Part 2. GOSH / RHSC ear reconstruction study: what are the main findings on children’s feelings about their new ears?

42 children whose ears were reconstructed by Neil Bulstrode at Great Ormond Street took part in this study – 37% of those who were asked to complete questionnaires. 27 children who undertook reconstruction with Ken Stewart at the Royal Hospital for Sick Children also replied – 56% of those contacted.

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35 out of 42 GOSH patients who took part in the research said that they were ‘satisfied with [their] new ear,’ and 7 out of 42 were not satisfied. Among RHSC patients, 23 out of 27 said they were ‘satisfied,’ and 4 out of 27 were not.

34 out of 42 GOSH children in the study said that their ‘new ear is similar to other ear,’ and 8 out of 42 that it is not similar. This compares to 19 out of 27 RHSC children who said their ear was ‘similar,’ vs 8 out of 27 who did not.

Among the GOSH patients, more were ‘satisfied with [the] shape’ of their new ear (40 out of 42) than were ‘satisfied with [the] size’ (34 out of 42). In contrast, more RHSC patients were ‘satisfied with [the] size’ (23 out of 27) than ‘satisfied with [the] shape’ (12 out of 27).

The questionnaires also asked about behaviours associated with children’s new ear. 4 of the 42 GOSH patients responding said they hide their new ‘ear with [a] hat,’ and 5 of the 27 RHSC patients.

6 of the 42 GOSH patients said they are ‘anxious about seeing [the] hairdresser,’ along with 5 of the 27 RHSC patients. Just 2 of the 42 GOSH children said they hide their new ear ‘in photos,’ compared to 7 of the 27 RHSC patients.

39 of the 42 GOSH children said they ‘would have [their] ear made from rib again,’ while 4 of the GOSH children said they ‘Would prefer to do nothing about [their] ear.’ This compares to 22 of the 27 RHSC patients who said they ‘would have [their] ear made from rib again,’ and 2 of the RHSC patients who said they ‘would prefer to do nothing about [their] ear.’

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It’s important to remember that only 37% of the GOSH patients who were asked to complete questionnaires replied, and 56% of the RHSC children. Those who didn’t respond may have given different answers, so these numbers can’t tell us about their outcomes.

However, what findings do show is that there is variety in experience and feelings about reconstructed ears, and that results are not always the same for different individuals.

Comparisons between GOSH patients and RHSC patients are made to highlight this variation. Again, however, remember that many patients did not reply to the questionnaires, and we can’t know what they would have said. So this study’s findings are not a comprehensive comparative assessment of the quality offered by the two surgeons.

Lastly, it is useful to remember that the study’s timeframes for reconstructions at the two hospitals are very different. The GOSH patients completed their surgeries between 2011 and 2013, while the RHSC patients completed theirs as far back as 2003.

It is possible that this could have some bearing on the different replies from children across the hospitals. For example, the much higher satisfaction rate of GOSH patients with the shape of their new ear may have something to do with the time at which their surgery took place. It would be interesting to know about the feelings of GOSH patients whose surgery took place before 2011.

There is one final, crucially important, point about this research. It has no comparison group of children who have not had reconstructive surgery. It can’t tell us how happy with their ears these individuals are, overall, in contrast to those who chose reconstruction. And it can’t tell us how study children felt before their surgery. But it helpfully gives us an idea of the current feelings of the small group of children who took part.

The full journal article can be found here: http://www.jprasurg.com/article/S1748-6815(16)30484-3/abstract

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