One of the most common birth defects involves the ear. The ear is a complex array of hills and valleys of cartilage and skin that give each ear its unique shape. How all the ear structures coalese together from many small hillocks in utero and form an ear is a miracle of embryology. But given its complexity and that it is a very flexible structure with many folds and indentations, it is no surprise that it can become misshapen during the developmentn and birth process. If one fold or bend of the ear is off or absent (e.g., lidding, cup ear, lop ear), then an ear defect is obvious at birth. It is estimated that as many of 10% of births have some minor ear shape abnormality or asymmetry.
Historically, surgery is the only option for the deformed ear correction or improvement in its shape. This must often wait until the child is five or six years of age until the ear has grown and reached a more mature size before any surgery is attempted. Unless the ear is partially or competely absent (microtia), any corrective ear surgery is viewed as cosmetic as it does not improve any ear function such as hearing.
One of the very unique features of the neonatal ear is that it is very malleable. The cartilage has not stiffened yet and the ear can be molded into a new shape. This has been known for a very long time and numerous methods of ear molding have been tried, particularly for the protruding ear that lacks an antihelical fold. These device attempts in the past have largely been unsuccessful due to the difficulty in keeping any ear dressing or molding appliance in place.
Since 2010, a more effective device for neonatal ear molding has been available. Known as the EarWell Correction System, this is a non-surgical device that can reshape numerous ear deformities into a more normal appearance. In a matter of weeks, the infant’s ear cartilage can be reshaped. The key, however, is early initiation of therapy. It should ideally begin within two weeks after birth when the ear cartilage is most malleable. The ear cradle is initially placed, which is then followed by a change in cradle every two weeks with a total of three ear cradle sets used. This would project to treatment completion in 6 to 8 weeks after it is started. By two to three months after birth, the ear cartilage has stiffened and is not longer externally moldable.
The EarWell system has four components. A posterior or scalp cradle that sites behind the ear and adheres to the scalp skin. (1)A retractor that shapes the ear cartilage. (2) A conchal former that shapes the inner ear. (3) And an external cradle that holds all the parts together. (4) Despite looking a bit uncomfortable, it is actually painless to the infant. They wear it without any problems. Currently, this device is covered by most medical insurance plans. Whether it will continue to be so in the future is unknown.
The EarWell system has a high success rate. But the key to this success is early initiation of treatment. It will not work or not very well if it is begun after the first month of life. This is usually the hard part as by the time most parents are aware that this non-surgical ear molding approach exists, the best time for treatment has passed.
Dr. Barry Eppley
Indianapolis, Indiana