The Association of Accessory Auricular Tissue With Solid Organ Abnormalities and Its Effect on Auditory and Vestibular Function Hillary E. Jenny, MPH, Benjamin B. Massenburg, BA, E. Hope Weissler, BA, and Peter J. Taub, MD, FACS, FAAP Background: Accessory auricular tissue is a common congenital anomaly rang- ing from an accessory skin appendage to a separate pinna. The association be- tween auditory or vestibular dysfunction and accessory auricular tissue is debated, and little is known about related solid organ abnormalities. We examine the prevalence of accessory auricular tissue, its association between solid organ abnormalities and auditory/vestibular dysfunction, and its management. Methods: A retrospective cohort study was performed using the 2000 to 2012 HCUP kids' inpatient database. Live newborns with a diagnosis of accessory au- ricle were included. Results: Of the 19,638,453 births recorded between 2000 and 2012, 0.13% had accessory auricular tissue (n = 25,802); 11.8% underwent excision or destruction of the tissue during birth admission. Newborns with this diagnosis were more likely to receive auditory and vestibular testing (5% vs 4.2%, P < 0.001; 5.5% vs 5%, P < 0.001) and to be diagnosed with abnormal auditory function (1.2% vs 0.5%, P < 0.001) and hearing loss (0.09% vs 0.02%, P < 0.001). Diag- nosis of auditory impairment had a 3-fold higher odds of surgical management during birth stay (odds ratio, 3.12; 95% confidence interval, 1.826–5.339). Al- though none were diagnosed with vestibular dysfunction, patients with accessory auricular tissue were 1.5-fold to 3-fold more likely to have cardiac malformations and 4-fold more likely to have renal anomalies. Conclusions: Newborns with accessory auricular tissue more frequently undergo auditory and vestibular testing during birth stay. Auditory dysfunction, cardiac malformations, and renal anomalies are more frequently diagnosed in patients with accessory auricular tissue. However, none were diagnosed with vestibular impairment, bringing into question the necessity of vestibular testing. Key Words: accessory auricular tissue, congenital abnormalities, auditory dysfunction, head/neck reconstruction (Ann Plast Surg 2017;78: 428–430) A ccessory auricular tissue is a common congenital finding that af- fects anywhere from 0.2% to 3.2% of newborns. 1–5 The diagnosis can range in severity from a small, single accessory skin appendage solely of skin to a mutilobulated, pinna containing skin, subcutaneous tissue, and cartilage. Because “ear abnormalities” in general are associated with CHARGE, Treacher Collins, velocardiofacial syndrome, and other syn- dromes, additional screening for solid organ abnormalities is often used when children present with microtia or other ear abnormalities. 6 How- ever, aside from an association between accessory auricle and Goldenhar syndrome, little is known about congenital anomalies associated specifi- cally with accessory auricle. 7 The association between accessory auricular tissue and auditory and vestibular impairment is still debated. Some studies have found an association between accessory auricle and auditory dysfunction with a prevalence ranging from 0.8% to 17.4% in children with this diagno- sis. 8,9 However, other studies have found no such association. 2,10 Management strategies vary. Some surgeons manage the single-accessory skin appendage with immediate suture ligation. However, this often leaves a nubbin of skin that can be considered an unacceptable aesthetic outcome for some patients. Ligation with a titanium clip has therefore been growing in popularity due to its better aesthetic outcomes. 11 Depending on the severity of the defect and the desired aesthetic outcome, other patients may require surgi- cal removal and reconstruction. 12–14 The present study aims to characterize the prevalence of acces- sory auricular tissue, its association with solid organ anomalies, audi- tory impairment, and vestibular impairment, and the frequency of operative management. METHODS A retrospective cohort study was conducted using the 2000 to 2012 Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID). In accordance with HCUP KID policies to ensure de- identification of these pediatric patients, no results with a cell count of greater than 0 but fewer than 10 patients were reported in this study. Because the HCUP KID database contains de-identified publicly avail- able data, no Institutional Review Board approval was required. Inclusion Criteria Live, newborn infants were included in the study if they were born in the hospital and were given an International Classifcation of Diseases, Ninth Revision (ICD-9) diagnosis of accessory auricular tissue during birth hospitalization (Table 1). The control population consisted of live newborns during their birth hospitalization from a normal vaginal de- livery or caesarean section without the diagnosis of accessory auricle. Outcomes Outcomes of interest included patient charges for this birth hos- pitalization and length of hospital stay. Use of auditory and vestibular testing to screen for dysfunction was defined as an ICD-9 coded use of these respective screening tools. Diagnosis of auditory or vestibular dysfunction was also measured using ICD-9 diagnosis codes. Manage- ment outcomes were also included, with surgical destruction or excision of the auricular tissue during the birth stay determined by ICD-9 proce- dure codes. Prevalence of other associated congenital anomalies was also assessed using ICD-9 diagnosis codes (Table 1). Statistical Analysis Categorical variables were compared with χ 2 tests. Indepen- dent t tests using Levene test for equality of variances were used to analyze continuous variables. Multivariate analysis was conducted using binary logistic regression to demonstrate the association be- tween accessory auricular tissue and auditory dysfunction. This model accounted for possible confounding due to race, sex, and bias due to increased audiological testing. Data were analyzed with SPSS Received May 22, 2016, and accepted for publication, after revision, July 7, 2016. From the Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Conflicts of interest and source of funding: none declared. Reprints: Peter J. Taub, MD, FACS, FAAP, Division of Plastic and Reconstructive Surgery Icahn School of Medicine at Mount Sinai 5 East 98th Street New York, NY 10029. E-mail: Peter.taub@mountsinai.org. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/17/7804–0428 DOI: 10.1097/SAP.0000000000000893 HEAD AND NECK SURGERY 428 www.annalsplasticsurgery.com Annals of Plastic Surgery • Volume 78, Number 4, April 2017 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.