Background: Prominauris, or protruding ears, is a common pediatric craniofacial deformity often associated with psychosocial distress. Although otoplasty can address these concerns, there is no standardized classification system to guide diagnosis or surgical decision-making. Existing definitions vary widely and inconsistently account for anatomic and developmental factors such as age and sex. This study aims to systematically review prominauris classification systems and propose a more objective, practical framework. Methods: A systematic review was conducted using MEDLINE, Embase, CINAHL, and Cochrane Trials to identify studies defining or classifying prominauris in individuals under 18 years old. Two independent reviewers screened articles, extracted data on classification features and methods, and performed a critical appraisal using 6 predefined criteria, including clarity, generalizability, objectivity, reproducibility, and demographic considerations. Results: Of the 2049 articles screened, 15 met the inclusion criteria. Classifications varied considerably: 47% used subjective assessments, 40% used physical measurements, and 13% used digital tools. Most incorporated multiple auricular features, with inconsistent use of anatomic landmarks and measurement thresholds. Only one system accounted for age, and one for sex; no classification integrated both. None met all 6appraisal criteria. On the basis of these findings, the authors propose a novel 2-step classification system using mastoid-helical distance at the tragal level, with age-specific and sex-specific thresholds derived from a large pediatric anthropometric data set. Conclusions: Existing prominauris classification systems are inconsistent and lack demographic variability. The authors' proposed system offers a simple, reproducible, objective approach that accounts for age and sex, facilitating more consistent diagnosis and surgical decision-making. Validation studies are warranted.
Covone et al. (Wed,) studied this question.