Malformed or deformed ears are very common in infants and can typically be corrected through a technique called molding. At Atlantic Surgical Associates, we perform infant ear molding with a high rate of success at our office in West Long Beach, New Jersey. We welcome families in surrounding areas of Essex, Ocean, and Monmouth counties.
As a parent you might be surprised to know that many infants do not have normal looking ears at birth. Abnormal looking ears are quite common and can create unique distress to parents and families of newborns.
Compared to individuals with normal appearing ears, people with ear abnormalities may experience significantly more stress, anxiety, social avoidance, self esteem issues, bullying, etc.
The abnormal looking ears can be divided into 2 groups – malformations and deformities.
What are Ear Malformations?
Ear malformation is when the child is missing portions of the ear. The malformations are not very common. It is estimated that they occur 11.5 per 10,000 birth and usually the correction requires surgery. They do not correct by themselves.
What are Ear Deformations?
Ear deformations are much more common. Some studies report that as many as 15 or 25 percent of all kids are born with some ear abnormalities. Deformations or deformities occur when all parts of normal ear are present at birth but they are not in normal position. Many physician believe that the main cause of deformed ear is abnormal force or pressure on the ear while still in utero, during delivery or during first days after birth.
Most traditional pediatricians believe that about 30% of these deformities will eventually self correct, however, there is no way to predict which ones will correct and which ones will not. Also it is impossible to predict the degree of correction as well as final symmetry to the other side. By the time correction of 30% of ears occur, the non-surgical molding is not available any longer and surgery is the only option.
Because all the parts of normal ear are actually there, the infant ear can be corrected without surgery with the process known as molding. However, infant ear can ONLY be molded only within first weeks of life. After that molding will not be successful and the child most likely will require surgery later on in life to correct the deformity. The main principle of infant ear molding is to create a gentle guiding force to soft cartilage of the ear while it is still malleable (can be bent without cracking and maintain the shape for the rest of child’s life).
The reason the infant’s cartilage is moldable is because of maternal estrogen remaining in baby’s bloodstream. The levels of maternal estrogen slowly decrease over the first 3 months after birth. The molding process has to be completed by 3 month mark. After 3 months, molding is not effective. The higher the level of maternal estrogen is, the easier and faster molding process occurs and the better results are can be achieved. As the matter of fact, the hormone level usually peaks about 72 hours after birth and then progressively decreases. If molding is initiated within the first 7 days of life, it usually takes about 2-3 weeks and can produce very dramatic improvement. After 21 days molding required multiple adjustment sessions, takes about 6-8 weeks and will not produce the same degree of improvement. Dr Volshteyn prefers to start molding process during the first 3 days of life (preferably the first day) and definitely no later than 7-10 days after birth for the best possible results. There are reports of reasonable outcomes if treatment was initiated at 2 months but it takes up to 3 months.
images Above provided courtesy of InfantEar
Most common ear deformities are
Protruding or Prominent ear deformity,
Lop ear deformity,
Constricted ear deformity,
Cup ear deformity,
Stahl ear deformity,
Mixed ear deformity,
Lidding ear deformity,
Helical rim (outer ear rim) ear deformity,
Inverted Concha ear deformity,
What is the Success Rate of Ear Molding?
The success rate of ear molding is about 90 percent. Even if the deformity is not corrected completely, the residual deformity is significantly less noticeable. If the child still requires corrective surgery later in life (usually 6-7 years of age right before school) the surgery is much less complicated and less expensive.
What Ear Molding Techniques are Available?
There are several techniques exist for ear molding from double sided tapes to sophisticated mold systems. Some of them are home-based and others require professional expertise.
Tapes. Several companies manufacture double sided tapeproducts, such as OtoStick for example. Using different modifications of double sided tape, the protruding or prominent ear is taped to the skin behind the ear reducing outward position. It is simple, inexpensive (costs about $35), but it is very limited in what it can correct, unpredictable, very difficult to achieve a truly natural appearance and commonly produces telephone ear deformity instead.
There is also a home-based system developed by British Plastic Surgeon Dr. David Gault, known as EarBuddies, which is very similar to what we used to do 20 years ago, and it is quite useful in many cases. You are provided with a splint, which is taped to the ear to recreate a fold. Cost for basic kit is about $80 and premium kit is about $150.
Infant Ear Molding Systems. Modern ear molding systems are a bit more sophisticated and address multiple deformities at the same time. We can correct the shape of the outer cartilage, crura, concha and prominent ear deformity at the same time.
Dr. Volshteyn can compare modern molding systems to injection moldings of plastics or a very gentle press. Because the mold is the same, or a mirror image for right and left, the degree of symmetry achievable with this method is excellent.
What Ear Molding Systems Do We Use?
Infant Ear Correction System. It was developed by Texas plastic surgeon Dr. Steve Byrd. You can click on the picture of Dr. Byrd to view his video explaining how EarWell Infant Ear Correction System works or you can click on the Earwell image below to view a live application.
The other system we use is
Non-Surgical Ear Molding System developed by Pennsylvania Plastic Surgeon and former Chief of Plastic Surgery at The Children’s Hospital of Philadelphia (CHOP) Dr. Scott Bartlett.
We also use other custom molding systems depending on patient needs.
We select the specific device or system for infant ear deformity correction based each individual patient and we do not exclusively use a single system.
Insurance coverage. Most insurance plans do cover ear molding procedure as medically necessary. It is considered a congenital deformity and not cosmetic. Cost of procedure varies based on equipment used, one or both ears corrected, use of operating room and use of a specific ear molding system, etc. We are able to accept private insurance plans with referrals from primary care physicians or pediatricians. You may also use your FLEX or HSA accounts as procedure is considered medically necessary and not cosmetic. We also accept credit cards and offer third party financing options.
At this time we are unable to accept Medicaid and Medicaid HMO plans.
Why are Plastic Surgeons doing it?
Several companies market the ear molding systems to pediatricians, primary care doctors and dentists. Remember, none of them understand true complexities of ear anatomy and none of them can consider importance of priorities in mixed ear deformities.
As plastic surgeons when we apply these devices, we also consider what we can do in case of failure and what is easier to correct surgically in the future if needed.
We also understand the most vulnerable areas of the ear to overcorrection.
That is why I would prefer to have a plastic surgeon apply it to my child rather than an overnight expert with weekend education course.
What are the possible side effects or complications?
Infection. Infections are rare. Most commonly infection is not from bacteria but from yeast. It usually occurs after “spit-ups” or spilling of untreated milk. If it occurs, the child should return to the office for examination, cleaning and treatment, which usually includes repositioning of retractors also.
Skin irritations. Skin irritation can occur because of friction from retractors. The treatment involves returning to the office, removing of retractors for a couple of days to let abrasions heal. Then the molding system is reapplied. We recommend using Bacitracin and NOT Neomycin as the latter one can promote development of allergic reaction in a newborn.
Skin redness or rash. Skin redness is a result of combination of use of adhesive, alcohol swabs, and acetone/alcohol pads. Skin redness is common but is usually subsides after the device is removed. In case of very severe allergic reaction, we usually recommend removal of the device, use of over the counter cortisone cream three times a day for 2-3 days and secure ears with headband till resolution of the symptoms.
When is the best time to apply an infant ear molding system?
The best time to apply custom ear molding system is before 3 weeks of age. In this case, the treatment usually takes 4-6 weeks or more. However, if it is applied earlier, the course of treatment may shorten down to 2 weeks. Our recommendation is to start treatment during the first week of life. Ideally, within the first 48-72 hours of life.
What if the treatment is not started until the 4th-10th week of life?
If the treatment is not initiated until the 4th-10th week of life, the degree of possible improvement decreases significantly. The parents should be aware that the correction is still possible but most likely it will be incomplete. Also, at that time, the child will become more active and the chances of him/her removing the device increase significantly. That is why we recommend securing the arms or arm splinting for older infants.
What about premature babies?
Traditional recommendation is to start treatment after child reached 4-4.5 lb. However, dealing with premature babies is quite a bit more complex and requires significant degree of experience.
How long does the therapy last?
The duration of ear molding therapy depends on how early after birth the treatment is initiated, how complex the deformity is and how compliant the child and the parents are with hygiene guidelines.
If the deformity is mild to moderate, and the treatment is initiated within first 48 hours, the treatment usually takes 2-3 weeks. If it is initiated after 21 days or 3 weeks of life, the duration increases to up to 10 weeks. EarWell, for example, recommends full 6 weeks course routinely.
How do you know after 6 weeks that the ear will not “spring back” to the original deformity?
We do not. We check manually the rigidity of the ear to determine if the ear is rigid enough to maintain its own shape. We also compare the ear rigidity in both biologic parents, if possible, as ear rigidity varies significantly from person to person. If the ear is not rigid enough, the ear molding system is reapplied.
Does infant ear molding system affect hearing?
No, it is applied behind the ear canal.
Will it interfere with sleep?
The ear molding system is painless and does not interfere with child’s sleep and does not require any special devices or pillows.
How does the infant ear molding system affect nursing?
Ear molding system does not affect nursing. However milk spillage can result in skin irritation and even require temporary device removal in case of yeast infection.
Soft cloth shall be placed to prevent milk or milk products or formula from spilling onto the device.
Do you have to shave hair around the ear?
Yes. The system relies on proper attachment to the skin with gentle hypoallergenic adhesive specifically developed for this purpose by 3M corporation.
Hair underneath the system allow motion of the molding system and cause irritation and friction injury.
Is the application of the infant ear molding system very painful?
No, it is painless. But the child may cry to demonstrate dissatisfaction with the process.
How does the infant ear molding system actually work?
In contrast to surgery, when the stiff cartilage has to be cut and repositioned with sutures, ear molding does not require use of knives, sutures, or anesthesia. The cartilage is not cut but is gently molded in new shape.
It is traditionally thought that while mother’s estrogen hormone is circulating in the baby’s bloodstream, the ear cartilage is malleable. The peak concentration of maternal estrogen usually occur about 72 hour after birth and decrease significantly by 3 weeks of life and almost disappear by 3 month of life. The levels of estrogen usually guide the success or failure of the ear molding as well as duration of treatment.
Can I bathe my baby with the Infant Ear Molding System?
It is important not to get the device wet to prevent it from coming off, loosening or underneath skin irritation. We suggest washing around it carefully.
Will my insurance cover the treatment?
Ear deformities are considered congenital conditions and are usually covered by most insurance plans. We recommend you checking with your specific insurance carrier.
Which insurance plans do you accept?
Currently we participate with Medicare.
We do not participate as in-network providers with most insurance carriers. However, we do work with most private insurance companies, including traditional commercial ones and self insured plans based on referrals from pediatricians or other primary care providers. Because Infant Ear Molding treatment has to be initiated within 1 week of life, it usually requires parental assistance to obtain timely pre-authorizations for the procedure. We are able offer direct contracting to unions and other self insured third party payers.
At this time we do not accept Medicaid or Medicaid HMO plans.
If I have Medicaid, what can I do?
If you are Medicaid or Medicaid HMO recipient and you are unable to locate a provider in your insurance network who is able and available to provide these services in a timely fashion, you need to obtain out-of-network referral from your primary care physician and contact your Medicaid Carrier to receive approval to be seen by Dr. Boris Volshteyn. Each Medicaid plan has its own rules and protocols and the process is very time consuming. Unfortunately, our office will not be able to assist you with this process.
Alternatively, you may also choose to pay cash for the services. We also accept most credit cards and offer third party financing options. Please contact our office for pricing details.
Does breastfeeding affect duration of ear molding?
Maybe. Some surgeons believe that breastfeeding prolongs flexibility of ear cartilage. Therefore, duration of treatment in breastfed babies is usually prolonged. However, there is no universal agreement on this topic exist at this time. On a positive note, breastfeeding, if it indeed produces such an effect, may potentially allow cartilage remolding beyond 3-month benchmark.
Dr. Volshteyn is a Board-certified plastic surgeon specializing in facial fractures and reconstruction. If your child has been born with ear deformities or abnormalities, contact us right away to schedule a consultation and begin treatment for the best possible results. We welcome families to our West Long Beach, NJ office from surrounding areas of New Brunswick, East Brunswick, and Staten Island, NY.