title: Prominent ears: the effect of reconstructive surgery on self-esteem and social interaction in children with a minor defect compared to children with a major orthopedic defect.
abstract: BACKGROUND
  In a prospective study of patients with prominent ears, the effect of reconstructive surgery on self-esteem and social interaction was examined 1 year after surgery.
  
  
  METHODS
  Of 42 patients with prominent ears aged 7 to 15 years, 21 were matched with a comparison group of orthopedic patients (leg lengthening) and a control group of schoolchildren. Psychological measures evaluated self-esteem, depression, anxiety, cognition, parents' ratings of child behavior and symptoms, and parent anxiety. Semistructured interviews with the child and parents were also conducted.
  
  
  RESULTS
  The motivation to be operated on was pain, teasing, and feelings of being different. The satisfaction rate with the result of reconstructive surgery was high. The psychological measures of the prominent ears group had results close to those of the control group, although the leg lengthening group had lower self-esteem and higher depression and anxiety scores. With few exceptions, all patients had scores within the normal range on self-rating scales. Parents reported less activity at leisure time in both patient groups than in the control group. After surgery, parents reported improved behavior on the Child Behavior Checklist total problem score.
  
  
  CONCLUSIONS
  Patients with minor defects had fewer self-reported psychological and behavior problems than the major defect group. Interestingly, prominent ears patients also had low activity levels. Reconstructive surgery had no adverse effect on the prominent ears patients in this interim study but rather resulted in improved well-being. It is important to investigate further the effect of reconstructive surgery on children's self-esteem and social interaction.
authors.affiliation: Uppsala, Sweden From the Departments of Neuroscience and Child and Adolescent Psychiatry, and Department of Surgery, Plastic Surgery, Uppsala University, and the Department of Behavioral Sciences and Learning, Linköping University.
authors.forename: Birgitta Johansson
authors.initials: BJ
authors.lastname: Niemelä
authors.forename: Anders
authors.initials: A
authors.lastname: Hedlund
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.forename: Viveka Sundelin
authors.initials: VS
authors.lastname: Wahlsten
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000175:diagnosis; D002648:Child; D003863:Depression / Q000175:diagnosis; D004431:Ear, External / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D000297:Psychology, Adolescent; D002666:Psychology, Child; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000523:psychology*; D012649:Self Concept; D012720:Severity of Illness Index; D012919:Social Behavior