excess skin.  Remarkable results are usually achieved only through invasive ear surgery – known as conventional Otoplasty – in which the cartilage is cut. This procedure lasts 90 minutes and is conducted under general anesthetic.  In this procedure, surgeons will work to create an anti-helical fold, conchal reduction or setback, modification of the lobule and its fatty fibrous tissue, as well as an array of suture types to modify the look of the Auricle and its prominence.  Click on the Video “Otoplasty” (left) to review the current procedure.

Now there is a pioneering new procedure that can put an end to the torment, using an implant inserted under local anesthetic that corrects the ears’ prominence in just 15-20 minutes. 

What is the Earfold Procedure?

This Procedure, performed in less than 20 minutes under local anesthesia, offers immediate correction and rapid recovery.  The Earfold implant produces consistent outcomes with less discomfort and fewer side effects than traditional otoplasty surgery.  The implant reshapes the patient’s Auricle with a simple procedure that places it under the involved ear through a small incision. One of the most consistent methods for measuring the degree of prominence is the helical – mastoid (H-M) distance (Right).  Typically, the H-M distance is 18-20 mm.  As the H-M distance increases, the ear is perceived to be increasingly prominent or protruded.  The H-M distance is measured before treatment so that a comparison can be made with the H-M distance after treatment with earFold™. The incision is then closed. While in place, earFold™ re-molds the cartilage of the ear allowing it to maintain its new shape and, due to its  flexibility, allows for natural movement of the Auricle so that when moved it will always spring back to its corrected position. 

  The earfold™ implant is made of a short strip of nitinol metal alloy. Nitinol alloy is made of two metals, titanium and nickel, that are widely used in medical fields. The implant is made from the same material used for coronary artery stents (for patients with heart disease or vascular disease due to a blockage of their arteries) and also for unbreakable spectacles. The implant is simply a curved, wafer-thin strip of metal (about the thickness of a human hair), which is plated with 24-carat gold that reduces the visibility of the implant under the skin.   The earFold™ implant has undergone extensive laboratory and human clinical testing over several years but is not yet approved for use in the United States.

Results

One of the first patients to have benefited from the procedure is Jeremy Wood, 53, a senior valuer for the auction house Bonhams in York, England.  “I inherited my sticking-out ears from my father and was called ‘bat ears’ by the boys at school,” he recalls. “I have felt self-conscious about them all my adult life. Strangely I’ve minded more as I’ve got older, maybe because you notice it more as you get

balder. But I never considered surgery until I heard about the implant. My daughter has the same ears as me, and had traditional otoplasty surgery on the NHS at the age of ten. It was quite traumatic and she still suffers from increased sensitivity around her ears, four years on. But this sounded incredibly simple so it appealed.”  Although pain and swelling can last up to two weeks, no follow-up treatment is required.   Jeremy says: “It was a little sore for a few days afterwards but that was it. I was astonished.”