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Learning Objective: To assess the visibility of the round window (RW) during cochlear implant (CI) surgery in pediatric patients through posterior tympanotomy versus trans canal route. Methodology: 80 prelingual pediatric patients prepared for CI were divided in randomized manner into two groups. Group (A): 40 patients underwent CI through classic mastiodectomy posterior tympanotomy approach (MPTA). Group (B): 40 patients underwent CI using endoscopic assisted combined approach technique (CAT) with limited posterior tympanotomy. Intraoperative evaluation of RW visibility through wide posterior tympanotomy after blue lining of the facial nerve (FN) and chorda tympani nerve (CTN) in group (A) patients and compared to RW visibility through trans canal using oto-microscopy and oto-endoscopy in group (B) patients. Results: Out of 40 patients in group (A), RW was fully visible in 20 patients through wide posterior tympanotomy, more than 50% of RW was visible in 10 patients, less than 50% of RW was visible in 8 patients and in 2 patients the RW could not bee seen with maximum surgical effort. For group (B), RW was fully visible in 24 patients through trans canal, more than 50% of RW was visible in 12 patients and in 4 patients less than 50% of RW was visible when using the oto-microscopy. In group (B) patients, the RW was fully visible in all patients when 00 endoscope was used. Conclusion: Endoscopic assisted CI surgery improves the RW visibility which is an important issue during CI surgery. [ABSTRACT FROM AUTHOR]

Background: Several coronavirus vaccine have been fast-tracked to halt the pandemic, the usage of immune adjuvants that can boost immunological memory has come up to the surface. This is particularly of importance in view of the rates of failure of seroconversion and re-infection after COVID-19 infection, which could make the vaccine role and response debatable. Peroxisome proliferator-activated receptors (PPARs) have an established immune-modulatory role, but their effects as adjuvants to vaccination have not been explored to date. It is increasingly recognized that PPAR agonists can upregulate the levels of anti-apoptotic factors such as MCL-1. Such effect can improve the results of vaccination by enhancing the longevity of long-lived plasma cells (LLPCs). The interaction between PPAR agonists and the immune system does not halt here, as T cell memory is also stimulated through enhanced T regulatory cells, antagonizing PD-L1 and switching the metabolism of T cells to fatty acid oxidation, which has a remarkable effect on the persistence of T memory cells. What is even of a more significant value is the effect of PPAR gamma on ensuring a profound secretion of antibodies upon re-exposure to the offending antigen through upregulating lipoxin B4, therefore potentially assisting the vaccine response and deterring re-infection., Short Conclusion: In view of the above, we suggest the use of PPAR as adjuvants to vaccines in general especially the emerging COVID-19 vaccine due to their role in enhancing immunologic memory through DNA-dependent mechanisms.