2 The procedure
2.1.1 Protruding or prominent ears result when normal cartilaginous folds fail to form within the ear.
2.1.2 Surgery to correct protruding ears aims to reposition the elastic cartilage permanently while preserving a natural appearance. Cartilage-sparing techniques avoid radical excision, but reduce the cartilage spring by such measures as scoring, drilling and suturing. All techniques usually involve a post-auricular incision of the skin.
2.2.1 Incisionless otoplasty avoids the use of a standard incision, which can sometimes be complicated by anterior skin necrosis or keloid scar formation.
2.2.2 The procedure is usually carried out with the patient under general anaesthesia, but it can also be done under local anaesthesia. Precise details of the procedure depend on the nature of the ear abnormalities, the needs of the individual patient and the preferences of the surgeon. In an optional first stage, a needle is inserted into the anterior aspect of the ear and used to score the anterior surface of the cartilage and render it more malleable. A posterior approach is then used to insert subcutaneous retention sutures (usually non-absorbable) to create a natural looking antihelix with less ear protrusion. Conchal cartilage may also be anchored onto the mastoid bone by a subcutaneous stitch attached to non-elastic tissue such as the periosteum.
Sections 2.3 and 2.4 describe efficacy and safety outcomes from the published literature that the Committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the overview.
2.3.1 A case series of 13 patients (5 of whom were treated by incisionless otoplasty) reported that photographs showed good correction and that all patients and their families were satisfied with the outcome.
2.3.2 A case series of 11 patients reported that all results were 'satisfactory' with no recurrence during 6- to 30-month follow-up.
2.3.3 The Specialist Advisers listed key efficacy outcomes as aesthetic ear correction and avoidance of recurrence.
2.4.1 No safety concerns were reported in the published literature.
2.4.2 The Specialist Advisers listed anecdotal adverse events as anterior skin necrosis, collapse of the ear necessitating reconstruction with costal cartilage, poor aesthetic outcome and bleeding.
2.5.1 The Committee noted the psychological distress caused by protruding ears and the potential benefit of effective treatment, in particular by procedures that minimise scarring. However, the limited publications available provided inadequate evidence to suggest that incisionless otoplasty is an efficacious procedure. The Committee expressed particular disappointment at the paucity of the evidence base.