Search

Purpose: To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients. Methods: Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air–bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. Results: Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6 weeks to 24 months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12 months (OR = 2.24, 95% CI 1.33–3.78) and 24 months (OR = 2.96, 95% CI 1.18–7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6 weeks to 12 months). Conclusions: Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore the method of adding a secondary perichondrium patch to enhance the primary cartilage–perichondrium patch during endoscopic myringoplasty and to evaluate the effectiveness of this method in terms of healing rate and post-operative hearing of patients with poor prognostic factors (eustachian tube dysfunction, large perforations, subtotal perforations, and anterior marginal perforations). Design: This retrospective study analyzed a total of 80 patients (36 females and 44 males, median age of 40.55 years) who had received a secondary perichondrium patch during endoscopic cartilage myringoplasty. Patients were followed up for 6 months. Healing rates, complications, preoperative and postoperative pure-tone average (PTA) and air–bone gap (ABG) were analyzed. Results: At 6-month follow-up, the healing rate of tympanic membrane was 97.5% (78/80). The mean pure-tone average (PTA) improved from 43.18 ± 14.57 dB HL pre-operatively to 27.08 ± 9.36 dB HL 6 months after the operation (P = 0.002). Similarly, the mean ABG improved from 19.05 ± 5.72 dB HL pre-operatively to 9.36 ± 3.75 dB HL (P = 0.0019) at 6 months after the operation. Major complications were not observed during follow-up. Conclusions: The use of a secondary perichondrium patch during endoscopic cartilage myringoplasty for large, subtotal and marginal tympanic membrane perforations achieved a high healing rate and a statistically significant hearing gain with low incidence of complications. [ABSTRACT FROM AUTHOR]

Objective: We compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague–Dawley (SD) rats with and without excision of the mallear handle. Materials and methods: Bilateral, acute, and total TM perforations were created in 36 male SD rats. The mallear handle was preserved in the left ear (handle‐preserved ear [HPE]) and excised from the right ear (handle‐excised ear [HEE]). Endoscopical examination, auditory brainstem response (ABR) thresholds, histopathological, and scanning electron microscope (SEM) analysis were performed. Results: Endoscopic photographs showed that all perforations in the 18 SD rats were closed. The mean closure times were 6.83 ± 0.85 and 8.50 ± 0.71 days in the HPE and HEE groups, respectively (p <.001). SEM images showed radial arrangement of fiber bundles in a single direction in HPEs, although normal arrangement was not achieved. In contrast, HEEs showed disorganized arrangement. At 1 month after perforation closure, the ABR thresholds at high frequencies were significantly higher in the HEE group than in the HPE group (p =.029 and p =.017 for 16 and 32 kHz, respectively). Additionally, the changes in ABR threshold were significantly different at high frequencies (p =.011 and p =.017 for 16 and 32 kHz, respectively) before and 1 month after perforation closure between the HPE and HEE groups, although the differences were not statistically significant at the remaining frequencies. Conclusion: Although the malleus handle may not affect the closure of total perforation in SD rats, it contributes to accelerate the perforation closure by possible guide the migration of proliferative epithelial cell on the upper halves of the annulus. Additionally, resection of the malleus handle impairs high frequency hearing recovery following spontaneous closure of the TM. [ABSTRACT FROM AUTHOR]

To evaluate Eustachian tube (ET) function after Kobayashi plug surgery based on the tympanic membrane (TM) findings and active opening (AO) of the ET assessed with sonotubometry. A retrospective survey of medical records identified 74 ears of 66 patients with patulous ET (PET) received transtympanic insertion of the Kobayashi plug. Excluding the six ears (6 patients) with abnormal preoperative TM, sixty-eight ears of 60 patients were found to have normal TM preoperatively. Among these 68 ears, there were 51 ears in which sonotubometry was performed both before and after surgery to evaluate whether the AO of the ET was positive or not. Out of the 68 ears with normal preoperative TM, 52 ears (76.5%) were judged successful (sum of complete relief and significant improvement). The postoperative TM was normal in 41 ears (60.3%), while 27 ears (39.7%) had abnormal TM findings postoperatively. The success rate was 75.6% (31/41) in ears with normal postoperative TM, while it was 77.8% (21/27) in ears with abnormal TM. Success in maintaining normal postoperative TM was found in 45.6% (31/68) of the total ears treated. Out of the 51 ears in which sonotubometry was performed both before and after surgery, AO was preoperatively positive in 88.2% of the ears (45/51), while it was positive in 64.7% (33/51) postoperatively. In thirty-four ears with normal TM postoperatively, AO was positive in 24 ears (70.6%), while it was positive in 9 out of 17 ears (52.9%) with abnormal postoperative TM. The success rate was 70.6% (36/51) for the 51 ears in which AO was assessed both pre- and postoperatively, and it was 66.7% (22/33) in ears with positive AO postoperatively, while it was 77.8% (14/18) in ears without AO postoperatively. The incidence of ears either having normal postoperative TM or positive AO postoperatively was 84.3% (43/51). Abnormal postoperative TM findings without effectiveness were found in 8.8% (6/68). The obstructive dysfunction of the ET is a calculated risk but did not occur in most ears after plugging with the Kobayashi plug. Therefore, routine insertion of the VT at the same time as the initial surgery is not recommended for PET cases that are adequately followed up. [ABSTRACT FROM AUTHOR]

Butterfly inlay myringoplasty is a simple and practical surgical technique used in the repair of tympanic membrane perforation offering good outcomes in terms of hearing. The present study evaluates the effects of myringosclerosis on the success of surgery by reviewing demographic data, perforation size and hearing outcomes of patients undergoing endoscopic inlay butterfly myringoplasty due to chronic otitis media. The study included 75 patients who underwent endoscopic inlay butterfly myringoplasty with the diagnosis of chronic suppurative otitis media in the Department of Otorhinolaryngology at Fırat University Faculty of Medicine between March 2018 and July 2021. The patients were divided into three groups as the following. Group I: Patients without a myringosclerotic focus in the neighborhood of tympanic membrane perforation, Group II: Patients with a less than 50% myringosclerotic focus in the neighborhood of tympanic membrane, and Group III: Patients with a more than 50% myringosclerotic focus in the neighborhood of tympanic membrane. The comparison of all preoperative and postoperative parameters and the reduction in air-bone gap between the groups did not show statistically significant difference (p >0.05). The comparison of air-bone gaps between preoperative and postoperative measurements showed a statistically significant difference in all groups (p <0.05). The grafting success rate was 100% in Group I, 96.4% in Group II, and 95.6% in Group III. The mean operation time was 28.57±2.54 min in Group I, 32.14±2.44 min in Group II, and 30.69±3.43 in Group III; there was a statistically significant difference only between Group I and Group II (p = 0.001). The graft success rate and hearing gain in patients with myringosclerosis were similar to those in patients without myringosclerosis. Therefore, butterfly inlay myringoplasty is applicable to patients with chronic otitis media regardless of the presence or absence of myringosclerosis. [ABSTRACT FROM AUTHOR]

Featured Application: Our work shows the application of electrospinning and electrospray to develop a tympanic membrane patch based on alginic acid, aimed at delivering probiotics and/or postbiotics to the middle ear. The possibility of contrasting chronic infections using probiotics is an emerging strategy, proposed as an alternative to antibiotics. Middle ear bacteriotherapy mediated by a probiotic/alginate patch can open new therapeutic routes in otology for those patients with chronic otitis media. Antimicrobial resistance poses a growing challenge in respiratory tract diseases like otitis media, often necessitating surgical interventions due to pharmacological treatment limitations. Bacteriotherapy, involving probiotics and/or their bioproducts, emerges as a promising alternative in such a scenario. This study aims to pave the way to middle ear bacteriotherapy by developing an innovative sodium alginate (SA)-based probiotic delivery system using electrospinning and electrospray techniques. Electrospray enabled the precise production of probiotic-laden SA microparticles, demonstrating potential for targeted bacterial delivery. By overcoming challenges due to the SA molecular structure, we successfully electrospun SA-based fiber meshes with poly(ethylene oxide) (PEO) as a support polymer. The rheologic behavior of the probiotic/SA solutions and the morphology of the obtained microparticles and fibers was evaluated, along with the diameter variation over time. The cytocompatibility of the produced microparticles and fibers was assessed using human dermal keratinocytes and their antimicrobial activity was tested against E. coli. The incorporation of probiotic-laden SA microparticles within electrospun SA/PEO fiber meshes finally offered a patch-like structure to be applied on the tympanic membrane or on the outer auditory canal, which could be a versatile and ideally safe treatment strategy in chronic otitis media. This innovative approach holds promise for clinical applications dealing with inflammatory processes, infections and dysbiosis, thus possibly addressing the complex healing process of chronic upper respiratory diseases while mitigating antimicrobial resistance. [ABSTRACT FROM AUTHOR]

To report an adverse event after successful otosclerosis surgery: piston extrusion through the tympanic membrane, and its surgical solution. Four patients with a history of stapes surgery in context of otosclerosis presented with recurrent conductive hearing loss due to piston extrusion. Otoscopy, audiometric assessment and CT-imaging were conducted to assess the encountered conductive hearing loss and extrusion of the prosthesis. Revision stapes surgery was performed with interposition of cartilage between tympanic membrane and piston-loop. Pre- and postoperative audiometry and otoscopic evaluation. Revision surgery resulted in postoperative ABG within 15 dB. No recurrent extrusion was seen after the mentioned surgical procedure including use of cartilage graft. In case of piston extrusion (trans-tympanic membrane), revision stapes surgery with interposition of a cartilage layer between tympanic membrane and piston is advocated to prevent recurrence. [ABSTRACT FROM AUTHOR]

The anatomy of the auditory region of fossil hominins may shed light on the emergence of human spoken language. Humans differ from other great apes in several features of the external, middle and inner ear (e.g., short external ear canal, small tympanic membrane, large oval window). However, the functional implications of these differences remain poorly understood as comparative audiometric data from great apes are scarce and conflicting. Here, we measure the sound transfer function of the external and middle ears of humans, chimpanzees and bonobos, using laser-Doppler vibrometry and finite element analysis. This sound transfer function affects auditory thresholds, which relate to speech reception thresholds in humans. Unexpectedly we find that external and middle ears of chimpanzees and bonobos transfer sound better than human ones in the frequency range of spoken language. Our results suggest that auditory thresholds of the last common ancestor of Homo and Pan were already compatible with speech reception as observed in humans. Therefore, it seems unlikely that the morphological evolution observed in the bony auditory region of fossil hominins was driven by the emergence of spoken language. Instead, the peculiar human configuration may be a by-product of morpho-functional constraints linked to brain expansion. [ABSTRACT FROM AUTHOR]

Background: Chronic Otitis Media (COM) is the term used to describe any chronic inflammatory pathology of the middle ear cleft without reference to etiology or pathogenesis. High resolution computed tomography (HRCT) the temporal bone provide significant advantages in differentiating between the bone and soft tissue in high contrast images. In this research paper, we have studied the pre-operative HRCT effectiveness in identifying the abnormalities and its aid in tympanomastoid surgery. Methodology: This was a cross sectional study conducted in department of ENT, Indira Gandhi Government General Hospital and Postgraduate Institute, Puducherry from January 2019 to June 2020 with Sample size of 35. Patient diagnosis was made and pre-operative HRCT temporal bone done. Patient was then taken up for surgery and Intra-operative findings noted. Conclusion: In this study which included 35 patients of Chronic Otitis Media attending a tertiary care hospital, the following conclusions made. The mean age of presentation is 36.5 years. Visualization of Tympanic membrane is poor as it was tough to differentiate between Retraction and perforation. The involvement of middle ear identification in HRCT is satisfactory. The ossicles were visualized, even when surrounded soft tissue density. However they cannot be reliable on the scans. The visualization of bony structures (tegmen, LSCC) were high except for the facial canal. This may be misleading due to errors in reconstruction. HRCT couldn't differentiate between various soft tissue densities. [ABSTRACT FROM AUTHOR]

Hearing is an active process, and recent studies show that even the ear is affected by cognitive states or motor actions. One example are movements of the eardrum induced by saccadic eye movements, known as "eye movement-related eardrum oscillations" (EMREOs). While these are systematically shaped by the direction and size of saccades, the consequences of saccadic eye movements and their resulting EMREOs for hearing remain unclear. We here studied their implications for the detection of near-threshold clicks in human participants. Across three experiments, sound detection was not affected by their time of presentation relative to saccade onset, by saccade amplitude or direction. While the EMREOs were shaped by the direction and amplitude of the saccadic movement, inducing covert shifts in spatial attention did not affect the EMREO, suggesting that this signature of active sensing is restricted to overt changes in visual focus. Importantly, in our experiments, fluctuations in the EMREO amplitude were not related to detection performance, at least when monaural cues are sufficient. Hence, while eye movements may shape the transduction of acoustic information, the behavioral implications remain to be understood. [ABSTRACT FROM AUTHOR]

We report a rare case of isolated malleus dislocation into the external auditory canal with lateralized intact tympanic membrane following a head trauma. The patient was a 63-year-old woman who presented at the outpatient department of our institute with hearing loss of 10 years' duration after a bicycle accident. During physical examination of the patient, total dislocation of the malleus-like bony structure into the external auditory canal on the right side was observed. In the computed tomography scan, an isolated malleus dislocation with intact incus-stapes articulation was identified. The patient was successfully treated with endoscopic exploratory tympanotomy and partial ossicular replacement prosthesis. The isolated malleus dislocation can rarely occur after trauma. A careful diagnostic step through history, physical examination, and temporal bone computed tomography scan are needed to confirm this rare condition. [ABSTRACT FROM AUTHOR]

Objective: To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. Methods: A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. Results: Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. Conclusion: Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. Level of Evidence: 3B [ABSTRACT FROM AUTHOR]

Otitis media with effusion (OME), primarily seen in children aged 2 years and younger, is characterized by the presence of fluid in the middle ear, often resulting in hearing loss and aural fullness. While deep learning networks have been explored to aid OME diagnosis, prior work did not often specify if pediatric images were used for training, causing uncertainties about their clinical relevance, especially due to important distinctions between the tympanic membranes of small children and adults. We trained cross-validated ResNet50, DenseNet201, InceptionV3, and InceptionResNetV2 models on 1150 pediatric tympanic membrane images from otoendoscopes to classify OME. When assessed using a separate dataset of 100 pediatric tympanic membrane images, the models achieved mean accuracies of 92.9% (ResNet50), 97.2% (DenseNet201), 96.0% (InceptionV3), and 94.8% (InceptionResNetV2), compared to the seven otolaryngologists that achieved accuracies between 84.0% and 69.0%. The results showed that even the worst-performing model trained on fold 3 of InceptionResNetV2 with an accuracy of 88.0% exceeded the accuracy of the highest-performing otolaryngologist at 84.0%. Our findings suggest that these specifically trained deep learning models can potentially enhance the clinical diagnosis of OME using pediatric otoendoscopic tympanic membrane images. [ABSTRACT FROM AUTHOR]

Objectives: To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow‐up, 6–24 months after surgery. Design: A retrospective cohort study of prospectively collected data. Setting: Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013–2019. Participants: All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow‐up visit. Main Outcome Measures: The effect of PA use on TM healing rate at follow‐up and postoperative infection within 6 weeks of surgery. Results: In the study group (n = 1665) 86.2% had a healed TM at follow‐up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs. Conclusion: PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery. [ABSTRACT FROM AUTHOR]

Objective: Review the effectiveness of surgical and non‐surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma. Design: Narrative review. Setting: ENT and otology services worldwide. Participants: Patients with non‐cholesteatoma tympanic membrane retractions. Main Ouctome measure: Changes in retraction (progression or resolution, or development of a known sequela such as perforation). Results: Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures. Conclusion: Few high‐quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare graft outcome, operation time and surgical complications of the double and single perichondrium–cartilage underlay techniques for repairing subtotal tympanic membrane (TM) perforations. Materials and methods: Patients with unilateral subtotal perforations undergoing myringoplasty were prospectively randomized to undergo DPCN or SPCN. The operation time, graft success rate, audiometric outcomes, and complications were compared between these groups. Results: In total, 53 patients with unilateral subtotal perforations were included (DPCN group, 27; SPCN group, 26).All patients completed 6 months of follow-up. The mean operation time was 41.2 ± 1.8 min in the DPCN group and 37.2 ± 5.4 min in the SPCN group, the difference was not significant (p = 0.613).The graft success rates were 96.3% (26/27) in the DPCN group and 73.1% (19/26) in the SPCN group, the difference was significant (p = 0.048). During the period of follow-up, residual perforation was found at postoperative in one (3.7%) in the DPCN group, while cartilage graft slipped (graft lateralization) in 2 (7.7%) and residual perforation in 5 (19.2%) were found in the SPCN group, the difference of residual perforation was not significant among two group (p = 0.177).In addition, no significant between-group differences were observed pre- (p = 0.741) or post- (p = 0.687) operative ABG values or mean ABG gain (p = 0.659) (Table 2).The functional success rates (postoperative ABG ≤ 20 dB) were 85.2% (23/27) in the DPCN group and 73.1% (19/26) in the SPCN group (p = 0.454). Conclusion: Although similar functional result and operation time can be obtained with double perichondrium–cartilage underlay technique compared to the single perichondrium–cartilage underlay technique for endoscopic closure of subtotal perforations, double unerlay technique offers better anatomical result with minimum complications. [ABSTRACT FROM AUTHOR]

Acute otitis media (AOM) is one of the most common diseases found in the pediatric population. This disease is characterized by protrusion or bulging of the tympanic membrane which occurs together with otalgia and non-specific symptoms such as fever, irritability and malaise. Risk factors for this disease are related to young age, genetics, a history of recurrent upper respiratory tract infections, immune system disorders and facial anatomical abnormalities that affect the function of the eustachian tube. AOM needs appropriate treatment to prevent future complications such as speech and language disorders in children due to decreased hearing function caused by this disease. This literature review aims to discuss the current diagnosis and management of acute otitis media. [ABSTRACT FROM AUTHOR]

Objective: Attic retraction pockets, classified by degree of invasion and erosion, are reconstructed here as outlined by attic retraction pocket grade. Method: Attic retraction pocket grade, surgical management, subsequent conditions of tympanic membrane and middle ear, and improvement of air–bone gap pure tone average were recorded. Results: Our management strategy, based on attic retraction pocket grade, was applied to 200 ears: 44 grade I ears had non-surgical management and 156 grade II–V ears had surgical management. All 200 ears were followed up for 36–240 months, showing only 1 attic retraction pocket reformation and 1 adhesive otitis media (complication rate of 1 per cent), and improved air–bone gaps (p < 0.05). An earlier series of 50 grade IV attic retraction pockets used atticotomy with epitympanic reconstruction. These showed attic retraction pocket recurrence or cholesteatoma onset in 34 ears (68 per cent). When these ears were revised per protocol, there was no evidence of cholesteatoma thereafter. Conclusion: Reconstruction of the ossicles and scutal defect according to attic retraction pocket grade shows long-term stability of the tympanic membrane, middle ear and hearing. [ABSTRACT FROM AUTHOR]

Background. Animal communication consists of signal production and perception, which are crucial for social interactions. The main form used by anurans is auditory communication, in most cases produced as advertisement calls. Furthermore, sound perception happens mainly through an external tympanic membrane, and plays an important role in social behavior. In this study, we evaluated the influence of body and tympanic membrane sizes on call frequency across the phylogeny of anurans. Methods. We use data on snout-vent length, tympanic membrane diameter, and dominant frequency of the advertisement call from the literature and from natural history museum collections. We mapped these traits across the anuran phylogeny and tested different models of diversification. Our final dataset includes data on body size, tympanic membrane size, and call dominant frequency of 735 anuran species. Results. The best explanatory model includes body and tympanum size with no interaction term. Although our results show that call frequency is strongly constrained by body and tympanum size, we identify five evolutionary shifts in allometry from that ancestral constraint. We relate these evolutionary shifts to the background noise experienced by populations. Body size is important for myriad ecological interactions and tympanum size is strongly associated with female call frequency preferences. Thus, allometric escape in frog calls might arise through environmental selection such as breeding in fast flowing or soundscape competition, as well as sexual selection linked to tympanum size. [ABSTRACT FROM AUTHOR]

Adult mammals are generally believed to have limited ability to regenerate complex tissues and instead, repair wounds by forming scars. In humans and across mammalian species, the tympanic membrane (TM) rapidly repairs perforations without intervention. Using mouse models, we demonstrate that the TM repairs itself through a process that bears many hallmarks of epimorphic regeneration rather than typical wound healing. Following injury, the TM forms a wound epidermis characterized by EGFR ligand expression and signaling. After the expansion of the wound epidermis that emerges from known stem cell regions of the TM, a multi-lineage blastema-like cellular mass is recruited. After two weeks, the tissue architecture of the TM is largely restored, but with disorganized collagen. In the months that follow, the organized and patterned collagen framework of the TM is restored resulting in scar-free repair. Finally, we demonstrate that deletion of Egfr in the epidermis results in failure to expand the wound epidermis, recruit the blastema-like cells, and regenerate normal TM structure. This work establishes the TM as a model of mammalian complex tissue regeneration. [ABSTRACT FROM AUTHOR]

The three additive manufacturing techniques fused deposition modeling, gel plotting and melt electrowriting were combined to develop a mimicry of the tympanic membrane (TM) to tackle large TM perforations caused by chronic otitis media. The mimicry of the collagen fiber orientation of the TM was accompanied by a study of multiple funnel-shaped mimics of the TM morphology, resulting in mechanical and acoustic properties similar to those of the eardrum. For the different 3D printing techniques used, the process parameters were optimized to allow reasonable microfiber arrangements within the melt electrowriting setup. Interestingly, the fiber pattern was less important for the acousto-mechanical properties than the overall morphology. Furthermore, the behavior of keratinocytes and fibroblasts is crucial for the repair of the TM, and an in vitro study showed a high biocompatibility of both primary cell types while mimicking the respective cell layers of the TM. A simulation of the in vivo ingrowth of both cell types resulted in a cell growth orientation similar to the original collagen fiber orientation of the TM. Overall, the combined approach showed all the necessary parameters to support the growth of a neo-epithelial layer with a similar structure and morphology to the original membrane. It therefore offers a suitable alternative to autologous materials for the treatment of chronic otitis media. Millions of people worldwide suffer from chronic middle ear infections. Although the tympanic membrane (TM) can be reconstructed with autologous materials, the grafts used for this purpose require extensive manual preparation during surgery. This affects not only the hearing ability but also the stability of the reconstructed TM, especially in the case of full TM reconstruction. The synthetic alternative presented here mimicked not only the fibrous structure of the TM but also its morphology, resulting in similar acousto-mechanical properties. Furthermore, its high biocompatibility supported the migration of keratinocytes and fibroblasts to form a neo-epithelial layer. Overall, this completely new TM replacement was achieved by combining three different additive manufacturing processes. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Paragangliomas are neuroendocrine neoplasms derived from paraganglia of the sympathetic and parasympathetic nervous systems. Parasympathetic ganglia-derived tumors, also called non-chromaffin, are located almost exclusively in the neck and skull base and are usually non-secretory and inactive. A case of malignant glomus jugulare with a metastatic cervical lymph node is described here. Case Report: A 24-year-old woman was referred to an otolaryngology clinic for concern of voice change for 1 month, which was associated with right progressive hearing loss, pulsating tinnitus, and right facial weakness. A clinical examination revealed a reddish mass in the right ear behind an intact tympanic membrane with right facial weakness of House-Brackmann grade VI. A bedside flexible nasopharyngoscopy revealed an immobile right vocal fold. A computed tomography scan of the brain revealed a destructive lesion within the right jugular foramen. The patient underwent embolization followed by glomus tumor resection via infra-temporal fossa with Fisch type A approach. Pathology revealed that the tumor was an infiltrative epithelioid tumor with a spindle and nesting pattern separated by fibrovascular stroma. The submitted lateral neck lymph node revealed a metastatic tumor. Conclusions: Glomus jugulare tumors are uncommon paragangliomas, and malignant behavior with metastasis is extremely rare. Metastatic tumors are often associated with facial and vagal nerves palsy. There are no histological features that distinguish malignant glomus jugulare tumors. Malignant neoplasms are characterized by the presence of metastases. Tumors of the glomus jugulare that are malignant are treated with surgery, radiotherapy, or both. However, our search of the literature revealed no clear guidelines, given the scarcity of cases. Moreover, the presence of metastasis increases the risk of death. [ABSTRACT FROM AUTHOR]

This work focuses on developing a novel bioscaffold for tympanic membrane (TM) repair. A strategy to fabricate porous scaffolds is proposed, which is based on the chitosan membranes that were cross-linked and modified by tert-butyl acetoacetate esterified polyethylene glycol, while their mechanical properties and hydrophilicity were also improved. With two different crosslink methods, direct and freeze cross-linking, the chitosan-polyethylene glycol membranes were fabricated. Based on the morphology, hydrophilicity, and mechanical property, the biomedical scaffold has good enough properties for TM repair and the freeze cross-linking membrane is better. Our work provides a simple and reliable method for the preparation of bioscaffolds. [ABSTRACT FROM AUTHOR]

Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection. [ABSTRACT FROM AUTHOR]

Objective: In tympanic membrane perforations, the location and size of the perforation, and the mastoid and tympanic volume can affect the hearing level. The aim of the study is to reveal the level of hearing loss that develops in male patients with tympanic membrane perforation and evaluate the effect of tympanic and mastoid volume on hearing loss. Material and Methods: In this retrospective study, we included 35 ears of 28 male patients. The tympanic membrane perforation sizes, localizations, hearing levels, and mastoid and tympanic volumes were noted and compared. Results: When the correlation between the 'whole tympanic membrane diameter/perforation diameter' ratio and the air conduction hearing thresholds was analyzed, it was seen that there was a moderate and opposite correlation in all the frequencies and this was statistically significant. When the correlation between the tympanic volume and the air conduction thresholds was analyzed, it was seen that the diference not statistically significant. When the correlation between the mastoid volume and the air conduction thresholds was analyzed, no statistical significance was noted. Conclusion: The degree of conductive hearing loss resulting from a tympanic membrane perforation increases when the size of perforation expands, degree of middle ear pneumatization and mastoid pneumatization ratios have no effect on hearing. [ABSTRACT FROM AUTHOR]

Ossicular chain disruption is a typical consequence of temporal bone trauma. However, it can also occur as a result of direct trauma to the ossicular chain due to penetrating injuries. Hearing loss, dizziness, and facial nerve damage could also occur after penetrating middle ear injuries. Multiple ossicular chain disruption is a rare traumatic ossicular complication caused by direct penetrating lesions in the external auditory canal. We present two cases of multiple ossicular disruptions (dislocation of the incudostapedial and malleoincudal joints) after ear-pick injuries, both of which resulted in conductive hearing loss. The condition improved after delayed surgical intervention (ossiculoplasty). [ABSTRACT FROM AUTHOR]

Intratympanic steroid injection (ITSI) can be an effective treatment for sudden sensorineural hearing loss or Meniere's disease. Tympanic membrane (TM) perforation after ITSI is a major complication which needs additional treatment. The purpose of this study is to assess the factors associated with TM perforation after ITSI. We obtained the clinical data of patients who underwent ITSI treatment at the Department of Otolaryngology JR Tokyo General Hospital from April 2013 to March 2021. The data included age, sex, treated side, number of injections, average interval between injections, TM anesthesia with Zentöl solution, which contains phenol, any history of diabetes and any concurrent use of oral or intravenous steroids. We evaluated the association between these variables and TM perforation after ITSI using the Student's t-test, the chi-squared test, univariate logistic regression analysis and multivariate logistic regression analysis. TM perforation was defined as a case in which perforation was observed at least once during outpatient visits. Records of 205 ears in 190 patients were analyzed. The overall proportion of TM perforation in the early period after ITSI was 12.7% (26 out of 205 ears), which decreased to 9.3% (19 out of 205 ears) and 5.9% (12 out of 205 ears) at the 1- and 3-month follow-ups, respectively. The proportion of TM perforation in the early period after ITSI without TM anesthesia was 3.5% (5 ears out of 145 ears), which decreased to 1.4% (2 ears) or 0% at the 1- or 3- month follow-ups, respectively. The use of tympanic anesthetics which contain phenol was significantly associated with TM perforation in univariate logistic regression analysis (odds ratio: 15.08, 95% confidence interval: 5.34–42.56, p < 0.001) and in multivariate analysis (odds ratio: 20.76, 95% confidence interval: 6.31–68.3, p < 0.001). All TM perforation cases without TM anesthesia healed spontaneously or with paper tympanic closure treatment. TM perforation in 6 ears out of 21 ears with TM anesthesia did not heal during the follow-up. The overall proportion of TM perforations from the early period after ITSI was 12.7%, 9.3% at the 1-month post-ITSI outpatient follow-up, 5.9% at the 3-month post-ITSI outpatient follow-up. Tympanic anesthesia was significantly associated with TM perforation after ITSI, which indicated that TM anesthesia with solutions containing phenol is not recommended for ITSI. [ABSTRACT FROM AUTHOR]

This is an update of the 2015 Guidelines developed by the Japan Otological Society and Oto-Rhino-Laryngeal Society of Japan defining otitis media with effusion (OME) in children (younger than 12 years old) and describing the disease rate, diagnosis, and method of examination. Recommended therapies that received consensus from the guideline committee were updated in consideration of current therapies used in Japan and based on available evidence. Regarding the treatment of OME in children, we developed Clinical Questions (CQs) and retrieved documents on each theme, including the definition, disease state, method of diagnosis, and medical treatment. In the previous guidelines, no retrieval expression was used to designate a period of time for literature retrieval. Conversely, a literature search of publications from March 2014 to May 2019 has been added to the JOS 2015 Guidelines. For publication of the CQs, we developed and assigned strengths to recommendations based on the collected evidence. OME in children was classified into one group lacking the risk of developing chronic or intractable disease and another group at higher risk (e.g., children with Down syndrome, cleft palate), and recommendations for clinical management, including follow-up, is provided. Information regarding management of children with unilateral OME and intractable cases complicated by adhesive otitis media is also provided. In clinical management of OME in children, the Japanese Clinical Practice Guidelines recommends management not only of complications of OME itself, such as effusion in the middle ear and pathologic changes in the tympanic membrane, but also pathologic changes in surrounding organs associated with infectious or inflammatory diseases. [ABSTRACT FROM AUTHOR]

Background: Intratympanic injection has emerged as a novel approach to bypass the blood-labyrinth barrier and effectively deliver drugs into the inner ear. This technique is used for treatment of various inner ear diseases and overcomes the limitations of systemic drug therapy. In this paper, we provide an overview of the application of intratympanic injection using steroids and gentamicin and highlight the major diseases and summarize the reported efficacy of this approach. Current Concepts: Intratympanic steroid injections have been used for treatment of various inner ear diseases, including sudden sensorineural hearing loss, Ménière disease, and tinnitus. Therapeutic effects of steroids include reducing inflammation, modulating the immune response, improving cochlear blood flow, and maintaining ion homeostasis. Intratympanic gentamicin injections are primarily used to minimize hearing loss and control vertigo symptoms in patients with Ménière disease. Gentamicin selectively injures vestibular hair cells with minimal ototoxicity compared with other aminoglycoside antibiotics. Discussion and Conclusion: Intratympanic injections offer several advantages, including targeted drug delivery, minimal systemic adverse effects, and rapid action. Reportedly, intratympanic steroid injections used as primary or salvage treatment are associated with positive outcomes in patients with sudden sensorineural hearing loss. Ménière disease also shows positive outcomes following intratympanic steroid and gentamicin injections. However, studies have reported conflicting results, and further research is required to standardize dosing and administration protocols. Intratympanic injections are a promising therapeutic option, and ongoing research is essential to optimize their efficacy and safety. [ABSTRACT FROM AUTHOR]

Sarcopterygians evolved around 415 Ma and have developed a unique set of features, including the basilar papilla and the cochlear aqueduct of the inner ear. We provide an overview that shows the morphological integration of the various parts needed for hearing, e.g., basilar papilla, tectorial membrane, cochlear aqueduct, lungs, and tympanic membranes. The lagena of the inner ear evolved from a common macula of the saccule several times. It is near this lagena where the basilar papilla forms in Latimeria and tetrapods. The basilar papilla is lost in lungfish, certain caecilians and salamanders, but is transformed into the cochlea of mammals. Hearing in bony fish and tetrapods involves particle motion to improve sound pressure reception within the ear but also works without air. Lungs evolved after the chondrichthyans diverged and are present in sarcopterygians and actinopterygians. Lungs open to the outside in tetraposomorph sarcopterygians but are transformed from a lung into a swim bladder in ray-finned fishes. Elasmobranchs, polypterids, and many fossil fishes have open spiracles. In Latimeria, most frogs, and all amniotes, a tympanic membrane covering the spiracle evolved independently. The tympanic membrane is displaced by pressure changes and enabled tetrapods to perceive airborne sound pressure waves. The hyomandibular bone is associated with the spiracle/tympanic membrane in actinopterygians and piscine sarcopterygians. In tetrapods, it transforms into the stapes that connects the oval window of the inner ear with the tympanic membrane and allows hearing at higher frequencies by providing an impedance matching and amplification mechanism. The three characters—basilar papilla, cochlear aqueduct, and tympanic membrane—are fluid related elements in sarcopterygians, which interact with a set of unique features in Latimeria. Finally, we explore the possible interaction between the unique intracranial joint, basicranial muscle, and an enlarged notochord that allows fluid flow to the foramen magnum and the cochlear aqueduct which houses a comparatively small brain.

This article from the Canadian Medical Association Journal provides information on acquired cholesteatoma, a condition characterized by the presence of keratinizing squamous epithelium in the middle ear or mastoid. It clarifies that cholesteatoma is not a neoplasm and does not contain cholesterol. The article highlights that persistent otorrhea, foul-smelling otorrhea, and hearing loss are common symptoms of cholesteatoma, and recommends prompt referral to an otolaryngologist if cholesteatoma is suspected. Surgical removal is the main treatment, but recurrence rates are high, necessitating regular follow-up examinations. [Extracted from the article]

Significance Statement: Eustachian tube disorders are common outpatient otologic presentations that can present a diagnostic challenge due to overlapping symptoms. This article will focus on patulous Eustachian tube, how the symptoms can overlap with those of Eustachian tube dysfunction, and the diagnostic insight offered by a close inspection of the tympanic membrane. [ABSTRACT FROM AUTHOR]

The tympanic membrane (TM) is critical for hearing and requires continuous clearing of cellular debris, but little is known about homeostatic mechanisms in the TM epidermis. Using single-cell RNA sequencing, lineage tracing, whole-organ explant, and live-cell imaging, we show that homeostatic TM epidermis is distinct from other epidermal sites and has discrete proliferative zones with a three-dimensional hierarchy of multiple keratinocyte populations. TM stem cells reside in a discrete location of the superior TM and generate long-lived clones and committed progenitors (CPs). CP clones exhibit lateral migration, and their proliferative capacity is supported by Pdgfra+ fibroblasts, generating migratory but non-proliferative progeny. Single-cell sequencing of the human TM revealed similar cell types and transcriptional programming. Thus, during homeostasis, TM keratinocytes transit through a proliferative CP state and exhibit directional lateral migration. This work forms a foundation for understanding TM disorders and modeling keratinocyte biology.

Auditory and visual information involve different coordinate systems, with auditory spatial cues anchored to the head and visual spatial cues anchored to the eyes. Information about eye movements is therefore critical for reconciling visual and auditory spatial signals. The recent discovery of eye movement-related eardrum oscillations (EMREOs) suggests that this process could begin as early as the auditory periphery. How this reconciliation might happen remains poorly understood. Because humans and monkeys both have mobile eyes and therefore both must perform this shift of reference frames, comparison of the EMREO across species can provide insights to shared and therefore important parameters of the signal. Here we show that rhesus monkeys, like humans, have a consistent, significant EMREO signal that carries parametric information about eye displacement as well as onset times of eye movements. The dependence of the EMREO on the horizontal displacement of the eye is its most consistent feature, and is shared across behavioural tasks, subjects and species. Differences chiefly involve the waveform frequency (higher in monkeys than in humans) and patterns of individual variation (more prominent in monkeys than in humans), and the waveform of the EMREO when factors due to horizontal and vertical eye displacements were controlled for. This article is part of the theme issue 'Decision and control processes in multisensory perception'. [ABSTRACT FROM AUTHOR]

Otolaryngological diagnoses, such as otitis media, are traditionally performed using endoscopy, wherein diagnostic accuracy can be subjective and vary among clinicians. The integration of objective tools, like artificial intelligence (AI), could potentially improve the diagnostic process by minimizing the influence of subjective biases and variability. We systematically reviewed the AI techniques using medical imaging in otolaryngology. Relevant studies related to AI-assisted otitis media diagnosis were extracted from five databases: Google Scholar, PubMed, Medline, Embase, and IEEE Xplore, without date restrictions. Publications that did not relate to AI and otitis media diagnosis or did not utilize medical imaging were excluded. Of the 32identified studies, 26 used tympanic membrane images for classification, achieving an average diagnosis accuracy of 86% (range: 48.7–99.16%). Another three studies employed both segmentation and classification techniques, reporting an average diagnosis accuracy of 90.8% (range: 88.06–93.9%). These findings suggest that AI technologies hold promise for improving otitis media diagnosis, offering benefits for telemedicine and primary care settings due to their high diagnostic accuracy. However, to ensure patient safety and optimal outcomes, further improvements in diagnostic performance are necessary. [ABSTRACT FROM AUTHOR]

Previous studies of the middle ear in Chronic Otitis Media have focussed on radiological assessment of temporal bone; endoscopic studies were focussed on perforation size and location. The malleus handle (manubrium) is a constant ossicular feature visible on otoendoscopy. It's relative position may indicate the previously documented differences in ossicular chain and middle ear cleft development relative to the tympanic ring and inner ear capsule between affected ear and contralateral ear. Design: descriptive. Setting: hospital based. Subjects: 84 patients with unilateral mucosal chronic otitis media. Methods: each patient underwent Otoendoscopy and the findings were recorded through a camera connected to a laptop. Using image j software these images were analysed. Participants were of mean age of 35 years with left preponderance, and no gender preponderance was found. In our study, majority of the perforations were small sized perforations. The malleus handle foreshortening was about 92.6% compared to unaffected ear which was statistically insignificant. There was a significant inter group difference in the distance between the tip of the manubrium and the inferior annulus—which was decreased in affected ears and in the distance from the lateral process to the anterior tympanic ring—which was increased in affected ears. There was no difference in the malleo scutal angles. These differences were not dependent on the site or size of the perforation. The differences we found between ears were unexpected. The significance of the differences in the shape of the tympanic membrane between affected and unaffected ears in unilateral mucosal COM need further study. We did not find a statistically significant difference in the malleo-scutal angles between ears. [ABSTRACT FROM AUTHOR]

Optical Coherence Tomography (OCT) is a light-based imaging modality that is used widely in the diagnosis and management of eye disease, and it is starting to become used to evaluate for ear disease. However, manual image analysis to interpret the anatomical and pathological findings in the images it provides is complicated and time-consuming. To streamline data analysis and image processing, we applied a machine learning algorithm to identify and segment the key anatomical structure of interest for medical diagnostics, the tympanic membrane. Using 3D volumes of the human tympanic membrane, we used thresholding and contour finding to locate a series of objects. We then applied TensorFlow deep learning algorithms to identify the tympanic membrane within the objects using a convolutional neural network. Finally, we reconstructed the 3D volume to selectively display the tympanic membrane. The algorithm was able to correctly identify the tympanic membrane properly with an accuracy of ~98% while removing most of the artifacts within the images, caused by reflections and signal saturations. Thus, the algorithm significantly improved visualization of the tympanic membrane, which was our primary objective. Machine learning approaches, such as this one, will be critical to allowing OCT medical imaging to become a convenient and viable diagnostic tool within the field of otolaryngology. [ABSTRACT FROM AUTHOR]

Lumped element models facilitate investigating the fundamental mechanisms of human ear sound conduction. This systematic review aims to guide researchers to the optimal model for the investigated parameters. For this purpose, the literature was reviewed up to 12 July 2023, according to the PRISMA guidelines. Seven models are included via database searching, and another 19 via cross-referencing. The quality of the models is assessed by comparing the predicted middle ear transfer function, the tympanic membrane impedance, the energy reflectance, and the intracochlear pressures (ICPs) (scala vestibuli, scala tympani, and differential) with experimental data. Regarding air conduction (AC), the models characterize the pathway from the outer to the inner ear and accurately predict all six aforementioned parameters. This contrasts with the few existing bone conduction (BC) models that simulate only a part of the ear. In addition, these models excel at predicting one observable parameter, namely, ICP. Thus, a model that simulates BC from the coupling site to the inner ear is still lacking and would increase insights into the human ear sound conduction. Last, this review provides insights and recommendations to determine the appropriate model for AC and BC implants, which is highly relevant for future clinical applications. [ABSTRACT FROM AUTHOR]

The delivery of drugs through the skin barrier at a predetermined rate is the aim of transdermal drug delivery systems (TDDSs). However, so far, TDDS has not fully attained its potential as an alternative to hypodermic injections and oral delivery. In this study, we presented a proof of concept of a dual drug-loaded patch made of nanoparticles (NPs) and ultrafine fibers fabricated by using one equipment, i.e., the electrospinning apparatus. Such NP/fiber systems can be useful to release drugs locally through the skin and the tympanic membrane. Briefly, dexamethasone (DEX)-loaded poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBHV) fiber meshes were decorated with rhodamine (RHO)-loaded poly(lactic-co-glycolic acid) (PLGA) NPs, with RHO representing as a second drug model. By properly tuning the working parameters of electrospinning, DEX-loaded PHBHV fibers (i.e., by electrospinning mode) and RHO-loaded PLGA NPs (i.e., by electrospray mode) were successfully prepared and straightforwardly assembled to form a TDDS patch, which was characterized via Fourier transform infrared spectroscopy and dynamometry. The patch was then tested in vitro using human dermal fibroblasts (HDFs). The incorporation of DEX significantly reduced the fiber mesh stiffness. In vitro tests showed that HDFs were viable for 8 days in contact with drug-loaded samples, and significant signs of cytotoxicity were not highlighted. Finally, thanks to a beaded structure of the fibers, a controlled release of DEX from the electrospun patch was obtained over 4 weeks, which may accomplish the therapeutic objective of a local, sustained and prolonged anti-inflammatory action of a TDDS, as is requested in chronic inflammatory conditions, and other pathological conditions, such as in sudden sensorineural hearing loss treatment. [ABSTRACT FROM AUTHOR]

Objective: Granular myringitis is characterised by de-epithelialisation of the tympanic membrane. Patients present with intermittent otorrhoea, otalgia or itching. With improper or inadequate treatment, granular myringitis could cause ear canal fibrosis and stenosis. There are no standard topical ear drops for granular myringitis. Treatments have inconsistent success rates and variable timelines. This study aimed to compare the effectiveness of treating granular myringitis with 1 and 2 per cent acetic acid solutions for two weeks. Method: This double-blind, randomised, controlled trial enrolled and randomly allocated 47 participants to 2 groups between October 2021 and June 2022. Results: After two weeks, the groups' treatment success rates did not differ significantly. There was a 10 per cent recurrence rate 8 weeks after treatment completion. All patients tolerated the diluted vinegar. Conclusion: There is no difference in the efficacy of 1 and 2 per cent diluted vinegar in treating granular myringitis for two weeks. [ABSTRACT FROM AUTHOR]

Otitis media (presumably caused by Mycoplasma bovis) is a frequently encountered problem with big economic implications in the Dutch veal calf industry. Conservative treatment using antibiotics, NSAIDs and corticosteroids is regularly unsuccessful. The affected calves usually start to waste due to pain and decreased feed intake. This report describes a novel treatment option, performing a myringotomy (surgical opening of the eardrum), combined with local antibiotic and corticosteroid therapy. The outcome was positive; in four out of five calves, the clinical signs resolved within 3 weeks after intervention. On‐farm myringotomy is a promising treatment option in persistent otitis media. [ABSTRACT FROM AUTHOR]

Background: Osteomas are benign slow-growing tumors, which typically arise on the surface of the bone. They rarely arise from the temporal bone, accounting for 0.1–1% of all benign tumors of the skull. The external auditory canal (EAC) is the most common site for osteomas in the temporal bone. Other extra-canalicular osteomas of the temporal bone are uncommon and infrequently reported. In this case report, we discuss the clinical presentation and surgical management of osteoma of the squamous part of the temporal bone. A limited review of literature is also presented. Case presentation: A 20-year-old male presented to the outpatient department (OPD) with a chief complaint of a hard swelling above his left ear, for 4 years. He had no other complaints other than cosmetic concern. On examination, there was a solitary, smooth, bony hard swelling just antero-superior to the left pinna, and the overlying skin was unremarkable. The left EAC and tympanic membrane were normal. A non-contrast computed tomography (CT) scan of the head and face with 3-D reconstruction showed a16 × 18 mm exophytic, pedunculated bony lesion arising from the squamous part of the temporal bone suggestive of an osteoma. The patient was taken up for surgical excision under general anesthesia. The bony lesion was removed from its attachment to the skull using a gouge and a mallet. The base of the tumor was drilled using a polishing burr to ensure complete removal and prevent recurrence. The histopathology was confirmatory of compact osteoma. Postoperative period was uneventful, and follow-up at 18-month post-surgery did not reveal any recurrence clinically. Conclusion: Osteoma of the temporal squama is rarely reported, and surgical excision is the definitive treatment if symptomatic. This case report highlights the surgical management of this rare tumor. A limited review of literature suggests that squamous part of the temporal bone is an unusual site for extra-canalicular osteomas, and the prognosis is good after surgery. [ABSTRACT FROM AUTHOR]

Background. Hemotympanum may occur due to otic barotrauma secondary to Valsalva maneuver during the second phase of labor. A pressure differential across the tympanic membrane (TM) of about five psi can cause rupture. The increased intrathoracic and intraabdominal pressure spikes repeatedly manifested by "pushing" during second-stage labor easily approach (and may exceed) this level. Clinical Presentation. This case report describes a healthy thirty-seven-year-old multipara patient admitted for the 40-weeks' gestational age routine follow-up that proceeded to active labor followed by an aural fullness and bloody otorrhea. Otoscopic examination with a light microscope confirmed the hemotympanum of the right tympanic membrane. Conclusion. Forceful Valsalva can cause hemotympanum. Investigating the benefits and disadvantages of the pushing methods could help reduce such complications in the future. A prompt evaluation of an otolaryngologist should be requested in the event of a new postpartum hearing disturbance or bloody otorrhea. [ABSTRACT FROM AUTHOR]

Cholesteatoma, which potentially results from tympanic membrane retraction, is characterized by intractable local bone erosion and subsequent hearing loss and brain abscess formation. However, the pathophysiological mechanisms underlying bone destruction remain elusive. Here, we performed a single-cell RNA sequencing analysis on human cholesteatoma samples and identify a pathogenic fibroblast subset characterized by abundant expression of inhibin βA. We demonstrate that activin A, a homodimer of inhibin βA, promotes osteoclast differentiation. Furthermore, the deletion of inhibin βA /activin A in these fibroblasts results in decreased osteoclast differentiation in a murine model of cholesteatoma. Moreover, follistatin, an antagonist of activin A, reduces osteoclastogenesis and resultant bone erosion in cholesteatoma. Collectively, these findings indicate that unique activin A-producing fibroblasts present in human cholesteatoma tissues are accountable for bone destruction via the induction of local osteoclastogenesis, suggesting a potential therapeutic target. This study identified a subset of osteoclastogenic fibroblasts expressing INHBA/activin A in human cholesteatoma. It further elucidated the mechanism behind the induction of inflammatory bone destruction, suggesting a potential therapeutic target. [ABSTRACT FROM AUTHOR]

Manières disease (MD) is a chronic inner ear disease characterized by recurrent vertigo and fluctuation in auditory symptoms. Vertigo spells have a sudden onset and are difficult for patients to handle. Therefore, treating a patient with MD is still a challenge for clinicians. This study aims to analyse the short-term effects of intratympanic dexamethasone (ITD) on the various symptoms of unilateral MD. The study comprised 27 patients with unilateral MD and severe vertigo who failed medication therapy. Treatment was with ITD as an alternative to destructive therapy. Treatment is evaluated after four months. Significant improvements were measured with Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI), frequency of vertigo attacks longer than 20 min, Functional Level Scale (FLS), and tinnitus sensation measured by the Analog Visual Scale (AVS). Patients with severe symptoms grading with DHI and THI experienced the most improvement. Patients have achieved substantial vertigo control in 73%. ITD application shows improvement in controlling vertigo and tinnitus in patients under exacerbation in MD. It is a promising non-destructive addition to the 'stepwise treatment concept' in MD and can be used as a first-line treatment in vertigo control. [ABSTRACT FROM AUTHOR]

Objective: To investigate how dexamethasone dosage impacts intratympanic steroid therapy (IST) for treatment of sudden sensorineural hearing loss (SSNHL). Study Design: Retrospective review. Methods: Inclusion criteria identified subjects who received IST between January 1, 2010 and June 1, 2020 for iSSNHL. Subjects with Meniere's disease, autoimmune inner ear disease, subjects who received injections of non-dexamethasone steroid formulations, and subjects with missing audiogram data were excluded. Subjects were stratified by dexamethasone dosage: low-dose (10 mg/ml) versus high-dose (24 mg/ml), time-to-treatment and oral corticosteroid use. Outcome measures included post-treatment improvement in 4-frequency pure tone average (4F-PTA [500, 1000, 2000,4000 Hz]), low- and high-frequency PTA (250-1000 Hz and 2000-8000 Hz, respectively). Results: Of the 55 included subjects (50.9% male, mean age 48.9 ± 16.4 years), 31 received high-dose while 24 received low-dose injections. 90.9% of subjects were treated with oral steroids prior to or during IST. No significant differences in hearing outcomes were observed between low- and high-dose cohorts or when stratifying by oral steroid use. Time-to-treatment analysis comparing ≤1 month (67.3%) versus >1 month (32.7%) groups demonstrated a significant improvement in post-treatment 4F-PTA (P =.01) in the ≤1 month group. Conclusions: Hearing recovery was not significantly different between the 10 mg/ml versus 24 mg/ml doses of intratympanic dexamethasone, suggesting that steroid dose may not impact the efficacy of IST. A shorter time-to-treatment was observed to be favorable for hearing improvement. [ABSTRACT FROM AUTHOR]

Background: The observation of tympanic membrane displacement (TMD) opens up the possibility of indirect intracranial pressure (ICP) estimation. In this study, we applied a phase-based video motion magnification (VMM) algorithm to reveal spontaneous pulse TMD waveforms (spTMD) and compare them with invasively measured ICP in patients with intracranial pathologies. Methods: Nine adults (six traumatic brain injury and three aneurysmal subarachnoid haemorrhage; median age 44 (29–53) years admitted to the intensive care unit of Wroclaw Medical University between October 2021 and October 2022 with implanted ICP sensors were included in this retrospective study. Video recordings of the tympanic membrane were performed using a portable otoscope with a video camera and analysed by a custom-written VMM algorithm. ICP was monitored using intraparenchymal sensors and arterial blood pressure (ABP) was measured in the radial arterial lines. ICP, ABP, and spTMD videos were captured simultaneously. The pulse amplitudes of ICP (Amp_ICP), ABP (Amp_ABP) and spTMD (Amp_spTMD) were estimated using fast Fourier transform within the heart rate (HR)–related frequency range. Results: Amp_spTMD was significantly correlated with mean ICP (rS = 0.73; p = 0.025) and with Amp_ICP (rS = 0.88; p = 0.002). Age was not a significant moderator of this association. There were no significant relationships between Amp_spTMD and either mean ABP, HR, or Amp_ABP. Conclusions: The study suggests that Amp_spTMD increases with the increase in mean ICP and Amp_ICP. Estimation of Amp_spTMD using the VMM algorithm has the potential to allow for non-invasive detection of the risk of elevated ICP; however, further investigation in a larger group of patients is required. [ABSTRACT FROM AUTHOR]

Individual differences in ear-canal acoustics introduce variability into hearing aid output that can affect speech audibility. Measuring ear-canal acoustics in young children can be challenging, and relying on normative real-ear-to-coupler difference (RECD) transforms can lead to large fitting errors. Acoustic immittance measures characterize the impedance of the ear and are more easily measured than RECD. Using 226 Hz tympanometry to predict the RECD is more accurate than using age-based average RECD values. The current study sought to determine whether wideband acoustic immittance measurements could improve predictions of wideband real-ear-to-coupler difference (wRECD). 150 children ages 2–10 years with intact tympanic membranes underwent wRECD and wideband acoustic immittance measures in each ear. Three models were constructed to predict each child's measured wRECD: the age-based average wRECD, 226 Hz admittance wRECD, and wideband absorbance wRECD. The average age-based wRECD model predicted the child's measured wRECD within 3 dB in 62% of cases, but both the 226 Hz admittance and wideband absorbance wRECD were within 3 dB in 90% of cases. Using individual 226 Hz or wideband absorbance to predict wRECD improved the accuracy and precision of transforms used for pediatric hearing aid fitting. [ABSTRACT FROM AUTHOR]

In the last decades, finite-element models of the middle ear have been widely used to predict the middle-ear vibration outputs. Even with the simplest linear assumption for material properties of the structures in the middle ear, these models need tens of parameters. Due to the complexities of measurements of material properties of these structures, accurate estimations of the values of most of these parameters are not possible. In this study, we benefited from the stochastic finite-element model of the middle ear we had developed in the past, to perform global sensitivity analysis. For this aim, we implemented Sobol′ sensitivity analysis which ranks the importance of all uncertain parameters and interactions among them at different frequencies. To decrease the computational costs, we found Sobol′ indices from surrogate models that we created using stochastic finite-element results and the polynomial chaos expansion method. Based on the results, the Young's modulus and thickness of the tympanic membrane, Young's modulus and damping of the stapedial annular ligaments, and the Young's modulus of ossicles are among the parameters with the greatest impacts on vibrations of the umbo and stapes footplate. Furthermore, the most significant interactions happen between the Young's modulus and thickness of the tympanic membrane. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of the present clinical trial are to describe our surgical technique for advanced tympanosclerosis (TS) and to present the comparison of pre-and postoperative audiometric results. Methods: 21 patients suffering from advanced TS (Only type III and IV patients according to Wielinga–Kerr classification) were enrolled in this prospective study. A pure transcanal endoscopic approach was preferred for all patients included in the study. Titanium malleus replacement prosthesis (MRP) and polytetrafluoroethylene (PTFE) loop prosthesis combination were used to bypass fixed ossicles to achieve sound transmission to the inner ear. Pre-and postoperative pure tone audiometry (PTA) measurements and air–bone gap (ABG) results compared, and surgical technique was considered successful if postoperative ABG was less than 20 dB. Results: Six of the 21 patients had been operated on before and the tympanic membrane (TM) was intact. The remaining 15 of the 21 patients were the primary cases, and TM perforation repair and ossiculoplasty using combination of the MRP and PTFE loop prosthesis were performed at single-staged operation. The average preoperative ABG values significantly improved from 37.1 ± 6.2 to 14.5 ± 1.2 dB postoperatively (p < 0.001). The mean preoperative air conduction threshold (ACT) significantly decreased from 51.7 ± 11.4 to 28.5 ± 9.1 dB (p < 0.001). Conclusion: TS surgery is still a controversial issue particularly in stapes footplate fixation. However, our surgical and audiological results in this study are quite promising. The combination of titanium MRP and PTFE loop prosthesis for restoring sound transmission in advanced TS cases is reliable, effective and novel treatment option via endoscopic transcanal approach. [ABSTRACT FROM AUTHOR]