Time-Dependent Risk of Psychiatric Disorders in Pediatric and Adolescent Patients with Microtia: A Nationwide Population-Based Cohort Study.

Background/Objectives: Microtia, a congenital ear malformation ranging from mild anomalies to anotia, imposes a psychosocial burden, yet its link to pediatric psychiatric disorders in population-based settings is understudied. Methods: This study included 6048 patients with microtia and a control cohort of 120,960 age- and sex-matched participants from the Korean National Health Insurance database. The incidence of overall psychiatric disorder events was compared between the microtia and control cohorts. Results: Compared with the control cohort, the incidence rate ratio (IRR) in patients with microtia was 1.16 (95% CI, 1.05-1.29) for overall psychiatric disorders, 5.35 (95% CI, 4.56-6.27) for hyperkinetic disorder (HKD), and 9.67 (95% CI, 5.49-17.03) for autism. After adjusting for age group, sex, and socioeconomic status, microtia was associated with an increased risk of overall psychiatric disorders, HKD, and autism. Subgroup analyses revealed an elevated risk of overall psychiatric disorders among individuals aged 5 to 14 years, males, and those with low or high socioeconomic status. Ear reconstruction surgery was associated with a lower risk of HKD among patients aged 10 to 14 years, females, and those with low socioeconomic status. The observed association between ear reconstruction surgery and lower HKD risk in these specific subgroups warrants further investigation using study designs capable of establishing causal inference. Conclusions: Microtia is associated with an increased risk of psychiatric disorders in pediatric and adolescent populations, with particularly pronounced risks for HKD and childhood autism. These findings underscore the importance of early psychiatric screening in children with microtia.