Out of the 53 survey respondents, 30 patients were female (56.6%). The average age at the time of surgery was 11.9 ± 2.9 years old (6.3–16.4) and at the time of the survey 13.8 ± 3 (8–18 range). The average time between operation and retrospective data collection was 2.3 years old (0.9–3.8 range). Sixty-six percent of the patients had a family history of prominent ears. Helix valgus was bilateral in 77.4% of cases.

The modified Mustardé technique with anterior curettage of the antihelix was performed on all patients. In addition, 21 (39.6%) cases required resection of the concha cartilage because of its high projection. Otoplasty was performed as a treatment for recurrence in 11 children (20.7%).

Complications were found in 15 patients (28.3%): the most frequent (8–53.3%) was recurrence, followed by pathological scarring (3–20%), surgical wound infection (3–20%), and bleeding (2–13.3%).

The main motivation for the children to undergo otoplasty was aesthetic concern (58.5%), followed by lack of self-esteem (47.2%), teasing or bullying (35.9%), anxiety (33.9%), and parental concern (13.2%).

Average score on the POS-Head/Neck psychological functioning and aesthetic appearance scale was 55.9 ± 16.7 pre-surgically and 86.5 ± 15.7 post-surgically, with this difference in scores being statistically significant (p < 0.0001).

Average score on the POS-Head/Neck global post-surgical satisfaction scale was 73.45 ± 18.44. A total of 79.2% of patients reported a result above or in line with the preoperative expectations, and 84.9% would recommend the intervention.

The main motivation of parents to have their child undergo an otoplasty was the lack of self-esteem (64.2%), followed by mockery or bullying (49.1%), aesthetic concern (47.2%), parental concern (24.5%), and anxiety (7.6%).

Average score on the global GCBI scale was 24.6 ± 20.6; the average scores on the emotion, physical health, learning, and vitality subscales were 35.9 ± 29.4, 13.6 ± 9.4, 18.2 ± 20.3, and 27.1 ± 27.4, respectively (Fig. 2). A large proportion of parents, 90.6%, reported an improvement in health-related quality of life after otoplasty. The total score was negative in only 2 (3.8%) cases, both associated with recurrence.

Boxplot representing the Glasgow Children’s Benefit Inventory (GCBI) scores after otoplasty

In terms of overall satisfaction after surgery, 79.2% of the parents were very or totally satisfied, while 92.5% would recommend surgery to the child of a relative or friend with the same problem.

Impact of seven factors (that, according to the authors’ criteria, could influence changes in quality of life and satisfaction after surgery) was analysed: sex (male or female), age at the time of surgery (≤ 10 or > 10 years old), motivation for surgery (including bullying or not), laterality of the helix valgus (unilateral or bilateral), previous otoplasty (yes or no), surgical technique (with or without concha resection), and post-surgical helix valgus recurrence (yes or no). The results are shown in Table 1.

Significant age-related differences were found. Parents of children over 10 years old reported an improvement in health-related quality of life (p = 0.0116). Likewise, children older than 10 years old experimented a greater improvement in psychological functioning and aesthetic appearance than children younger than or equal to 10 years old (p = 0.0268). Results of the POS-Head/Neck questionnaire in these two age groups showed that children > 10 years old were significantly more dissatisfied with the shape of their ears before surgery (p = 0.0101); however, no significant differences were found in the post-surgical scores (Table 2).

On the other hand, children with post-surgical recurrence had significantly lower scores in terms of parent-reported quality of life (p = 0.0010).