title: Pre and post-operative psychological functioning in younger and older children with microtia.
abstract: OBJECTIVE
  Microtia ranges from a smaller ear to the absence of the external ear and has been associated with psychosocial distress. Traditional ear reconstruction takes place beginning at age six. Use of an alloplastic implant allows for earlier surgery starting at age three, which may reduce potential negative psychological effects. However, few studies have examined psychosocial outcomes of ear reconstruction with groups that include young children.
  
  
  METHODS
  Children (N = 23) with microtia and their parents completed two microtia-related scales, negative emotions and microtia social awareness, and the Behavioral Assessment System for Children - Second Edition (BASC-2) subscales of anxiety, depression, and social skills before surgery and one year after surgery. Participants (74% male) were three to nine years old with a mean age of 6.13 ± 2.10 years and were grouped by age at surgery, three to six years (n = 11) or seven to ten years (n = 12). The sample identified as Latino (96%) or "other" (4%).
  
  
  RESULTS
  Pre and postoperative scores by age group were compared using two-way repeated measures analyses of variance. Children and parents reported significantly less negative emotion and microtia social awareness following surgery, with an interaction for parental report of older children showing higher negative emotion preoperatively. Older children also had higher scores of depression and anxiety before surgery and both groups reported significant decreases following surgery, along with improved social skills. Older children showed significantly greater gains in social skills.
  
  
  CONCLUSIONS
  All participants and their parents reported improved psychological functioning postoperatively. However, older children may be at greater risk of psychological concerns given the longer time they have to cope with the impact of microtia on self-image and exposure to social stressors. Undergoing reconstructive surgery earlier may be a protective factor for children with microtia.
authors.affiliation: Children's Hospital Los Angeles, University of Southern California, USA. Electronic address: ajohns@chla.usc.edu.
authors.forename: Alexis L
authors.initials: AL
authors.lastname: Johns
authors.affiliation: Children's Hospital Los Angeles, USA.
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Lucash
authors.affiliation: Los Angeles County and University of Southern California Medical Center, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Im
authors.affiliation: Children's Hospital Los Angeles, Aesthetic Ear Reconstruction, USA.
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Lewin
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D065817:Congenital Microtia / Q000523:psychology* / Q000601:surgery*; D004423:Ear / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D011184:Postoperative Period; D057234:Preoperative Period; D019651:Plastic Surgery Procedures
keywords: Ear reconstruction; Medpor; Pediatric microtia; Psychological functioning