小耳畸形儿童的心理调整
耳再造手术之前和之后

亚历克西斯约翰, 博士
丹尼尔·我, BS
SHERYL卢因, 医师

抽象

Microtia is a congenital external ear malformation which can be treated by means of reconstructive surgery. 目前, 自体肋软骨耳廓再造最常用和首选材料 (比姆, 2002). The primary factors considered in determining the most appropriate timing for an auricular reconstruction via the cartilage method are the age of external ear maturity and the availability of adequate donor-site rib cartilage (Tanzer, 1971). This requires a child to wait till he or she is of at least 6 对 10 岁之前接受了手术 (Tollefson, 2006). A newer technique combines the concepts of prosthesis with implantation; 的高密度聚乙烯植入物 (例如,. Medpor) 耳廓的大小, 塑造, and contours. This Medpor technique permits earlier surgery—as early as age 3 (Eavey, 2006). It has been hypothesized that the preschool-age child may benefit from earlier treatment based on the premise that this minimizes the social stigma of a congenital deformity such as microtia (Tollefson, 2006).

The study will take place with two groups of participants. The first group will be a prospective investigation of participants born with isolated microtia who are receiving the Medpor technique ear reconstructive surgery for the first time and their parents. The second group will be retrospective with participants also born with isolated microtia who have already completed Medpor ear reconstruction. The participants will between 3 对 21 years of age and speak and understand English or Spanish. The first group of participants will complete questionnaires prior to surgery as well as a year following their ear reconstruction. For the children, 特定年龄组的调查问卷,将管理与他们的手术问题, 的朋友, 社交技巧, 信心, 出现, 戏弄, 学校, and family. Parents will complete a parallel questionnaire, along with questions about history of microtia diagnosis. The second group of participants and their parents will complete similar questionnaires, with questions about their functioning before and after their surgery. 此外, 所有的儿童和他们的父母便完成了小儿的生活质量库存 (PedsQL) 儿童行为评估系统 (BASC-II).

这两组参与者完成的措施提供了重要的描述性数据,他们目前的心理调整和发展的过程中,他们的自我形象, 同伴关系, and social skills. It is expected that older children will have experienced significantly more teasing than younger children and consequently the older children will report lower positive adjustment and higher negative adjustment. For the prospective group, 研究也将提供一个更好地了解手术的期望, 如何在手术过程中经历, and their satisfaction with the outcome. In the year follow-up, 预计所有儿童报告的改进和早期耳再造预测更好的心理调节.

Introduction

虽然没有实质性的研究存在研究早期先天性小耳畸形重建的心理优势, 它已经构思,学龄前的孩子 (岁左右 3) may benefit from minimizing the social stigma of a congenital deformity such as microtia by utilizing either a prosthetic ear or reconstruction with alloplast (例如,. Medpor). With the Brent (年龄 6) 或永田 (年龄 10) 方法, 孩子前必须等待足够的肋软骨可以收获, 和孩子已经面临着同侪嘲笑的社会心理后果 (Tollefson, 2006). A patient who reaches approximately 10 岁之前,重建可能已经有了永久的心理后遗症,如因骚扰同侪 (DellaCroce, 2001).

儿童颅面畸形, 如先天性小耳畸形, 体验显著戏弄, 拒绝, 和其他消极的社会反应, 如从其他社交回避. 这些事件表明社交退缩的趋势, 可能别人的消极反应的反应 (斯奈德, 2005). Children with craniofacial anomalies are treated differently than children without such defects; 因此受影响的儿童已被证明是比较内向,表达了消极的自我概念比未受影响的儿童 (温斯坦, 2005). These negative events may also result in decreased self-esteem, 增加焦虑, 行为问题, and difficulty with social integration. The patients who request ear reconstruction often complain of diminished self-consciousness and being teased by peers. Children born with microtia tend towards social isolation, 他们与其他孩子玩的少了,, 开会的人, 和隐藏某些人更常见的从, and avoid school. The longer the individual has to cope with microtia, the greater the psychosocial morbidity is likely to become. With increasing age, 戏弄和固定在孩子们的心态变得越来越不受欢迎较难外部正面影响 (Horlock, 2005).

有没有经过大量的研究完成戏弄的小耳畸形出生的孩子的心理影响; 但, 一个大量的工作已经做了相关的出生的孩子与其他颅面畸形,如唇裂和颚 (中电) and hemangiomas. Teachers rate children with CLP as having more internalizing behaviors and being more inhibited in the classroom. A study found that having CLP was not the main cause of psychosocial morbidity, 但相当的经验,往往伴随着中华的存在, 最显著, 戏弄 (Hunt等人, 2007). The experience of being teased is associated with depressive symptoms, 一般焦虑, 负面评价的恐惧, and loneliness. It is believed that age is significantly related to behavioral problems and happiness with facial appearance; 年长者有更多的行为问题和较年轻的受试者对自己的外表感到高兴 (Hunt等人, 2006). With hemangiomas, studies have found that children with craniofacial hemangiomas had a consistently negative perception of how they were valued by others and that these children often identified with pictures of children playing alone and less often picked themselves as the child their parents liked. One study reported that a child’s social sensitivity about their hemaniogioma began around 4 岁, ,因此, 在此之前实现社会意识, 孩子们太年轻了,感谢任何差异或有任何行为上的变化,由于存在的病变 (温斯坦, 2005).

现有的文献在没有进行充分调查的大致年龄小耳畸形出生的孩子意识到他或她的差异,, 更重要的是, at what age a child born with microtia begins to suffer the negative psychosocial consequences associated with the social stigma of microtia. 因此, 本研究的目的是确定大致年龄,当孩子第一次成为他或她的先天性小耳畸形的自我意识, 以及年龄,当孩子第一次开始遭受负面的心理影响, most likely due to peer derision and teasing. Also, this study will examine if earlier microtia reconstruction is predictive of longitudinal psychosocial benefits. It is thought that surgery at a younger age (三至六个月岁) 减轻或防止在年龄较大的负面影响接受手术治疗 (7岁或以上), when the child has already started school and experienced the social stigma of being born with a physical defect. As earlier positive psychosocial adjustment contributes to healthier development of social skills and self-esteem, undergoing ear construction at a young age is hypothesized to minimize the negative effects of the years of social stigma and teasing associated with later surgery. It is expected that children older than seven years old will have experienced more teasing and social disapproval compared to children younger than seven years old and thus consequently will report lower self-esteem, 社交技巧, 自信, and satisfaction with appearance. It is expected that the more positive outcomes with earlier surgical intervention will be seen in the prospective and retrospective groups of participants.