Efficacy of ear molding in infants using the EarWell infant correction system and factors affecting outcome.
Abstract
BACKGROUND: One-third of infants have ear anomalies, and less than one-third self-correct. Correction of ear deformities by molding exploits the plasticity of the auricular cartilage because of circulating maternal estrogen during infancy. In this study, the authors assess the efficacy of the EarWell Infant Correction System in the correction of ear deformities and determine the factors that affect its outcome. METHODS: The authors conducted a single-center prospective study over a 3-year period. Consecutive full-term infants who underwent ear molding with the EarWell system were recruited. Primary outcome was successful correction of ear anomaly. Secondary outcomes included complications and maintenance of ear shape. Factors identified included type of anomaly, age at application, duration of application, and breastfeeding. RESULTS: Sixty-seven patients with a total of 105 ears were recruited. The anomalies were classified into deformations (66.7 percent) and malformations (33.3 percent). The median age group at presentation was 0 to 7 days (67 percent). Average duration of application was 4.1 weeks. Successful correction was achieved in 86 percent of patients. Ear deformations achieved a significantly higher rate of successful outcome (98 percent) compared with malformations (64 percent) (p < 0.001). Skin complications were common (46 percent) and attributed to our tropical climate. Patients with complications were of a higher mean age (22.1 days) compared with patients with no complications (10.6 days) (p = 0.037). CONCLUSIONS: The EarWell system is an effective nonsurgical option for the treatment of ear anomalies. The type of anomaly was the only predictor of successful correction, whereas age at application, duration of molding, and breastfeeding were not. Complications were more common in older infants. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Virtually all studies evaluating ear molding efficacy have focused on short-term results, with follow-up limited to less than a few years.
“Virtually all studies evaluating ear molding efficacy have focused on short-term results, with follow-up limited to less than a few years.7,9–16”
From Long-term Outcomes of Infant Ear Molding: A 10-year Single-Surgeon Experience (2025) · cites this paper as [12]
Chan et al found no significant relation between duration of treatment and outcome.
“Chan et al found no significant relation between duration of treatment and outcome.30”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
Chan et al found a higher degree of successful outcomes after ear molding for deformities compared with malformations.
“A previous study by Chan et al found a higher degree of successful outcomes after ear molding for deformities compared with malformations.3”
From A Retrospective Review of Outcomes and Complications after Infant Ear Molding at a Single Institution (2023) · cites this paper as [3]
The first-line therapy for infants with mild-to-moderate ear anomalies is ear molding.
“The first-line therapy for infants with mild-to-moderate anomalies is ear molding, a nonsurgical intervention that gradually reshapes the ear cartilage over the course of several days to weeks, through the application of continuous tension.1,3”
From A Retrospective Review of Outcomes and Complications after Infant Ear Molding at a Single Institution (2023) · cites this paper as [3]
Reported outcomes in the literature are excellent, with 82%-90% of patients achieving favorable results.
“Reported outcomes in the literature are excellent, with 82%–90% of patients achieving favorable results.1,3”
From A Retrospective Review of Outcomes and Complications after Infant Ear Molding at a Single Institution (2023) · cites this paper as [3]
The parent satisfaction rate of 80.4% is comparable to existing reports ranging from 86% to 92% using different outcome measures.
“At a median of 5 years after treatment, the satisfaction rate among 97 parents was high at 80.4%, which is comparable to existing reports ranging from 86% to 92% using different outcome measures.11,12,20”
From Long-term Outcomes of Infant Ear Molding: A 10-year Single-Surgeon Experience (2025) · cites this paper as [12]
The main problem encountered in use of the different treatment materials was mal-adhesion and early loosening of the material.
“The main problem encountered in use of the different treatment materials was mal-adhesion and early loosening of the material.6,28,30,31,35,36”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
In some cases, clinicians were independent or blinded.
“In some cases, clinicians were independent28,30,37 or blinded.31”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
Chan et al, Chang et al, and Mohammadi et al found no significant relation between the age at initiation of treatment and outcome.
“Chan et al, Chang et al, and Mohammadi et al found no significant relation between the age at initiation of treatment and outcome,28–30”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
Chan et al showed that the success rate of treatment is lower in malformations than in deformations, but stated that parents were more inclined to opt for ear molding despite this, due to malformations appearing more severe.
“Chan et al showed that the success rate of treatment is lower in malformations than in deformations, but stated that parents were more inclined to opt for ear molding despite this, due to malformations appearing more severe.”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
Chan et al found no significant difference regarding breastfeeding prolonging the ideal treatment interval.
“Chan et al, however, found no significant difference.30”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
Two articles reported on the treatment of malformations, including constriction and cryptotia as malformations.
“Two articles reported on the treatment of malformations,30,31, including constriction and cryptotia as malformations.”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
The grading moment varied; most studies assessed results immediately after treatment and at follow-up, Schratt et al graded 2 years after treatment completion, Chan et al graded 6 months after treatment, and Doft et al did not clarify the moment of assessment.
“The grading moment varied. Most of the studies assessed the results immediately after treatment and at follow-up. Schratt et al, however, graded patients 2 years after treatment completion, while Chan et al graded patients 6 months after treatment.30,36 Doft et al 32 did not clarify the moment of assessment.”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
It has been suggested by Tan et al that the treatment interval may increase due to breastfeeding increasing estrogen levels, but there is little data available on the subject.
“Although it has been suggested by Tan et al that the treatment interval may increase due to breastfeeding increasing estrogen levels, there is little data available on the subject.30,57”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
Chan et al showed one of the highest rates of complications (46%), attributing this to the warm and humid climate of Singapore.
“Chan et al showed one of the highest rates of complications (46%),30 attributing this to the warm and humid climate of Singapore.”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
Most complications resolved spontaneously; other cases had to be conservatively or topically treated or treatment was (temporarily) stopped.
“Most complications resolved spontaneously. Other cases had to be conservatively or topically treated6,30,32,36 or treatment was (temporarily) stopped.28,32,36”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
The correlation between age and complications was attributed to the immune system becoming more hyperreactive with age and progressive hardening of the cartilage, making ears more prone to dermatitis and pressure ulcers.
“This was attributed to the immune system becoming more hyperreactive with age and progressive hardening of the cartilage, making ears more prone to dermatitis and pressure ulcers, respectively.30”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [30]
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Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature
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“Other possible outcomes included (1) issues with peers in social settings, (2) complications associated with the ear molding process, and (3) difficulties related to the operation or maintenance of the ear molding device.”
BackgroundAlper, D. P., Almeida, M. N., Craver, A., Hosseini, H., De Baun, H. M., Moscarelli, J., Collar, J. L., Parikh, N., Shah, J., & Alperovich, M. (2024) · Aesthetic Plastic Surgery · doi:10.1007/s00266-023-03523-8 · Cited by 5 · see citing works
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Long-term Outcomes of Infant Ear Molding: A 10-year Single-Surgeon Experience
Wu, M., Chang, A. E., Platukus, A. M., Massenburg, B. B., Byrns, C. N., Romeo, D. J., Ng, J. J., Swanson, J. W., Taylor, J. A., & Bartlett, S. P. (2025) · Plastic and Reconstructive Surgery - Global Open · doi:10.1097/gox.0000000000006673 · Cited by 2 · see citing works
“11,12,20 Alper et al 16 found that among 38 caretakers, satisfaction regarding ear appearance, as measured by a 5-point Likert scale, remained stable at 3 years compared with immediately after treat-ment (4.17 versus 4.18, P = 0.54), whereas anticipated social distress decreased over time.”
Influential
- Authors
- Chan, S. L. S., Lim, G. J. S., Por, Y. C., Chiang, M. F., Ho, S., Saffari, S. E., & Chia, H.-L.
- Affiliations
- National University of Singapore (SG)
- Venue
- Plastic & Reconstructive Surgery
- Published
- 2019-10
- Volume
- 144
- Issue
- 4
- Pages
- 648e-658e
- ISSN
- 0032-1052 (ISSN-L)
- OpenAlex
- W2978404310
- Cited by
- 45
- References
- 21
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 6 · 2023: 10 · 2022: 9 · 2021: 7 · 2020: 6
- FWCI
- 5.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Plastic & Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Genetics › Congenital Ear and Nasal Anomalies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Keywords
- ear deformity, auricular malformation, maternal estrogen, skin complications, breastfeeding, treatment outcome predictors
- MeSH terms
- Congenital Abnormalities, Ear, External, Equipment Design, Female, Humans, Infant, Infant, Newborn, Male, Prospective Studies, Treatment Outcome
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