Search

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of this study was to evaluate auditory performance of military instructors as part of a training course involving noise and blast exposure. Boothless audiometry was used to estimate the test-retest reliability of the auditory measures under realistic field conditions and to determine risk of acute auditory injury during standard training practices. Thirteen U.S. Marine instructors participated in study activities. An audiologic testing suite embedded in a noise-attenuating headset was used to test various tone detection tasks on subjects after exposure. Acoustic exposures were captured with sound level meters. Boothless audiometry provide highly repeatable results for various tests of auditory performance in the field environment. In this test population, changes in auditory performance pre- and post-noise exposure were minimal for most measures. The notable exception was binaural (NoSπ) tone detection, which showed significant degradations both as a function of pre- and post-noise exposure on the same day and as a result of cumulative noise exposure over the period of the study. Study outcomes are consistent with prior laboratory and epidemiological work and suggest a link between the binaural processes required for NoSπ detection and the hearing-related issues reported by blast-exposed service members. [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]

The article discusses the case of a patient with spontaneous temporomandibular joint (TMJ) herniation into the external auditory canal. Topics discussed include intermittent left-sided aural fullness presented by the patient, the results of otoscopy and high-resolution computed tomography of the temporal bone, and surgical reconstruction of the bony defect recommended to symptomatic patients.

Background and Aim: Physical injuries affect the psychological dimension of human beings. This study aimed to investigate the impact of physical injuries on the psychological dimension of people. Methods: This is a cross-sectional descriptive study that was conducted on traffic police staff who were referred to Valiasr hospital in Tehran, Iran due to injuries between April 2015 and November 2021. The required information was collected from the database using medical documents and registered files of injured employees. After coding data, SPSS version 26 software was used for statistical analysis. Results: Among the 120 injured people, the highest average score evaluated by the GHQ questionnaire was obtained by the ear, nose, and throat group (22%), upper limb (20%), eye (19%), lower limb (17%), and digestion (14%), which shows that in some cases (physical scale, anxiety and sleep disorder, symptoms of social action, symptoms of depression) are exposed to damage. The urology-affected group got the lowest score among the different groups with 8%, which indicates that this group is in a very favorable state in terms of mental health. Conclusion: The results of this study showed that the most type of physical injury that affected the psychological dimension of people was the ear, nose, and throat injury, and the least injury was related to urology. [ABSTRACT FROM AUTHOR]

Objective: Suppurative chondritis is a potentially devastating complication of burns to the ear. The infection and inflammation can liquify cartilage, leading to significant aesthetic deformities which are difficult to treat. This article reviews published measures for preventing post-burn chondritis. Method: A comprehensive search of all available literature up to September 2020 was performed, according to PRISMA guidelines, for studies assessing preventive measures for post-burn chondritis. Randomised controlled trials (RCT), cohort studies, case–control studies, case reports and series were eligible for inclusion Results: A total of 10 studies, including one RCT and nine retrospective observational analyses, were included, incorporating 1369 patients with burns to the ear. The most common interventions were pressure avoidance (70%), daily cleansing (60%), topical mafenide acetate (60%) and targeted debridement (30%). Packages of measures which included pressure avoidance were the most effective, all of which achieved a chondritis incidence of <6%. Conclusion: Low-level but strong published evidence suggests that important treatment principles include prevention by pressure relief, targeted debridement, prophylactic local antibiotics, local antisepsis and the avoidance of desiccation. [ABSTRACT FROM AUTHOR]

In the livestock activity there are setbacks or accidents that cause injuries to the animals. The clips placement to identify the calves requires the application of product that accelerates healing and prevents opportunistic infection (cutaneous myiasis, among others). The lack of veterinary products for this purpose, makes it necessary to search for new alternatives. This work describes the evolution of a clinical calf case from the "Niña Bonita" Livestock Genetic Company, Rearing Unit 907, with an ear wound due to placement identification clip, which was inflamed, with necrotic tissue, abundant infection, excruciating pain and a hole through the auricular labellum. The treatment applied so far was Ivomec®, to eliminating the cutaneous myiasis larvae. The OleoVET was applied inmidiatly, after carrying out a deep mechanical cleaning with HPI product and enough quantity was applied to cover the entire lesion and avoid flies. The cures were carried out every 24 h for five days. The evolution photos of the perforating wound were recorded in which a reduction of the typical infectious secretion is observed, together with the vascular regeneration, in addition to the growth of new bright red blood vessels and the progressive closure of the wound. The germicidal action of OleoVET, its stimulating action on wound healing and its usefulness in Veterinary Medicine were confirmed. [ABSTRACT FROM AUTHOR]

Introduction: Inner ear barotrauma (IEBt) and inner ear decompression sickness (IEDCS) are the two dysbaric inner ear injuries associated with diving. Both conditions manifest as cochleovestibular symptoms, causing difficulties in differential diagnosis and possibly delaying (or leading to inappropriate) treatment. Methods: This was a systematic review of IEBt and IEDCS cases aiming to define diving and clinical variables that help differentiate these conditions. The search strategy consisted of a preliminary search, followed by a systematic search covering three databases (PubMed, Medline, Scopus). Studies were included when published in English and adequately reporting one or more IEBt or IEDCS patients in diving. Concerns regarding missing and duplicate data were minimised by contacting original authors when necessary. Results: In total, 25 studies with IEBt patients (n = 183) and 18 studies with IEDCS patients (n = 397) were included. Variables most useful in differentiating between IEBt and IEDCS were dive type (free diving versus scuba diving), dive gas (compressed air versus mixed gas), dive profile (mean depth 13 versus 43 metres of seawater), symptom onset (when descending versus when ascending or surfacing), distribution of cochleovestibular symptoms (vestibular versus cochlear) and absence or presence of other DCS symptoms. Symptoms of difficult middle ear equalisation or findings consistent with middle ear barotrauma could not be reliably assessed in this context, being insufficiently reported in the IEDCS literature. Conclusions: There are multiple useful variables to help distinguish IEBt from IEDCS. Symptoms of difficult middle ear equalisation or findings consistent with middle ear barotrauma require further study as means of distinguishing IEBt and IEDCS. [ABSTRACT FROM AUTHOR]

Objective: Tegmen defects occur mainly due to cholesteatoma and iatrogenic trauma, and the intervention for the related defects is still a debate. In this study, we aimed to discuss our clinical experience on the management of the tegmen defects which were revealed during the mastoidectomy surgeries. Methods: This study was designed as a retrospective chart review study and patients who were operated between 2007-2017 were included. The causes of the defects, repair technics, and results of the long-term follow up were evaluated. The perioperative and postoperative defect sizes which were obtained from the radiological studies were analyzed. Results: Total number of 62 patients had tegmen defects, and their etiologic factors were cholesteatoma in 31 (50%), iatrogenic factors in 29 (46.7%), and chronic infection in 2 (3.3%) patients. The number of the tegmen defects was higher in intact canal wall technic. All of the tegmen defects were repaired with different materials, and no complication was detected. The obtained data from the postoperative radiological images revealed that the related perioperative defects were significantly decreased (p<0.001). Conclusion: The perioperative bone defects were observedly decreased significantly in postoperative period. Early detection of the defect and appropriate interventions may help to manage this problem without any complication in the long term. [ABSTRACT FROM AUTHOR]

Background: The primary aim of the study is to evaluate the functional outcome following AMIC procedure in patients with osteochondral injury of the talus. The secondary aim is to evaluate if size of the lesion and patient's age influence outcome.Materials and Methods: This is a retrospective study of 25 patients who underwent AMIC procedure of the talus treated by a single surgeon. Functional outcomes were evaluated using pre and post operative AOFAS and VAS scores.Results: The mean lesion size was 1.74 cms with 88% of lesions in the study more than 1.4 cms. There was a significant improvement in AOFAS score with mean improvement of 49.40 (p < 0.05) and VAS score of 5.36 (p < 0.05). We could not find any correlation between either age or lesion size with functional outcome for AMIC procedure.Conclusion: AMIC procedure seems to be a reliable treatment method for larger diameter osteochondral lesions of the talus up to 2.5 cms in diameter. [ABSTRACT FROM AUTHOR]

Background: The anterior surface of the auricle is especially susceptible to a variety of traumatic insults and cutaneous malignancies. However, given the unique anatomy of this structure and the lack of local tissue available, the reconstruction of these defects is still a challenge. Despite of their positive outcomes, tunneled flaps have not been thoroughly explored in the literature. Objectives: To review the clinical utility of tunneled flaps in reconstructing anterior auricle defects. Materials and methods: A review of the literature on surgical reconstruction of the anterior auricle surface was performed in PubMed, with specific reference to tunneled flaps. Conclusions: When designed and executed properly, tunneled flaps offer unrivalled opportunities to reconstruct anterior auricle defects, with maximal preservation of the symmetry. [ABSTRACT FROM AUTHOR]

Purpose: A meta-analysis was conducted to evaluate how effective the Gaps-in-Noise (GIN) test is in separating populations who are and who are not at risk of having neurological damage related to the central auditory nervous system (CANS). This was investigated by asking three specific questions: (1) Does ear and side of lesion have an effect over the individual's performance? (2) How large is the difference in performance between control and neurological groups? (3) What are the diagnostic indices related to the GIN test? Data Collection and Analysis: A literature review was performed between April 2016 and April 2017. The eligibility criteria for inclusion were as follows: (1) studies that used the GIN test as an outcome measure, (2) studies that included adult participants who either had confirmed lesions or were at risk of having lesions to the CANS or related regions, and (3) studies that had a neurologically normal control group. From relevant studies that met eligibility criteria, information regarding study design, participants, lesion details and origins, use of additional assessments, GIN performance scores for both control (CTRL) and neurological (NRLG) groups, GIN cutoff scores and proportion of individuals with normal and abnormal performances were all included. Results: Nine studies were included, totaling 221 participants in NRLG (stroke 5 90, epilepsy 5 67, and blast exposure [BLST] 5 64) and 262 in CTRL (Stroke 5 106, Epilepsy 5 98, and BLST 5 58). No significant ear effects related to side of lesion were observed for the GIN test in neurological patients nor were there significant ear differences for normal individuals with symmetrically normal hearing. The GIN demonstrated consistency among different neurological populations, presented good sensitivity and specificity rates, and was overall accurate in discriminating between participants with neuroauditory lesions from neurologically normal individuals. Conclusions: The GIN is thus a clinically effective measure that provides insight into the CANS integrity and may aid in clinical diagnosis by distinguishing between populations who are and who are not at risk of having neurological damage affecting the CANS. [ABSTRACT FROM AUTHOR]

Immunological factors play important roles in the occurrence of hypertrophic scars. Imiquimod can be used as an immunosuppressive agent to regulate the function of T‐helper (Th) cell subsets Th1 and Th2. In this article, we explored the impact of imiquimod on scar hyperplasia through Th cells. A rabbit ear hypertrophic scar model was built. Four round wounds were cut in each rabbit's ears ventrally with a diameter of 1 cm and bilateral symmetry. All the right ear wounds were treated with 5% imiquimod cream. The blank control group contained all the left ear wounds, which were treated with Vaseline ointment at the same time. Haematoxylin and eosin and Masson staining showed that imiquimod collagen deposition was significantly reduced compared with the control group, scar index (SEI) showed that the proliferative degree reached its peak on the 28th day after operation in blank group, and the degree of hyperplasia was significantly higher than that of the imiquimod group (P < .05). Real‐time Polymerase chain reaction results showed that the imiquimod induced the expression of Th2 cell‐related chemokines CCL2, CCL3, CCL5, CCL7, and CCL13 at each time point, which were significantly lower than that of the blank control group, and the expressions of Th1 cell‐associated chemokines CXCL10 and CXCL12 at each time point was significantly higher than the blank control group (P < .05). Imiquimod can be used to regulate the expression of Th1 and Th2 cell‐associated chemokines to control scar hyperplasia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to improve and accelerate the rehabilitation process for patients with severe ear microtia with an implant-anchored auricular prosthesis. A medically approved robot system was used to place the craniofacial implants and a new process was developed for preoperative fabrication of the prosthesis using a rapid prototyping technique. Materials and Methods: Preoperatively, after computerized tomography, the implant positions were determined in a planning tool according to bone availability and esthetic considerations. Intraoperatively, the robot showed the surgeon the planned implant positions and guided the placement procedure. Results: The accuracy measurements showed that with this robot system, absolute implant position accuracy of approximately -0.5 ± 0.4 mm, a relative accuracy between the implants of approximately 0.2 ± 0.5 mm, and a deviation from the parallel position of approximately 0.6 ± 0.5 degrees were achieved. Thirty implants were placed in 13 patients with robot assistance with no intraoperative injuries. Discussion: This technique made it possible to apply the preoperatively fabricated auricular prosthesis directly after surgery. Conclusion: From this experience it can be concluded that the robot system and the new manufacturing concept for anaplastology can be applied advantageously in other areas of the head as well. [ABSTRACT FROM AUTHOR]

In adult mammals, skin wounds typically heal by scarring rather than through regeneration. In contrast, "super-healer" Murphy Roths Large (MRL) mice have the unusual ability to regenerate ear punch wounds; however, the molecular basis for this regeneration remains elusive. Here, in hybrid crosses between MRL and non-regenerating mice, we used allele-specific gene expression to identify cis-regulatory variation associated with ear regeneration. Analyzing three major cell populations (immune, fibroblast, and endothelial), we found that genes with cis-regulatory differences specifically in fibroblasts were associated with wound-healing pathways and also co-localized with quantitative trait loci for ear wound-healing. Ectopic treatment with one of these proteins, complement factor H (CFH), accelerated wound repair and induced regeneration in typically fibrotic wounds. Through single-cell RNA sequencing (RNA-seq), we observed that CFH treatment dramatically reduced immune cell recruitment to wounds, suggesting a potential mechanism for CFH's effect. Overall, our results provide insights into the molecular drivers of regeneration with potential clinical implications., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Middle ear barotrauma (MEB), one of the side effects of hyperbaric oxygen (HBO2) therapy, sometimes cannot be directly diagnosed during the therapy itself. Instead, its incidence and degree are judged based on subjective statements made by patients when in conversation with medical staff regarding how they feel. To prevent MEB in practice it is proposed that the tympanic membrane evaluation system and automatic control chamber developed in a previous study be applied as part of a prevention algorithm [16]. The proposed algorithm, which determines and equalizes the unbalanced pressure of a subject based on their tympanic admittance, was evaluated in conjunction with conventional HBO2 therapy in an experiment involving 100 subjects. Among the 50 subjects in the control group who received HBO2 therapy 16 subjects experienced MEB. In contrast, the experimental group of 50 subjects were treated with a hyperbaric chamber protocol incorporating the automatic control system and proposed algorithm. At the conclusion of the treatment, no subjects exhibited middle ear barotrauma. In the case of the control group, while the target pressure was achieved, middle ear barotrauma still occurred. However, in the case of the experimental group, the pressure inside the chamber was adjusted as per the algorithm, which allowed the target pressure for every subject to be achieved without experiencing MEB. When a particular subject was unable to perform any pressure equalization method such as swallowing or the Valsalva maneuver, the chamber was not pressurized based on the tympanic admittance and thus no MEB occurred. [ABSTRACT FROM AUTHOR]

Hyperbaric-associated middle ear barotrauma (MEB) is one of the most common side effects of the exposure to hyperbaric oxygen (HBO2) therapy. This retrospective observational study of 5,962 patients undergoing longterm therapy for chronic conditions took place at the local Diving & Hyperbaric Medicine Unit (DHMU) in Villafranca- Verona (Italy), a DHMU that administers, in multiplace chambers, more than 20,000 HBO2 treatments per year. The study was designed to weight and analyze both the incidence and severity of MEBs at the facility. Thanks to a systematic recording method over eight years, 2003-2010, we observed 549 MEBs (9.2% of all HBO2 treatments). The majority of them were female patients older than 50. MEBs observed were usually of minor complexity, with minimal otoscopic changes (69.03% of our occurrences were registered as Wallace-Teed Grade 1). MEBs were registered in 20.3% of those patients already suffering from difficulties in equalizing ear pressure, and/or presenting ear pain during the initial compression phase (descent) of the hyperbaric treatment. Inflammatory diseases of the upper respiratory tract, with special attention to rhinitis, appear to be a condition capable of predisposing patients in developing MEB. MEB did lead to the suspension of therapy for 89 patients in our case series. This was 16.2% of all the MEBs registered, or 1.49% of all patients who underwent HBO2 at the facility in the considered time lapse. [ABSTRACT FROM AUTHOR]

Aim: There are several methods for covering post-traumatic soft tissue defects, such as skin grafts or flaps. However, these options have some limitations, including a paucity of suitable adjacent tissue, and exposure of neurovascular, bony, or cartilage structures. Therefore, alternative dermal substitutes have been developed for soft-tissue defects. Matriderm® (Dr. Suwelack Skin and Health Care AG, Billerbeck, Germany), a single-layer dermal matrix, has been used often in burn treatment. This study aims to present the use of a dermal matrix in reconstructive surgery. Method: A 39-year-old male presented to the emergency department with a complaint of total amputation of the right ear due to a dog bite. Surgical debridement and proper antibiotic therapy were administered. A two-stage ear reconstruction was then planned using a costal cartilage graft. After the first stage of ear reconstruction surgery, it was noticed that the skin flap on the cartilage prefabrication was thinner, there were detachments in the infected suture lines (Fig. 1). The infected wound was debrided. Afterwards, the exposed cartilage prefabrication, which excludes the perichondrium, was covered with a one-mm Matriderm® and a split-thickness skin graft in a single-step procedure. In addition, a vacuum device was applied. Results / Discussion: The presented case had cartilage exposition, in which Matriderm® allowed the host cell to produce a fuller subdermal bed, over which the skin can epithelize. Complete healing of the skin graft was confirmed through outpatient follow-up at 4 weeks postoperatively. Conclusion: The use of Matriderm® in combination with a skin graft in exposed structures is a simple, feasible method. Therefore, Matriderm® can be indicated in reconstructive surgery, where flap options are limited. [ABSTRACT FROM AUTHOR]

Objective: The application of moisture to the ear is anecdotally claimed to relieve the pain from otic barotrauma that can arise during aircraft descent. This claim was tested in a randomised double-blind study on an aircraft with eight participants heavily predisposed to barotrauma. Methods: On the outward flight, half the participants wore 'active' devices that applied moisture to the external ear; the remainder wore placebo devices that contained no moisture, but were otherwise identical. On the return flight, the groups were reversed. Participants wore the devices from just before descent until landing, unless they experienced symptoms of barotrauma, in which case they switched to what they knew was an active device. Results: There were no significant differences between conditions regarding the appearance of the tympanic membrane on landing or the discomfort levels immediately before and after any switch. Conclusion: Applying moisture is ineffective for passengers heavily predisposed to otic barotrauma. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the various methods and outcomes of post-traumatic partial auricle wound reconstruction, and to review the benefit to the patient's quality of life and their psychological improvement after the operation. Methods: The prospective study included patients who suffered from post-traumatic partial auricular wounds. The defects were repaired using various techniques including simple local cutaneous advancement flaps, tube flaps, cartilage framework using conchal and costal cartilage with local skin flap cover. Results: A total of 18 patients were included, with a male predominance (sex ratio: 7:2), mean age with standard deviation of 31.66 ±9.27 years. Causes included road traffic accident (RTA), assault, human and insect bite and avulsion injuries. Injuries were sustained in the upper third of the auricle (n=8); middle third (n=5), lower third (n=3), and upper two-thirds (n=2). Out of the 18 patients, wound were repaired using post auricular mastoid skin flap (n=7); local superior and inferior chondrocutaneous flap (n=3); costal cartilage as a cartilage framework (n=4), temporoparietal fascia used to cover the costal cartilage graft (n=1), and conchal cartilage as a cartilage framework (n=3). In our study 13/18 patients were ‘highly satisfied’ with the aesthetic outcome, 3/18 were ‘moderately satisfied’, and 2/18 were ‘slightly satisfied’. None were dissatisfied by the postoperative result. In terms of objective assessment, patient outcome in two patients was graded ‘good’ while the outcome of remaining patients (n=16) was graded as ‘excellent’. Conclusions: The use of skin flaps in the post-auricular region and the mastoid region associated with or without cartilage framework yields good cosmetic and functional result. The various techniques used for ear reconstruction yielded 100% satisfactory results in terms of functional outcome as well as boosting the confidence of patients. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Traumatic noise causes hearing loss by damaging sensory hair cells and their auditory synapses. There are no treatments. Here, we investigated mice exposed to a blast wave approximating a roadside bomb. In vivo cochlear imaging revealed an increase in the volume of endolymph, the fluid within scala media, termed endolymphatic hydrops. Endolymphatic hydrops, hair cell loss, and cochlear synaptopathy were initiated by trauma to the mechanosensitive hair cell stereocilia and were K+-dependent. Increasing the osmolality of the adjacent perilymph treated endolymphatic hydrops and prevented synaptopathy, but did not prevent hair cell loss. Conversely, inducing endolymphatic hydrops in control mice by lowering perilymph osmolality caused cochlear synaptopathy that was glutamate-dependent, but did not cause hair cell loss. Thus, endolymphatic hydrops is a surrogate marker for synaptic bouton swelling after hair cells release excitotoxic levels of glutamate. Because osmotic stabilization prevents neural damage, it is a potential treatment to reduce hearing loss after noise exposure. [ABSTRACT FROM AUTHOR]

Patients with Parkinsonism are at risk of frequent falls by virtue of their unstable gait. Auricular lacerations involving the cartilage are usually managed by Plastics Surgeons. Patient Mr Jones (an alias for this case review) had sustained a significant full thickness auricular laceration that was complicated by a past medical history with Parkinson's disease. This case review summarises a nurse practitioner's (NP) clinical decision-making processes and the experience in the management and treatment of auricular cartilage lacerations in the emergency department. [ABSTRACT FROM AUTHOR]

Auricular burns represent a unique type of injury. The acute management and clinical course of these injuries can be different from other facial burns. There is a paucity of literature pertaining to the epidemiology and acute management of auricular burns. Most studies focus on deformity reconstruction. The aim of this study was to characterize the epidemiology, treatment, and outcomes of auricular burns. Data from all patients presenting to a regional burn center in a 4-year period were reviewed and those with auricular burns were identified. Demographic data, burn mechanism, insurance status, method of treatment, need for skin grafting, percentage graft-take, time to reepithelialization and incidence of deformity were reviewed. During the study period, 593 facial burns were evaluated and 132 (22%) sustained burns to the auricle. The most common mechanisms of injury were flame (65.1%) and scalding (22.5%). Auricular burns were mostly second degree (88%), involved both ears in 44%, and involved only the ventral aspect of the ear in 57%. The majority of patients healed well with conservative management; none suffered from chondritis. Of the 89 patients followed to healing, 1 patient (1.1%) received full-thickness skin grafts to the auricle, resulting in excellent graft-take. All other patients were managed nonoperatively, and none suffered from ear deformities. Auricular burns occur with surprising frequency in patients presenting to burn centers. Careful acute management of these injuries can eliminate development of chondritis and minimize the rate of deformity and need for reconstruction. The majority of wounds heal with conservative management, but time to reepithelialization can be prolonged. [ABSTRACT FROM AUTHOR]

The article reports on the tympanic membrane perforations (TMP), an ear injury due to yucca plants. Topics mentioned include the screening for TMP, the prevention of ear injury due to yucca, and the electronystagmograph performed to patients. Also mentioned are the safety measures for surgical operation for TMP patients and the complications of TMP.

Facial trauma is uncommon in children. However, the unique features of these injuries, as well as the assessment and management considerations to minimize radiation exposure and ensure optimal cosmetic outcome, require an awareness of the diagnostic and therapeutic approach in pediatric patients. The authors provide an overview of orofacial, eye, and ear trauma in children. [ABSTRACT FROM AUTHOR]

Background: Keloid is an abnormal growth of scar at the site of skin injury, which usually does not regress. It proliferates beyond the original scar. The ear keloid usually develops after piercing injury to wear ornaments. A patient usually asks for removal of keloid, as it is aesthetically unpleasant. Patient may sometimes complain of itching and pain. Aim: The study was conducted to analyze results following excision of keloid with its tract and topical silicone gel as the postsurgical adjuvant. Materials and Methods: Ear keloids measuring less than 0.5 cm or more than 5 cm in maximum dimension were excluded from the study. Nonpiercing causes such as burns, trauma, and recurrent keloid were excluded from the study. The study was carried out on 22 patients who had keloid because of piercing injury, including 4 cases with both ear keloids. Of 26 ear keloids, 19 had the tract or connecting tissue. The lesion was excised under anesthesia using magnification. For all the operated cases, topical liquid silicone gel was used as postsurgical adjuvant therapy. The method of application of topical silicone gel was taught to each patient and was considered significant. Result: The magnification helped in identification of tract in 73% of the cases in this study. Twenty patients had successfully responded to proposed treatment, and two patients developed recurrence while using topical silicone gel as the adjuvant. These two patients were managed with conventional triamcinolone injection. Conclusion: The topical silicone gel as postsurgical adjuvant therapy avoided the use of painful postsurgical injection or radiotherapy for the 1-3 cm primary ear keloids. The advantages of magnification were better clearance of keloid tissue, easier identification of tract and removal of keloid pseudopods, meticulous suturing, and comfortable elevation of a small local flap. [ABSTRACT FROM AUTHOR]

Background: An early soft tissue reconstruction is mandatory after burns of the outer ear to avoid cartilage loss. Although different procedures for covering soft tissue defects of the outer ear have been described in the past, the biomechanical properties and cosmetic outcome of reconstructed burned tissue are yet to be investigated more thoroughly. Methods: Using photographs and the Cutometer, a device for measuring biomechanical skin properties such as firmness and elasticity, the 12 ears in six healthy volunteers and the 12 mainly deep partial-thickness injured ears in six patients who suffered burn injuries were examined. Three of the burned ears were covered with temporoparietal fascial flaps with split skin grafts based on the superficial temporal artery, four with retroauricular random pattern flaps, and five with full thickness skin graft. Results: The median values of the firmness and elasticity of skin were approximately equal in the control group compared to the random pattern flap group. The median values of firmness and elasticity differ between the control group and the temporoparietal fascial flap and skin graft group ( p = 0.05). Cosmetic outcome in terms of anatomical structures revealed full thickness grafts as the superior method. Conclusions: Considering burn depth, the results of cosmetic outcome support the clinical principle of the reconstructive ladder, suggesting full thickness skin grafts as first choice. If high biomechanical skin quality is necessary, random pattern skin flaps from the lateral head region were the favorable procedure for burn reconstructions in the outer ear. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Traumatic cleft earlobes are a common problem encountered by plastic and reconstructive surgeons. Various techniques have been reported for the repair of traumatic cleft earlobes. Usually, the techniques of split earlobe repair are divided into two categories, namely straight- and broken-line repairs. Straight-line repair is simple and easy, but scar contracture frequently results in notching of the inferior border of the lobule. It can be avoided by the broken-line repair such as Z-plasty, L-plasty, or a V-shaped flap. Between April 2016 and February 2017, six patients who presented with traumatic cleft earlobe underwent surgical correction using a combination of the inverted V-shaped excision technique and vertical mattress suture method. All the patients were female and had a unilateral complete cleft earlobe. No postoperative notching of the inferior border the lobule occurred during 6-16 months of follow-up. Without the use of a broken-line repair, both the patients and the operators attained aesthetically satisfactory results. Therefore, the combination of the inverted V-shaped excision technique and vertical mattress suture method is considered useful in the treatment of traumatic cleft earlobes. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old male patient that was diagnosed with cotton swab injury-related subacute deafness.

Hypertrophic scar (HS) is a dermal fibroproliferative disorder characterized by the excessive proliferation of fibroblasts and is thought to result from a cellular imbalance caused by the increased growth and reduced apoptosis of hypertrophic scar fibroblasts (HSFs). Our recent study demonstrated that recombinant human endostatin (rhEndostatin) plays a key role in the inhibition of HSF proliferation in vitro , with a resulting decrease in dermal thickness and scar hypertrophy. However, the effect of this protein on HSF apoptosis is unknown. The present study was undertaken to directly examine the effect of rhEndostatin on HSF apoptosis in the rabbit ear model. Transmission electron microscopy and flow cytometry were used to investigate HSF apoptosis in scar tissues and cultured HSFs in vitro , respectively. The expression levels of the c-jun , c-fos , NF-κB , fas , caspase-3 , and bcl-2 gene products in HSFs were quantified using real-time PCR and Western blotting assays. Our data reveal that rhEndostatin (2.5 or 5 mg/ml) induces HSF apoptotic cell death in scar tissue. Additionally, HSFs treated with rhEndostatin (100 mg/L) in vitro accumulated in early and late apoptosis and displayed significantly decreased expression of c-jun, c-fos, NF-κB, fas, caspase-3 and bcl-2. In sum, these results demonstrate that rhEndostatin induces HSF apoptosis, and this phenotypeis partially due to downregulation of NF-κB and bcl-2. These findings suggest that rhEndostatin may have an inhibitory effect on scar hypertrophy in vivo via HSF apoptotic induction and therefore has potential therapeutic use for the treatment of HS. [ABSTRACT FROM AUTHOR]

Self-ear cleaning is the insertion of objects into the ear canal to clean it, a widespread practice that has the potential to compromise its integrity as a natural, selfcleansing mechanism, and a risk factor for possible injuries. The practice is common among young adults and highest in university than any other graduates. This study aimed to determine the self-ear cleaning practices and associated risk of injury and related symptoms in undergraduate students at KwaZulu-Natal University. The descriptive survey utilized a self-administered questionnaire. Of the 206 participants that responded, 98% engaged in self-ear cleaning, with 75% indicating that it was beneficial. The commonest method (79.6%) being the use of cotton buds, with an associated injury rate of 2.4%. There was no statistically significant associations between those who used or did not use cotton buds and the symptoms experienced. The complications indicate that self-ear cleaning does pose a risk for injury, necessitating more community information and education. [ABSTRACT FROM AUTHOR]

Cutaneous leishmaniasis typically presents as a painless papule progressing to an ulcer or plaque. In this case study of the ear, the disease manifested as a small painful bump progressing into redness and swelling about the ear with purulent drainage. After multiple oral/intravenous antipseudomonal, antistaphylococcal, and antifungal treatments, there was no improvement. The skin progressed to an erythematous plaque and hemorrhagic ulcer; punch biopsy and speciation revealed Leishmaniasis guyanensis. The patient was switched to a seven-dose course of intravenous L-amphotericin B (visceral leishmaniasis protocol). Within 21 days, pain and edema resolved and the ulcers healed. Three-month follow-up demonstrated no recurrence. Further studies are needed to evaluate the use of L-amphotericin B in Leishmaniasis guyanensis. [ABSTRACT FROM AUTHOR]

This prospective study was conducted to evaluate the efficacy of sea buckthorn oil patches in treating traumatic tympanic membrane (TM) perforations. We enrolled 370 patients with traumatic TM perforations of different sizes. These patients were randomly assigned to control group and treatment group. In the treatment group, a sterile cotton patch with sea buckthorn oil was used to cover the TM perforations. In the control group, patients were treated with a sterile cotton patch. The healing rate and time were compared between the two groups. We found that the overall healing rate was significantly higher in the treatment group than in the control group. For middle and large TM perforations, sea buckthorn oil treatment led to a significant increase in the healing rate. At 2 months after injury, the duration of healing was, generally, shorter in the treatment group than in the control group (P<0.05). In conclusion, sea buckthorn oil patches are effective in treating middle and large TM perforations, which results in increased healing rates and decreased healing time. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to identify the otologic injuries due to handmade explosive-welded blast travma in the law enforcement officers during the combat operations in the curfew security region and to specify the disorders that Otolaryngology and Head Neck Surgery (OHNS) physicians can face during such operations. Methods: Medical records of patients in law enforcement who were initially treated by OHNS physicians of Silopi State Hospital during combat operations, between December 14, 2015 and January 15, 2016 were reviewed. Twenty-five patients with otologic injuries due to blast trauma were included in the study. Trauma characteristics, physical examination findings, and beginning treatments were identified. Results: Primary blast injury (PBI) was identified as the major disorder in all 24 cases. Tinnitus and hearing loss were the most frequent complaints. In physical examination, tympanic membrane perforations were found in four ears of three patients. Oral methylprednisolone in decreasing doses for 10 days was commenced as an initial treatment in patients with PBI. Secondary blast injury presented in the form of soft tissue damage in the auricular helix due to shrapnel pieces in one patient and a minor surgery was performed. Conclusion: Otologic injuries due to blast trauma may often develop during this type of combat operations. Otologic symptoms should be checked, otoscopic examination should be performed, and patients should consult OHNS physicians as soon as possible after trauma. [ABSTRACT FROM AUTHOR]

This paper investigates mutilation of the nose and ears in New Kingdom Egypt (c. 1550-1070BCE). The topic is first contextualised within cross-cultural mutilation research, before discussion shifts to focus more closely on Egypt. The threat of mutilation in oaths is considered, as is the possibility of mutilation not being enforced if such oaths were broken. The paper then investigates the lived experience of mutilation, encompassing both physiological and social impairments. Finally, a ‘supra-practical’ aspect is proposed, considering the esoteric connotations of mutilation, this latter understood as a set of practices including but not confined to actual physical dismemberment. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of topical use of silver sulfadiazine cream (SSD) on wound healing and subsequent scarring in a rabbit ear wound model. Seven millimeter full-thickness excisional wounds were created in rabbit ears. Twenty-four rabbits were randomized into four groups in which each group received base cream, 0.01% SSD, 0.1% SSD, or 1% SSD, respectively. Each treatment was applied at 2-day intervals from postoperative days (PODs) 2 to 14. At POD 7, half of the rabbits from each group were killed and tissues were harvested to measure wound healing parameters that included epithelial gap and granulation area. At POD 28, the remaining rabbits from each group were assessed for hypertrophic scarring. Epithelial gaps in SSD-treated groups at concentrations of 0.1 and 1% were significantly larger than those of base cream-treated controls. In contrast, analysis of granulation areas that represent volume of granulation tissue formed during healing did not show any statistical differences between the base cream-treated group and all three SSD-treated groups. At POD 28, when compared to the base cream-treated group (1.44 ± 0.03), SSD-treated-groups (0.1 and 1%) had more (P < .05) hypertrophic scar formation (scar elevation index = 1.65 ± 0.04, 0.1%; 1.63 ± 0.06, 1%). The results of this study demonstrate that SSD treatment contributes not only to impaired reepithelialization but also to a greater hypertrophic scar formation. These results also indicate that caution should be exercised when using SSD clinically to prevent or treat wound infections. [ABSTRACT FROM AUTHOR]

Purpose: To measure the association between drainage use and postoperative complications (POCs) after posttraumatic ear reconstruction (PTER) with Dieffenbach's postauricular flap (DPF) in patients with antithrombotic therapy (ATT)., Methods: This was a retrospective double-cohort study of patients undergoing posttraumatic DRF with vs. without drainage in 4 maxillofacial units during a 7-year interval. The primary predictor variable was drainage use, and the main outcome was POCs (i.e., auricular haematoma and infection). Descriptive, bi- and multivariate statistics were computed with P ≤ 0.05 defined as statistically significant., Results: The sample was composed of 365 unilateral PTER patients (14% POCs, 15.6% ATT, 34.5% females) aged 58.1 ± 19.7 years (range, 18-101). Among subjects with ATT, drainage use significantly reduced POCs (OR, 0.5; 95% CI, 0.3 to 0.8; P = 0.009; absolute risk reduction [ASR], 34.04%; NNT, 3), especially when delayed surgery > 5 h after trauma was evident (forward stepwise logistic modelling: OR, 20.6; 95% CI, 2 to 215.9; P = 0.012). Drainage placement under DPF in ATT patients with smoking habit, concomitant diseases (e.g. diabetes mellitus), ear cartilage loss, or wound contamination almost halved POC rates (ASR, 34.5 ± 12.1%; range, 22.1% to 49%). Patient's age, gender, American Society of Anesthesiologists (ASA) class, alcohol misuse, ATT and antibiotic type, and international normalised ratio (INR) before surgery had no meaningful effect on POCs., Conclusions: Drainage should be placed under DPF in patients with ATT, regardless of age, gender, ATT and antibiotic type, and preoperative INR., Competing Interests: Declaration of Competing Interest All of the authors indicate full freedom of investigation and manuscript preparation without potential conflict of interest as regards this study. Prof. Dr. Dr. Andreas Neff has served as a consultant to material designs for Medartis (Basel, Switzerland) and has received remuneration for scientific presentations from Karl Storz (Tuttlingen, Germany)., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background. The goal of this study was to obtain representative Kenyan data on the point prevalence of acute otitis media (AOM) and its sequelae (otitis media with effusion [OME] and chronic suppurative otitis media [CSOM]), a major cause of preventable hearing loss in children in developing countries. In Africa, there are limited studies on the prevalence of AOM and its sequelae in children. Methods. Study subjects were children aged 2 to 15 years and were enrolled from randomly selected preprimary and primary schools. After parental or guardian consent, subjects had a questionnaire administered, otoscopy and tympanometry were done, and audiometry was performed on those with ear problems detected on these examinations. Results. A total of 9825 (75%) children was from rural schools. The prevalence of CSOM was 15 of 1000, OME was 15 of 1000, and AOM was 7 of 1000 children. Rural Rift Valley schoolchildren had the highest prevalence of CSOM (24 of 1000) compared with other regions (12 of 1000; P < .0001). Ear discharge occurred before 3.5 years in 50% of 901 children with ear discharge. A history of ear discharge was associated with abnormal tympanograms (odds ratio [OR], 11.9-19.2) and mild-to-severe hearing loss (OR, 21.6-38.6), even in children without ear disease (OR, 10.7-24.4). Conclusions. The burden of AOM sequelae in Kenyan preschool and schoolchildren is significant, and it occurs mostly in the first 4 years of life. By preventing early recurrent AOM, pneumococcal vaccination might partly avert nonreversible sequelae. [ABSTRACT FROM AUTHOR]

Ear reconstruction remains a challenging procedure, especially in burn victims. The ear is particularly vulnerable to thermal injury because of its location and the thin integument. The thermal injury could subsequently include skin and the deeper located auricular cartilage framework. This type of injury could have long lasting mutilating effect not only because the ear's morphology is mainly related to this framework but also because it will not recover or regenerate once injured. Grafts of costal cartilage or synthetic materials might replace missing cartilage. However, the poor quality of the adjacent skin and subcutaneous tissues makes the reconstruction of a burned ear an even more daunting procedure than congenital or many oncologic indications. As such, regeneration of the skin will be the next step in reconstruction of the burned ear. There is still much development and research to be done, but encouraging results have been shown in tissue engineering of skin and cartilage. Furthermore, 3D (bio)printing of cartilage to facilitate reproduction of the ear's complex shape certainly has potential and might find an interesting role in ear reconstruction. In this review, different clinical challenges and options for ear reconstruction in burn patients are described. Subsequently, although still far from large scale clinical application, state of the art developments in the field of tissue engineering and 3D (bio)printing are also discussed. [ABSTRACT FROM AUTHOR]

Objective: The aim of the retrospective study was to compare the reconstruction results of total (TORP) or partial (PORP) ossicular replacement prostheses after ear trauma. Methods: Fifteen patients with conductive or mixed hearing loss due to trauma were retrospectively analyzed. Patients underwent tympanoplasty in tertiary referral center between 2009 to 2018 using TORP (n=10 patients) or PORP (n=5). Their mean age was 36 years. 80% of the study group was men. Demographic data, clinical data, audiometric data and intraoperative findings were collected. Air and bone conduction hearing thresholds were measured by pure tone audiometry on initial admission, at 1 and at least 2 years postoperatively. The hearing threshold was calculated as the mean value of the threshold for 500, 1000, 2000, and 4000 Hz. Results: The most common cause of ear injury was head trauma, then foreign body, burn and explosion. Incudostapedial disarticulation or damage of incus was the most common ossicular pathology. In the TORP group the air conduction pure tone average was 53.75±19.26 dB HL preoperatively, 42.38±21.04 dB HL 1 year postoperatively and 42.75±21.51 dB HL at least 2 years postoperatively. In the PORP group the air conduction pure tone average was 50.75±14.21 dB HL preoperatively, 37.50±17.39 dB HL 1 year postoperatively and 27.50±13.20 dB HL at least 2 years postoperatively. For TORP mean air-bone gap (ABG) was 35.00±10.70 dB before surgery, 1 year after surgery 25.63±13.01 dB and at least 2 years postoperatively 24.13±14.04 dB. In the PORP population mean air-bone gap (ABG) was 30.75±9.50 dB before surgery, 1 year after surgery 20.50±10.33 dB and at least 2 years postoperatively 12.50±5.52 dB. In the whole group 10 out of 15 cases (67%) showed a postoperative ABG of less than 20 dB. Conclusions: Ossicular disruption can be caused by multiple factors. Hearing results after immediate or delayed ossiculoplasty are apparently satisfying, although late cases are assumed to be associated with adhesion, cholesteatoma or fibrosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare anatomical and audiological results of boomerang-shaped chondroperichondrial graft (BSCPG) with temporal muscle fascia in type 1 tympanoplasties. Sixty-eight patients in BSCPG group and 54 patients in fascia group were evaluated. Otomicroscopic examination was done periodically till 24 months as for graft perforation, lateralization and retraction and mean air conduction threshold and airbone gap values were measured. At long term controls, in BSCPG group, rates of neomembrane, perforation, retraction and lateralization were 91.17 % (n = 62), 8.82 % (n = 6), 4.41 % (n = 3) and 0 % (n = 0), respectively. In fascia group, the corresponding rates were 79.62 % (n = 43), 20.37 % (n = 11), 12.96 % (n = 7) and 3.7 % (n = 2), respectively. In both groups, mean postoperative PTA and ABG values were significantly better while postoperative same values were significantly different between groups ( p = 0.044 and 0.032, respectively). Compared to fascia, BSCPG is an ideal grafting technique in the repair of tympanic membrane perforations. [ABSTRACT FROM AUTHOR]

Context: Damage to the auditory system by loud sounds can be avoided by hearing protection devices (HPDs) such as earmuffs, earplugs, or both for maximum attenuation. However, the attenuation can be limited by air conduction (AC) leakage around the earplugs and earmuffs by the occlusion effect (OE) and by skull vibrations initiating bone conduction (BC).Aims: To assess maximum attenuation by HPDs and possible flanking pathways to the inner ear.Subjects and Methods: AC attenuation and resulting thresholds were assessed using the real ear attenuation at threshold (REAT) procedure on 15 normal-hearing participants in four free-field conditions: (a) unprotected ears, (b) ears covered with earmuffs, (c) ears blocked with deeply inserted customized earplugs, and (d) ears blocked with both earplugs and earmuffs. BC thresholds were assessed with and without earplugs to assess the OE.Results: Addition of earmuffs to earplugs did not cause significantly greater attenuation than earplugs alone, confirming minimal AC leakage through the external meatus and the absence of the OE. Maximum REATs ranged between 40 and 46 dB, leading to thresholds of 46-54 dB HL. Furthermore, calculation of the acoustic impedance mismatch between air and bone predicted at least 60 dB attenuation of BC.Conclusion: Results do not support the notion that skull vibrations (BC) contributed to the limited attenuation provided by traditional HPDs. An alternative explanation, supported by experimental evidence, suggests transmission of sound to inner ear via non-osseous pathways such as skin, soft tissues, and fluid. Because the acoustic impedance mismatch between air and soft tissues is smaller than that between air and bone, air-borne sounds would be transmitted to soft tissues more effectively than to bone, and therefore less attenuation is expected through soft tissue sound conduction. This can contribute to the limited attenuation provided by traditional HPDs. The present study has practical implications for hearing conservation protocols. [ABSTRACT FROM AUTHOR]

The article presents a case of a reconstruction after full-thickness loss of the antihelix, scapha, and triangular fossa in a 66-year-old man with recurrent basal cell carcinoma who underwent Mohs micrographic surgery. The patient underwent postauricular pull-through subcutaneous pedicle flap, combined with subsequent staged cartilage grafting. Noted are the options for repairing small auricular defects including full-thickness skin graft.