الفهرس 
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Abstract
Autologous ear reconstruction is a complex procedure with inevitable learning curve that needs dedicated surgeons. In order to achieve aesthetically pleasing results it is advised that adequate training is undertaken and then having a regular high volume case load is essential to achieve significant improvement in outcomes.
Evaluation of outcomes should consider the satisfaction of microtia patients (patient-reported outcome measures). A future study which compares the clinician-reported and patient-reported outcomes is recommended.
Semantic, idiomatic, experiential, and conceptual equivalence of the items, instructions, and response options was achieved for each of the EAR-Q translations, suggesting that the EAR-Q can be transferred to other contexts with other respondents. Upon completion of the EAR-Q development, it can be used in clinical practice, research, and benchmarking of outcomes internationally.
In the absence of nationally designated centers for microtia-atresia, the service is always widely varied and fragmented. Service reform and development can benefit from the concept of reform which was pioneered in cleft lip and palate services in some countries. The UK care standards for microtia-atresia can be a useful model to start setting up standardized and comprehensive microtia-atresia services.
These five recommendations are the keys to global reform of microtia services:
1) Establishing nationally designated ear reconstruction units/centers where microtia and atresia procedures are performed on a regular basis to concentrate the required expertise and maintain competence.
2) Assigning fewer high-volume ear reconstructive surgeons, who have received adequate training in the early period of their practice, is a key to optimize the surgical outcomes.
Conclusions
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3) Providing treatment by experienced multidisciplinary teams. Core members of the teams include reconstructive microtia surgeon, audiologist, otologist, paediatrician, clinical psychologist, and specialist nurse.
4) Using validated tools of aesthetic and psychological patient-reported outcome measures (PROMs) should be an integral part of the service because the ultimate audit should be the patients‟ perception of the outcome of care.
5) Collecting and keeping standardized records of all aspects of microtia treatment are essential for regular audit and participation in inter-center studies.