Nonoperative molding of congenital ear deformities: the impact of birth-initiation delay on correction outcome.
Abstract
Ear molding can improve the majority congenital ear deformities when employed early after birth. However, the best time to initiate treatment remains debated. In describing one surgeon's experience over the past near decade, this study aims to highlight differences conferred by treatment timing. The authors hypothesize that auricular outcomes are superior when deformities are molded beginning in the first 3 weeks of life. A retrospective review (2010-2018) of 272 cases was performed to compare early initiation of molding (<3 weeks of birth) and delayed initiation (>3 weeks). The mean patient age was 20.4 days and the mean follow-up was 0.5 months. The overall treatment was approximately 31 days. The number of devices required was similar (2.3 versus 2.5) between early and delayed molding cases, but fall-outs (1.0 versus 0.7, P = 0.02) and replacements (0.9 versus 0.6, P = 0.004) were more common after delayed molding. Skin complications developed in 13.6% (37) of ears overall and did not differ by treatment timing. Follow-up surgery was reported in 2 (0.7%) ears. The 85% of families reported subjective satisfaction with the final outcome; satisfaction was significantly higher for early cases (97% versus 79%, P = 0.03). Ear molding of congenital ear deformities should begin within 3 weeks of birth. From our experience, setting realistic expectations helps limit discrepancies between expectation and outcome.
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Patients who begin treatment after 3 weeks of age have increased rates of device fall-off and replacements.
“Patients who begin treatment after 3 weeks of age also have increased rates of device fall-off and replacements, which are detrimental to treatment success.19”
From A Retrospective Review of Outcomes and Complications after Infant Ear Molding at a Single Institution (2023) · cites this paper as [19]
Delayed intervention results in lower treatment compliance and increased rates of device falloff and replacements in patients who begin treatment after 3 weeks of age.
“Moreover, delayed intervention results in lower treatment compliance and increased rates of device falloff and replacements have been reported in patients who begin treatment after 3 weeks of age.22”
From Long-term Outcomes of Infant Ear Molding: A 10-year Single-Surgeon Experience (2025) · cites this paper as [22]
Cites
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“The conclusions were congruent with limited prior case reports suggesting an association between poor outcomes and initiation at older ages (>3 months).(15) More recently, Doft et al conducted a prospective study of 158 ears in 96 consecutive infants treated with the EarWell system.”
ResultThe Newborn Butterfly Project: A Shortened Treatment Protocol for Ear Molding
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“’’ While all cases treated within the first 3 weeks of life resulted in favorable outcomes, unfavorable outcomes (‘‘very poor’’ or ‘‘poor’’) were seen in only cases that had been treated after the first 3 weeks of life (n1⁄4 3).(18) Recently in 2019, Chan et al published in 2019 a 3-year prospective study of 105 ears…”
BackgroundA simplified nonsurgical method for the correction of neonatal deformational auricular anomalies.
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Deformations of the Ear and Their Nonsurgical Correction
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Self-citationMalformation, Deformity, and Discrepancy
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Sayadi, J. J., Arora, J. S., Chattopadhyay, A., Hopkins, E., Quiter, A., & Khosla, R. K. (2023) · Plastic and Reconstructive Surgery - Global Open · doi:10.1097/gox.0000000000005133 · Cited by 5 · see citing works
Ear Molding in Children—Timing, Technique, and Follow-up: A Systematic Review
Sulibhavi, A., Reddy, S. P., Butts, S. C., & Schmalbach, C. E. (2024) · Facial Plastic Surgery & Aesthetic Medicine · doi:10.1089/fpsam.2023.0321 · Cited by 4 · see citing works
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
“22 Therefore, interrelated factors contributing to parent satisfaction among patients treated with InfantEar include features of the device system itself and the potentially improved efficacy related to earlier treatment initiation.”
- Authors
- Nigam, M., Kotha, V. S., Barra, C., & Baker, S. B.
- Affiliations
- MedStar Georgetown University Hospital (US)
- George Washington University (US)
- Georgetown University Medical Center (US)
- Corresponding author
- Nigam, Manas
- Kotha, Vikas S.
- Barra, Christina
- Baker, Stephen B.
- ORCID
- Kotha, Vikas S.
- Venue
- Journal of Craniofacial Surgery
- Published
- 2020-05-04
- Volume
- 31
- Issue
- 6
- Pages
- 1588-1592
- ISSN
- 1049-2275 (ISSN-L)
- 1536-3732
- OpenAlex
- W3021521908
- Cited by
- 20
- References
- 20
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 7 · 2021: 1
- FWCI
- 2.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Craniofacial 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
- congenital ear deformity, treatment timing, skin complications, patient satisfaction, pediatric otolaryngology
- MeSH terms
- Ear Diseases, Ear, External, Equipment and Supplies, Female, Humans, Infant, Newborn, Male, Personal Satisfaction, Retrospective Studies, Skin, Treatment Outcome, Ear Auricle
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