GENERAL
Why are babies born with problem ears?
There are a number of types of problem ear at birth, but most are due to an abnormality of development. The ear develops from a collection of tiny hillocks on the side of the head. Between the 38th and 50th days of development, the human embryo grows at a fantastic rate, its length alone increasing tenfold from 13 to 135 mm. During this period the tiny hillocks fuse together to form a primitive ear, and most deformities of the ear, and especially those in which tissue is lacking, happen around this time when the process fails in some way. From the 50th day, the primitive ear slowly increases in size, but changes little in shape, to form the definitive ear at about 7 months of life.
Why do ears stick out?
Ears become prominent either because a fold in the cartilage of the ear is not properly developed or because the conchal hollow grows very deep. There is some evidence that an abnormal muscle attachment may have a role to play.
- The cartilage of the ear is actually cup shaped, rather like a Shrek ear. The antehelical fold makes it lie against the side of the head. The cartilage is very soft at birth, but if it hardens without the normal fold, it sticks out. An Ear Buddies splint restores the normal folding of the ear.
Can ears which look odd at birth get better on their own?
Occasionally ears which are folded over at birth later unfold and regain their shape somewhat, if not completely. However, it is uncommon for ears which are prominent at birth to improve, and in fact 30% of children who develop bat ears look normal for the first three months.
What problems do Ear Buddies splints solve?
Ear Buddies splints can correct a variety of problems of shape, contour and position of the outer ear. They can be used to correct prominent or bat ears, Stahl's bar, lop ear, shell ear, cryptotia (hidden ear) and kinks of the rim. They cannot correct conditions caused by a lack of tissue, such as microtia and anotia.
How do Ear Buddies splints work?
The splints work by reshaping the pliable cartilage which forms the framework of a baby’s ear. At birth the cartilage is particularly soft because it is under the influence of oestrogen from mother; it slowly hardens with age. Splintage simply moulds the framework towards a normal shape by reforming the antihelical groove; the groove is vital to enable the ear to sit properly against the side of the head.
My child’s ears weren’t too bad at birth, but now they really stick out
- This is either because the head shape has changed or because the ear cartilage has started to harden without normal folding.
- Thirty percent of children who develop bat ears look normal for the first three months.
Do Ear Buddies splints come in different sizes?
Ear Buddies splints are designed to be worn by newborns. Success is so much easier when the splints are applied early and we want to encourage this. Nevertheless, the splints will still fit babies up to a year old. The hats are sized for newborns up to three months of age. The velour hats do stretch more, however, and with the cuff down they will fit some older babies.
Why fit so soon after birth?
The cartilage of the ear starts to harden at birth, although it is possible the process is slower in breast fed babies. Babies move their heads very little in the first few weeks of life, the skin hardly sweats and once the birth coating has been cleaned off, the tapes used to fix the splints in place usually stick for long enough – about two weeks - to ensure a perfect fix and avoid the need for future surgery.
How much improvement can I expect with Ear Buddies kits?
Prominent ears, lop ears and rim kinks are easier to correct than Stahl’s bar and cryptotia. Cup ears are the most difficult to correct, since there is some lack of tissue. If you start early and splint for the recommended times, then almost all prominent and lop ears can be corrected, and most rim kinks can be corrected. We do not give guarantees, but perseverance is really worthwhile.
How can I follow the progress?
The best way is to take photographs from the front, the side, and particularly from behind. Do this every two weeks in babies who start splintage at less than three months of age, and in babies older than this, each month.
Bat ears run in the family – do I need any special advice?
- If bat ears do tend to run in the family, we recommend immediate splintage at birth for two weeks whether or not the child has any evidence of the problem.
- About 30% of children who develop bat ears look normal for the first three months, and by this time, the splints must be worn for longer to take effect.
- The success of Ear Buddies kits on ears of children of bat-eared families may be partly because parents have suffered teasing themselves in the past, and are particularly dedicated to splintage.
Can Ear Buddies splints be taken off for a special occasion?
They can indeed, but we would recommend re-applying as soon as possible, as it is very easy to lose the benefit of the correction if the splints are removed before the cartilage has hardened sufficiently to retain the shape.
How soon should I see a difference?
Depends on how early you splint. If the splints are applied with a day or two of birth, then you can sometimes see a complete correction within a couple of days (although you should leave the splint in place for the full two weeks to allow the cartilage to harden enough to maintain the correct shape). If the splints are applied at three months (this is the time at which the ears can surge in prominence), then splintage has first to overcome this tendency before any progress can be made. Remember that there is good evidence that at least some ears are amenable to splintage up to adulthood.
One ear is worse than the other – should I splint both?
We would recommend that both ears are splinted if either is slightly prominent or abnormal, since as the cartilage hardens any abnormal features are likely to become more obvious. However, ear deformity is often asymmetrical, and if one ear is completely normal then you need only apply the splint to the abnormal ear.
If I splint both ears, could splintage work too well on the less prominent ear?
The splint acts to reform the normal antihelical fold and groove. This is the part of the ear which naturally allows it to sit against the side of the head. It should not cause the ear to look abnormally "stuck" to the side of the head, and the match of the two ears should improve greatly.
How will I know when it is safe to take off the splints?
Leave the splints on for the recommended time for your baby’s age. If you have managed to re-mould a good antihelical fold then it is likely that you have done enough.
Could the ears start to stick out again?
Anything which can push the ears forward for a sustained period can threaten the correction - the younger the baby, the floppier the ear, the more likely this is - ears are commonly pushed forward when being breast fed, for example.
My baby is teething and keeps pulling at his ears
You might find it helpful to put an extra strip of tape at the top of the ear to obliterate the groove (between the ear and the side of the head) to reduce the ease with which your baby can dislodge the splints once he/she can reach the ears with the hands.
OBTAINING EAR BUDDIES KITS
How can I order them?
You can most easily order Ear Buddies kit products on-line through our secure site. You can also order by telephone, fax and mail. It is important to allow five days for cheques sent by mail to clear before product is dispatched.
Are Ear Buddies kits available on the NHS?
Ear Buddies kits are supplied to a number of NHS Trusts and to some GP practices direct. However, you will need to be referred quickly, and preferably seen before you leave hospital with your baby. Some sites are beginning to operate a fast-track service to keep your splintage time to a minimum.
Do I need to buy more than one Ear Buddies kit?
A kit contains all you need to fit Ear Buddies kits to both ears. There is normally enough tape included in the pack to enable you to complete the splintage period in a newborn. Because splintage times are longer the later you fit, you may need to order further supplies of tape.
Are Ear Buddies splints "trick or treatment?"
Ear Buddies kits are registered as a Class 1 Device with the Medical Device Agency. Their efficacy is supported by peer-reviewed academic research.
Where can I obtain medical advice?
Your GP is your first point of call. If necessary he can refer you to your local Paediatric or Plastic Surgery Unit. Ear Buddies splints are designed to be fitted by parents, but if you are really concerned, Mr David Gault regularly sees babies as private patients at the Portland Hospital. His consultation fee is £120 - you may book an appointment on 08707 66 1066.
Can Ear Buddies splints be re-used on another baby?
Ear Buddies splints can be re-used on another baby, and we used to recommend cleaning the splints with baby bath between children. However we are aware that some types of baby bath shampoos actually denature the silicone body of the splints and can cause your next child to become allergic to them. In this case, Ear Buddies splints should be removed immediately and a new set purchased.
Do you ship outside the UK?
We can send product to anywhere in the world. The quoted price includes VAT which you pay only if you are resident in an EEC country - the site automatically calculates the cost of the product and the postage payable, in £ sterling. This appears on your credit card statement in your own currency according to the rate applicable at the time.
OLDER BABIES
What is the maximum age at which Ear Buddies kits can still be effective?
Our own figures show that Ear Buddies splints can be successful in babies of up to one year, and independent research into splintage in Japan shows that it can be effective in much older children and even in adults. However, it does need perseverance. The older your baby is, the longer the splints must be worn to take effect.
How long will my baby have to wear Ear Buddies splints?
We recommend two weeks of splintage at birth, one month of splintage at one month of age, two months of splintage at two months of age, 10 weeks at three months and three months at four to six months. Babies over six months may need to wear the splints for at least four months. These times are weighted towards the generous side to ensure that you maximise the potential for improvement.
Are there special tips to make Ear Buddies splints work in older babies?
Your baby's skin becomes greasier and sweats more with age, and so you need to clean the skin very well indeed before you start to fit if the tapes are to stick properly. Using gentle baby soap and water, "squidge" the ears between your fingers thoroughly but carefully, and allow the soap to stay on for as long as you can - then pat the ears dry and allow the skin to dry naturally in the air for at least 90 minutes. We supply Superwide tapes specially for older babies. You might find it helpful to put an extra strip of this tape at the top of the ear to obliterate the groove between the ear and the side of the head for a few days to discourage any tugging during, for example, teething.
- Although older babies have the co-ordination to put their hands up to the sides of their heads, and can pull at the splints when they are first fitted, if they are properly fixed, babies do not have the dexterity to move them out of position.
Can Ear Buddies splints work in adults?
Independent research into splintage in Japan shows that it can be effective in much older children and in adults. However, in some of the case studies, the splints were worn for from twelve months to several years. Such extremes of use require exceptional dedication and would be less acceptable in Western society.
What are the alternatives to Ear Buddies kits?
The alternatives are camouflage, usually with a hair style, or surgery. There is no upper age limit to surgery, and indeed, many adult males have surgery when their hair begins to thin. The earliest age at which surgery can be contemplated is 5 years. Earlier than this and the cartilage is too soft to hold the stitches without tearing. The safest option is under local anaesthetic, with or without mild sedation. Many children can tolerate this from the age of 10, but if not, a general anaesthetic will be required. Because of the risk of haematoma and ensuing infection (please link to Bat to Worse page), Mr Gault advises against the use of anterior scoring and suture technique.
THE SPLINTS
Will my baby find Ear Buddies splints uncomfortable?
The splints can be worn continuously without discomfort. Occasionally the area between the back of the ear and the side of the head becomes a little inflamed and sometimes weepy, usually due to the close contact of two skin surfaces. You can minimise this by keeping your baby’s head dry at bath time. If the area looks as though it might become inflamed, we would recommend a dry titanium dioxide -containing barrier cream like Metanium, applied with a cotton bud, which will protect the skin and allow it to settle. Paradoxically, children who develop this tissue reaction often achieve a better, quicker result, perhaps because of the influx of prostaglandins into the inflamed area. If the area is frankly inflamed and weeping then you must take off the splints immediately and allow the skin to heal. Only re-apply when it is completely better.
My baby is premature and the ears are tiny – will the splints be too long to fit?
In very premature babies the ears will indeed continue to grow until 28 weeks of age – the curved, crook-like end of the splint should be placed in the usual position whilst any over-length portion is positioned over the lobe. The splint should never be cut to reduce its length.
Could my baby swallow the splints?
Could my baby swallow the splints?
The front end of the splint keeps popping out of the front of the ear – what can I do?
IIf the end of the splint (nearest the face) won’t stay in, then you may need to twist it further inwards, so that when you lay the Ear Buddy on the table it no longer lies flat. Remember that if you look at your baby's head from above, it is an ellipse, not a rectangle, and so the splint should ideally not only follow the curve of your baby's ear, but also the overall curve of the side of the baby's head.
THE TAPES
Does the tape stick to the baby’s hair?
If baby has a lot of hair then it is best to shave it, otherwise the tape won’t stick properly and changing it will be difficult. (Don’t worry about shaving a baby’s hair – in some countries it is done routinely, often several times before the age of one, where it is thought to improve the strength of the hair – shaving a small amount around the ears certainly will not do any harm.)
Can’t I just tape the ears back without the splints?
Ear Buddies splints work by resetting the tendency of the cartilage to push the ear out from the side of the head. The pressure of the splint in the anti-helical groove actually reforms the anti-helical fold which is usually missing or abnormally formed in those with prominent or misshapen ears. Merely taping an ear back without the splint in place is most unlikely to be effective, and can cause later kinking or distortion of the rim of the ear.
How often should I change the tapes?
Change the tapes only when they are no longer doing their job, and not simply because they look a little dog-eared and grubby. By the time you first do this, you should see the beginnings of what can be achieved. In newborns, you might be able to make a single application do the trick. If your baby is older than two to three weeks then you would normally have to change the tapes at least once.
You can change the long tape only, if the short tapes are doing their job We recommend leaving the part which is adhering well in situ, trimming the non-adherent part, and then attaching a new tape over the top. This can allow good fixation for another few weeks, after which the whole lot can be soaked off in the bath. In newborns, in particular, the tapes stick so well that they can be difficult to remove, and in these cases, we recommend adhesive remover wipes, as below.
Can I still wash my baby’s hair?
It is best to simply top and tail baby to prevent the tapes from getting wet, and to give baby a really good bath and hair wash only when you are about to change the tapes. We would recommend that you try to keep the tapes in place for two to three weeks at a time.
Do I need to buy extra tape?
The pack comes with the correct combination of short and long tapes for a newborn. In older babies we would recommend using Superwide tapes to fix the splinted ears to the side of the head (instead of the long tapes, or after you have used the ones supplied). Each Superwide pack contains 8 strips 1’ x 5’, and is the most cost efficient way of buying the tape - you can cut the pieces crossways to make the short strips too, if you wish.
What is the best way to remove the tapes?
However well-meaning, advice to rip off the tape as one would with a plaster in an adult should be disregarded around the delicate skin of the ear, particularly when the baby has hair. You can soak the tapes off in the bath, using a smear of baby shampoo on each strip. Alternatively, Smith and Nephew do individually packed adhesive remover wipes.
Could my baby be allergic to the tapes?
The Suture Strips we supply have the lowest adverse reaction rates of all those we have tried. It is very rarely necessary to discontinue splintage altogether.
THE HATS
Does my baby need to wear a hat all the time?
The hats are designed solely to cover up the splinted ears when you take baby out. It’s very easy to be worn down by people asking “what’s wrong with his ears?” or by people making you feel uncomfortable about splintage. We hope that Ear Buddies splints will become as acceptable as braces on teeth, but this will take some time.
Once the ears have been corrected, we recommend that baby wears a hat or headband whenever the head is on the mattress to prevent the ears being pushed forwards. Beware, however, merely wearing headgear or a hat without splintage WILL NOT correct a misshapen ear.
My baby has a large head – will the hat fit?
Ear Buddies splints come in one-size only, since they are really meant for newborns, so if your baby’s head is on the large size, the hat in the kit may not fit. The velour hats stretch much better than the cotton ones.