title: Dynamometric Analysis of Normative Auricular Stiffness and Comparison With Operated Prominent Ears.
abstract: OBJECTIVE
  Stiffness of the auricular cartilage is the main determining factor for the choice of operative technique of the prominent ear deformity. The aim of this study is to evaluate the stiffness of normal appearing ears objectively and quantitatively, compare the results with the operated prominent ear patients, and present prospective short-term dynamometric evaluation of the operated prominent ear patients.
  
  
  METHODS
  A total of 190 volunteers without ear deformities were recruited and 9 age groups were formed: group (5-9), group (10-14), group (15-19), group (20-24), group (25-29), group (30-34), group (35-39), group (40-49), and group (50+). Total 28 ears (14 patients) with otoplasty were included in the study as group (operated 5-9) and group (operated 10-14). In addition, 3 patients with prominent ear deformity were prospectively followed for dynamometric changes that occur with otoplasty operation. The auriculocephalic angle (ACA) was measured once and auricle to scalp distance was measured at 4 different standardized levels. Ear stiffness was measured on each ear individually at 4 different points over the antihelix using digital computer-aided dynamometry. Each ear was compared in terms of ACA, distance, and dynamometric values.
  
  
  RESULTS
  Dynamometric values tend to increase with age, which increase and peak around 35 years of age and declines after 40 years of age. Measurements of the first 2 age groups were statistically different compared with the other groups. Postoperative dynamometric measurements (DNM) of group (operated 5-9) were similar with normative values of group (5-9) and postoperative satisfaction visual analogue scale (VAS) score was 92.8%. Postoperative DNM of group (operated 10-14) were higher compared with normative values of group (10-14) for each different measuring level and the postoperative satisfaction VAS score was 75.3. A total of 3 patients with prominent ears had lower dynamometric values preoperatively; these values approached closer to normative values of their age group postoperatively.
  
  
  CONCLUSIONS
  Results show that auricular cartilage stiffens and malleability decreases with increased age. This stiffness peaks in the 35-39 age group and declines after 40 years of age. Dynamometric values increase, at all levels, suggesting increased cartilage stiffness is related to age. In the scope of these results, cartilage sparing techniques are more suitable for 5 to 14 years of age and cartilage-cutting techniques are more suitable for older patients.
authors.affiliation: Department of Otorhinolaryngology, Medical Faculty, Bezmialem Vakif University, Fatih, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Ozturan
authors.forename: Remzi
authors.initials: R
authors.lastname: Dogan
authors.forename: Berke
authors.initials: B
authors.lastname: Ozucer
authors.forename: Yavuz Selim
authors.initials: YS
authors.lastname: Yildirim
authors.forename: Aysenur
authors.initials: A
authors.lastname: Meric
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001696:Biomechanical Phenomena; D002508:Cephalometry / Q000379:methods; D002648:Child; D002675:Child, Preschool; D054644:Ear Auricle / Q000033:anatomy & histology / Q000502:physiology*; D004425:Ear Cartilage / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D004431:Ear, External / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D004548:Elasticity; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult