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IntroductionPatients with otitis media (OM) encounter significant functional hearing impairment with conductive, or a combined hearing loss and long-term sequelae involving impaired speech/language development in children, reduced academic achievement and irreversible disorders of middle and inner ear requiring a long time therapy and/or multiple surgeries. In its persistent chronic form, Otitis media (COM) can often only be treated by undergoing ear surgery for hearing restoration. The persistent inflammatory reaction plays a major role, often caused by multi-resistant pathogens in the ear. Herein, we present outcomes of patients implanted with currently the only FDA approved active Middle Ear Implant Vibrant Soundbridge (VSB), suffering from persistent COM.MethodsThe study enrolled 42 patients, treated by performing middle ear (ME) surgery to different extents and implanted with the VSB to various structures in the ME. Included were 17 children and 25 adults that had recurrent and/or persisting OM and significant hearing loss. Preoperative and postoperative patients' audiometric data were evaluated and the benefit with VSB assessed using the Glasgow Benefit Inventory for adults and pediatric cohorts. The microbial spectrum of pathogens was assessed before and after surgery, exploring the colonization of the otopathogens, as well as the intestinal microbiome from individually burdened patients.ResultsThe mean functional gain is 29.7 dB HL (range from 10 to 56.2 dB HL) with a significant improvement in speech intelligibility in quiet. Following VSB implantation, no significant differences in coupling were observed at low complication rates. Postoperatively patients showed significantly increased benefit with VSB compared to the untreated situation, including less otorrhea, pain, medical visits, and medication intake, with no recurrent OM and significant bacterial shift in otopathogens. The analysis of the intestinal microbiome displayed a high abundance of bacterial strains that might be linked to chronic and persistent inflammation.ConclusionsFunctional ear surgery including rehabilitation with a VSB in patients suffering from COM present to be safe and effective. The successful acceptance accompanied by the improved audiological performance resulted in significant benefit with VSB, with a shift in the ear pathogens and altered microbiome and thus is a great opportunity to be treated.

Background: Suppurative perichondritis of the auricle is a common disease that can easily cause malformations if it develops into an uncontrolled infection. In nearly half of the cases, otolaryngologists cannot identify the pathogens involved. Case presentation: In the present work, we described two cases of pyogenic perichondritis, with negative on conventional culture. However, using metagenomic next-generation sequencing (mNGS), we detected fungal infections in the patients and after the patients were given anti-fungal treatment, the patients achieved a good prognosis. Conclusions: These cases highlighted the possibility that fungi might be the involved pathogens in patients who have had multiple negative bacterial cultures, and mNGS should be applied in these cases. mNGS could be used as a supplement to traditional culture methods. [ABSTRACT FROM AUTHOR]

Purpose: Determine the prevalence of otological symptoms and tympanic membrane perforation, healing rates of tympanic membrane perforation with surgical and conservative management, and hearing function in civilian victims of terrorist explosions. Methods: A systematic review was conducted with searches on Medline, Embase, EMCare and CINAHL for publications between the 1st January 1945 and 26th May 2023. Studies with quantitative data addressing our aims were included. This review is registered with PROSPERO: CRD42020166768. Among 2611 studies screened, 18 studies comprising prospective and retrospective cohort studies were included. Results: The percentage of eardrums perforated in patients admitted to hospital, under ENT follow up and attending the emergency department is 69.0% (CI 55.5–80.5%), 38.7% (CI 19.0–63.0%, I2 0.715%) and 21.0% (CI 11.9–34.3%, I2 0.718%) respectively. Perforated eardrums heal spontaneously in 62.9% (CI 50.4–73.8%, I2 0.687%) of cases and in 88.8% (CI 75.9–96.3%, I2 0.500%) of cases after surgery. Common symptoms present within one month of bombings are tinnitus 84.7% (CI 70.0–92.9%, I2 0.506%), hearing loss 83.0% (CI 64.5–92.9%, I2 0.505%) and ear fullness 59.7% (CI 13.4–93.4%, I2 0.719). Symptomatic status between one and six months commonly include no symptoms 57.5% (CI 46.0–68.3%), hearing loss 35.4% (CI 21.8–51.8%, I2 0.673%) and tinnitus 15.6% (CI 4.9–40.0%, I2 0.500%). Within one month of bombings, the most common hearing abnormality is sensorineural hearing loss affecting 26.9% (CI 16.9–40.1%, I2 0.689%) of ears 43.5% (CI 33.4–54.2%, I2 0.500) of people. Conclusion: Tympanic membrane perforation, subjective hearing loss, tinnitus, ear fullness and sensorineural hearing loss are common sequelae of civilian terrorist explosions. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to investigate the course of the hearing capacity of the better-hearing ear in single-sided deafness (SSD) and asymmetric hearing loss (AHL) over time, in a multicenter study. Methods: We included 2086 pure-tone audiograms from 323 patients with SSD and AHL from four hospitals and 156 private practice otorhinolaryngologists. We collected: age, gender, etiology, duration of deafness, treatment with CI, number and monosyllabic speech recognition, numerical rating scale (NRS) of tinnitus intensity, and the tinnitus questionnaire according to Goebel and Hiller. We compared the pure tone audiogram of the better-hearing ear in patients with SSD with age- and gender-controlled hearing thresholds from ISO 7029:2017. Results: First, individuals with SSD showed a significantly higher hearing threshold from 0.125 to 8 kHz in the better-hearing ear compared to the ISO 7029:2017. The duration of deafness of the poorer-hearing ear showed no relationship with the hearing threshold of the better-hearing ear. The hearing threshold was significantly higher in typically bilaterally presenting etiologies (chronic otitis media, otosclerosis, and congenital hearing loss), except for Menière's disease. Second, subjects that developed AHL did so in 5.19 ± 5.91 years and showed significant reduction in monosyllabic word and number recognition. Conclusions: Individuals with SSD show significantly poorer hearing in the better-hearing ear than individuals with NH from the ISO 7029:2017. In clinical practice, we should, therefore, inform our SSD patients that their disease is accompanied by a reduced hearing capacity on the contralateral side, especially in certain etiologies. [ABSTRACT FROM AUTHOR]

Purpose: Benign paroxysmal positional vertigo (BPPV) may be found in patients complaining of hearing disorders. The aim of our investigation was to describe audiological findings in BPPV patients, focusing on subjects with asymmetric hearing loss (AHL), to better understand whether otoconial displacement may occur preferentially in the worst hearing ear. Methods: A prospective study was performed on 112 BPPV patients. We divided the sample into subjects who suffered from AHL (G1) and patients with did not (G2). Data regarding vestibular symptoms, tinnitus, migraine, antivertigo drug therapy, and vascular risk factors were collected. Results: Out of 30 AHL subjects, 83.33% of them were affected by sensorineural hearing loss (SNHL) in at least one ear, with a significant difference in the distribution of hearing loss type between groups (p = 0.0006). In 70% of cases, the ear affected by BPPV was the one with the worst hearing threshold (p = 0.02); threshold asymmetry predicted BPPV in the worst hearing ear (p = 0.03). The predictability depended neither on the hearing threshold gap between ears nor the severity of the hearing threshold in the worst ear (p > 0.05). No differences in vascular risk factors between groups were observed (p > 0.05). We evidenced a moderate correlation between age and hearing threshold (ρ = 0.43). Age did not result a predictive factor for residual dizziness or BPPV in the worst ear (p > 0.05). Conclusions: Our study supports the likelihood of an otoconial displacement in the worse hearing ear in BPPV patients. Clinicians should start testing the worst hearing ear when managing AHL patients with suspected BPPV. [ABSTRACT FROM AUTHOR]

Purpose: To determine hearing preservation and subjective benefit after cochlear implant (CI) surgery in patients with low frequency hearing in the ear to be implanted (i.e., they have partial deafness, PD) and close to normal hearing in the other. Methods: There were two study groups. The test group was made up of 12 adult patients (mean age 43.4 years; SD 13.6) with normal hearing or mild hearing loss in one ear, and with PD in the ear to be implanted. The reference group consisted of 12 adult patients (mean age 44.5 years; SD 14.1) who had PD in both ears and who underwent unilateral implantation in their worse ear. Hearing preservation was assessed 1 and 14 months after CI surgery using the Skarzynski Hearing Preservation Classification System. The APHAB questionnaire was used to evaluate the benefit from the CI. Results: The differences in HP% between the groups were not significant: mean hearing preservation (HP%) in the test group was 82% one month after CI surgery and 75% some 14 months after implantation; corresponding results in the reference group were 71% and 69%. However, on the APHAB background noise subscale, the benefit in the test group was significantly larger than in the reference group. Conclusion: To a large extent it was possible to preserve low-frequency hearing in the implanted ear. This means that individuals with low frequency hearing in the implanted ear (partial deafness) and with normal hearing in the other generally received more benefits from cochlear implantation than did patients with partial deafness in both ears. We conclude that residual low frequency hearing in the ear to be implanted should not be considered a contraindication for a CI in a patient with single-sided deafness. [ABSTRACT FROM AUTHOR]

Purpose: Extreme weather events are rising due to the accelerating pace of climate change. These events impact human health and increase emergency room visits (EV) for many morbidities. Tinnitus is a common cause of EVs within otolaryngology in Germany and Austria. The effect of extreme weather conditions on tinnitus-related EVs is unknown. Methods: A total of 526 tinnitus-related EVs at a tertiary care hospital in Vienna were identified. A distributed lag non-linear model with a maximum lag period of 14 days was fitted to investigate the immediate and delayed effect of single-day and prolonged (three-day) extreme atmospheric pressure, relative humidity, mean temperature, precipitation and mean wind speed on EV rates. Extreme conditions were defined as the 1st, 5th, 95th, and 99th percentile of the meteorological variables. Relative risk (RR) is defined as risk for tinnitus-related EVs at an extreme condition compared to the risk at the median weather condition. Cumulative RR (cRR) is the total cumulated EV risk for a given time period. Results: High relative humidity increased same-day RR for tinnitus-related EVs to 1.75. Both low and high atmospheric pressure raised cRR as early as three days after an event to a maximum of 3.24. Low temperatures mitigated cRR within 4 days, while high temperatures tended to increase risk. Prolonged precipitation reduced cRR within one day. Conclusion: Extreme meteorological conditions are associated with tinnitus-related EV rates. Further investigation into potential causative links and underlying pathophysiological mechanisms is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Overhanging facial nerve (FN) may be challenging in imaging diagnosis. The purpose of the study is to investigate the imaging clues for overhanging FN near the oval window on ultra-high-resolution computed tomography (U-HRCT) images. Methods: Between October 2020 and August 2021, images of 325 ears (276 patients) were included in the analysis obtained by an experimental U-HRCT scanner. On standard reformatted images, the morphology of FN was evaluated and its position was quantitatively measured using the following indices: protrusion ratio (PR), protruding angle (A), position of FN (P-FN), distance between FN and stapes (D-S), and distance between FN and anterior and posterior crura of stapes (D-AC and D-PC). According to the FN morphology in imaging, images were divided into overhanging FN group and non-overhanging FN group. Binary univariate logistic regression analysis was used to identify the imaging indices independently associated with overhanging FN. Results: Overhanging FN was found in 66 ears (20.3%), which manifested as downwards protrusion of either local segment (61 ears, 61/66) or the entire course near the oval window (5 ears, 5/66). D-AC [odds ratio: 0.063, 95% CI 0.012–0.334, P = 0.001) and D-PC (odds ratio: 0.008, 95% CI 0.001–0.050, P = 0.000) were identified as independent predictors of FN overhang (area under the curve: 0.828 and 0.865, respectively). Conclusion: Abnormal morphology of the lower margin of FN, D-AC and D-PC on U-HRCT images provide valuable diagnostic clues for FN overhang. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to compare speech recognition at different postoperative times for both ears in bilaterally implanted patients and to assess the influence of the time of deafness, frequency-to-place mismatch, angular insertion depth (AID) and angular separation between neighbouring electrode contacts on audiometric outcomes. Methods: This study was performed at an academic tertiary referral centre. A total of 19 adult patients (6 men, 13 women), who received sequential bilateral implantation with lateral wall electrode arrays, were analysed in retrospective. Statistical analysis was performed using two-sided t test, Wilcoxon test, median test, and Spearman's correlation. Results: Postlingually deafened patients (deafness after the age of 10) had a significantly better speech perception (WRS65[CI]) than the perilingually deafened subjects (deafness at the age of 1–10 years) (p < 0.001). Comparison of cochlear duct length between peri- and postlingually deafened subjects showed a slightly significantly smaller cochleae in perilingual patients (p = 0.045). No association between frequency-to-place mismatch as well as angular separation and speech perception could be detected. There was even no significant difference between the both ears in the intraindividual comparison, even if insertion parameters differed. Conclusion: The exact electrode position seems to have less influence on the speech comprehension of CI patients than already established parameters as preoperative speech recognition or duration of deafness. [ABSTRACT FROM AUTHOR]

Purpose: To compare the audiological performances of Turkey's most up-to-date bone conduction implant processors. Methods: Twenty-six bone-anchored hearing instrument users, thirteen in each group, were evaluated for speech understanding in quiet and several signal-to-noise ratios. Results: We noticed the differences at 0.5 and 1 kHz measurements in free field frequency specific test, aided SRT scores, non-adaptive and adaptive matrix test results for a few conditions created a statistically significant difference in favor of Baha-6®. Conclusions: Both processors offer positive gains to their users in noisy and silent conditions. However, the data showed statistically significant differences for some measurements that may be critical for patients in daily practice. [ABSTRACT FROM AUTHOR]

Purpose: Otoendoscopy represents the initial non-invasive diagnostic cornerstone for external and middle ear disorders. Recently, new techniques of enhanced imaging such as narrow-band imaging (NBI) have been introduced but their role as a potential aid in otological practice remains unproven. In this pictorial review, we want to present the potential application of this endoscopic method, highlight its limitations, and give some hints regarding its future implementation. Methods: Representative cases of external and/or middle ear pathologies were selected to illustrate the role of NBI in this regard. Results: NBI may represent a useful aid in the otological work-up, in the differential diagnosis of ear tumor-like masses, and, possibly, in the prognosis of tympanic perforations. For other ear disorders, instead, this technique does not seem to add anything to the standard clinical practice. Conclusions: NBI might prove useful in the assessment of selected external and middle ear disorders but its role must be prospectively validated. [ABSTRACT FROM AUTHOR]

Objectives of review: To review the literature for the evidence base for the aetiology and management of referred otalgia, looking particularly at non-malignant, neuralgic, structural and functional issues. Type of review: Systematic review. Search strategy: A systematic literature search was undertaken from the databases of EMBASE, CINAHL, MEDLINE®, BNI, and Cochrane Library according to predefined inclusion and exclusion criteria. Evaluation method: All relevant titles, abstracts and full text articles were reviewed by three authors who resolved any differences by discussion and consultation with senior author. Results: 44 articles were included in our review. The overall quality of evidence was low, with the vast majority of the studies being case-series with three cohort and four randomised-controlled trials included. The prime causes and management strategies were focussed on temporomandibular joint dysfunction (TMJD), Eagle syndrome and neuralgia. Our meta-analyses found no difference on the management strategies for the interventions found. Conclusions: Referred otalgia is common and treatment should be aimed at the underlying pathology. Potential aetiologies are vast given the extensive sensory innervation of the ear. An understanding of this and a structured approach to patient assessment is important for optimal patient management. [ABSTRACT FROM AUTHOR]

Purpose: Report our experience in the management of posterior petrous surface meningiomas (PPSMs), and identify features that affect hearing, facial nerve (FN) function, and control of the disease. Methods: Retrospective case series of 131 patients surgically managed for PPSMs. FN status, hearing and tumour radicality were assessed and compared between patients with tumours of different locations (Desgeorges classification) and internal auditory canal involvement (IAC). Results: At the time of surgery 74.8% of patients had a hearing loss. Hearing was mostly unserviceable in tumors attached to the meatus. Pure tone audiometry did not correlate to IAC extension, while speech discrimination scores were statistically worse when the tumor occupied the IAC (unpaired t test, p = 0.0152). Similarly, extrameatal tumors undergoing removal by otic preserving techniques maintained postoperative hearing, whereas hearing worsened significantly in tumors involving the IAC (paired t test, p = 0.048). The FN was affected preoperatively in 11.4% of cases. Postoperative FN palsy was significantly correlated to the IAC involvement (Fisher's exact test, p = 0.0013), while it was not correlated to tumor size. According to the Desgeorges classification, a postoperative FN palsy complicated the majority of anteriorly extending tumors and, two-fifths of meatus centred tumors. 75% of posterior located tumors had a postoperative FN grade I HB. Conclusions: Since the involvement of the IAC by the tumor affects both hearing and FN function, the IAC is of primary importance in PPSMs and should be studied and addressed as much as the tumor location in the CPA. [ABSTRACT FROM AUTHOR]

Purpose: Current studies show that frequency tuning modification is a good marker for the detection of endolymphatic hydrops (EH) employing magnetic resonance imaging (MRI) in patients with Ménière's disease (MD). The purpose of the present study is to analyze the auditory and vestibular function with audiometric and vestibular-evoked myogenic potentials (VEMP) responses, respectively, in both the affected and unaffected ears of patients with unilateral MD using MRI as diagnostic support for the degree of EH. Methods: We retrospectively reviewed the medical records of 76 consecutive patients with unilateral definite MD (age 55 (28–75); 39 women, 37 men). MRI was used through intravenous gadolinium administration, audiometry, and VEMPs. Functional tests were performed up to a week after the MRI. All were followed up one year after imaging utilizing clinical, auditory, and vestibular testing to rule out bilateral involvement. Results: In the unaffected ear, the mean pure-tone average is normal even in cases with hydrops and, for a similar severity of hydrops is significantly lower than in the affected ear. Significant differences for the amplitude of the response at 0.5 kHz, at 1 kHz between the affected and unaffected ears were found to be lower in the affected ears. The relative amplitude ratio (1 Kz–0.5 kHz) was significantly lower in the affected ear and in the case of the oVEMP response depends on the degree of EH. The response in the unaffected ear was not modified by the presence or the degree of hydrops. Conclusion: In the unaffected ear, hydrops is not associated with hearing deterioration. For a similar degree of hydrops, hearing loss is significantly greater in the affected ear. The endolymphatic hydrops in the vestibule induces a frequency bias in the VEMP response only in the affected ear and not in the unaffected ear. Because of these findings we consider that hydrops does not represent an active disorder in the unaffected ear. [ABSTRACT FROM AUTHOR]

Purpose: Continuous technological advances result in the availability of new bone conduction hearing implants, of which their suitability for pediatric patients is of major concern. The CochlearTMOsia® 2 is a new active osseointegrated steady-state implant system that uses digital piezoelectric stimulation to treat hearing loss. The implant in the United States was approved for patients aged 12 years and above, whereas the CE mark is independent of age, the only requirement is body weight of at least 7 kg. Therefore, further clinical studies are required to assess device characteristics in younger patients. The aim of our study was to perform a morphometric study among 5–12-year-old children, and to develop a surgical protocol for Osia 2 system implantation based on these findings. Methods: We examined retrospectively cranial CT scans of 5–12-year-old patients from our clinical database. We measured the bone and soft-tissue thickness in the region of interest, and the position of the sigmoid sinus. 3D printed temporal bones were also used for planning. Results: Soft-tissue thickness varied between 3.2 ± 0.5 mm and 3.6 ± 0.6 mm and bone thickness varied between 3.5 ± 1.1 mm and 4.7 ± 0.3 mm. The sigmoid sinus was located 1.3 ± 0.2 cm posterior to the ear canal, and the anterior distance was 4.8 ± 0.9 to 7.1 ± 1.1 mm. Conclusions: Our morphometric studies showed that patients aged 5–12 have different anatomical dimensions compared to adults, but that implantation of the Osia 2 system is feasible in these patients using an altered implant positioning recommended by our data. The Cochlear™ Osia® 2 is, therefore, an option for hearing rehabilitation in younger pediatrics. [ABSTRACT FROM AUTHOR]

Purpose: The classical surgical approach for superior semicircular canal dehiscences (SSCD) is via the extradural middle cranial fossa. This pathway is used to resurface or to plug the SSC. In this paper, we present long-term data on an alternative route: the transmastoid pathway. The predictive factors for a successful surgery are equally presented in this paper. Methods: Thirty reports of patients operated between September 2007 to January 2020 were analysed. SSCD was confirmed by the association of concordant complaints, audiometric data, cervical vestibular evoked myogenic potentials (cVEMP) responses and computerized tomography findings. Before and after surgery, the following factors were analysed: auditory and vestibular subjective symptoms, Tullio phenomenon, pure-tone audiometry thresholds for air and bone conduction, air–bone gap, cVEMP threshold, and computerized tomography data, for instance the size of the dehiscence. Results: The follow-up is 21 months on average. The transmastoid approach significantly improves all symptoms (although there were less probing results for the vestibular symptoms). Objectively, we can observe, a closure of the audiometric air–bone gap on the low frequencies and an improvement in the cVEMP. The only correlation that was identified was between the preoperative cVEMP results and the postoperative air conduction. Conclusions: The originality of this study is the long postoperative follow-up. It allowed us to evaluate the symptoms in the long term and to determine a predictive factor of postoperative complication, which has not yet been described until today.The transmastoid plugging technique is safe and effective. Additional long-term data with a larger cohort are needed to confirm our results and correlation studies. [ABSTRACT FROM AUTHOR]

Purpose: To compare the calibre of the cochlear (CN), superior vestibular (SVN) and inferior vestibular (IVN) nerves on magnetic resonance imaging (MRI), both between Ménière’s Disease (MD) ears and clinical controls, and between inner ears with and without endolymphatic hydrops (EH) on MRI.A retrospective case–control study evaluated patients undergoing MRI for suspected hydropic ear disease from 9/2017 to 8/2022. The CN, SVN, IVN and facial nerve (FN) diameters and cross-sectional areas (CSA) were measured on T2-weighted sequences whilst EH was evaluated on delayed post-gadolinium MRI. Absolute nerve calibre (and that relative to the FN) in unilateral definite MD ears (2015 Barany criteria) was compared to that in both asymptomatic contralateral ears and clinical control ears. Nerve calibre in ears with severe cochlear and vestibular EH was compared to ears without EH. t tests or Wilcoxon signed-rank test/Mann–Whitney U test were applied (p < 0.001).173 patients (mean age 51.3 ± 15.1, 65 men) with 84 MD (62 unilateral) and 62 clinical control ears were studied. Absolute and relative CN dimensions were decreased in both MD ears (CSA and diameter) and the contralateral asymptomatic ears (CSA) when compared to clinical controls (p < 0.001). Absolute nerve dimensions were reduced in both severe vestibular EH (CN, IVN and SVN) and severe cochlear EH (CN) (p < 0.001), however this was not evident when adjusted according to facial nerve calibre.There is decreased absolute CN calibre in both symptomatic and asymptomatic MD ears as well as ears with severe cochlear and vestibular EH on MRI.Methods: To compare the calibre of the cochlear (CN), superior vestibular (SVN) and inferior vestibular (IVN) nerves on magnetic resonance imaging (MRI), both between Ménière’s Disease (MD) ears and clinical controls, and between inner ears with and without endolymphatic hydrops (EH) on MRI.A retrospective case–control study evaluated patients undergoing MRI for suspected hydropic ear disease from 9/2017 to 8/2022. The CN, SVN, IVN and facial nerve (FN) diameters and cross-sectional areas (CSA) were measured on T2-weighted sequences whilst EH was evaluated on delayed post-gadolinium MRI. Absolute nerve calibre (and that relative to the FN) in unilateral definite MD ears (2015 Barany criteria) was compared to that in both asymptomatic contralateral ears and clinical control ears. Nerve calibre in ears with severe cochlear and vestibular EH was compared to ears without EH. t tests or Wilcoxon signed-rank test/Mann–Whitney U test were applied (p < 0.001).173 patients (mean age 51.3 ± 15.1, 65 men) with 84 MD (62 unilateral) and 62 clinical control ears were studied. Absolute and relative CN dimensions were decreased in both MD ears (CSA and diameter) and the contralateral asymptomatic ears (CSA) when compared to clinical controls (p < 0.001). Absolute nerve dimensions were reduced in both severe vestibular EH (CN, IVN and SVN) and severe cochlear EH (CN) (p < 0.001), however this was not evident when adjusted according to facial nerve calibre.There is decreased absolute CN calibre in both symptomatic and asymptomatic MD ears as well as ears with severe cochlear and vestibular EH on MRI.Results: To compare the calibre of the cochlear (CN), superior vestibular (SVN) and inferior vestibular (IVN) nerves on magnetic resonance imaging (MRI), both between Ménière’s Disease (MD) ears and clinical controls, and between inner ears with and without endolymphatic hydrops (EH) on MRI.A retrospective case–control study evaluated patients undergoing MRI for suspected hydropic ear disease from 9/2017 to 8/2022. The CN, SVN, IVN and facial nerve (FN) diameters and cross-sectional areas (CSA) were measured on T2-weighted sequences whilst EH was evaluated on delayed post-gadolinium MRI. Absolute nerve calibre (and that relative to the FN) in unilateral definite MD ears (2015 Barany criteria) was compared to that in both asymptomatic contralateral ears and clinical control ears. Nerve calibre in ears with severe cochlear and vestibular EH was compared to ears without EH. t tests or Wilcoxon signed-rank test/Mann–Whitney U test were applied (p < 0.001).173 patients (mean age 51.3 ± 15.1, 65 men) with 84 MD (62 unilateral) and 62 clinical control ears were studied. Absolute and relative CN dimensions were decreased in both MD ears (CSA and diameter) and the contralateral asymptomatic ears (CSA) when compared to clinical controls (p < 0.001). Absolute nerve dimensions were reduced in both severe vestibular EH (CN, IVN and SVN) and severe cochlear EH (CN) (p < 0.001), however this was not evident when adjusted according to facial nerve calibre.There is decreased absolute CN calibre in both symptomatic and asymptomatic MD ears as well as ears with severe cochlear and vestibular EH on MRI.Conclusion: To compare the calibre of the cochlear (CN), superior vestibular (SVN) and inferior vestibular (IVN) nerves on magnetic resonance imaging (MRI), both between Ménière’s Disease (MD) ears and clinical controls, and between inner ears with and without endolymphatic hydrops (EH) on MRI.A retrospective case–control study evaluated patients undergoing MRI for suspected hydropic ear disease from 9/2017 to 8/2022. The CN, SVN, IVN and facial nerve (FN) diameters and cross-sectional areas (CSA) were measured on T2-weighted sequences whilst EH was evaluated on delayed post-gadolinium MRI. Absolute nerve calibre (and that relative to the FN) in unilateral definite MD ears (2015 Barany criteria) was compared to that in both asymptomatic contralateral ears and clinical control ears. Nerve calibre in ears with severe cochlear and vestibular EH was compared to ears without EH. t tests or Wilcoxon signed-rank test/Mann–Whitney U test were applied (p < 0.001).173 patients (mean age 51.3 ± 15.1, 65 men) with 84 MD (62 unilateral) and 62 clinical control ears were studied. Absolute and relative CN dimensions were decreased in both MD ears (CSA and diameter) and the contralateral asymptomatic ears (CSA) when compared to clinical controls (p < 0.001). Absolute nerve dimensions were reduced in both severe vestibular EH (CN, IVN and SVN) and severe cochlear EH (CN) (p < 0.001), however this was not evident when adjusted according to facial nerve calibre.There is decreased absolute CN calibre in both symptomatic and asymptomatic MD ears as well as ears with severe cochlear and vestibular EH on MRI. [ABSTRACT FROM AUTHOR]

Purpose: The ability to predict the degree of a conductive hearing loss caused by a tympanic membrane perforation is important for every otologist, as it may require additional diagnostic tests and prevent unexpected intraoperative findings. The aim of this study was to correlate the various characteristics of a perforation (etiology, size, location, involvement of the manubrium or umbo) with the degree and frequency predominance of the consequent hearing loss. Methods: A transversal study in a tertiary hospital center was conducted between July 2019 and December 2020. Fifty-eight patients with 65 tympanic perforations underwent a comprehensive medical and audiological evaluation, which included an otoendoscopy. An image processing software (ImageJ®) was used to measure the perforated area. The qualitative variables were etiology, affected quadrants, presence of myringosclerosis and involvement of umbo or manubrium of the malleus. The air–bone gap was measured at 250, 500, 1000, 2000 and 4000 Hz. Primary outcomes (mean air–bone gap and pure-tone average) were evaluated to find clinical factors associated with worse hearing. Results: Data collected from 50 ears was included. Perforation size showed a positive statistically significant correlation with the air–bone gap (r =.508; p <.001) and pure-tone average (r =.375; p <.001). Higher air-bone gaps were found in perforations involving the posterior quadrants and the manubrium (p <.001 and p =.031, respectively). Inflammatory causes showed higher bone and air conduction pure-tone averages (p =.031 and p =.084, respectively) compared to traumatic or iatrogenic. An "inverted V" pattern of the air–bone gap, with the 2 kHz frequency being the least affected, was a consistent finding. However, it was not due to the Carhart's notch in bone conduction. Conclusion: The conductive hearing loss resulting from a tympanic membrane perforation is etiology, size and location-dependent, with higher losses occurring for inflammatory backgrounds, large perforations and when the posterior quadrants or the manubrium are involved. If the "inverted V" is absent, additional middle ear pathology should be investigated. [ABSTRACT FROM AUTHOR]

Background: It is rare to find pseudoepitheliomatous hyperplasia (PEH) on the auricle. PEH should be differentiated from squamous cell carcinoma (SCC). Diagnosis is made after surgery as a biopsy is often inconclusive. A free or pedicled skin flap is needed to avoid deformation of the auricle. Methods: Adjacent pedicled skin flap is a good option for reconstruction. Moreover, it was shown how to repair the wound in the following two cases. Results: The flaps grew well after surgery, and the wound healed well. Conclusion: PEH is a benign lesion. Adjacent pedicled skin flap is a good option for reconstruction, which can avoid deformation of the auricle. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction. Methods: This is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing. Results: 79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p =.002). There were no differences in audiological outcome and incidence of complications between the two techniques. Conclusion: We show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques. [ABSTRACT FROM AUTHOR]

Purpose: (1) To assess the effectiveness and safety of a bone-conduction implant, the Bonebridge BCI 602, in adults with conductive or mixed hearing loss. (2) To investigate whether the Bonebridge BCI 602 is at least as effective as the Bonebridge BCI 601 in such patients. Methods: The study group included 42 adults who had either conductive or mixed hearing loss. All patients underwent Bonebridge BCI 602 implant surgery. Before and after implantation, pure-tone audiometry, speech recognition tests (in quiet and noise), and free-field audiometry were performed. Word recognition scores were evaluated using the Polish Monosyllabic Word Test. Speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test. Subjective assessment of benefits was done using the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire. Results: The APHAB questionnaire showed that difficulties in hearing decreased after BCI 602 implantation. Both word recognition in quiet and speech reception threshold in noise were significantly better after BCI 602 implantation and remained stable for at least 12 months. A significant advantage of the device is a reduced time for surgery while maintaining safety. In this study, the mean time for BCI 602 implantation was 28.3 min ± 9.4. Conclusions: The second-generation Bonebridge BCI 602 implant is an effective hearing rehabilitation device for patients with conductive or mixed hearing loss. Patient satisfaction and audiological results confirm its efficacy and safety. Its new shape and dimensions allow it to be used in patients previously excluded due to insufficient or difficult anatomical conditions. The new BCI 602 implant is as effective as its predecessor, the BCI 601. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of chirp and tone burst stimuli in oVEMP and cVEMP testing for healthy adults Methods: This study was conducted in 56 healthy volunteers (112 ears). Ocular and cervical VEMP (oVEMP, cVEMP) tests were performed for each participant using tone burst and chirp stimuli. VEMP response rates, latency of each peak (p1–n1, n1–p1), peak to peak amplitude (p1–n1 amplitude and n1–p1 amplitude), and rectified amplitudes were measured and compared between these two different stimuli. Results: VEMP response rates with chirp stimuli are higher than the tone burst stimuli for both cVEMP and oVEMP tests (The difference was statistically significant for oVEMP, p = 0.001). Chirp stimuli have higher p1n1 amplitude and rectified amplitude and shorter p1and n1 latency then tone burst stimuli for cVEMP (p = 0.015, p = 0.007, p < 0.001, p < 0.001, respectively). Chirp stimuli also have higher n1p1 amplitude and shorter n1and p1 latency then tone burst stimuli for oVEMP (p = 0.006, p < 0.001, p < 0.001, respectively). Conclusion: The present findings show that the chirp stimulus triggers earlier VEMP responses with higher amplitudes than the tone burst stimulus during cVEMP and oVEMP testing. VEMP response rate with chirp stimulus is also higher than the tone burst. Therefore chirp stimulus can be used in VEMP testing as effectively as, if not more than, tone burst stimulus in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To describe the suprameatal–transzygomatic root endoscopic approach (STEA) to the geniculate ganglion (GG), the labyrinthine facial nerve (FN) and epitympanum. Methods: The feasibility and limits of the STEA, maintaining the integrity of the ossicular chain, were analysed. Ten human cadaveric ears were dissected. Step-by-step description of the technique and relevant measurements were taken during the approach. The visualization and surgical working field on the anterior and posterior medial epitympanum, GG, greater superficial petrosal nerve, the labyrinthine FN and suprageniculate area were evaluated. The range of motion through the approach and the rate of the decompression of the GG and the labyrinthine portion of the FN were assessed as well. CT-scan measurements were compared with those obtained during the dissection. Results: A complete exploration of the epitympanum was possible in every specimen. Decompression of the GG and first portion of the FN was achieved without any trauma to the ossicular chain in nine ears. The endoscope movements were mainly limited by the distance between bony buttress–short process of the incus–tegmen. The working space, during GG and labyrinthine FN decompression, was limited by the distance between malleus head–medial epitympanic wall and malleus head–GG. Radiologic measurements were consistent with those obtained during the dissections. Conclusion: The STEA is a promising minimally invasive approach for decompression of the GG and FN's labyrinthine portion. The applications of this corridor include the exploration and surgery of the medial epitympanum, preserving the ossicular chain. [ABSTRACT FROM AUTHOR]

Purpose: Limited literature exists on primary external auditory canal (EAC) cholesteatoma (EACC). Here, we focus on the clinical features of this rare disease, especially the invasive patterns of lesion progression, through a large population study and present simple and practical staging. Methods: In all, 276 patients (male 99; female 177; mean age 41.3 ± 21 years; ears 301) with primary EACC were retrospectively analyzed. Stage I indicated EACC without bony lesions, stage II indicated invasion confined within EAC, stage III indicated invasion beyond the EAC involving mastoid air cells or tympanic cavity, but within the temporal bone, and stage IV indicated invasion beyond the temporal bone. Results: In all, 41, 219, 40, and 1 ear with Stage I, II, III, and IV lesions were found, respectively. Common clinical symptoms were hearing loss (237 ears, 78.7%), otalgia (221 ears, 73.4%), and otorrhea (85 ears, 28.2%). The mean air conduction and air-bone gaps were 45.4 ± 17.9 dB HL and 24.6 ± 15 dB HL, respectively. EACCs were found to invade in all directions of the EAC, with the inferior wall (224 ears, 74.4%) > posterior wall (207 ears, 68.8%) > anterior wall (186 ears, 61.8%) > superior wall (86 ears, 28.6%) invasion; multiwall invasions (207 ears) were common; however, inward invasions into the tympanic cavity were rare. Conclusion: Primary EACCs occurred mostly in women and often unilaterally invaded multiple bony walls in the lower half of the EAC. The present staging reflects the patterns and severity of lesion progression and may be beneficial in treatment planning. [ABSTRACT FROM AUTHOR]

Purpose: To present a large series ears with tympanic membrane perforations (TMP), to describe their characteristics, and to propose a new classification system based on the pathogenesis of TMP. Methods: This cross-sectional study was conducted at a tertiary university hospital with 1003 ears (792 consecutive patients with TMP in at least 1 ear). Otoendoscopy and audiometry were performed. Perforation measurements and their locations were digitally assessed. TMP with no suggestive signs of previous retraction were classified as Group 1, and those with possible previous retraction were classified as Group 2. Signs of retraction previous to the TMP, symptom length, perforation size and location, status of the contralateral ear, and hearing status were compared. Results: Group 1 comprised 63.5% of the included ears. Compared to Group 2, Group 1 presented a higher rate of central perforations (99% vs. 53%), a shorter duration of symptoms, smaller perforations (mean area: 18.5% vs. 41.4%), a higher rate of perforations in the anterior quadrants, better hearing levels (mean tritonal gap: 23.9 dB vs. 29.2 dB), and a lower rate of abnormal contralateral ears (28% vs. 66%). Conclusion: The classification of TMP into two groups based on signs of previous retractions is feasible and indicates two different levels of disease severity. While the group without previous signs of retraction comprises ears with more limited disease, membranes with previous retraction seem to show more severe disease and, consequently, a less functional middle ear. [ABSTRACT FROM AUTHOR]

Objective: To review long-term outcomes for chronic otitis media with and without cholesteatoma in staged canal-wall-up tympanoplasty with temporary silastic sheeting and to compare hearing and recurrence results with the literature. Methods: Retrospective data analysis of all patients suffering from chronic otitis media with or without cholesteatoma (COMC/COM) and treated by staged canal-wall-up (CWU) technique with silastic insertion between 1992 and 2012. Literature analysis in PubMed 1990–2017. Results: 74 cases were included in the analysis. In COMC (n = 47) a total of 2 (4%) recurrent and 14 (30%) residual cholesteatoma were documented. The postoperative hearing test showed a pure-tone-average (PTA) of 36 dB hearing level (HL) and an air-bone-gap (ABG) of 21 dB HL. A significant improvement was only observed for stage I disease (PTA 8 dB HL and ABG 9 dB HL). In COM (n = 27) postoperative PTA and ABG were significantly improved by 33 dB HL and 23 dB HL, respectively. Mean postoperative follow-up was 47 months (12–173) for COMC and 22 months (2–120) for COM. Conclusions: The cholesteatoma recurrence rate in this study reflects contemporary published rates. Assessment of hearing outcome is difficult due to the low number of cases and very high heterogeneity of published data. Still, the staged CWU procedure with temporary silastic sheeting seems to bear some advantages in regard to hearing. The role of additional factors such as Eustachian Tube function to assess outcome should be considered. An internationally agreed upon reporting system should be followed, if various surgical approaches are to be compared. Level of evidence: 3. [ABSTRACT FROM AUTHOR]

Purpose: Deformities of the external ear can affect psychosocial well-being and hearing. Current gold-standard reconstructive treatment is autologous costal cartilage grafting despite the vast morbidity profile. Tissue engineering using stem cells and 3D printing can create patient-specific reconstructed auricles with superior cosmetic outcomes and reduced morbidity. This review critically analyses recent and breakthrough research in the field of regenerative medicine for the pinna, considering gaps in current literature and suggesting further steps to identify whether this could be the new gold-standard. Methods: A literature review was conducted. PubMed (MEDLINE) and Cochrane databases were searched using key terms regenerative medicine, tissue engineering, 3D printing, biofabrication, auricular reconstruction, auricular cartilage, chondrocyte, outer ear and pinna. Studies in which tissue-engineered auricles were implanted into animal or human subjects were included. Exclusion criteria included articles not in English and not published within the last ten years. Titles, abstracts and full texts were screened. Reference searching was conducted and significant breakthrough studies included. Results: 8 studies, 6 animal and 2 human, were selected for inclusion. Strengths and weaknesses of each are discussed. Common limitations include a lack of human studies, small sample sizes and short follow-up times. Conclusion: Regenerative medicine holds significant potential to improve auricular reconstruction. To date there are no large multi-centred human studies in which tissue-engineered auricles have been implanted. However, recent human studies suggest promising results, raising the ever-growing possibility that tissue engineering is the future of auricular reconstruction. We aim to continue developing knowledge in this field. [ABSTRACT FROM AUTHOR]

Purpose: The prognostic significance of auricular location in cutaneous squamous cell carcinoma (cSCC) is controversial. We aimed to characterize risk factors for, and evaluate the cumulative incidence of, locoregional recurrence in a cohort of patients with primary auricular cSCC. Methods: The study design was a single-institution retrospective cohort review from 1/2007 to 12/2016. Results: Among 851 potentially eligible individuals, 178 patients with primary auricular cSCC met strict criteria for inclusion. Median follow-up was 32 months, 93% were AJCC 8th edition (AJCC8) stage I and 6% were AJCC8 stage II. Most underwent Mohs micrographic surgery (MMS; 97%) and the remainder underwent wide local excision ± parotidectomy ± neck dissection ± adjuvant therapy (3%). Recurrences occurred in seven patients (4%): six were local and one was regional. The 3-year cumulative incidence of local and regional recurrence for AJCC8 stage I–II tumors were 1% (95% CI 0–5%) and 0%, respectively. Among ten patients upstaged to pT3 disease who underwent MMS alone, none recurred locoregionally. Compared to their respective counterparts, advanced stage, PNI, and LVI associated with a significantly increased risk of locoregional recurrence. Conclusions: Our findings suggest that auricular location may not be a significant risk factor for cSCC staging systems. In the absence of other risk factors, unimodal therapy appears adequate for patients with primary, stage I–II auricular cSCC. The prognostic significance of pT3 auricular cSCC stage due to depth of invasion alone should be evaluated further. [ABSTRACT FROM AUTHOR]

Purpose: Ear, nose and throat physicians (ENTp) encounter dental trauma (DT) when patients refer to the emergency department, as well as during operations such as tonsillectomy and suspension laryngoscopy. This study aimed to investigate the attitudes and knowledge of ENTp about managing DT, and motivation for further education. Methods: This study was a cross-sectional observational survey on a sample of ENTp from 15 different private/public hospitals. A questionnaire of 22 questions was divided into three parts: the level of professional experience and the frequency of encountering DT; specific questions on the management of DT; self-assessment of educational approach and level of knowledge regarding DT. Results: A total of 128 surveys were accomplished and included in the evaluation. A larger percentage (96.9%) of the participants have experienced at least one case in the practice, and one-third (31.3%) have encountered more than ten DT cases. Although the duration of experience significantly affected the total number of correct responses to knowledge and attitudes regarding DT questions (p:0.028), more than half of the participants (44.38%) responded incorrectly to the questions. The majority of participants (97.7%) stated that they had no education on DT, and 90.6% were willing to receive DT training. Conclusions: The results of this study emphasize the deficiency of ENTp' knowledge level about the management of DT. In addition, results demonstrated the enthusiasm of ENTp for further training, which can contribute to the requirement of education for providing appropriate management of DT cases. [ABSTRACT FROM AUTHOR]

Objective: To validate a smartphone-based Rinne test employing the vibration application of mobile telephones. Study design: Prospective controlled clinical study. Setting: Tertiary referral medical center. Methods: Twenty consecutive patients hospitalized in the otolaryngology department of a tertiary medical center due to unilateral hearing loss (HL study group), and 30 consecutive inpatients on the same ward who had no otological history (controls) were enrolled. Each participant underwent the traditional 512 Hz tuning fork-based Rinne test, as well as a smartphone-based Rinne test by means of a single uncovered smartphone with a vibration application. The test results were compared to those of formal audiometry. Results: The overall agreement between the traditional Rinne test and the smartphone-based test was 98%. The Sensitivity was 85% for both tests, specificity was 90% and 93% for smartphone and tuning fork tests, respectively. The smartphone-based Rinne test could correctly discriminate between patients with an air–bone gap ≥ 25 dB at 512 Hz from patients with a lower or no air–bone gap at 512 Hz. The smartphone-based Rinne could not evaluate two patients with a moderately severe/severe sensorineural hearing loss due to their inability to detect the vibrations. Conclusion: A smartphone-based Rinne test was validated for the detection of an air–bone gap ≥ 25 dB at 512 Hz in the clinical setting. The validity of patient-operated smartphone-based Rinne test awaits further study. Level of evidence: 2B. [ABSTRACT FROM AUTHOR]

Purpose: Our group recently proposed the novel Padova prognostic scoring system for temporal bone carcinoma (TBSCC) that considers: the revised Pittsburgh staging system; radiological dura mater involvement; non-anterior spread (medial, inferior or posterior into the temporal bone and skull base) of T4 tumors; and histological grade. The aim of the present study was to validate this prognostic TBSCC scoring system in a case series selected from the literature. Methods: A search was run to identify studies on TBSCC reporting the variables included in our score for each patient. Then our system was applied to the data extracted. Results: Only two published investigations reported all the clinical and pathological data required for our scoring system. In one series from the Gruppo Otologico in Piacenza (Italy), a significantly higher recurrence rate (p = 0.008), shorter disease-free survival (DFS) (p = 0.001), higher disease-specific mortality (DSM) (p = 0.006), and shorter disease-specific survival (DSS) (p = 0.004) were associated with scores ≥ 5. Receiver operating curve (ROC) analysis showed an AUC of 0.804 for TBSCC recurrence, and 0.832 for DSM. In a series from Kyushu University Hospital (Japan), a significantly higher DSM (p = 0.018) and shorter DSS (p = 0.021) were associated with scores ≥ 5. ROC analysis showed an AUC of 0.812 for tumor relapse and 0.790 for DSM. Conclusion: Our TBSCC Padova scoring system confirmed its validity when applied to the only two international TBSCC series providing the required data. These preliminary results need to be confirmed in a multi-center prospective setting. [ABSTRACT FROM AUTHOR]

Background: The Cochlear™ Osia® System leaves a retroauricular bump that can cause discomfort and poor aesthetic outcome. Method: To reduce the retroauricular bump, we introduced an implant well in the bone behind the ear for the transducer. We used cutting and diamond drills to create the implant well with an average depth of 4–5 mm. The surgical time including the implant well (40 min) was within the range of reported average surgical time (52 min). Conclusion: Introduction of an implant well resulted in a better aesthetic outcome and improved patients' comfort. The reduced distance between BI300 and ear canal might improve audiological outcome. [ABSTRACT FROM AUTHOR]

Objective: To evaluate early results on hygiene, safety and functional outcome in a population undergoing a canal wall up technique with bony obliteration of the mastoid and epitympanic space (CWU-BOT) for extensive cholesteatoma, performed by a single surgeon. This study compares different techniques of tympanic membrane reconstruction, viz. allografts and autografts. Patients: A consecutive series of 61 ears with acquired cholesteatoma treated with primary or revision CWU-BOT surgery from 2009 to 2014. Intervention: Obliteration was performed by the use of cortical bone-chips and bone pâté. Patients were followed up with micro-otoscopy and MRI with diffusion-weighted imaging. Ossicular reconstruction was performed using a remodelled autologous or allogenic incus or malleus. Main outcome measures: Residual and recurrence rate and short- and mid-term hearing outcome prior to any revision tympanoplasty were analysed, the effect of type of tympanic membrane reconstruction was considered. Results: 44 Ears were primary cholesteatoma cases, 17 cases were referred for revision surgery. Mean postoperative follow up was 45 months (SD 18.08) and mean follow-up until the last non-EP DW MRI 42 months (SD 17.72). Recurrent disease was present in 3%, no residual disease was present. An AC gain was seen in 75% of all ears undergoing ossicular reconstruction. Conclusion: Reproducible safety, hygiene and hearing results with limited recurrence and residual disease can be obtained by younger otologic surgeons performing the BOT-CWU for extensive cholesteatoma while using a variety of grafts for tympano-ossicular reconstruction. The tympano-ossicular allograft nevertheless shows superior hearing results when a mobile intact stapes is present. Level of evidence: Level 4 [ABSTRACT FROM AUTHOR]

Hearing loss (HL) is the most common sensory impairment and is caused by a broad range of inherited to environmental causes. Inherited HL consists 50-60% of all HL cases. The inherited form of HL is further classified to different categories. More than 300 syndromes and 40 genes have been identified to result in different levels of HL. Although several diagnostic or screening tests have been developed, yet there are controversies around their use.

Purpose: The advent of endoscopic otosurgery provides reduced tissue destruction with theoretically improved views, yet a quantification of the difference of exposure between microscopic and endoscopic approaches has not yet been performed in human specimens. The objective of this study was to assess the difference in views of cadaveric tympanic membranes when inspected with operating microscopes or endoscopes. Methods: A circular graduated disc was inserted into eight cadaveric external ear canals to rest against the tympanic membrane. Three independent observers assessed the maximum possible observable radius of the graduated disc in each ear using a 0° endoscope and a surgical microscope in superior, inferior, posterior, and anterior directions. Results: The endoscope was able to view a significantly larger mean maximum visible radius than the microscope in posterior, superior, anterior, and inferior directions. This represented a mean gain in observable distance of 19.18%. There was a smaller variation in mean maximum visible radius than the microscope. Conclusion: The wider field of view in an endoscope compared to a microscope implies reduced surgical tissue damage is needed to provide sufficient operative exposure. Enhanced views of the attic were demonstrated by the endoscope, further indicating utility in cholesteatoma observation and surgery. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to evaluate the importance of acoustic modifications generated by different commercially available ear-tips, focused on domes of receiver in the canal hearing aids using Real Ear Measurement (REM). Methods: We enrolled 110 people selecting 200 ears bearers of hearing aids. In every patient, we performed REM and audiological tests with three different dome types: Open, Tulip and Double Closed (DC). Data about real-ear occluded gain (REOG), Pure Tone Average (PTA), Word Recognition Score (WRS) with aids switched on in Free Field, Ear and Auditory Comfort were collected and analyzed. Results: REOG gain was statistically significant different between the three types of dome, with a DC that always closes the external auditory canal (EAC) (p < 0.001). There was no statistically significant difference between the PTA (p = 0.11). Regarding the WRS there were statistically significant differences between Open and DC dome (p < 0.001) and between Tulip and DC dome (p < 0.001), with worse discrimination when using DC. Both auditory and ear comfort are worse in the DC than in the other two domes (p < 0.001). From measured REOG gain values, in 135 cases Tulip dome does not occlude the EAC, with a statistically significant difference compared to DC (p < 0.001; Odd Ratio 0.0012; 95% CI 0.001–0.0196). Conclusion: Our study confirms the necessity to perform REM to evaluate if the prescription target is achieved, especially when tulip domes are used, because they may not occlude the ear canal, causing in some cases the reduction of the vocal discrimination. [ABSTRACT FROM AUTHOR]

Purpose: Otolaryngologists have had to postpone the majority of surgical procedures in the current COVID-19 pandemic. Airborne transmission, beyond the projection of droplets from upper airways, expose healthcare workers to a risk of viral infection. Aerosol generating procedures (AGP) increase the risk of viral transmission to staff within the operating room. Methods: Surgery of middle ear and mastoid is also considered an AGP, particularly mastoidectomy performed using a high-speed drill. The authors report their experience in endoscopic ear surgery as an alternative technique to reduce AGP in otologic procedures. Results: Transcanal endoscopic ear surgery is a reliable technique used to manage many otologic conditions. Conclusion: The endoscopic approach may reduce the risk of viral transmission to operating room staff by reducing the need for mastoidectomy. [ABSTRACT FROM AUTHOR]

Purpose: This study analyzed the late ear complications of radiotherapy for nasopharyngeal cancer (NPC) and compared the conventional and intensity-modulated radiotherapy (2D-RT and IMRT, respectively).Methods: At 2-21 years after the end of NPC treatment, 104 ears of 52 patients were evaluated with the otoscopic examination, pure tone audiometry test, tympanometry, and subjective complaints by being blinded to the radiotherapy technique.Results: There were no differences in terms of the pathology of the external, middle or inner ear, air and bone-conduction hearing thresholds, and the air-bone (A-B) gap at 500, 1000, 2000, and 4000 Hz, and tympanometry types between 2D-RT and IMRT groups (p > 0.05). There were positive correlations between the values of A500 and A1000 thresholds; gap 500, 4000, and mean cochlear RT dose (p < 0.05). There were positive correlations between the values of A500, A1000, and A4000 thresholds; gap 500, 1000, 2000, 4000, and maximum cochlear RT dose (p < 0.05).Conclusion: IMRT was not found to be superior to 2D-RT to prevent RT-induced ear complications. The solution of the middle ear problems must be the goal of the strategies for complications treatment. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to explore if food perception can be influenced by sound mastication level when the external ear canal was occluded. Methods: Fifty-nine adults (38 women) with normal hearing, smell, and taste participated in the study. They tasted five crispy and five soft food items over two sessions: one with and one without an earplug inserted in the external ear canal. Participants were asked to rate freshness and taste of the food as well as their willingness to eat more of it and how much they usually like this kind of food. The sound pressure level related to the food mastication was recorded with a probe microphone placed in the external ear canal. Results: Compared to the open ear canal condition, levels of the mastication sounds were higher when the participants had their ears occluded, as well as for crispy than for soft food. Regarding food freshness, food appreciation, and willingness to eat more of the same food, there was no significant difference concerning food type, ear condition, and sex. For soft foods, men rated their usual liking of this food higher when they were wearing ear plugs compared to the opened condition. Conclusion: Plugging the ear canals led to increased mastication sound levels. Participants did not seem to consider these additional acoustic cues when they rated food freshness, food appreciation, and willingness of eating the specific food. Only men seemed to take these cues into account when they rated their habit consumption of soft food. [ABSTRACT FROM AUTHOR]

Microbial infection is one of the most significant causes of ear diseases, but microbial profiles are very diverse according to the diseases and change over time. The purpose of the study was to clarify differences and chronological changes in causative pathogens among infectious ear diseases over the last 20 years, and to identify antibiotic resistance. In total, 1191 isolates were included from patients diagnosed with chronic otitis media without cholesteatoma (COM), cholesteatomatous otitis media (Chole), middle ear effusion (MEE), including acute otitis media and otitis media with effusion, and external otitis (EO). Data were collected periodically for the years 1995, 2000, 2004, 2009, and 2013. Culture results and antibiotic resistance were assessed. The most common microorganism identified was S. aureus. The microbial profiles differed significant among the COM, Chole, and MEE groups ( p < 0.001). In contrast, there was no distinct difference between COM and EO ( p = 0.332). COM, Chole, and MEE also showed significant chronological changes in microbial profiles over time. The frequency of CNS increased markedly in COM and Chole ( p = 0.029 and 0.028, respectively); however, S. pneumoniae infection decreased significantly in MEE ( p = 0.016). Methicillin-resistant S. aureus (MRSA) demonstrated a constant trend ( p = 0.564), whereas ciprofloxacin-resistant P. aeruginosa increased over time ( p < 0.001). Microbial profiles have changed over a 20-year period. Increases in the frequency of coagulase-negative Staphylococcus (CNS) and bacterial resistance to ciprofloxacin, used widely in treating ear infections, are noteworthy. [ABSTRACT FROM AUTHOR]

Ménière's disease is associated with hydrops of the inner ear endolymphatic space, and histopathologically, the cochlea and vestibule are usually involved. We used gadolinium-enhanced magnetic resonance imaging and measured cervical and ocular vestibular evoked myogenic potentials and the gain in the utricular induced linear vestibulo-ocular reflex to test the hypothesis that vestibular hydrops in Ménière's disease patients is associated with otolith organ dysfunction. We evaluated 21 patients diagnosed with unilateral definitive Ménière's disease using gadolinium magnetic resonance imaging to detect endolymphatic hydrops in the cochlea and vestibule. Cervical and ocular vestibular evoked myogenic potentials and the gain in utricular induced linear vestibulo-ocular reflex during eccentric rotation were measured to assess otolith organ function. For eccentric rotation, patients were rotated while displaced from the axis of rotation, while linear acceleration stimulated the utricle and induced the vestibulo-ocular reflex. Magnetic resonance imaging revealed vestibular hydrops in 14 of 20 patients (70%). Among the 14 patients, ten (71%) had abnormal cervical and three (21%) had abnormal ocular vestibular evoked myogenic potentials. Four patients (4/21, 19%) had abnormal linear vestibulo-ocular reflexes, three of whom also had abnormal ocular vestibular evoked myogenic potentials. Overall, 16 of 17 patients had normal linear vestibulo-ocular reflexes and normal ocular vestibular evoked myogenic potentials. Vestibular endolymphatic hydrops in Ménière's disease patients caused otolith organ dysfunction, mainly in the saccule. The number of Ménière's disease patients with abnormal ocular vestibular evoked myogenic potentials was low (19%), and they also had abnormal utricular induced linear vestibulo-ocular reflexes. [ABSTRACT FROM AUTHOR]

The objective of the present study was to clarify the features of otological complications for hyperbaric oxygen therapy (HBOT) and the risk factors for these complications. We enrolled 1115 patients (776 males and 339 females; age 5-89 years) who underwent HBOT. All otological symptoms experienced during HBOT sessions were evaluated, and risk factors were analysed using multivariate logistic regression analysis. Otoscopic findings and interventions for otological complications were assessed in 58 symptomatic patients who visited the Otolaryngology Department. Otological symptoms were experienced by 165 (14.8 %) of the 1115 patients. The multivariate logistic regression analysis identified ages of >60 years and female sex as independent risk factors, whereas patients with sports injuries were at lower risk than those with other primary diseases, except for severe infectious disease. Eighty-two patients (49.7 %) suffered from symptoms at the first HBOT session. The most prevalent symptoms were otalgia (157/165), followed by ear fullness (13/165), hearing loss (12/165) and tinnitus (3/165). One patient experienced vertigo and deterioration of the bone-conduction pure-tone thresholds, suggesting inner ear barotrauma. In 116 ears of the 58 symptomatic patients, abnormal otoscopic findings were recognized in 58 ears (50.0 %). Twenty-seven of the 58 ears required myringotomy or tube insertion, and HBOT was stopped in eight ears in four patients. Of the remaining 58 ears with normal otoscopic findings, 51 received no treatment. Physicians should be aware of both middle and inner ear barotrauma as potential complications of HBOT. [ABSTRACT FROM AUTHOR]

Turner syndrome (TS) is one of the most frequently encountered sex-linked chromosomal abnormalities, occurring in one per 2,000 female births. These patients present with short stature and failure to begin puberty. In this syndrome, there are multiple organ abnormalities, including auditory disorders. TS patients were referred to the ENT clinic by a pediatric endocrinologist. A questionnaire was filled out and the patients went through a complete otologic examination. They were then referred to the audiology clinic to undergo audiologic test battery plus high-frequency pure tone audiometry. From a total of 48 ears examined, 11 (22.9 %) had a normal audiometry. Mid-frequency sensorineural hearing loss (SNHL), high-frequency SNHL, combined and mixed hearing loss were diagnosed in 6 (12/5 %), 20 (41/7 %), 6 (12/5 %) and 1 (2/1 %) ear, respectively. Tympanogram results showed normal compliance (A, As, Ad) in the majority of cases. B and C patterns were found in a few cases. Speech discrimination score was normal in all patients whereas speech reception threshold was normal in 92 % of the ears. Audiometry abnormality especially SNHL is common in TS patients, with the high-frequency pattern being the most frequent. [ABSTRACT FROM AUTHOR]

The pathogenesis of a seborrheic keratosis has not been fully elucidated. In the present study, we reviewed the literature to increase the awareness of this disease among otolaryngologists and to stress the need for prompt diagnosis and treatment. This was a retrospective study in seven patients presenting with seborrheic keratoses in the ear. We included only those patients in whom keratoses were confirmed by pathology after a complete excision. In six patients, seborrheic keratoses were observed in the external auditory canal, and in one patient, they were observed in the auricle. The subtype of keratoses was classified as acanthotic in six patients; one patient had an unclassified type associated with basal cell carcinoma. Seborrheic keratoses are benign skin tumors; however, the lesions can recur after removal. Moreover, an association between seborrheic keratoses and malignant skin tumors has been reported. Therefore, otolaryngologists should consider a complete removal and histological examination of seborrheic keratoses. [ABSTRACT FROM AUTHOR]

The objective of the study was to determine the temporal occurrence of cochlear obliteration following translabyrinthine vestibular schwannoma resection. A retrospective chart review, cross-sectional study, and sequential analysis of the time series were performed. The retrospective study included patients undergoing translabyrinthine resection for stage T1-T2 vestibular schwannoma from 2007 to 2010 without prior therapy and postoperative follow-up including MRI of the brain and the cerebellopontine angle. Already 3 months after surgery a radiographic labyrinthine change was observed in 66.7 %, a partial obstruction in 50 %, and an obstruction limited to the saccule in 16.7 %. Only 33.3 % of the patients showed an unchanged inner ear. In consideration of early cochlear obstruction after translabyrinthine vestibular schwannoma resection, temporary follow-up is necessary. Since the indications for cochlear implantation (CI) have been extended, especially concerning patients with single-side deafness, a simultaneous or early second-stage CI after tumour removal should be discussed. [ABSTRACT FROM AUTHOR]

Caffeine is implicated as causing or aggravating numerous otorhinolaryngological conditions, including tinnitus, Ménière's disease, laryngopharyngeal reflux, globus pharyngeus and dysphonia. We address caffeine's effects in such conditions and to determine whether such implications are founded. The defined search limits of data sources included human trials and either randomised control trials, meta-analyses, editorials, letters, clinical trials, case reports, comments or journal articles over the last 40 years. MEDLINE, EMBASE and CINAHL databases were searched using 'otorhinolaryngological diseases' and 'caffeine' as a duplicate filter. PubMed databases were searched using 'caffeine' in combination with 'tinnitus', 'Ménière's', 'vertigo', 'motion sickness', 'imbalance', 'vestibular migraine', 'voice', 'vocal hygiene', 'reflux', 'ear', 'nose', 'throat' and 'head neck cancer', respectively. Searches were not limited to the English language. MEDLINE, EMBASE and CINAHL database searches identified 417 papers. Of these, 200 abstracts were chosen for further scrutiny, following which 30 full manuscripts were chosen for full review. The PubMed database search identified 275 abstracts of which 33 were reviewed. Of the total 692 studies searched, 63 studies were reviewed and 36 were finally used. At present, there is little evidence in the literature to support the notion that caffeine causes or aggravates otorhinolaryngological conditions. In tinnitus, its withdrawal may actually worsen symptoms whereas in motion sickness, there is some clinical evidence for its benefit. More research is needed into the role caffeine plays in otorhinolaryngological conditions to allow clinicians to give informed advice to their patients. [ABSTRACT FROM AUTHOR]