Correction of deformational auricular anomalies by moulding--results of a fast-track service

To report on the result of a fast-track referral service in treating deformational auricular anomalies using moulding therapy, by employing nurses who were familiar with the indications and technique, working in close liaison with plastic surgeons.

A deformational auricular anomaly is defined as an ear having normal chondrocutaneous components but an abnormal architecture; therefore, it can be manipulated digitally to a normal shape. Having demonstrated the value of auricular moulding therapy to our neonatal practitioners, we established a fast-track referral and treatment protocol for infants with deformational auricular anomalies. Treatment was initiated promptly by one of four nurses. The type and severity of the auricular anomaly were documented both clinically and photographically before and three months following cessation of treatment. Assessment of the results was made by comparing the pre- and post-treatment photographs and by a postal questionnaire, which was dispatched to the parents of the patients three months after treatment was discontinued.

Sixteen male and 14 female patients, aged between one day and 15 weeks (mean 24 days) with 44 deformational auricular anomalies, underwent moulding therapy. Complete correction or marked improvement was achieved in 26 patients (87%) with 38 ears (86%) while slight or no improvement occurred in 4 patients (6 ears), following one to 14 (mean 7) weeks of moulding. Questionnaires were returned by the parents of 24 patients (80%). According to the parents' assessment, complete correction or marked improvement occurred in 29 of 35 anomalous ears (83%) in 20 of these 24 patients (83%). All parents felt that auricular moulding was worthwhile.

Deformational auricular anomalies should be treated non-surgically with moulding therapy. For this treatment to be effective, it should be initiated in the first three months of life. Parental persistence with the treatment is essential for a satisfactory outcome. A fast-track referral service, employing nurses who form the first point of contact and work in close association with a plastic surgery service, is an effective treatment strategy that will largely negate the need for surgical correction of deformational auricular anomalies.