In this period of the Covid-19 pandemic, a protective mask has become a common object of use to contain virus transmission. The imminent need for masks has led many governments to produce them, including surgical masks with mask earloop or masks with side cuts at the ears. Among those on the market, surgical masks with elastic loops are the ones most chosen by parents for their children. These elastics cause constant compression on the skin and, consequently, on the cartilage of the auricle, leading to erythematous and painful lesions of the retroauricular skin when the masks are used for many hours a day. Pre-adolescent children have undeveloped auricular cartilage with less resistance to deformation; prolonged pressure from the elastic loops of the mask at the hollow or, even worse, at the anthelix level can influence the correct growth and angulation of the outer ear. In fact, unlike when using conservative methods for the treatment of protruding ears, this prolonged pressure can increase the cephaloauricular angle of the outer auricle. It is important for the authorities supplying the masks to be aware of this potential risk and for alternative solutions to be found while maintaining the possibility of legitimate prevention of the potential spread of the virus.
Many adults (health care workers and others) complain about discomfort associated with round elastic earloop, due to the continuous pressure of the elastic behind the ear. Several methods have been proposed to overcome this problem: from the use of hairpins to hang the elastic bands from the forehead to the use of various types of bands that pass behind the back of the neck and to which the loops of the mask are attached. However, these methods used by adults are not used by children, resulting in constant pressure of the elastic on the skin of the posterior portion of the auricle.
It is well known that the pressure of the mask elastic on the skin of the posterior concha of the auricle for a long time causes pain and erythema, due to the continuous rubbing of the elastic on the skin in the same position. This has led some users to apply silicone rear ear supports that decrease decubitus, but increase the distance of the auricle from the mastoid region. Others, on the other hand, prefer to change the position of the elastic by moving it more towards the antihelix than the mastoid region, thus applying an elastic force in an area where the cartilage has less resistance, with a consequent increase in the cephaloauricular angle of the outer auricle.
Therefore, the use of surgical masks with flat elastic earloop in growing children for many hours a day not only leads to intolerance and decubitus of the retroauricular skin (as for adults), but can also influence the correct growth and angulation of the outer ear with the consequent increase in the incidence of protrusion of the outer auricle (Fig. 2a and b).
One alternative to the surgical mask is the earmuffs mask (in which the ears are completely wrapped, held in place by mask elastic cord at the back of the ear) or the band mask with lateral slits at the ears: also these models, due to their conformation, tend to create a constant pressure on the antihelix, increasing the auriculocephalic angle (Fig. 2c).
