Volume 17, Issue 2 (Summer & Autumn 2020)                   ASJ 2020, 17(2): 47-54 | Back to browse issues page

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Elyasi L, Araban S, Eftekhar Vaghefi S H. Auricle Morphometry in Iranian Population. ASJ. 2020; 17 (2) :47-54
URL: http://anatomyjournal.ir/article-1-232-en.html
1- Neuroscience Research Center, Department of Anatomy, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
2- Department of Medical Anatomy, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
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1. Introduction
Anthropometry is a science that studies human body characteristics, including length, circumference, width, and height [1], which are affected by gender, race, and nutrition [2]. This information can be used to design and improve the tools, equipments, workstations, and clothing items [1]. Anthropometric data can be gathered from dead or alive bodies [2]. Also, anthropometry is one of the simple, noninvasive, inexpensive, and universal ways to survey morphological structures [3, 4]. Therefore, with such a tool that can determine the standard dimensions, many musculoskeletal diseases and work-related injuries will be prevented [2]. 
This science is helpful in otoplasty surgery [5], forensics, biomedical engineering, and ergonomics [6]. Although several anthropometric studies are performed worldwide [2, 3, 7-11], there are few anthropometric studies in Iran. In 2015, Mehrparvar et al. studied 19 anthropometric dimensions in 9476 high school students (4703 boys and 4773 girls; age range, 15-18 years) from six ethnicities (ie, Fars, Turk, Kurd, Lor, Baluch, and Arab). The high school students significantly differed in all the anthropometric parameters, regarding gender, age, and ethnicity [12]. Dianat et al. evaluated the dimensions of the classroom furniture and nine anthropometric parameters in 978 Iranian high school students. These researchers found a considerable mismatch between the anthropometric parameters of the students and the dimensions of classroom furniture [13].
In humans, the ear is one of the facial appearance characteristics that reflect gender and age features [14]. Besides, the ear’s shape and dimensions are unique just as fingerprint [15]. Thus, understanding the ear dimensions can be useful in forensics [16-18]. 
The ear is divided into three parts: inner, middle, and outer. The outer ear includes the pinna or auricle and the external meatus [14]. In terms of the embryology of the human ear, the pinna is devolved from six mesenchymal proliferations at the end of the first and second pharynx arches, which surround the first pharyngeal cleft called the auricular hillocks. Later, three auricular hillocks on each side of the external meatus fuse to form the definitive auricle. Any kind of malformation in the shape, size, and location of pinna can be helpful in the diagnosis of abnormalities [19]. 
The auricle gathers the sound waves and conducts them through the tympanic membrane, so, the auricle can be considered as the primary element of acoustic modification in the auditory apparatus. The lateral surface of the auricle includes several elevations and depressions. The prominent curved rim of this surface is called the helix. The Darwin tubercle lies posterosuperior to the helix. The antihelix is another prominent curve lay anterior to the helix and is superiorly divided into two crura that surround a triangular fossa. The scaphoid fossa lies between the helix and antihelix. Indeed, the antihelix surrounds the concha. Moreover, a prominence lies anterior to the concha and inferior to helix crus and is called the tragus. The tragus is separated by antitragus and intertragic notch [20]. 
The congenital anomalies of the ear may occur during the developmental period of the auricle (at 5-9 weeks of gestation), maybe because of unusual pressure that affects the normal growth of the ear, during the intrauterine life [21]. Anthropometric knowledge provides the necessary standards for the body dimensions of a region’s population. Therefore, using specific indices, this study aimed to investigate the auricular form in a population from Bandar Abbas City (age range, 20-30 years). These data can help to identify congenital anomalies and would be effective in the abnormality surgeries. 

2. Materials and Methods 
The study participants included 400 people (200 males and 200 females) aged 20 to 30 years, in Bandar Abbas City. The subjects were recruited from the students of the Hormozgan University of Medical Sciences, the staff of teaching hospitals, the patients’ visitors, and the patients admitted to different wards, except the Ear, Nose, and Throat wards. The instruments used included a vernier caliper, a goniometer, a Morrison compass, and a ruler. The auricular dimensions on both sides were compared in both sexes and the dominant type was identified to evaluate the auricular form.
We excluded the people with a history of facial cosmetic or reconstructive surgeries, a history of face or ear trauma, and head or facial deformities. Before the study, we obtained the approval of the respective authorities and explained the study objectives to the participants. Moreover, we only included subjects whose two preceding generations were residing in Bandar Abbas. The measured variables were the shape of the ear lobe, the lengths and widths of auricle and concha, cephalo-auricular angle, ear-skull distance, tragus-alar distance, nasal length, and the type of lop ear deformity. The obtained data were analyzed with t test and Pearson correlation coefficient, in SPSS. 
The auricle was measured based on the following parameters (Figure 1):

The shape of lobule (round);
The auricle length: The distance between the superaurale and subaurale (the distance between the most superior point on auricle and the most inferior point on the earlobe) (Figure 1, from point 1 to 2) [22, 23];
The auricle width: The distance between preaurale and postaurale (Figure 1, from point 3 to 4);
The concha length: The distance between concha superior and incisura intertragic inferior (Figure 1, from point 5 to 6);
The concha width: The distance between incisura anterior auris posterior and the strongest antihelical curvature (Figure 1, from point 7 to 8) [22];
The ear-skull distance: The distance of the medial surface of the auricle to the base of mastoid at the Darwin tubercle level [23];
The cephalo-auricular angle: An angle between the medial surface of the auricle and mastoid process [24];
The nasal length: The distance between nasion and anterior nasal spine [25];
The tragus-alar distance: From the apex of tragus to the outermost adherence of nasal alar cartilage.
Also, the lop ear deformity was determined by the evaluation of 1. undeveloped antihelix; 2. the overgrowth of conchal cartilage, and 3. the protrusion of lobule [26].

3. Results
In males, the mean values of the length of the auricle, the width of the auricle, the length of the concha, the width of the concha, cephalo-auricular angle, ear-skull distance, tragus-alar distance, nasal length, and the most common lobule shape were 59.86 mm, 30.71 mm, 24.32 mm, 17.83 mm, 57.63˚, 8.71 mm, 101.72 mm, 50.31 mm, and round lobule, respectively, while in females, were 60.12 mm, 31.36 mm, 25.32 mm, 17.73 mm, 55.68˚, 8.40 mm, 101.36 mm, 40.76 mm, and round lobule, respectively. 
Also, in the right ear, the mean values of the length of the auricle, the width of the auricle, the length of the concha, the width of the concha, cephalo-auricular angle, ear-skull distance, tragus-alar distance, and the most common lobule shape were 59.86 mm, 30.36 mm, 24.46 mm, 17.72 mm, 54.83˚, 8.30 mm, 101.56 mm, and round lobule, respectively, and in the left ear, they were 60.13 mm, 31.43 mm, 25.19 mm, 17.84 mm, 58.48˚, 8.81 mm, 101.52 mm, and round lobule, respectively (Tables 1 and 2).

The rates of lop ear deformity in male and female subjects were 10.5% and 7.8%, respectively. Also, the other significant differences were as follows: the auricle width between the two sexes; the auricle width in the left and right ears, regardless of gender; the width of the left and right auricles in females; the concha length between the two sexes, regardless of side; the concha length between the right and left sides, regardless of gender; the length of concha between the left and right sides, in males; the cephalo-auricular angle between the two sexes, regardless of side; the cephalo-auricular angle between the two sides, regardless of gender; the cephalo-auricular angle between the left and right sides, in males; the cephalo-auricular angle between the left and right sides, in females; the ear-skull distance between the two sexes, regardless of side; the ear-skull distance between the left and right sides, regardless of gender; the ear-skull distance on both sides, in females; and the nasal length in both sexes.
Abbreviations: LA, length of the lobule; WA, width of the lobule; LC, length of concha; WC, width of concha. 

4. Discussion
Overall, 400 subjects (200 males and 200 females) with the age range of 20 to 30 years were included in this study to evaluate the shape and dimensions of auricle among the residents of Bandar Abbas. The present study mainly aimed to evaluate and compare the auricle’s dimensions and shapes of the both sides and sexes and determine the dominant type. The measured variables were lobule shape, auricle and concha length and width, cephalon-auricular angle, ear-skull distance, tragus-alar distance, nasal length, and lop ear deformity. 
The ear appearance is one of the facial appearance characteristics that are distinct in individuals. For many years, the reconstructive surgery of the ear has been a challenge, but tissue engineering has progressed in this regard [23]. The study of the human ear morphometry would be helpful, considering that ear dimensions differ between ethnicities and races [24]. The ear morphometry plays an important role in the recognition of congenital deformities. Any kind of deformity in auricle shape, size, or location is contributed to the diagnosis of congenital anomalies [25], such as Down syndrome [26] and Martin‐Bell syndrome [27]. Therefore, we evaluated the auricle shape and dimensions among a group of participants from Bandar Abbas to promote clinical efficiency. 
Our results showed that the auricle length and width were greater in females than in males. However, the auricle length has been greater in males than in females, in an Indian population with the age range of 18-24 years [24]. Also, Kumar and Selvi studied the morphometric parameters in Malaysian and Indian people aged 20-30 years, in 2016. These authors reported that the total pinna length and width and the length of cartilaginous ear canal were greater in Malaysian males than in females, but the lobule length was greater in females; all these parameters were greater in Indian males than in Indian females [28]. In the Turkish population, males had a greater total ear length than females. Besides, the ear length significantly differs between the Turkish and Japanese populations, based on the reports of the literature [29]. 
in 2016, Sharma studied the northern Indian people aged 10-50 years. Results demonstrated that the total ear length and width were greater in males than in females, while the lobule length and width were greater in females than in males [30]. Besides, Sadacharan found that the ear length and width were greater in Indo-American males than in females (age range, 18-30 years) [5]. In a population from Urhobo, southern Nigeria, it was observed that the length of lobule was greater in females than in males, whereas the two genders did not significantly differ in other parameters, such as the ear length and width and the lobule width [31].
We observed the greater length and width of auricle on the left side, compared with the right side. This finding was similar to the results of Aktuc and Barut. They reported that the width of the left ear was longer than that of the right ear, in the high school students of Turkey, but ear length, lobule width, and the ear-face indices of the right side were nonsignificantly greater than those of the left side [9]. Also, Garba et al. reported that the total length of the right ear increased with advancing age [32]. 
Also, we found that the length of the left ear was nonsignificantly greater than that of the right ear, in both genders. Moreover, the concha length was significantly greater in females, while the concha width was nonsignificantly greater in males than in females. In contrast with our findings, Arora and Singh showed that the length and width of concha were greater in males than in females, but there was not any significant difference between the two sides in terms of concha width [24]. Similarly, Ahmed and Omer, as well as Zhu et al. found that the concha width was greater in males than in females [33, 34]. In our population, the concha length of the left ear in both sexes (the difference was significant in males) and the concha width of the left ear in females were nonsignificantly greater than those of the right ear. However, the concha width of the right ear was nonsignificantly greater than that of the left ear, in males.
Males had significantly a greater cephalo-auricular angle than females. It was also significantly greater on the left side than on the right side, in both sexes. The ear-skull distance (ear protrusion) was significantly more in males than in females. We measured this parameter at the level of the Darwin tubercle. Our findings were consistent with the results of Bozkir et al. and Tatlisumak et al. [29, 35]. They measured the ear protrusion at the level of the tragus. We observed that the left ear had more protrusion than the right ear, in both genders; the difference was only significant in females.
In our population, males had a longer tragus-alar distance than females. Besides, the distance was greater on the right side than on the left side, regardless of gender. Although the tragus-alar distance was greater on the left side in females and on the right side in males, these differences were not significant.
In this study, the nasal length and lop ear deformity were more in males than in females. However, only the difference in nasal length was significant. Furthermore, the round shape of lobule was more common in males, compared with females; it was completely similar on both sides, in males. However, there was an insignificant difference in females in this regard. In terms of nasal length, our findings were in line with those of Zankl et al. and Oladipo et al. [10, 36].
Finally, our study revealed considerable differences in the auricular shape and dimensions, among different ethnicities, races, genders, and age groups. Also, males had a smaller auricle size than females, but it was more symmetrical in male subjects. 

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Ethics Committee of Kerman University of Medical Sciences.

This research was fully supported by Kerman University of Medical Sciences (grant No.: 89.276).

Authors' contributions
Conceptualization: Seyed Hassan Eftekhar Vaghefi; Data collection and Data analysis: Leila Elyasi; Writing – original draft: Leila Elyasi and Sanaz Araban; Writing – review & editing and Supervision: All authors.

Conflict of interest
The authors declared no conflict of interest.

We would like to thank Hormozgan University of Medical Sciences. The authors would also like to express their gratitude to all the employees who willingly participated in the data collection.

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Type of Study: Original | Subject: Morphometry
Received: 2018/12/2 | Accepted: 2019/04/20 | Published: 2020/07/11

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