Overlap/pressure between Retractor and the Posterior Conformer
MOTION ABRASIONS Skin irritations from EarWell™ therapy are the consequence of either motion or pressure. If the Cradle adhesive loosens and separates from the skin, it can result in motion between the cradle and the skin, and also movement of the internal Retractor(s) or Conchal Former. Either situation can cause superficial abrasions. Becon includes rolls of 3M™ Micropore™ Tape to be given to the parents to manage this event. The family should be directed to examine the adhesive daily and to reinforce the adhesive bond with strips of tape when the Cradle Adhesive begins to separate. At that point, the device will necessarily need to be removed by the applying physician, and a new device and components reapplied.
Bacitracin is applied to the abraded skin. Systemic antibiotics are not required.
RETRACTOR OVERLAP Skin abrasion will also occur when the Retractor (above the ear) is positioned in a manner whereby it directly overlies the Posterior Conformer (beneath the ear). It is important that if this occurs to review the section of the Training Video that covers this possibility (link to video). Care should be taken to confirm that the Retractor is never placed in this position.
If it is necessary to position the Retractor over the standard Posterior Conformer location, a modification of the Posterior Conformer must be made to allow sufficient space to prevent Retractor overlap. This modification can be reviewed in the Applying the Retractor segment of the Training Video and in the video below.
RETROAURICULAR SULCUS ABRASION Abrasion in the retroauricular sulcus can be caused by not allowing sufficient space between the Posterior Conformer and the sulcus. One to two mm of spacing should be given to avoid this possibility. See Attaching the Posterior Cradle in the Training Video.
CONCHAL FORMER PRESSURE ABRASION Pressure irritations can occur when employing a Conchal Former to treat the very prominent conchal crus. The nature of this deformity necessitates applied positive pressure to eliminate or minimize the excessive cartilage in this area.
A close monitoring of these deformities is necessary to balance the application of adequate vertical pressure while simultaneously minimizing skin irritation. It is not recommended that any Conchal Former Foam be attached to the Conchal Former on the initial application. Anchorage of the Conchal Former to the posterior vertical wall of the concha with adhesive may be indicated to keep the Conchal Former from sliding down when the anterior shell is attached. Foam (at one-half thicknesses) may be applied to the Conchal Former for the second application, and full thickness at the third application. Even with this conservative application sequence, irritation and abrasion from pressure may still result. It is recommended that parents be alerted to this possibility in advance. Awareness will often minimize parental reactions.
Since no other non-surgical option exists to correct high conchal crus, the interval irritation should be evaluated in conjunction with the outcome benefit. Please review the Inserting the Conchal Former segment of the Training Video and the Conchal Crus segments under Technique Variations.
Becon recommends the moving or removing of the contributing component, from the area of pressure for a short period of time, to eliminate the causative factor. Treatment may be continued when the irritation subsides.