title: A novel approach for classifying protruding ears is easy to calculate and implement in daily clinical practice.
abstract: OBJECTIVE
  Protruding ears are a prevalent deformity, with a reported incidence of 5% in the paediatric population, but it lacks a simple digital classification. The aim of this study was to find a parameter that would objectively allow the photographic classification of protrusion, by comparing frontal facial images of patients with protruding ears with aged-matched controls.
  
  
  METHODS
  This prospective cohort study compared the frontal facial images of 105 patients with protruding ears with 112 aged-matched controls without protruding ears. A rectangle was drawn on the image for each ear, encompassing its full visible anatomy. The width of each rectangle was divided by its height to create an index. The mean value of both ears was defined as the Frontal Aesthetics Translation Index for Measurement of Amplitude of the Ears (FATIMAE).
  
  
  RESULTS
  The calculated values for group with protruding ears were significantly higher than for the controls. No gender differences were found. However, the FATIMAE values decreased with age, establishing different classification criteria for separate age groups.
  
  
  CONCLUSIONS
  The FATIMAE is easy to calculate and implement in daily clinical practice and establishes a practical approach for classification of protrusion, as well as for referral criteria for a specialised surgical consultation.
authors.affiliation: Department of Paediatric Surgery, Centro Hospitalar do Porto (CHP)/Centro Materno Infantil do Norte (CMIN), Porto, Portugal.|Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
authors.forename: José A
authors.identifier: http://orcid.org/0000-0002-4872-9947
authors.initials: JA
authors.lastname: Lopes-Santos
authors.affiliation: Instituto Superior de Engenharia do Porto (ISEP), Politécnico do Porto, Porto, Portugal.
authors.forename: Constantino
authors.initials: C
authors.lastname: Martins
authors.affiliation: Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
authors.forename: José M
authors.initials: JM
authors.lastname: La Fuente
authors.affiliation: Department of Paediatric Surgery, Centro Hospitalar do Porto (CHP)/Centro Materno Infantil do Norte (CMIN), Porto, Portugal.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Costa-Carvalho
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D054644:Ear Auricle / Q000002:abnormalities* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D011446:Prospective Studies; D012016:Reference Values; D012720:Severity of Illness Index
keywords: Clinical photography; Diagnostic criteria; Digital classification; Prominent ears; Protruding ears