1. Copyright restrictions may apply JAMA Facial Plastic Surgery Journal Club Slides: Protruding Ears Litschel R, Majoor J, Tasman A-J. Effect of protruding ears on visual fixation time and perception of personality. JAMA Facial Plast Surg. Published online March 19, 2015. doi:10.1001/jamafacial.2015.0078.

2. Copyright restrictions may apply Introduction Protruding ears are often felt to be a stigma, supposedly drawing attention and negatively influencing the perception of personality. These purported negative effects that may indicate corrective aesthetic otoplasty in patients too young for informed consent have not been quantified.

3. Copyright restrictions may apply Purpose To quantify attention directed toward protruding ears and its effect on the perception of selected personality traits.

4. Copyright restrictions may apply Relevance to Clinical Practice Patients and their parents can be better counseled preoperatively if the surgeon knows whether protruding ears attract attention and also understands how this affects the perception of personality. The data may be used as reference for further studies on the attention- drawing potential of physical deformities.

5. Copyright restrictions may apply Description of Evidence The sample size of photographs and observers was based on a power calculation. Protrusion of the auricle was the single variable in otherwise identical photographs of candidates for otoplasty. A consecutive sample of 2 photographs per patient was used, with 1 original preoperative photograph and 1 photograph that was identical with the exception of the auricles that had been virtually corrected by computer imaging.

6. Copyright restrictions may apply Description of Evidence Mean (SD) fixation time of protruding ears was significantly longer compared with morphed nonprotruding ears (9.6% [5.6%] vs 5.8% [3.2%] of total fixation time; P =.04). The differences between the overall personality questionnaire scores and between individual scores for assiduousness, intelligence, and likeability were not significant for protruding and nonprotruding ears. Faces in which the protruding auricles received the highest percentage of visual attention scored higher than average for the overall personality scores and for the items assiduousness, intelligence, and likeability.

7. Copyright restrictions may apply Controversies and Consensus The confirmation of the hypothesis that protruding ears catch the attention of observers was expected. Surprisingly, there was no support for the second hypothesis, that protruding ears negatively affect the perception of personality traits.

8. Copyright restrictions may apply Comment It remains unclear whether extraneous factors such as cultural differences influenced the unexpected finding that even the most conspicuously protruding ears need not herald a negative perception of personality. A possible confounder may have been the high incidence of protruding ears (50%) in the faces shown to the naive observers, who may have picked up a clue regarding the end point of the study. Irrespective of these uncertainties, the findings of this study may still be helpful in counseling patients or their parents.

9. Copyright restrictions may apply Comment For future research in this area, significantly increasing the number of faces not showing the deformity that is studied may increase the likelihood of maintaining observer naïveté about the end point of the study. However, this must take into account the expected maximum attention span of the observer. Given the concept of attractiveness positively correlating with the perception of personality (attractiveness halo), future studies measuring the perception of personality in relation to a visible deformity may consider measuring the perceived degree of facial attractiveness.

10. Copyright restrictions may apply Contact Information If you have questions, please contact the corresponding author: –Abel-Jan Tasman, MD, Department of Otorhinolaryngology–Head and Neck Surgery, Cantonal Hospital, Rorschacher Str 95, 9007 St Gallen, Switzerland (abel-jan.tasman@kssg.ch). Conflict of Interest Disclosures None reported.