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Palaeogene South American faunas include enigmatic ungulates that cannot be classified unequivocally within any of the main South American (SA) Native Ungulates clades (Litopterna, Notoungulata, Astrapotheria, Pyrotheria and Xenungulata) because they retain plesiomorphic features, resembling Laurasian ‘archaic ungulates’ traditionally classified within the order ‘Condylarthra’. Most SA ‘condylarths’ are known by partial dental series and isolated teeth and unassociated postcranial remains, hampering comparisons with better-known ungulates. Here, we describe a nearly complete skull and associated mandible of an SA ‘condylarth’, Talquinodus puertai gen. et sp. nov., preserving most of the dentition and basicranium, derived from middle Eocene rocks of the Sarmiento Formation at Central Patagonia. Talquinodus shows a combination of plesiomorphic traits (complete dentition with bunolophodont cheek teeth, ring like ectotympanic, retention of stapedial system, etc.), combined with some autapomorphies, as the reduction of the m3 talonid. Our phylogenetic analyses support consistently that Talquinodus belongs to the SA radiation of Euungulata along with Litopterna, Notoungulata and Astrapotheria. However, the internal relationships could not be resolved unambiguously: Talquinodus could be a didolodontid related to the origin of Litopterna, or could be part of a separate radiation of South American archaic ungulates, along Depaulacoutoia, Lamegoia and Escribania, with no descendants in post-Eocene faunas. [ABSTRACT FROM AUTHOR]

Purpose: The association between microtia severity and hearing function has been thoroughly investigated. This study examined the relationship between microtia grade, number of ear subunits (i.e., helix, antihelix, scapha, triangularis fossa, concha, lobule, tragus, and antitragus) with auditory brainstem response (ABR) findings in children with microtia. Study Design: A retrospective chart review was employed in this study. Method: We analyzed the ABR test results and photographs of 22 children with 30 microtia ears at Dr. Cipto Mangunkusumo National Hospital, Jakarta. The ABR test results were acquired using click (air conduction only) and 500-Hz tone burst stimuli (air- and bone-conduction). Ear photographs were overlaid with a template of a normal ear to determine the number of ear subunits present and the subsequent microtia grade. Number of ear subunits and ABR results were analyzed using the chi-square, Mann--Whitney U, and Spearman's correlation tests. Results: ABR thresholds for click and 500-Hz tone bursts air-conduction were significantly poorer for ears with a subunit < 5 compared to ears with a subunit ≥ 5. No significant difference was observed in 500 Hz bone-conduction ABR thresholds between these groups. Correlation analysis showed a significant negative correlation between increased ear subunits and click ABR thresholds. No significant correlation was found between ear subunits and 500-Hz air- and bone-conduction ABR thresholds. Conclusions: A higher number of ear subunits are associated with a lower hearing threshold, as assessed using ABR with click stimuli. Therefore, the number of ear subunits and microtia grades can be used to examine the hearing level thresholds in infants and children with microtia. [ABSTRACT FROM AUTHOR]

Introduction: This clinical focus article describes a structured counseling protocol for use with protected sound management and therapeutic sound in a transitional intervention for debilitating hyperacusis. The counseling protocol and its associated visual aids are crafted as a teaching tool to educate affected individuals about hyperacusis and encourage their acceptance of a transitional intervention. Description of Counseling Components: The counseling protocol includes five components. First, the patient’s audiometric results are reviewed with the patient, and the transitional intervention is introduced. An overview of peripheral auditory structures and central neural pathways and the concept of central gain are covered in the second and third components. Maladaptive hyper-gain processes within the auditory neural pathways, which underlie the hyperacusis condition, and associated connections with nonauditory processes responsible for negative reactions to hyperacusis are covered in the fourth component. Detrimental effects from misused hearing protection devices (HPDs) and the necessity to wean the patient from overuse of HPDs are also discussed. In the fifth component, the importance of therapeutic sound is introduced as a tool to downregulate hyper-gain activity within the auditory pathways; its implementation in uncontrolled and controlled sound environments is described. It is explained that, over the course of the transitional intervention, recalibration of the hyper-gain processes will be ongoing, leading to restoration of normal homeostasis within the auditory pathways. In turn, associated activation of reactive nonauditory processes, which contribute to hyperacusis-related distress, will be reduced or eliminated. As recalibration progresses, there will be less need for protected sound management and sound therapy. Sound tolerance will improve, hyperacusis will subside, and daily activities in typical healthy sound environments will again become routine. Results and Conclusion: The combination of counseling with protected sound management and therapeutic sound is highlighted in companion reports, including a summary of the outcomes of a successful trial of the transitional intervention. [ABSTRACT FROM AUTHOR]

Background Hypothesis/Objectives Animals Materials and Methods Results Conclusions and Clinical Relevance Lop‐eared rabbits may be predisposed to otitis externa (OE) as a consequence of their ear conformation. Although otoscopy, otic cytological evaluation and culture are valuable tools in dogs and cats, published data on rabbits remain lacking.This study aimed to assess the utility of otoscopy and cytological results in evaluating healthy rabbit external ear canals (EECs) and to characterise ear cytological and microbiological findings through culture techniques and metagenomic sequencing.Sixty‐three otitis‐free client‐owned rabbits.All rabbits underwent otoscopy and ear cytological evaluation. In a subset of 12 rabbits, further bacterial and fungal culture, fungal DNA assessment and metagenomic sequencing were performed.Otic cytological results revealed yeast in 73%, cocci in 42.9% and rods in 28.6% of healthy rabbit EECs. Compared to upright‐eared rabbits, lop‐eared rabbits had more discharge and more bacteria per oil immersion field. Culture isolated eight different species yet metagenomic sequencing identified 36, belonging to the Bacillota (Firmicutes), Pseudomonadota and Actinomycetota phyla. Staphylococcus were the most commonly observed species with both methods. Ten of 12 rabbits were yeast‐positive on cytological evaluation with only three yielding fungal growth identified as Yarrowia (Candida) lipolytica, Eurotium echinulatum and Cystofilobasidium infirmominiatum.Healthy rabbit EECs lack inflammatory cells yet can host yeast and bacteria, emphasising the need to evaluate cytological results alongside the clinical signs. Lop‐ear anatomy may predispose to bacterial overgrowth and OE. Notably, yeasts may be present despite a negative culture. [ABSTRACT FROM AUTHOR]

Anthropometry is vital to provide design references when seeking proper product fit. Nowadays, 3D anthropometry is widely used to provide more size and shape details for improving product designs. However, 3D ear anthropometry is still at an explorative stage, considering the complex ear morphology and other technical obstacles. The proposed research method in this study is applicable to analyse the 3D point cloud of the entire external ear. With the cross-parameterisation technique, the dataset was used to explore the morphological characteristics of the ear. Ear dimensions were automatically extracted and further analysed to explore the gender and symmetry differences using two-way ANOVA. The 3D ear models were investigated through Principal Component Analysis (PCA). The most significant variation was found in the helix and concha region, and the overall ear size is the second important factor determining ear variance. The statistical models were generated as 3D design references for ear-related products. Practitioner summary: This study revealed the morphological variations of the entire 3D external ear with a parameterised 3D ear dataset. Based on the PCA findings, a set of statistical models were generated as design references for product evaluation digitally or physically. [ABSTRACT FROM AUTHOR]

Optical coherence tomography (OCT) is a novel technology for performing real-time high-speed and high-resolution cross-sectional imaging on the micro-scale in situ. It is analogous to ultrasound imaging, except that it uses light instead of sound. OCT has recently been introduced in auditory research to visualize the various structures of the ear with a minimally invasive operation. In addition, OCT can be used as a vibrometry system that is capable to detect sound-induced sub-nanometer vibrations of the middle and inner ear. OCT-vibrometry measures depth-resolved vibrations into the specimen, which overcomes several limitations of classical vibrometry techniques (e.g., single surface point measurements using laser interferometry). In this article, we illustrate how to visualize the anatomy and function of the middle and inner ear (the cochlea) in a gerbil model using recently developed spectral-domain OCT. Our results demonstrate that the largest clinical impact of OCT for otology is to visualize various pathologies and quantify sound conduction and processing in the individual peripheral human ear. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the complication rate and satisfaction status of patients who underwent otoplasty with the combined Mustardé and Furnas sutures with minimal medial conchal cartilage excision. Materials and Methods: Forty-four ears of 22 patients, operated for prominent ear deformity were retrospectively included in the study. Patients were called for follow-up at various time intervals. At the sixth month, the patient and parents were asked to rate their satisfaction with the operation on a scale of 1-10 and noted. Results: The mean age of the patients was 8.09±2.72 years. The antihelix was created with Mustardé technique, minimal medial conchal excisions were performed, two conchamastoid sutures were placed with Furnas technique. The mean follow-up period was 23.86±11.97 months. Complications developed in 4 of 44 ears (9%). Major complication rate was 4.5%. Two patients (4.5%) had suture extrusion in one ear. None of the patients scored lower than 7 in the satisfaction questionnaire. Conclusion: Otoplasty with a combination of cartilage-sparing techniques has low complication, revision, and high satisfaction rates. Minimal medial conchal cartilage excision in addition to this technique is beneficial in reducing the conchamastoid tension and does not increase the risk of complications. [ABSTRACT FROM AUTHOR]

At present, there are not international unified standards and reports on Congenital Ear Malformation (CEM) in the world, which makes it difficult to transfer information and compare the literature. Through the statistical analysis of a large sample of CEM, a unified standard of all aspects of CEM is proposed and the data are provided for reference, which is convenient for the international work and literature comparison in this field. Based on the author's 30 years of clinical and scientific research work on CEM and the relevant cases of 3231 (4714 ears) in our hospital, and combined with literature, statistical analysis was made. This paper summarizes the classification, definition, epidemiology, embryonic development, pathogenic factors of CEM and elaborates on the clinical manifestations, examination and sequence therapy of representative Congenital Malformation of the Middle and Outer Ear (CMMOE). We also introduce malformation of the auricle and inner ear, so as to cover the outer, middle and inner ear. At the same time, we introduce our achievements and contributions in this field. This study provides reference to the international unified standard and treatment principle of the CEM. [ABSTRACT FROM AUTHOR]

Purpose: Although early identification of pediatric hearing loss is crucial, a formal online training course has not been freely accessible to a global audience. In response, we created a novel course for health professionals worldwide. Method: Course development occurred from February 2019 to May 2020. Seventeen multidisciplinary experts provided video lectures and demonstrations, including a tour of ear anatomy, operating footage of cochlear implant insertion, and demonstrations of children undergoing hearing testing. Content also included steps for interpreting audiograms, an overview of early screening programs, interviews with deaf/hard of hearing children, and an introduction to public health/educational infrastructure. The course was hosted on Coursera and launched on May 4, 2020. Results: The course was approved for 11.5 Continuing Medical Education and American Board of Pediatrics Maintenance of Certification-Part 2 credits and spanned five modules composed of 50 video learning segments: (a) Ear Anatomy, (b) Hearing Loss and Assessments, (c) Hearing Loss Diagnosis and Impact on Speech and Language Development, (d) Interventions for Hearing Loss, and (e) Pediatric Vestibular System and Balance. Since its launch, 6,556 learners have enrolled and 1,540 have fully completed the course: 50% were 25-34 years old, 62% were women, and 43% were from Asia. Average rating was 4.9/5 (n = 180 reviews). Conclusions: We created a freely accessible course for a global audience that provides a broad overview of pediatric hearing loss. Our multidisciplinary approach addresses an educational gap and can serve as a model for developing other online courses. [ABSTRACT FROM AUTHOR]

Background. Angelica Yinzi (AYZ) is a Chinese traditional herbal formula reported to attenuate itches and inflammation caused by atopic dermatitis (AD). However, the underlying mechanism of AYZ in the attenuation of itchiness and inflammation remains unknown. Objective. This study investigated the mechanism of AYZ in reducing itchiness in mice with 1-chloro-2,4-dinitrobenzene- (DNCB-)-induced atopic dermatitis. Methods. Hematoxylin and eosin (H&E) and toluidine blue staining were used to evaluate pathological changes in skin tissue, while an enzyme‐linked immunosorbent assay (ELISA) was used to assess the cytokine levels in the skin. After that, qRT-PCR was performed to determine the mRNA levels of cytokines in the skin. Immunofluorescence and western blotting analysis were further used to assess µ-opioid receptor (MOR) expression and immunohistochemistry to assess the p-ERK, p-AKT, and κ-opioid receptor (KOR). Results. The AYZ treatment alleviated the AD clinical symptoms, including decreasing the scratching frequency, the ear thickness, and the infiltration of mast cells, lymphocytes, inflammatory cells, and mononuclear cells. In addition, AYZ inhibited the expression of interleukin (IL)-13, thymic stromal lymphopoietin (TSLP), and reduced neuraminidase (NA), corticotropin-releasing factor (CRF), and reactive oxygen species (ROS) expression. Markers involved in itches, such as p-ERK and p-AKT, were significantly downregulated following AYZ treatment. Besides, AYZ significantly increased MOR expression and downregulated KOR in the epidermis and spinal cord. Conclusion. Our findings imply that AYZ ameliorates pruritus-related AD through skin repair, antioxidation, and balancing peripheral MOR and KOR. The findings in this study lay a theoretical foundation for the control mechanism of peripheral itch. [ABSTRACT FROM AUTHOR]

Background and Aim: Real-Ear Unaided Gain (REUG) can reveal the outer-ear resonance which reflects the effects of body and ear factors. Deformity in the outer ear may change the real-ear unaided responses. Cauliflower ear is a common ear deformity in wrestlers. This study aimed to compare the REUG of normal and cauliflower ear in wrestlers to investigate the frequencies at which the gain may be inaccurate. Methods: Ten male wrestlers with the age ranged from 21 to 31 years participated in this study. The study had within-subject design and only one group. The REUGs was recorded for both ears, normal and cauliflower ears, and the results analyzed. Results: The mean of REUG values were significantly different between the deformed and normal ears. There were two distinct peaks in the REUG curve of the deformed ear, while there was a single peak in that of the normal ear. Conclusion: The differences in the REUG at 2-6 kHz between the deformed and normal ears was seen. [ABSTRACT FROM AUTHOR]

When someone without permission does pre-intrusion activities like auditory surveillance close to a door or window and has oils and waxes on their auricles, the deposition of a latent ear print may take place. By using methods analogous to those used in fingerprint lifting processes, the visibility of this print can be increased. An earprint is a 2D representation of the auricle segments that have come into contact with a certain surface, similar to the impression left by a rubber stamp. This study critically reviewed the efficacy of ear prints as a form of corroborative evidence and its significance in the realm of personal identification. Ear prints, in conjunction with other latent evidence, have the potential to be identified and gathered at the location of a criminal incident. The literature that has been examined exhibits promising advancements and a notable level of precision in the field of ear print development and identification, thereby emphasizing the necessity for further study. [ABSTRACT FROM AUTHOR]

Pediatric patients frequently present to emergency departments with complaint of foreign bodies in the ear and/or nose. Emergency nurse practitioners need the knowledge base to safely and effectively manage ear and nose foreign bodies in urgent and emergent care settings. The purpose of this article is to teach the common anatomical sites where foreign bodies are placed, the make-up of foreign body material, procedural technique of removal, and specific circumstances that require specialty referral. [ABSTRACT FROM AUTHOR]

Background: Delivering sufficient otology education for undergraduates is known to be difficult, with limited teaching time being a contributing factor. Increasing student access to dissections of the ear could serve to increase satisfaction with teaching at St George's, University of London, UK. Objective: To evaluate student satisfaction with clinical ear anatomy teaching and investigate whether it can be improved using dissected specimens. Method: Participants completed an online survey and knowledge examinations, both before and after attending a new tutorial, with answers from before and after the session being compared. Results: Pre-teaching satisfaction scores concerning teaching were low, at an average of 2.45 (out of 7), with a mean examination result of 6.53 (out of 10). Post-teaching average satisfaction increased by 3.20 points to 5.65 (out of 7) (p < 0.01) and examination scores increased by 1.53 points to 8.07 (out of 10) (p < 0.01). Conclusion: Students are supportive of increased access to cadaver dissections of the ear, and facilitating this can improve satisfaction with otology teaching. [ABSTRACT FROM AUTHOR]

Objectives: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. Methods: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Results: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. Conclusion: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps. [ABSTRACT FROM AUTHOR]

Objective: Otological complications are considered early symptoms of severe acute respiratory syndrome coronavirus-2; however, it is unknown how long these symptoms last and whether the virus leaves any hearing disorders post-recovery. Methods: This prospective cohort study comprised 31 mild or moderate confirmed coronavirus disease 2019 patients and 26 age-matched control peers (21–50 years old). Patients were questioned about their otological symptoms, and their hearing status was assessed during one month post-diagnosis. Results: Patients showed a significantly higher rate of otological symptoms (hearing loss, ear fullness, ear pain, dizziness or vertigo, communication difficulties, and hyperacusis) versus the control group (p ≤ 0.022). The symptoms resolved early, between 2 and 8 days after their appearance. No significant differences were observed between the two groups in pure tone and extended high-frequency audiometry, transient evoked otoacoustic emissions, distortion product otoacoustic emissions, or auditory brainstem response following recovery. Conclusion: The findings indicate that, in mild to moderate coronavirus disease 2019 cases, otological symptoms resolve within a week, and the virus has no lasting impact on the auditory system. [ABSTRACT FROM AUTHOR]

Introduction: Congenital hearing loss can become a chronic condition if untreated. Children born with this illness struggle with language and speech acquisition, cognitive functions, and social interactions. Early detection and treatment, which include cochlear implantation, play a huge role in further development and quality of life. Case Report: We present a case of a 10-month-old female patient, who was brought to the Otorhinolaryngology Clinic from Targu Mures complaining of hearing impairment. Several tests were performed. Clinical examination reveals a narrow ear canal.Tympanometry dysplays an As tympanogram curve type. Otoacoustic emissions and Auditory Brainstem Response are bilaterally negative. Early auditory evoked potentials shows the fifth wave present bilaterally at 70-80 dB. Auditory Steady-State Response (ASSR) reveals the hearing threshold at 70-85 dB in the left ear and 75-85 dB in the right ear. Based on these findings the patient was diagnosed with Congenital Bilateral Mixed Severe Hearing Loss, so a Cochlear Implantation was recommended. A preoperative CT scan discovered an anatomical variation of the Sigmoid Sinus. During the surgery, turned out that the Sigmoid Sinus protruded and partially covered the surgical field, so the access to the Round Window was complicated. This situation forced the surgeon to adopt a new surgical technique to perform the cochlear implant. Discussions : The surgical procedure involves working close to important structures including the Sigmoid sinus, Chorda tympani nerve, Facial Nerve, and Semicircular canals. Anatomical abnormalities of any of these components may harden the surgical technique. In the given case, the Sigmoid Sinus protrusion partially occluded the access to the Round Window. The CT images couldn't predict the real struggle that was later discovered on the operating table. Conclusions: Some anatomical variations can harden the surgical procedure of Cochlear implantation. Sometimes preoperative imaging can't reveal the real anatomical features and the surgery becomes a real challenge as the surgeon has to rethink the technique during the operation. [ABSTRACT FROM AUTHOR]

Background. Coronavirus disease 2019 (COVID-19) causes psychological distress and can have a negative impact on the general mental health and rehabilitation in affected patients under currently implemented isolation guidelines. Auricular point pressure (APP) as well-established technique in traditional Chinese medicine may help to relieve sleep disturbance and anxiety in COVID-19 patients. Methods. During the early phase of the epidemic/pandemic, patients were enrolled in this study (02/2020 until 03/2020 n = 84). They were strictly isolated on specific wards at the Hubei Provincial Hospital of Integrated Chinese and Western Medicine in Hubei. The retrospective cohort study design included two groups. Group A patients were treated with an auricular point pressure (APP) in addition to standard intensive care medicine while Group B participants (No-APP) received routine nursing measures alone. Treatment outcome was measured using the St. Mary's Hospital Sleep Questionnaire (SMH) Score and the 7-Item Generalized Anxiety Disorder Scale (GAD-7). Both scores were measured in each patient at baseline and on the discharge day. Results. The SMH score and sleep status changed in APP patients at the end of the treatment period when compared with No-APP patients (P < 0.01). APP-treated patients demonstrated lower GAD-7 scores than No-APP controls (P < 0.01). Further, no significant differences in safety or adverse events between the APP and No-APP groups were observed. Conclusion. The results from our snapshot study during the early phase of the SARS-CoV-2 epidemic/pandemic suggest that auricular point pressure could be a simple and effective tool to relieve insomnia and situational anxiety in hospitalized patients suffering from COVID-19 and kept under disconcerting conditions of isolation. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that perceptual and cognitive asymmetries are present in the auditory system in patients with adolescent idiopathic scoliosis (AIS). The Dichotic Listening (DL) paradigm was formerly performed in non-forced (NF) conditions only, and no study has examined the conditions of attention to one ear. Objective: To investigate the perceptual and cognitive asymmetry in the auditory system in patients with AIS as well as the asymmetry changes according to the curvature characteristics of patients with AIS. Method: The DL paradigm was performed on 38 patients with AIS and 10 healthy individuals in all conditions (NF, Forced Right [FR], Forced Left [FL]). Results: In the NF and FL conditions, the mean number of correct responses for the left ear was significantly lower in patients with AIS than in healthy individuals (p < 0.05). The correct responses for the right ear in the NF condition, right and left ear in the FR condition, and right ear in the FL condition did not show a significant difference between the groups (p > 0.05). Also, there was no difference between patients with AIS with both functional 3-curve and 4-curve (p > 0.05). Conclusion: Our study indicates perceptual and cognitive asymmetry or lateralisation in the auditory system in patients with AIS. The asymmetry might be caused by the inability to direct their attention to the left ear, which is not affected by their curvature type. Further studies are needed to investigate perceptual and cognitive asymmetry behaviour models in the auditory system in patients with AIS. Clinical implications: Determination of perceptual and cognitive asymmetry in the auditory system may offer a new perspective on conservative treatment protocols for AIS patients. Besides, the DL paradigm can be easily used in patients with AIS as a non-invasive evaluation method in clinics. [ABSTRACT FROM AUTHOR]

Purpose: This clinical focus article is a companion to the work of Erdman et al. (2019), in which we described the rationale, development, and implementation of the standardof- care protocol used in the Tinnitus Retraining Therapy Trial (TRTT), a multicenter, placebo-controlled, randomized, definitive efficacy trial of tinnitus retraining therapy (TRT). We now describe the historical background, development, and standardized implementation and delivery of the TRT counseling protocol (tinnitus counseling [TC]) used in the TRTT. TC is conjectured to be the key component in the TRT protocol for initiating the habituation process that reduces the response to the tinnitus signal and, ultimately, reduces its impact. In the TRTT, participants assigned to receive TC achieved > 30% reduction in the impact of tinnitus. Method and Results: The design and implementation of standardized treatments in multisite randomized controlled trials presents many challenges for investigators. Here, subsequent to presenting the background, rationale, and the TRT protocol model, we describe the development, refinement, and training/certification for standardized delivery of TC in the TRTT. The primary challenges encountered while distilling and streamlining TC for standardized delivery across multiple clinicians and their replacements at six participating military treatment centers in the TRTT are considered, and the resulting counseling protocol is detailed. Conclusions: The standardized and streamlined TC used in the TRTT was successful for treating debilitating tinnitus among persons with functionally adequate unaided hearing sensitivity. The structured TC protocol described here appears to be the main determinant of the significant and sizable TRT treatment effects measured in the TRTT, thus bolstering the merits of this standardized counseling approach as one model for the clinical implementation of TRT for the treatment of primary tinnitus. [ABSTRACT FROM AUTHOR]

The article offers information on congenital ear malformation (CEM), detailing its types, complications, and the need for a multidisciplinary approach to treatment. Topics discussed include the complexity of CEM treatment across various disciplines; the innovative sequential therapy and reconstructive technologies developed by the authors; and the establishment of a comprehensive CEM resource and international collaboration system.

Background: β-thalassaemia is a common hereditary disorders in Iraq and worldwide. with different treatment schemes, including blood transfusion, iron chelation and splenectomy, patients with B thalassemia may develop different skeletal changes. Limited studies link these complications with orofacial changes, This study aimed to evaluate the orofacial dimensions in β-thalassemia patients with age, gender, blood groups, splenectomy and cholecystectomy and to assist surgeons for planning their future intervention. Method: This study was conducted on 130 β-thalassemia patients of both gender, and two age categories (20-30 yrs), & (21-40 yrs), five orofacial measurements (face, eyes, nose, mouth and ears) and sixteen parameters were measured and calculated for differences, P value is estimated, data analysis were done by using Chi square test and SPSS version 20 Results: Significant findings were found for mandibular width and mouth width at older age group (31-40 years), the nasal width and ear height are more in male, patients with splenectomy have significance for lower 1\3 face and ear width. Cholecystectomy increase eye length measurements and ear height but for blood groups the P > 0.05 Conclusions: Orofacial bone changes are pronounced in β-thalassaemia with distinct findings regarding sex dimorphism, older are more prone to have variations, earlier splenectomy is advisable, cholecystectomy is better choice for symptomatic patients, blood groups have no significance. [ABSTRACT FROM AUTHOR]

Transcription factors that contain a homeodomain DNA-binding domain have crucial functions in most aspects of cellular function and embryonic development in both animals and plants. Hmx proteins are a subfamily of NK homeodomain-containing proteins that have fundamental roles in development of sensory structures such as the eye and the ear. However, Hmx functions in spinal cord development have not been analyzed. Here, we show that zebrafish (Danio rerio) hmx2 and hmx3a are coexpressed in spinal dI2 and V1 interneurons, whereas hmx3b, hmx1, and hmx4 are not expressed in spinal cord. Using mutational analyses, we demonstrate that, in addition to its previously reported role in ear development, hmx3a is required for correct specification of a subset of spinal interneuron neurotransmitter phenotypes, as well as correct lateral line progression and survival to adulthood. Surprisingly, despite similar expression patterns of hmx2 and hmx3a during embryonic development, zebrafish hmx2 mutants are viable and have no obviously abnormal phenotypes in sensory structures or neurons that require hmx3a. In addition, embryos homozygous for deletions of both hmx2 and hmx3a have identical phenotypes to severe hmx3a single mutants. However, mutating hmx2 in hypomorphic hmx3a mutants that usually develop normally, results in abnormal ear and lateral line phenotypes. This suggests that while hmx2 cannot compensate for loss of hmx3a, it does function in these developmental processes, although to a much lesser extent than hmx3a. More surprisingly, our mutational analyses suggest that Hmx3a may not require its homeodomain DNA-binding domain for its roles in viability or embryonic development. [ABSTRACT FROM AUTHOR]

Insomnia inflicts mental burden and decreases physical productivity and affects life quality. Transcutaneous vagus nerve stimulation (ta-VNS) may be an effective treatment option for insomnia. This study aims to evaluate the effect and safety of ta-VNS and compare it with transcutaneous nonvagus nerve stimulation (tn-VNS). A multicenter, randomized, clinical trial was conducted at 3 hospitals in China enrolling 72 insomnia participants from May 2016 to June 2017. Participants were randomly assigned (1 : 1) to receive 40 sessions of ta-VNS or tn-VNS treatment. 63 participants completed the trial. ta-VNS treatment significantly decreased the Pittsburgh Sleep Quality Index score, Epworth Sleepiness Scale score, Flinders Fatigue Scale score, Hamilton Depression Scale score, and Hamilton Anxiety Scale score over 4 weeks compared with those of the baseline. Moreover, it also significantly increased the 36-item Short-Form Health Survey Questionnaire scores compared with that of the baseline. However, it did not show significant differences compared with tn-VNS in changes of primary and secondary outcomes. The incidence of adverse events was low. ta-VNS significantly relieved insomnia over 4 weeks. Moreover, it also alleviated fatigue and improved participants' quality of life as well as other concomitant symptoms such as depression and anxiety. This trial is registered at Chinese Clinical Trial Registry (http://www.chictr.org.cn) with the registration number: ChiCTR-TRC-13003519. [ABSTRACT FROM AUTHOR]

Background: Surgical landmarks are widely used across all surgical specialties to assist surgeons in accurately estimating the deep anatomical structures. We describe the crus of helix curvature as a potential indicator for the anterior border of the sigmoid sinus (SS) in the setting of minimally invasive presigmoid approaches. Methods: Anatomy investigations were performed on injected cadaveric heads to identify consistent surface surgical landmarks estimating the curse of the SS. Results: Presigmoid mastoid was noted in the center of the skin incision in 100% of the specimens. The crus of helix curvature was superimposed on the anterior border of the SS on 6 sides (60%). On the other four sides, the curvature lays within 5 mm of the anterior SS border (40%). Conclusion: For the minimally invasive presigmoid approaches, the "crus of helix curvature" can be used as a landmark for the anterior border of the SS, which can aid in the speed and safety of the procedure. The ease of use of this landmark makes it particularly convenient for physicians early in training. [ABSTRACT FROM AUTHOR]

Introduction: Ear lobe crease (ELC) was first described in 1973 as a physical examination finding indicating significant coronary artery disease (CAD). Several studies have been carried out in relation to this finding, and it has been shown that it is a marker of intima-media thickness, carotid artery disease, and CAD. We aimed to investigate the relationship between earlobe crease, which is a simple physical examination finding, and GRACE score as a risk estimation index in acute coronary syndromes without ST-segment elevation (NSTE-ACS) patients. Methods: 360 patients (mean age 62.2 years, 70% male) were included in our study. Patients were divided into two groups of GRACE scores ≤ 109 and >109, 167 patients were enrolled in group 1, and 193 cases in group 2. Results: The group 2 patients were older, had higher systolic blood pressure (SBP) levels, a higher rate of hypertension, higher glucose levels, lower creatinine clearance levels, higher initial and peak troponin levels, lower hemoglobin levels, lower left ventricular ejection fraction (LVEF) and higher Gensini scores than the patients in group 1. The higher GRACE score group had markedly increased frequencies of ELC compared to the lower GRACE score group (80.8% vs. 24.5%, respectively, P<0.001). Conclusion: The presence of ELC may predict moderate to high risk group of patients with NSTEACS. [ABSTRACT FROM AUTHOR]

The main aim of our study was to study morphological state of the autograft from the fascia of the temporal muscle in myringoplasty. Until now, there is no consensus on issue of which fabrics are more suitable for use in the eardrum. We decided to study of use of an autograft from the fascia of the temporal muscle for myringoplasty in rabbits in the experiment, and in patients with chronic dry mesotympanitis. An electron microscopic examination of the fascia taken immediately, after 10, 20 min and 1 h after sampling. It was found that there are no gross destructive changes in the fascia structure. Minor changes are detected in the form of a light disorganization of the collagen complex, granular dystrophy with an increase in cell. Inflammatory diseases of the middle ear are widespread among population of all age groups. In the experiment, a positive result was obtained in 29 (82.8%) rabbits. In our research we performed morphological features of xenograft engraftment in an experimental animal on 3, 7, 14, 21 days and 1-3 months. In period from 3 days to 3 months after operation, the animals were euthanized by an air embolism and subjected to pathological examination. Then recovered xenograft, was examined macro and microscopically. Pieces were fixed in a 10% solution of neutral formalin. After washing with water, dehydration was carried out in alcohol and chloroform, and after, waxed with paraffin. Histological sections were stained with hematoxylin-eosin. Collagen fibers were detected by method of Vann-Gieson. [ABSTRACT FROM AUTHOR]

Recent studies have indicated that direct administration of viral vectors or small compounds to the inner ear may aid in the treatment of Sensorineural hearing loss (SNHL). However, due to species differences between humans and rodents, translating experimental results into clinical applications remains challenging. The common marmoset (Callithrix jacchus), a New World monkey, is considered a pre-clinical animal model. In the present study, we describe morphometric data acquired from the temporal bone of the common marmoset in order to define the routes of topical drug administration to the inner ear. Dissection and diffusion tensor tractography (DTT) were performed on the fixed cadaverous heads of 13 common marmosets. To investigate potential routes for drug administration to the inner ear, we explored the anatomy of the round window, oval window (OW), semicircular canal, and endolymphatic sac (ES). Among these, the approach via the round window with posterior tympanotomy appeared feasible for delivering drugs to the inner ear without manipulating the tympanic membrane, minimizing the chances of conductive hearing loss. The courses of four critical nerves [including the facial nerve (FN)] were visualized using three-dimensional (3D) DTT, which may help to avoid nerve damage during surgery. Finally, to investigate the feasibility of actual drug administration, we measured the volume of the round window niche (RWN), which was approximately 0.9 μL. The present findings may help to establish experimental standards for evaluating new therapies in this primate model.

Background The human ear is a distinctive facial feature, revealing valuable information about ethnicity, gender, and age. Anthropometric measures play a crucial role in fields such as forensic medicine, prosthetics, and plastic surgery. The external ear, known for its diversity in structure and individual characteristics, has become a subject of interest in various populations. This study aims to determine the mean values of morphometric measurements for both right and left ears while exploring sexual dimorphism in ear dimensions. Methodology A prospective, observational, cross-sectional study was conducted among 200 volunteers from the eastern province of Saudi Arabia, comprising 98 males and 102 females, at the Department of Anatomy, Institute of Medical Sciences, Imam Abdulrahman Bin Faisal University. Participants were randomly selected from King Fahad University Hospital workers and patients. Using a Vernier caliper and after obtaining consent, various aspects of ear morphology were measured. The study employed statistical analyses such as the volunteers' t-test, Pearson's coefficient of correlation, and linear regression equations. Results In males, the mean total height of the right and left ears was 6.054 ± 0.5394 and 6.044 ± 0.5235 cm, respectively, while for females, it was 5.489 ± 0.4481 and 5.763 ± 4.8446 cm, respectively. The mean widths, heights, and other dimensions of the ears exhibited variations between genders. Conclusions The study provides comprehensive insights into the dimensions and indices of the pinna among the population of the eastern province of Saudi Arabia. The findings confirmed the presence of sexual dimorphism in the ear measurements, consistent with observations in other ethnic groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Hiware et al.)

Background: Cochlear implantation (CI) in children with malformed ears can be challenging through the standard surgical technique. Several alternative approaches have been described. The endoscopic-assisted approach can be chosen as an effective and safe surgical technique, overcoming the drawbacks of the traditional approach., Material: We further describe a combined technique based on a limited mastoidectomy with no posterior tympanotomy and an endoscopic transmeatal approach to the round window (RW): the electrode is driven from the mastoid to the middle ear through the attic., Results: The concomitant endoscopic assistance allows for improved surgical vision, reducing the risk of major complications. The main advantages of this technique are related to better visualization of the RW for safe insertion of the electrode; avoidance of damage to the facial nerve (FN), due to direct visualization, and sparing the posterior tympanotomy; avoidance of subtotal petrosectomy, if not necessary., Conclusion: The purpose of this article, supported with a video file, is to describe step by step this endoscopic-assisted procedure in a patient with middle ear malformation., Competing Interests: Conflict of interest The authors have no conflict of interests, and the work was not supported or funded by any organization., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background. Psoriasis has been reported as a high-risk factor for quality of life and survival rate in patients with metabolic disorder. However, there is no animal model for studying this disease. This study aimed to establish and evaluate mouse models of psoriasis with blood stasis syndrome (which is a key to psoriasis pathogenesis, according to Chinese Medicine) complicated with metabolic disorders. Method. Forty-five C57BL/6 mice were randomly divided into the blank control (Control), psoriasis (Imiquimod (IMQ)), psoriasis with metabolic disorders (IMQ + streptozotocin (STZ)), psoriasis with blood stasis syndrome (BSS) (IMQ + BSS), and psoriasis with blood stasis syndrome complicated with metabolic disorders (IMQ + STZ + BSS) groups (n = 9 mice/group). Psoriasis lesions were induced using IMQ cream (on both the ears and back, except in the Control group). Mice of the IMQ + BSS group were fed a half-fat, high-sugar diet and stimulated with ice-water swimming every day. Mice of the IMQ + STZ group were fed a half-fat, high-sugar diet and injected with STZ. Mice of the IMQ + STZ + BSS group were subjected to the same treatments as the IMQ + STZ and IMQ + BSS groups. After induction, the mice in each group were observed for vital signs, ear thickness, body weight, and psoriasis area and severity index (PASI) score. The mice were fasted for 12 h before determination of related laboratory serum indexes. Dorsal skin lesions, aortic arch pathology sections, and signal transducer and activator of transcription 3 (STAT3) were examined by H&E staining and immunohistochemistry. Results. Laboratory indexes in the four model groups were significantly different from those in the Control group (p < 0.01); indicators of the IMQ + STZ, IMQ + BSS, and IMQ + STZ + BSS groups showed varying degrees of difference from those of the IMQ group. Conclusions. The established mouse models of psoriasis blood stasis syndrome complicated with glucose and lipid metabolism disorders met the clinical and Chinese Medicine characteristics, and thus they could be used as animal models in future studies of psoriasis complicated with glucose and lipid metabolism disorders. [ABSTRACT FROM AUTHOR]

Background: Acellular dermal allograft (AlloDerm) and cartilage perichondrium are two common materials used for repair of tympanic membrane perforations (TMPs). To date, comparative evaluations of their efficacy have rarely been reported. Aim/objectives: To compare anatomical and audiological outcomes between AlloDerm and cartilage perichondrium in type I tympanoplasty. Methods: A total of 61 patients of TMP were studied. In total, 27 patients (Group 1) underwent AlloDerm myringoplasty, and the remaining 34 patients (Group 2) underwent perichondrium myringoplasty. Operating time, closure rate and hearing gain were compared between Groups 1 and 2. Results: Successful closure rates at 6-month follow-up were 88.9% (Group 1) and 82.4% (group 2). The average improvement of air-bone gap (ABG) was 13.5 ± 11.8 dB for Group 1 and 13.1 ± 13.1 dB for Group 2. The difference in between preoperative and 6 months postoperative ABG values was statistically significant (p <.001). Conclusions and significance: Success rates and improvement of hearing level were similar for the AlloDerm (Group 1) and the cartilage perichondrium (Group 2) groups. However, AlloDerm requires shorter operative time and avoids the incisions in the harvest of allografts. Our results suggest that AlloDerm can be recommended as an attractive alternative to cartilage grafts. [ABSTRACT FROM AUTHOR]

Music, an important tool of social and cultural value, has found relevance in healthcare and is being harnessed for therapeutic purposes. However, the art of producing music with musical instruments, has potential health benefits and hazards, which are often ignored. In this article, we review literature, and expound on the effects of playing wind instruments on the health of the player. Some authors have documented superior lung function and a lower risk of obstructive sleep apnea amongst wind instrumentalists. However, the list of health hazards associated with playing wind instruments exceed the potential benefits, with myriad cases of adverse events documented following wind instrument playing. Many of these adverse events are as a result of increased pressures (intra-thoracic, intra-abdominal, intra-ocular, intra-cranial etc.), especially with high resistance instruments, when delivering high pitches and volumes. It is recommended that wind instrument players be aware of the potential health benefits and risks associated with playing their instruments, avoid prolonged playing, ensure adequate rest intervals between playing, and avail themselves of regular (at least annual) medical fitness checks, with special attention paid to their otolaryngologic, cardiovascular, respiratory and ocular health. [ABSTRACT FROM AUTHOR]

Recent studies have indicated that direct administration of viral vectors or small compounds to the inner ear may aid in the treatment of Sensorineural hearing loss (SNHL). However, due to species differences between humans and rodents, translating experimental results into clinical applications remains challenging. The common marmoset (Callithrix jacchus), a New World monkey, is considered a pre-clinical animal model. In the present study, we describe morphometric data acquired from the temporal bone of the common marmoset in order to define the routes of topical drug administration to the inner ear. Dissection and diffusion tensor tractography (DTT) were performed on the fixed cadaverous heads of 13 common marmosets. To investigate potential routes for drug administration to the inner ear, we explored the anatomy of the round window, oval window (OW), semicircular canal, and endolymphatic sac (ES). Among these, the approach via the round window with posterior tympanotomy appeared feasible for delivering drugs to the inner ear without manipulating the tympanic membrane, minimizing the chances of conductive hearing loss. The courses of four critical nerves [including the facial nerve (FN)] were visualized using three-dimensional (3D) DTT, which may help to avoid nerve damage during surgery. Finally, to investigate the feasibility of actual drug administration, we measured the volume of the round window niche (RWN), which was approximately 0.9 μL. The present findings may help to establish experimental standards for evaluating new therapies in this primate model. [ABSTRACT FROM AUTHOR]

Purpose: Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method: Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions: Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. [ABSTRACT FROM AUTHOR]

• The morphological characters of the ear are a tool in physiognomic identification. • Most of the characters of the ear are associated with each other. • When there is a positive association, only one character should be considered. • The characters with negative association have a greater identification weight. The aim of this paper is to provide information on dependency relationships between the morphological characters of the external ear and their importance in physical identification. At present, there is a lack of population data in this field, and little research has been published. Our study sample consisted of 281 Spanish university students of European descent aged between 18 and 31 years old. We analysed a total of 562 ears. For a large number of characters, we found a dependency between anatomically related characters, confirming our hypothesis. For example, we found relationships between ear shape and protrusion, between rolling of the superior and posterior helix, and between the upper and lower parts of the scapha. However, our results also indicated that some anatomically related characters did not present relationships. Thus, we found no dependency between contour shape of the supero-posterior helix and rolling of the posterior helix or between intertragic incisure shape and tragus or antitragus shape. In addition, we found that some characters that are not anatomically related also showed relationships. These included rolling of the superior helix and intertragic incisure shape, and contour shape of the superior helix and the inferior part of the scapha. These results are of great importance and should be taken into account in forensic applications. [ABSTRACT FROM AUTHOR]

The International Collaboration on Cancer Reporting (ICCR) was established to internationally unify and standardize the pathologic reporting of cancers based on collected evidence, as well as to allow systematic multi-institutional intercountry data collection to guide cancer care in the future. Such collaborative efforts are particularly essential for developing an evidence base for rare neoplasms or those with marked geographic variation in incidence, such as the tumors of the ear and the temporal bone. The ear and the temporal bone, including the external auditory canal and the middle and inner ear, with the closely associated facial nerve, internal carotid artery, and internal jugular vein, is one of the most complex anatomic structures in the head and neck. A wide range of benign and malignant neoplasms arise in this region. The management of these neoplasms involves complex surgery because of the anatomic confines, and as such, both benign and malignant tumors are included in this data set, as the oncologically equivalent management requires a multidisciplinary approach and standardized nomenclature and terminology. Surgical procedures at this site result in multifaceted 3-dimensional specimens that can be difficult to handle at macroscopic exam. A comprehensive macroscopic ex- amination is important for identifying critical prognostic factors and often requires clinical and radiologic correlation. Histologic examination is straightforward for basal cell or squamous cell carcinoma but can be quite challenging for other neoplasms. A summary of the ICCR guidelines for ear tumors is presented, along with discussion of the salient evidence and practical issues. [ABSTRACT FROM AUTHOR]

This study is to investigate the effects of imperatorin (IMP) on allergic responses mediated by mast cells, both in vitro and in vivo. Passive cutaneous anaphylaxis (PCA) model was established. Histological detection was performed to assess the ear histology. ELISA and Western blot analysis were used to detect the levels of corresponding cytokines and signalling pathway proteins. IMP decreased the leakage of Evans blue and the ear thickness in the PCA models, in a dose-dependent manner, and alleviated the degranulation of mast cells. Moreover, IMP reduced the expression of TNF-α, IL-4, IL-1β, IL-8, and IL-13. Furthermore, IMP inhibited the phosphorylation levels of Syk, Lyn, PLC-γ1, and Gab2, as well as the downstream MAPK, PI3K/AKT, and NF-κB signaling pathways. In addition, IMP inhibited the mast cell-mediated allergic responses through the Nrf2/HO-1 pathway. IMP attenuates the allergic responses through inhibiting the degranulation and decreasing the expression levels of proinflammatory cytokines in the mast cells, involving the PI3K/Akt, MAPK, NF-κB, and Nrf2/HO-1 pathways. [ABSTRACT FROM AUTHOR]

Purpose: Distortion product otoacoustic emission (DPOAE) amplitude is sensitive to the primary tone level separation effective within the cochlea. Despite potential for middle ear sound transmission characteristics to affect this separation, no primary tone level optimization formula accounts for its influence. This study was conducted to determine if inclusion of ear- and frequency-specific immittance features improves primary tone level optimization formula performance beyond that achieved using a univariate, L2-based formula. Method: For 30 adults with normal hearing, DPOAE, wideband absorbance, and 226-Hz tympanometry measures were completed. A mixed linear modeling technique, incorporating both primary tone and acoustic immittance features, was used to generate a multivariable formula for the middle ear--specific recommendation of primary tone level separations for f2 = 1-6 kHz. The accuracy with which L1OPT, or the L1 observed to maximize DPOAE level for each given L2, could be predicted using the multivariable formula was then compared with that of a traditional, L2-based univariate formula for each individual ear. Results: Use of the multivariable formula L1 = 0.47L2 + 2.40A + f2param + 38 [dB SPL] resulted in significantly more accurate L1OPT predictions than did the univariate formula L1 = 0.49L2 + 41 [dB SPL]. Although average improvement was small, meaningful improvements were identified within individual ears, especially for f2 = 1 and 6 kHz. Conclusion: Incorporation of a wideband absorbance measure into a primary tone level optimization formula resulted in a minor average improvement in L1OPT prediction accuracy when compared with a traditional univariate optimization formula. Further research is needed to identify characteristics of ears that might disproportionately benefit from the additional measure. [ABSTRACT FROM AUTHOR]

This paper proposes a personalized head-related transfer function (HRTF) estimation method based on deep neural networks by using anthropometric measurements and ear images. The proposed method consists of three sub-networks for representing personalized features and estimating the HRTF. As input features for neural networks, the anthropometric measurements regarding the head and torso are used for a feedforward deep neural network (DNN), and the ear images are used for a convolutional neural network (CNN). After that, the outputs of these two sub-networks are merged into another DNN for estimation of the personalized HRTF. To evaluate the performance of the proposed method, objective and subjective evaluations are conducted. For the objective evaluation, the root mean square error (RMSE) and the log spectral distance (LSD) between the reference HRTF and the estimated one are measured. Consequently, the proposed method provides the RMSE of −18.40 dB and LSD of 4.47 dB, which are lower by 0.02 dB and higher by 0.85 dB than the DNN-based method using anthropometric data without pinna measurements, respectively. Next, a sound localization test is performed for the subjective evaluation. As a result, it is shown that the proposed method can localize sound sources with higher accuracy of around 11% and 6% than the average HRTF method and DNN-based method, respectively. In addition, the reductions of the front/back confusion rate by 12.5% and 2.5% are achieved by the proposed method, compared to the average HRTF method and DNN-based method, respectively. [ABSTRACT FROM AUTHOR]

The present study measured 25 dimensions of the ear including the concha and ear canal for ergonomic design of ear products and compared with existing ear measurement studies. Scanning and casting methods were employed to produce 3D ear images for 230 Koreans and 96 Caucasians and measurements of the ear dimensions were obtained by identifying 21 landmarks on individual ear scan image. The Korean ear measurements were found significantly larger (mean difference  = 0.4-3.7 mm) and more varied (ratio of SDs =1.01-1.55) than those of Caucasians in most of ear dimensions. The average ear length and ear breadth of male were significantly longer ( = 1.3-7.0 mm) and wider ( = 0.8-3.0 mm) than those of female. Use of gender- and ethnicity-composite ear data is recommended in product design due to the much larger intra-population variations (7.5-22.2 mm) than the corresponding inter-population variations. Practitioner Summary: The 3D ear measurements of Koreans and Caucasians were collected and compared with those of different ethnic populations. The distinct ear features of the populations identified in this study are applicable to ergonomic design of ear products with better fit and comfort. Abbreviations: CCW: cavum concha width; CV: coefficient of variation; EB: ear breadth; EL: ear length; SD: standard deviation; SE: sampling error; 3D: 3 dimensional [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Ilex asprella (Hook. et Arn.) Champ. ex Benth. (IA) is a representative medicinal plant from the South of the Five Ridges of China. Its roots (RIA) and stems (SIA) have been traditionally used for the inflammation-related diseases, such as acute and chronic pharyngitis, cough, and sore throats. Aim of the study To evaluate the in vivo anti-inflammatory effects of IA extracts to provide evidence for its traditional use and to enhance the knowledge of the medicinal properties of IA. Materials and methods Models of xylene-induced ear edema in mice and carrageenan-induced paw edema in rats were used for the pharmacological evaluations. The mice were randomly divided into eight groups (n = 10 per group): a model group, a positive control group [dexamethasone (Dex), 10 mg/kg, intragastrically (i.g.)], RIA aqueous extract groups with three dosages (30, 15, and 7.5 mg/kg, i.g.), and SIA aqueous extract groups with three dosages (60, 30, and 15 mg/kg, i.g.). The rats were randomly divided into eight groups (n = 6 per group): a model group, a positive control group [acetylsalicylic acid (ASA), 300 mg/kg, i.g.], RIA groups with three dosages (80, 40, and 20 mg/kg, i.g.) and SIA aqueous extract groups with three dosages (160, 80, and 40 mg/kg, i.g.). Histological examinations of the ear and paw tissues were observed by hematoxylin-eosin (HE) staining, and neutrophil elastase levels were assessed in ear tissues by immunohistochemical analysis. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) were measured by ELISAs, and expression levels of TNF-α, IL-6, and IL-1β in rat paw tissues were measured by RT-PCR. The signal transduction proteins p65, IκBα, Janus kinase 2 (JAK2), signal transducer and activator of transcription 3 (STAT3), p38 mitogen-activated protein kinases (p38), extracellular regulated protein kinases (ERK1/2), and c-Jun N-terminal kinase (JNK) in the rat paw tissues were investigated by western blot analyses. RIA and SIA were characterized by HPLC and LC-MS analyses, and the components were confirmed by comparison with isolated compounds. Results Intragastric administration with RIA (30 mg/kg) and SIA (60, 30 mg/kg) significantly mitigated ear edema in mice. RIA administration at 80 and 40 mg/kg reduced paw edema in rats 2‒3 h after injection. SIA administration with 160 mg/kg inhibited paw edema in rats after the injection of carrageenan for 1‒4 h, and SIA administration at 80 mg/kg inhibited paw edema after the injection of carrageenan for 2‒4 h. Meanwhile, RIA (80, 40 mg/kg) and SIA (160, 80 mg/kg) reduced inflammatory cell infiltration in the ear and paw tissues and infiltration of neutrophil leukocytes in rat paw tissues. RIA (80, 40, and 20 mg/kg) and SIA (160, 80, and 40 mg/kg) notably inhibited the increases of TNF-α, IL-6 and IL-1β in the serum and mRNA expression in the rat paw tissues. RIA (80, 40 mg/kg) and SIA (160, 80 mg/kg) reduced the p-p65/p-IκBα, p-JAK2/p-STAT3, and p-p38/p-ERK1/2/p-JNK levels in the pathological tissues of the animals. Phenolic acids and triterpenoids likely contributed to the anti-inflammatory activity. Conclusions Both RIA and SIA aqueous extracts showed anti-inflammatory effects in vivo in a dose-independent manner (20‒80 and 40‒160 mg/kg, respectively). The underlying mechanisms are mediated by inhibiting the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β via regulation of the NF-κB, JAK2/STAT3, and MAPK signaling pathways. The present results provided pharmacological evidence that stems are alternative medicinal parts of IA but function at different doses. Additionally, this study supports the use of IA as an anti-inflammatory herbal medicine. [ABSTRACT FROM AUTHOR]

Background: Microscopic stapedotomy is very successful and has long history, but it still has some constraints. Thus, otoendoscopy is increasingly popular nowadays. Aims/Objectives: The retrospective review study was to investigate the role of endoscopic laser stapedotomy in treating patients with otosclerosis. Materials and methods: Seventeen patients who received endoscopic laser stapedotomy from April 2014 to July 2017 were enrolled and compared to 13 patients who had microscopic stapedotomy from February 2009 to March 2012. The anatomical structures, operative time, and postoperative hearing outcomes were assessed in two groups. Relation between external acoustic canal and operative time was also analyzed. Results: Using an endoscope, the operative field was clear, with easily identified anatomy, without need to sacrifice bony structures. The operative time was significantly longer in the endoscopic group in 2014 and decreased in the following years. There was no significant difference of hearing improvements between the two groups. There was a weak correlation between the width of the external auditory canal and the operative time. Conclusions and significance: Fully endoscopic stapes surgery is a feasible and safe surgical technique and results in satisfactory hearing outcomes. However, surgeons take longer to master the technique and to achieve shorter endoscopic operative times. [ABSTRACT FROM AUTHOR]