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Psychological distress, emotional trauma, and behavioral problems related to prominent ears can cause complicated situations in children and adults. This study aimed to investigate the changes in the psychological impact on quality of life after Otoplasty. The study used several measures, including the Glasgow Benefit Inventory, Social Appearance Anxiety Scale (SAAS), Body Image Scale (BIS), Rosenberg Self-Esteem Scale (RSES), and Visual Analogue Score (VAS), which were completed before and six months after the surgery. The GBI questionnaire was used to detect the health-related quality of life changes after Otoplasty, as it is a reliable, valid, and responsive measure. Six months after the surgery, BIS total scores, VAS scores, and SAAS scores decreased significantly, while RSES scores were not significantly different. These results suggest that Otoplasty can significantly impact adult patients' psychological well-being and quality of life and that the surgery should be considered regardless of age., Competing Interests: Conflict of interestThe authors declare that they have no competing interests., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

What distinguishes human beings from other living organisms is that a human perceives himself as a "self". The self is developed hierarchially in a multi-layered process, which is based on the evolutionary maturation of the nervous system and patterns according to the rules and demands of the external world. Many researchers have attempted to explain the different aspects of the self, as well as the related neural substrates. In this paper, we first review the previously proposed ideas regarding the neurobiology of the self. We then suggest a new hypothesis regarding the hierarchial self, which proposes that the self is developed at three stages: subjective, objective, and reflective selves. In the second part, we attempt to answer the question "Why do we need a self?" We therefore explain that different parts of the self developed in an effort to identify stability in space, stability against constantly changing objects, and stability against changing cognitions. Finally, we discuss the role of the cerebellum as the neural substrate for the self.