RAG rating
n/a
Document type
Clinical policy
Place
Hertfordshire and West Essex ICB
Output type
Clinical Policies & Evidence-based Interventions
Document
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Correction of Congenital Ear Deformity, Pinnaplasty – Otoplasty

July 2022 v1.0

Funding may be available if one of the following sets of criteria are met:

SET A 
  • Age between 5 – 18 years old at the time of referral and procedure
  • The child has prominent ears.
  • The child is suffering from significant distress, e.g., from bullying. The impact of this distress should be recorded within the application.
  • Surgical correction must be desired by the child; referral should not be made for children who appear indifferent or opposed to the idea of surgery. Parents requesting surgery for their child in order to prevent distress when their child starts school or at some time in the future should be advised that referral should wait until their child specifically requests treatment.
SET B 
  • In children and adults when correction of ear prominence is required to better support a hearing aid.
Rationale

Pinnaplasty and Otoplasty are surgical methods of correcting prominent ears. Ear prominence is very common and can lead to low self-esteem, bullying and significant psychological morbidity in childhood and adolescence. A Commissioning Guide produced by the Royal College of Surgeons advises that surgical correction should only be offered to children between the ages of 5 years and 18 years, and only in cases when the child themselves desires the correction. Referral to a specialist should not be made for children who appear indifferent or opposed to the idea of surgery; any parent requesting surgery for their child in order to prevent psychological distress should be advised that referral should wait until their child specifically requests treatment. 

In infants up to the age of 6 months, cartilage moulding devices should be used, and when correctly applied and well tolerated can reduce ear prominence. However, they are most effective in the neonatal period when the cartilage is malleable and therefore should be applied as soon as possible. Surgery should not be offered to children under the age of 5 years as they are unlikely to be able to tolerate the procedure or be compliant with dressings care.  In addition, children less than 5 are unlikely to develop significant psychological stress associated with the appearance of their ears. However, the Royal College of Surgeons advises that surgical correction may be considered appropriate in children under the age of 5 years, when a hearing aid is required, which will be better supported following the correction of ear prominence.

References

Royal College of Surgeons. Pinnaplasty Commissioning Guide
 
Prior Approval Form

 Please refer to GP Plastic Surgery Referral Form on Ardens or https://www.hweclinicalguidance.nhs.uk/assets/PA-Forms/Plastic-Surgery-procedures-(GP-)-V1.1-Nov-23.docx


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