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Otitis media is a medical concept that represents a range of inflammatory middle ear disorders. The high costs of medical devices utilized by field experts to diagnose the disease relevant to otitis media prevent the widespread use of these devices. This makes it difficult for field experts to make an accurate diagnosis and increases subjectivity in diagnosing the disease. To solve these problems, there is a need to develop computer-aided middle ear disease diagnosis systems. In this study, a deep learning-based approach is proposed for the detection of OM disease to meet this emerging need. This approach is the first that addresses the performance of a voting ensemble framework that uses Inception V3, DenseNet 121, VGG16, MobileNet, and EfficientNet B0 pre-trained DL models. All pre-trained CNN models used in the proposed approach were trained using the Public Ear Imagery dataset, which has a total of 880 otoscopy images, including different eardrum cases such as normal, earwax plug, myringosclerosis, and chronic otitis media. The prediction results of these models were evaluated with voting approaches to increase the overall prediction accuracy. In this context, the performances of both soft and hard voting ensembles were examined. Soft voting ensemble framework achieved highest performance in experiments with 98.8% accuracy, 97.5% sensitivity, and 99.1% specificity. Our proposed model achieved the highest classification performance so far in the current dataset. The results reveal that our voting ensemble-based DL approach showed quite high performance for the diagnosis of middle ear disease. In clinical applications, this approach can provide a preliminary diagnosis of the patient's condition just before field experts make a diagnosis on otoscopic images. Thus, our proposed approach can help field experts to diagnose the disease quickly and accurately. In this way, clinicians can make the final diagnosis by integrating automatic diagnostic prediction with their experience. [ABSTRACT FROM AUTHOR]

Purpose: Cauliflower ear in wrestlers can lead to hearing impairment. This study primarily aims to assess the hearing of wrestlers with bilateral cauliflower ears and determine their external ear canal (EEC) resonance frequencies. Our second aim is to evaluate their hearing quality, speech, and spatial perception. Method: This study included 28 male wrestlers aged 18--35 years with bilateral cauliflower ears, as well as 27 male participants in the control group with no wrestling history. The participants' hearing thresholds were determined across the frequency range of 125--16000 Hz for air-conduction and 500--4000 Hz for bone conduction. EEC resonance frequencies were measured. Additionally, all participants completed the Turkish version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) questionnaire. Results: Wrestlers with cauliflower ears exhibited significantly higher hearing thresholds, particularly at frequencies above 4000 Hz (p < .05). Analysis of EEC resonance showed a shift to higher frequencies in the second resonance peak of the right ear (p < .001) and the first resonance peak of the left ear (p = .045). SSQ scores revealed that wrestlers had higher spatial perception (p = .046), hearing quality (p = .004), and general scores (p = .042) in comparison to the control group. Conclusions: Blunt traumas in wrestlers, leading to cauliflower ear, can result in hearing loss. Moreover, deformities in the external ear affect the resonance frequencies of the EEC. Therefore, it is crucial to advocate for the use of ear protection equipment among wrestlers. When fitting hearing aids, attention should be given to changes in the EEC resonance frequency. [ABSTRACT FROM AUTHOR]

Purpose: Bone conduction hearing devices (BCDs) that deliver sound across the skin (i.e., transcutaneous) are suitable for some individuals who have con- ductive or mixed hearing losses. Prescriptive targets for percutaneous devices are available, for example, from the Desired Sensation Level--Bone Conduction Hearing Device (DSL-BCD) algorithm. These targets, however, may require modification for use with transcutaneous BCDs. The current study investigated three key variables that may inform target modification: (a) comparison of thresholds measured using an audiometric bone conduction (BC) transducer versus transcutaneous BCDs that offer in situ threshold measurement, (b) trans- cutaneous BCD default force level outputs versus recommended DSL percuta- neous BC targets, and (c) the preferred listening levels (PLLs) of adults wearing transcutaneous BCDs in a laboratory setting. Method: Bilateral conductive hearing loss was simulated in 20 normal-hearing adults via earplugs. Thresholds were measured using a B-71 BC transducer and two commercially available BCDs coupled to a soft headband. DSL percu- taneous BC targets were generated, and PLLs were obtained for a 60-dB SPL speech stimulus. Force level outputs were measured using a skull simulator on the Audioscan Verifit2 at the hearing aids' default settings and at the partici- pants' PLL for each device. Results: On average, audiometric BC thresholds were significantly better than those measured in situ with each BCD. PLLs were similar to prescribed targets for one device with the smoother response shape and agreed in the high fre- quencies for both devices. Conclusions: In situ thresholds are significantly higher than audiometric BC thresholds, suggesting that device-based in situ measurement more accurately accounts for the signal transmission from transcutaneous BCDs. PLLs differed from the percutaneous targets and varied between devices, which may indicate that either target modifications or manipulations of device frequency response shaping are needed to approximate PLL with transcutaneous BCD devices. [ABSTRACT FROM AUTHOR]

Objective: Describe the ear and hearing outcomes in Aboriginal infants in an Australian urban area. Design: Aboriginal infants enrolled in the Djaalinj Waakinj prospective cohort study had ear health screenings at ages 2-4, 6-8 and 12-18 months and audiological assessment at ∼12 months of age. Sociodemographic, environmental characteristics, otoscopy, otoacoustic emissions, tympanometry and visual reinforcement audiometry data were collected. Study Sample: 125 infants were enrolled in the study; 67 completed audiological assessment, 62, 54, and 58 of whom attended ear screenings at 2-4, 6-8 and 12-18 months. Results: Of the children that attended the audiological assessment, 36.5%, 50% and 64.3% of infants had otitis media (OM) at 2-4, 6-8 and 12-18 months. Using a 10 dB correction factor, 44.8% of infants had hearing loss (HL) (≥ 25 dB HL) at ∼ 12 months of age. More males (X2=5.4 (1df, p = 0.02)) and infants with OM at audiological assessment (X2=5.8 (1df, p = 0.02)) had HL. More infants that used a pacifier at 12-18 months of age had HL (X2=4.7 (1df, p = 0.03)). Conclusion: Aboriginal infants in an urban area have high rates of HL and OM, which requires early surveillance and timely treatment to reduce the medical and developmental impacts of OM and HL. [ABSTRACT FROM AUTHOR]

Introduction: Otoscopes and otomicroscopes are the most commonly used instruments for visualizing the ear. Digital otoscopy (DO) could be used to improve diagnostics in primary health care by utilizing image enlargement. The aim of the study was to explore the possibilities of DO in remote consultations. Materials and Methods: Based on real‐life referrals, 45 otologic outpatients were recruited. DO was performed followed by an attending otologist's appointment, serving as the gold standard. Twenty‐four patient cases were analyzed on a digital platform as remote consultation cases containing the given referral information supplemented with DO videos (DOVs). A total of 71 evaluations were performed by five otologists. The quality of the DOVs, their suitability for remote consultations, the accuracy of diagnoses and the usefulness of remote consultations were determined. Results: The average DOV quality was judged to be 7.4 ± 0.3 (mean ± standard error of the mean; scale of 1–10). The diagnosis was correct in 79% of the cases. In 59% of the patients, the otologists considered that remote consultation could have replaced an in‐person visit. Conclusions: In our simulated remote consultation setup, DOV quality was sufficient for diagnostic purposes, DO improved diagnostics and treatment planning in most cases and could be used to reduce the need for in‐person visits. DO‐aided remote consultation may improve diagnostics and access to care. Level of evidence: 3. [ABSTRACT FROM AUTHOR]

Background: Bacterial meningitis is a rare, but life-threatening disease, which sometimes occurs as a complication to acute otitis media (AOM). The proportion of meningitis cases originating from AOM is not clear. Purpose: The aim of this study was to investigate the proportion of meningitis cases caused by AOM, to compare risk factors, bacteriology and outcome between otogenic and non-otogenic meningitis, and to analyse the incidence of bacterial meningitis after the introduction of conjugate pneumococcal vaccines (PCV). Methods: The medical charts of all patients admitted to hospitals in southern Sweden with bacterial meningitis between 2000 and 2017 were retrieved. Based on otoscopy and/or imaging, the proportion of otogenic meningitis cases was calculated, as were annual incidences. Results: A total of 216 patients were identified, 25 of whom died. The proportion of otogenic meningitis was 31% but varied from 6% among teenagers to 40% among adults. Before PCV, 23% of all meningitis cases were children < 2 years, compared to 1% post-PCV. The average incidence in the adult population, on the other hand, increased post-PCV, though there were large annual variations. S. pneumoniae was the most commonly identified pathogen in everyone but teenagers, in whom N. meningitidis was predominant. Conclusion: AOM is an important cause of meningitis in children and adults. Though bacterial meningitis almost disappeared in children < 2 years after the introduction of PCV, the incidence of pneumococcal meningitis in adults seems to have increased. [ABSTRACT FROM AUTHOR]

This comprehensive document delves into acute otitis media (AOM) in children, exploring various aspects such as diagnosis, risk factors, definition, aetiology, clinical presentation, complications, treatment, prevention, and new approaches. It is updated based on recent consensus documents and considers the impact of pneumococcal vaccines. Emphasis is placed on the importance of rigorous clinical criteria, diagnostic tools are discussed, and treatment strategies are proposed, highlighting the relevance of individualised care. Specific considerations regarding pneumatic otoscopy and the appropriateness of imaging tests are addressed. The document concludes with key points to enhance diagnostic accuracy, antibiotic treatment strategies, and recommendations for managing recurrent AOM, providing a comprehensive and up-to-date guide for pediatric healthcare professionals. [ABSTRACT FROM AUTHOR]

Abstract Background The study aimed to assess the impact of different training modalities on otoscopy performance during a practical exam using a high-fidelity simulator and to determine if objective evaluation of otoscopy is feasible using a simulator that records insertion depth and tympanic membrane coverage. Methods Participants were assigned to one of four groups: control and three intervention groups with varying training approaches. Participants received otoscopy training and then were assessed through a practical exam on a high-fidelity simulator that uses virtual reality to visualize the ear canal and middle ear. Performance was evaluated using a modified Objective Structured Assessment of Technical Skills checklist and Integrated Procedural Performance Instrument checklist. Insertion depth, tympanic membrane coverage, and correct diagnosis were recorded. Data were tested for normal distribution using the Shapiro-Wilk test. One-way ANOVA and, for non-normally distributed data, Kruskal-Wallis test combined with Dunn’s test for multiple comparisons were used. Interrater reliability was assessed using Cohen’s κ and Intraclass correlation coefficient. Results All groups rated their training sessions positively. Performance on the OSATS checklist was similar among groups. IPPI scores indicated comparable patient handling skills. The feedback group examined larger tympanic membrane areas and had higher rates of correct diagnosis. The correct insertion depth was rarely achieved by all participants. Interrater reliability for OSATS was strong. IPPI reliability showed good correlation. Conclusion Regardless of training modality, participants perceived learning improvement and skill acquisition. Feedback improved examination performance, indicating simulator-guided training enhances skills. High-fidelity simulator usage in exams provides an objective assessment of performance.

Middle-ear conditions are common causes of primary care visits, hearing impairment, and inappropriate antibiotic use. Deep learning (DL) may assist clinicians in interpreting otoscopic images. This study included patients over 5 years old from an ambulatory ENT practice in Strasbourg, France, between 2013 and 2020. Digital otoscopic images were obtained using a smartphone-attached otoscope (Smart Scope, Karl Storz, Germany) and labeled by a senior ENT specialist across 11 diagnostic classes (reference standard). An Inception-v2 DL model was trained using 41,664 otoscopic images, and its diagnostic accuracy was evaluated by calculating class-specific estimates of sensitivity and specificity. The model was then incorporated into a smartphone app called i-Nside. The DL model was evaluated on a validation set of 3,962 images and a held-out test set comprising 326 images. On the validation set, all class-specific estimates of sensitivity and specificity exceeded 98%. On the test set, the DL model achieved a sensitivity of 99.0% (95% confidence interval: 94.5–100) and a specificity of 95.2% (91.5–97.6) for the binary classification of normal vs. abnormal images; wax plugs were detected with a sensitivity of 100% (94.6–100) and specificity of 97.7% (95.0–99.1); other class-specific estimates of sensitivity and specificity ranged from 33.3% to 92.3% and 96.0% to 100%, respectively. We present an end-to-end DL-enabled system able to achieve expert-level diagnostic accuracy for identifying normal tympanic aspects and wax plugs within digital otoscopic images. However, the system's performance varied for other middle-ear conditions. Further prospective validation is necessary before wider clinical deployment. [ABSTRACT FROM AUTHOR]

Palatine and pharyngeal tonsil hypertrophy may lead to dysfunction of the auditory tube due to a propensity for infection, potentially giving rise to otitis media. This is a quantitative and longitudinal study, developed from 2019 to 2021, at the State University of Campinas (UNICAMP). The studied sample comprised 15 participants aged 5 to 12 years (mean 7.9 years), 12 male and 3 female, arranged into two groups: children diagnosed with pharyngeal and/or palatine tonsil hypertrophy who were candidates for surgery (G1), and children who were later evaluated after surgery (G2). As part of the test, an otoscopy and measurements of logoaudiometry, pure-tone threshold audiometry, wideband tympanometry (ambient and peak pressure), and otoacoustic emissions (TEOAEs and DPOAEs, both at ambient and peak pressure) were all performed. There were statistically significant differences between phases in pure-tone audiometry, in terms of 226 Hz tympanometry, wideband tympanometry in peak pressure conditions, in the amplitude measurement TEOAEs in both pressure conditions, in DPOAEs in ambient pressure conditions, and in the signal/noise measurement in both pressures in DPOAEs. Overall, it was found that hearing tests were different for subjects with palatine and pharyngeal tonsil hypertrophy compared to the post-surgical group. [ABSTRACT FROM AUTHOR]

Primary ectopic meningioma of the middle ear is relatively rare in clinical practice. It is often difficult to distinguish it from chronic otitis media or otitis media with effusion due to its similar and atypical clinical symptoms. We report a case of epithelial tympanic ectopic meningioma with the main complaints of otalgia, aural fullness, and hearing loss. It was accidentally discovered during tympanotomy due to the symptoms of recurring refractory secretory otitis media. This article briefly reviews the relevant literature in recent years, summarizes the characteristics of primary ectopic tympanic meningioma with intact tympanic membrane, and emphasizes the diagnosis and treatment strategy of the middle ear mass. [ABSTRACT FROM AUTHOR]

Purpose: Masseter vestibular evoked myogenic potentials (mVEMP) involve the connection between the vestibular complex and trigeminal nerve nuclei. Given the theory that migraine is caused by increased activation of the trigeminal nerve, it is believed that mVEMP responses may have influenced in migraine patients. Method: The study included 20 individuals with migraine and 20 healthy controls. Latency, amplitude, and interaural amplitude asymmetry ratio of mVEMP responses recorded in migraine patients were compared with control group. Results: Considering the mVEMP normalization study conducted by Başöz et al. (2021) in a similar age group and in the same clinic, latency prolongation and amplitude decrease were observed in subjects with migraines. Migraine is considered a central pathology, as shown in the cervical and ocular VEMP (cVEMP/oVEMP) literature. No difference was observed in the interaural amplitude asymmetry ratio, which is important in peripheral pathologies. Additionally, when the number of pathological ears was examined in order to understand the total exposure, it was observed that the number of pathological ears was significantly higher in the migraine group. Conclusion: In future studies, using mVEMP together with cVEMP and oVEMP tests, which allow evaluation of otolith organs and vestibular nuclei, will be valuable in determining the lesion location. [ABSTRACT FROM AUTHOR]

Chronic otitis media (COM) poses a significant global health burden, contributing to ear discharge and preventable hearing loss. This study aimed to evaluate the ossicular status in COM patients undergoing surgery and correlate the findings with preoperative otoscopic and audiogram assessments. The primary focus was to discern differences in ossicular involvement between squamous and mucosal diseases, shedding light on distinct pathologies crucial for tailoring surgical interventions. A total of 98 patients with COM (26 squamous disease, 72 mucosal disease) were included in the study. Analysis revealed the incus as the most commonly eroded ossicle, observed in 25 of 26 patients with squamous disease and 19 of 72 patients with mucosal disease. Conversely, the stapes exhibited remarkable resistance to erosion, remaining intact in 89 patients, with the stapes footplate found intact in all cases. Malleus erosion was observed in 13 patients categorized as "unsafe" and 6 patients in the "safe" category. Additionally, ossicular joints were more frequently eroded in squamous disease patients compared to those with mucosal disease. The study provides valuable insights into the distinct pathology of COM squamosal and COM mucosal cases, emphasizing the need for tailored surgical interventions to address the specific requirements of each patient group. By correlating operative findings with clinical findings, this research contributes to a deeper understanding of COM pathology, paving the way for more targeted and effective intraoperative ossicular reconstruction strategies. [ABSTRACT FROM AUTHOR]

Background: The study aimed to assess the impact of different training modalities on otoscopy performance during a practical exam using a high-fidelity simulator and to determine if objective evaluation of otoscopy is feasible using a simulator that records insertion depth and tympanic membrane coverage. Methods: Participants were assigned to one of four groups: control and three intervention groups with varying training approaches. Participants received otoscopy training and then were assessed through a practical exam on a high-fidelity simulator that uses virtual reality to visualize the ear canal and middle ear. Performance was evaluated using a modified Objective Structured Assessment of Technical Skills checklist and Integrated Procedural Performance Instrument checklist. Insertion depth, tympanic membrane coverage, and correct diagnosis were recorded. Data were tested for normal distribution using the Shapiro-Wilk test. One-way ANOVA and, for non-normally distributed data, Kruskal-Wallis test combined with Dunn's test for multiple comparisons were used. Interrater reliability was assessed using Cohen's κ and Intraclass correlation coefficient. Results: All groups rated their training sessions positively. Performance on the OSATS checklist was similar among groups. IPPI scores indicated comparable patient handling skills. The feedback group examined larger tympanic membrane areas and had higher rates of correct diagnosis. The correct insertion depth was rarely achieved by all participants. Interrater reliability for OSATS was strong. IPPI reliability showed good correlation. Conclusion: Regardless of training modality, participants perceived learning improvement and skill acquisition. Feedback improved examination performance, indicating simulator-guided training enhances skills. High-fidelity simulator usage in exams provides an objective assessment of performance. [ABSTRACT FROM AUTHOR]

The aim of this interventional non-randomised prospective controlled study was to assess the effectiveness of transcutaneous vagus nerve stimulation (tVNS) in human subjects with tinnitus. The ParasymTM tVNS device was paired with an auditory stimulation. Treatment and observations were conducted over 12 weeks. Audiological evaluation was performed. Responses from a set of questionnaires and quantitative electroencephalography (qEEG) before and after treatment were collected. Voice measurements were done to assess possible side-effects of tVNS. The study involved 29 adults who had chronic tinnitus (15 patients who underwent tVNS paired with sounds and a control group of 14 patients who did not). In general, subjective and objective measurements of tinnitus showed no improvement in the study group compared to the controls, although certain parameters as gauged by the questionnaires did statistically improve. The loudness and frequency of tinnitus remained the same in both groups. For the qEEG, activity in the theta band increased significantly in the study group compared to the control group. The tVNS was not effective in reducing tinnitus symptoms in our study group. However, changes in the theta band suggest there might be cortical effects that might, with sustained treatment, lead to improvements. [ABSTRACT FROM AUTHOR]

This study aimed to determine the prevalence of dizziness and its associated factors in patients with COM at two otologic referral centres in a middle-income country. Cross-sectional study. Adults with and without COM diagnosis from two otology-referral centres in Bogotá (Colombia) were included. Dizziness and quality of life were assessed using the "Chronic Suppurative Otitis Media Questionnaire-12" (COMQ-12), and sociodemographic questionnaires were applied. Otoscopic evaluation and audiometric data were collected. A total of 231 adults. Of the 231 participants, up to 64.5% (n = 149) reported at least mild inconvenience due to dizziness. Factors associated with dizziness included female sex (aPR: 1.23; 95% CI: 1.04–1.46), chronic suppurative otitis media (aPR: 3.02; 95% CI: 1.21–7.52), and severe tinnitus (aPR: 1.75; 95% CI: 1.24–2.48). An interaction was found between socioeconomic status and educational level, with more frequent reports of dizziness in the middle/high economic status and secondary education (aPR: 3.09; 95% CI: 0.52–18.55; p < 0.001). Differences of 14 points in symptom severity and 18.5 points in the total score of the COMQ-12 were found between the groups with dizziness and without dizziness. Dizziness was frequent in patients with COM and was associated with severe tinnitus and quality of life deterioration. [ABSTRACT FROM AUTHOR]

Mucormycosis is an opportunistic fungal infection that often affects the nose and paranasal sinuses. The disease prevalence was very high in India during the coronavirus disease 2019 pandemic, thereby raising public awareness about this disease. The general practitioners were updated about the disease characteristics and the requirement for emergency management. Yet, in some instances, the treatment was inadequate due to delayed presentation and low affordability for treatment. The mucormycosis of the ear, on the other hand, is a rare occurrence that demands meticulous study for early diagnosis and management. Here, we discuss the case of a patient with mucormycosis of the middle ear. [ABSTRACT FROM AUTHOR]

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Abstract Background Diagnosis of acute otitis media (AOM) in children can be challenging, given that symptoms are often non-specific or absent, and that the direct observation of the tympanic membrane in its entirety through otoscopy can sometimes be difficult. The aim of this study is to assess the diagnostic concordance in detection of AOM episodes between primary care paediatricians and physicians especially trained in paediatric otoscopy, and to characterize the most misleading elements in diagnostic failure. Methods Consecutive clinical charts of children regularly followed for recurrent AOM (RAOM, i.e.: >3 episodes in 6 months or > 4 episodes in 1 year) at our Otitis Media paediatric outpatient clinic were retrospectively screened, in order to collect any diagnosis of AOM episode (and the related clinical findings/middle ear complaints) performed by primary care paediatricians/emergency room paediatricians. Diagnosis of AOM episode was validated by the same experienced physician (FF) in case of otoscopic relief of a bulging eardrum with at least one of the following: hyperaemia or yellow-like colour. The diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was expressed as the percentage of matching diagnosis. Results One hundred and thirty-four single AOM episodes occurring in 87 children (mean age: 26.9 +/- 18.9 months) were included in the analysis. Diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was reported in 72.4% of cases. The most common pitfall found in our study was the misleading diagnosis of AOM in case of hyperaemic tympanic membrane without bulging (32/37 out of non-validated diagnoses). Conclusions AOM diagnosis still represents a relevant issue among paediatricians in our country, and the presence of tympanic membrane hyperaemia without concomitant bulging can be confusing.

Purpose: U.S. national data for otoscopic examinations of 13,055 individuals aged 6-80+ years included in the National Health and Nutrition Examination Survey surveys for 2011-2012, 2015-2016, and 2017-2020 were analyzed and described. Method: Analyses were primarily descriptive and relied on prevalence estimates, supported by logistic-regression analyses, and distribution-free medians. Otoscopic examinations were performed by trained technicians with review and supervision by a clinical audiologist. Effects of age, sex, and race/ethnicity were also examined. Results: Overall, the prevalence of abnormal otoscopy was approximately 12%-15% with higher prevalence among males at most ages and for both sexes for age ≥ 60 years. Typically, 93% or more of the observed abnormalities were due to excessive or impacted cerumen, mainly the former. Logisticregression analyses for the 6-19-year-olds found that only race/ethnicity affected the odds with non-Hispanic Blacks and Asians have higher odds for otoscopic abnormalities than non-Hispanic Whites. For 20- to 69-year-old adults, the odds of having abnormal otoscopic findings were about twice as high for males versus females, 60-year-olds versus 20-year-olds, and non- Hispanic Blacks versus non-Hispanic Whites. Overall, the effect of otoscopic abnormalities on the pure-tone averages for 500, 1000, 2000, and 4000 Hz and 3000, 4000, and 6000 Hz were negligible (< 3 dB), and this did not vary substantially with sex, race/ethnicity, or age. Conclusion: Abnormal otoscopy, typically excessive cerumen, was observed in about 12%-15% of the individuals in this national sample, but the presence of such abnormalities had minimal effect on hearing sensitivity. [ABSTRACT FROM AUTHOR]

Purpose: The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a randomized clinical trial designed to determine the effects of a bestpractice hearing intervention versus a successful aging health education control intervention on cognitive decline among community-dwelling older adults with untreated mild-to-moderate hearing loss. We describe the baseline audiologic characteristics of the ACHIEVE participants. Method: Participants aged 70-84 years (N = 977; Mage = 76.8) were enrolled at four U.S. sites through two recruitment routes: (a) an ongoing longitudinal study and (b) de novo through the community. Participants underwent diagnostic evaluation including otoscopy, tympanometry, pure-tone and speech audiometry, speech-in-noise testing, and provided self-reported hearing abilities. Baseline characteristics are reported as frequencies (percentages) for categorical variables or medians (interquartiles, Q1-Q3) for continuous variables. Between-groups comparisons were conducted using chi-square tests for categorical variables or Kruskal--Wallis test for continuous variables. Spearman correlations assessed relationships between measured hearing function and self-reported hearing handicap. Results: The median four-frequency pure-tone average of the better ear was 39 dB HL, and the median speech-in-noise performance was a 6-dB SNR loss, indicating mild speech-in-noise difficulty. No clinically meaningful differences were found across sites. Significant differences in subjective measures were found for recruitment route. Expected correlations between hearing measurements and self-reported handicap were found. Conclusions: The extensive baseline audiologic characteristics reported here will inform future analyses examining associations between hearing loss and cognitive decline. The final ACHIEVE data set will be publicly available for use among the scientific community. [ABSTRACT FROM AUTHOR]

Purpose: Chronic obstructive Eustachian tube dysfunction (OETD) can lead to tympanic membrane (TM) retraction and middle ear effusion (MEE) which can cause conductive hearing impairment, which among other ear symptoms can lower the quality of life (QoL). In this prospective study we assess hearing results and subjective changes in QoL following balloon Eustachian tuboplasty (BET) in treatment of OETD. Methods: Totally 25 ears with TM retraction and 18 ears with MEE due to chronic OETD underwent BET as the sole intervention. Outcomes including otoscopy, ability to perform the Valsalva maneuver, tympanometry, audiometry, Eustachian tube inflammation scale and the Glasgow Benefit Inventory questionnaire (GBI) were obtained on all patients preoperatively and 6 months postoperatively. Results: Hearing thresholds improved statistically significantly (p < 0.05) with means of 3 dB in the TM retraction group and 9 dB in the MEE group. Total GBI results indicated a positive influence on patients' QoL. Valsalva success rate was 80% in patients with TM retraction and 67% in patients with MEE. Tympanometry results improved in 50% of TM retraction patients and in 33% of MEE patients. Conclusions: Here we demonstrated that the BET has a positive impact on patients' conductive hearing loss and QoL in patients with TM retraction or MEE. Results were better in TM retraction group than in MEE group. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 challenged the delivery of healthcare in Australia, disproportionately impacting vulnerable patients, including Aboriginal and/or Torres Strait Islander peoples and those living in remote regions. The otolaryngology service provided to remote Western Australia adapted to these barriers by altering clinical consultations to a digital model. Methods: A review was undertaken of patients in regional Western Australia. Demographics and clinical outcomes from 20 live telehealth clinics were retrospectively reviewed and compared to 16 face-to-face clinics. Results: The demographics of patients reviewed in both live telehealth and face-to-face clinics were similar, except for a larger proportion of Aboriginal and/or Torres Strait Islander patients utilising telehealth. The outcomes of patients reviewed through each model of care were comparable. Live video-otoscopy provided diagnostic quality images in 92 per cent of cases. Conclusion: The findings of our review suggest that, despite its limitations, a large proportion of ENT patients may be safely assessed through a live telehealth model. [ABSTRACT FROM AUTHOR]

Purpose: Age-related sensorineural hearing loss (SNHL), is a progressive, usually bilateral hearing loss that occurs in elderly. It is correctable using rehabilitative hearing devices, which can vastly improve the older person's quality of life. This study aimed to find out the prevalence and related factors of age-related sensorineural hearing loss among elderly patients in Tanzania. Methods: A total of 380 elderly patients who received Otorhinolaryngology (ORL) services at Muhimbili tertiary hospital were enrolled. Participants were screened for hearing loss and interviewed by the structured questionnaire followed by otoscopic examination and Pure tone Audiometry (PTA). Results: This study included 182(47.9%) males, and 198 (52.1%) females. The prevalence of SNHL was 27.6%, males were mostly affected 57(31.3%) p = 0.574. Bilateral SNHL was found 90 (85.7%) p = 0.026, and the severity of age-related SNHL was found to increase as age increases. Conclusion: Sensorineural hearing loss among the elderly was prevalent, mostly bilateral, and the severity increases with age. Confounding factors such as hypertension, diabetes mellitus (DM), cigarette smoking, and ototoxic medication may have contributed. Elderly should be screened for hearing loss especially on the individuals with other co-morbidities for early diagnosis and management in order to improve the quality of life of the elderly. [ABSTRACT FROM AUTHOR]

Introduction: Aging negatively influences the structure of the human brain including the white matter. The objective of our study was to identify, using fixel-based morphometry, the age induced changes in the pathways connecting several regions of the central auditory system (inferior colliculus, Heschl's gyrus, planumtemporale) and the pathways connecting these structures with parts of the limbic system (anterior insula, hippocampus and amygdala). In addition, we were interested in the extent to which the integrity of these pathways is influenced by hearing loss and tinnitus. Methods: Tractographic data were acquired using a 3 T MRI in 79 volunteers. The participants were categorized into multiple groups in accordance with their age, auditory thresholds and tinnitus status. Fixel-based analysis was utilized to identify alterations in the subsequent three parameters: logarithm of fiber cross-section, fiber density, fiber density and cross-section. Two modes of analysis were used: whole brain analysis and targeted analysis using fixel mask, corresponding to the pathways connecting the aforementioned structures. Results: A significantly negative effect of aging was present for all fixel-based metrics, namely the logarithm of the fiber cross-section, (7 % fixels in whole-brain, 14% fixels in fixel mask), fiber density (5 % fixels in whole-brain, 15% fixels in fixel mask), fiber density and cross section (7 % fixels in whole-brain, 19% fixels in fixel mask). Expressed age-related losses, exceeding 30% fixels, were particularly present in pathways connecting the auditory structures with limbic structures. The effect of hearing loss and/or tinnitus did not reach significance. Conclusions: Our results show that although an age-related reduction of fibers is present in pathways connecting several auditory regions, the connections of these structures with limbic structures are even more reduced. To what extent this fact influences the symptoms of presbycusis, such as decreased speech comprehension, especially in noise conditions, remains to be elucidated. [ABSTRACT FROM AUTHOR]

To compare the concordance of advanced audiologists (AA), junior doctors (JD) and paediatric audiologists (PA) with an Ear, Nose and Throat (ENT) specialist on the diagnosis and management of children with middle ear or hearing concerns. A clinical equivalence (concordance) study. Three AAs, five JDs, three PAs and one ENT specialist asynchronously reported diagnoses and management plans for ten, online paediatric cases consisting of video-otoscopic images and clinical findings. For medical diagnosis, significant agreement with the ENT specialist was observed at moderate and near-perfect levels for two AAs (k = 0.561 and 0.815), moderate levels for four JDs (k = 0.5 to 0.603) and near-perfect level for one PA (k = 0.815). For management decisions, significant agreement with the ENT specialist was observed at substantial (k = 0.636) and near-perfect (k = 0.818) levels for two AAs, and at a moderate level (k = 0.538) for one PA. Within group inter-rater agreement for management plans was substantial for AAs and JDs, and moderate for PAs. For children with middle ear disease or hearing concerns, AAs, JDs and PAs showed similar levels of agreement with an ENT specialist on diagnosis, but AAs were more likely than JDs or PAs to agree with an ENT specialist on management. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the frequency of ear canal protection use and looked at its influence on external auditory exostosis severity and knowledge about external auditory exostosis among windsurfers and kitesurfers on the German coast. Method: This retrospective cross-sectional study interviewed 130 windsurfers and kitesurfers along the German coast on knowledge of external auditory exostosis, exposure time, use of neoprene hoods and earplugs, and otological complaints. Participants underwent bilateral video-otoscopic examination. Results: Knowledge of external auditory exostosis was 'good' or 'excellent' in 78 of 130 (60 per cent) individuals and 'poor' or non-existent in 52 of 130 (40 per cent) individuals. Knowledge was positively correlated with hours of exposure, otological complaints and frequency of ear canal protection use. A significant negative influence of neoprene hood use on external auditory exostosis severity was shown. Conclusion: The positive effect of external auditory exostosis knowledge on the frequency of ear canal protection and the reduction of external auditory exostosis risk implies a need for health education on this topic. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To design and fabricate a suction port adapter to use various sizes of suction cannulas with a wireless otoendoscope enabling ear cleaning under endoscopic guidance demonstrated using an ear examination simulator. Methods: Design: Instrument Innovation Setting: Tertiary Private Training Hospital Patient: Ear Examination Simulator Results: The fabricated suction port adapters were able to hold the wireless otoendoscope and suction cannulas together, allowing simultaneous inspection of the ear canal and suctioning of ear canal debris using the Ear Examination Simulator Conclusion: Our prototype 3D-printed suction port adapters for a wireless otoendoscope may improve ear cleaning by enhancing the accuracy of suctioning debris and decreasing duration since they hold the suction cannulas in place under endoscopic guidance. They may aid ENT physicians in easier visualization and simultaneous ear cleaning of patients and improve ear cleaning techniques and times, especially among less experienced physicians, but actual clinical trials are needed to confirm this.

Otitis media with effusion is one of the most commonly encountered diseases by otolaryngologists. Hearing loss is the most common symptom, particularly affecting academic performance in school-age children. Therefore, establishing an accurate diagnosis is crucial. The primary diagnostic method is an otoscopic ear examination. Tympanometry is the most frequently used technique for diagnosis. In this study, we aimed to compare the results of tympanometric examinations with intraoperative findings. Our study included a total of 126 patients with a diagnosis of chronic otitis media with effusion and a decision for surgery, comprising 224 ears that were followed by our clinic. All patients underwent at least one myringotomy. Ventilation tubes were inserted in cases of glue ear. Preoperative physical examination and tympanometry results were compared with intraoperative findings. Of the 126 patients, 81 were male. The mean age was 5.3 years (range: 2-15). Preoperatively, 135 ears exhibited Type B tympanogram, and 89 ears exhibited Type C tympanogram. The rate of tube insertion was statistically significant in cases with type B tympanogram. Additionally, the tube insertion rate was determined to be 32.5% in cases with Type C tympanograms. In conclusion, diagnosing effusive otitis media is a crucial matter. While physical examination is the most important diagnostic tool, it may sometimes be insufficient. Tympanometry is a highly useful method for improving the diagnostic rate of this condition. [ABSTRACT FROM AUTHOR]

Significance Statement: Neurofibromas, derived from perineural cells, are usually benign in the nervous system. Although neurofibromas are common in the head and neck, they rarely affect the external auditory canal (EAC), and few cases have been reported. We describe a case of a solitary EAC neurofibroma with otoscopy, radiological imaging, a surgical approach, and an uneventful outcome. [ABSTRACT FROM AUTHOR]

A cholesteatoma is an expansion of keratinizing squamous epithelium that enters the middle ear cleft from the outer layer of the tympanic membrane or ear canal. Choleatomas are always treated surgically. Recurrence of the illness presents another challenge for the patient and the surgeon, though. There have been reports of recurrence rates as high as 30% in adults and as high as 70% in children. Here, we describe a case of persistent recurrent otorrhea following revision surgery, along with acquired recurrent cholesteatoma following canal wall down surgery. Case presentation: A 38-year -male with underlying Diabetes Mellitus and Hypertension presented with left scanty and foul-smelling ear discharge for 2 years and left reduced hearing. He was diagnosed with left chronic active otitis media with cholesteatoma for which he underwent left modified radical mastoidectomy, meatoplasty and tympanoplasty in 2017. Five months post operatively, he presented with left otorrhea. However, he defaulted followed up and presented in April 2018 for similar complaints. Otoscopy examination revealed left tympanic membrane perforation at poster superior quadrant of pars tensa and bluish discoloration behind pars flacida. He was diagnosed as recurrent left cholesteatoma and subsequently he underwent left mastoid exploration under general anesthesia in June 2018. Post-surgery, he developed recurrent ear discharge which was treated with topical antibiotics and ear toileting. Conclusions: We report a case of recurrent Cholesteatoma despite canal wall down procedure requiring a second redo procedure and with persistent recurrent otorrhea after the redo procedure. However, this case demonstrates the need for regular follow ups even after a canal wall down procedure for detecting recurrence of disease. Moreover, this case denotes some of the patient factors and surgeon factors involved in disease recurrence. Furthermore, importance of opting for an imaging study in case of high suspicion of the disease. [ABSTRACT FROM AUTHOR]

Otitis media is a common childhood condition and refers to inflammation of the middle ear. It encompasses a spectrum of diseases including acute otitis media, otitis media with effusion ('glue ear') and chronic otitis media which are both common in childhood. This short article offers practical advice about how to evaluate and manage otological presentations. A careful history and examination are essential in children presenting with ear problems. Parents and children should be asked about pain, discharge, hearing loss, delays in speech or learning, reports of tinnitus and balance concerns. Examination includes evaluation of the pinna and mastoid, otoscopy evaluating the ear canal and tympanic membrane alongside nose, throat and neck examination. The management of otitis media differs according to the disease subtype. In acute otitis media, the mainstay of treatment is conservative or medical. Glue ear treatment initially involves active monitoring; surgical intervention or hearing rehabilitation is required in a proportion of cases. In chronic otitis media, non-surgical and surgical options are tailored to the disease under specialist care. [ABSTRACT FROM AUTHOR]

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

To examine the association between individual and cumulative leisure noise exposure in addition to acceptable yearly exposure (AYE) and hearing outcomes among a nationally representative sample of Canadians. Audiometry, distortion-product otoacoustic emissions (DPOAEs) and in-person questionnaires were used to evaluate hearing and leisure noise exposure across age, sex, and household income/education level. High-risk cumulative leisure noise exposure was defined as 85 dBA or greater for 40 h or more per week, with AYE calculations also based on this occupational limit. A randomised sample of 10,460 respondents, aged 6–79, completed questionnaires and hearing evaluations between 2012 and 2015. Among 50–79 year olds, high-risk cumulative leisure noise was associated with increased odds of a notch while high exposure to farming/construction equipment noise was associated with hearing loss, notches and absent DPOAEs. No associations with hearing loss were found however, non-significant tendencies observed included higher mean hearing thresholds, notches and hearing loss odds. Educational outreach and monitoring of hearing among young and middle-aged populations exposed to hazardous leisure noise would be beneficial. [ABSTRACT FROM AUTHOR]

Introduction: Otosclerosis is the primary cause of conductive hearing loss with normal otoscopy. As the condition worsens, certain patients may develop a sensorineural component. Patients with successful surgeries may still need hearing aids, which creates a dilemma for health professionals as there are insufficient data to make informed decisions. This study investigated the influence of the surgeon's proficiency level, individual patient factors (e.g., age at the time of intervention and survival rates), and surgery costs on the cost-effectiveness of stapes surgery. Methods: We performed a cost-effectiveness analysis using an adapted Markov model incorporating annual all-cause mortalities. In addition, we introduced sensitivity analyses to address the effects of surgical expertise on adults with bilateral conductive hearing loss due to otosclerosis. A model was developed based on a decision tree with treatment options and complication scenarios for otosclerosis patients undergoing stapes surgery or receiving hearing aids. Annual all-cause mortality was considered. A sensitivity analysis was performed assigned to different training levels ("experts" and "less experienced") to simulate the effects of surgical experience on the cost-effectiveness of surgical outcomes. Successful surgery was defined as closing of the air-bone gap to 10 dB or less. Based on published data, "experts" were simulated with a 93.7% success rate, and "less experienced" were manufactured with a 68.9% success rate. Results: Stapes surgery provides improved quality of life (QoL) compared to hearing aids with lower cumulative costs up to 87 years of age in the case of "expert" surgeons and up to 78 years of age, when performed by "less experienced" surgeons. Conclusions: Primary stapes surgery is highly cost-effective and delivers improved QoL compared to hearing aids with lower cumulative costs. Additionally, undergoing stapes surgical training remains highly cost-effective. [ABSTRACT FROM AUTHOR]

Otoscopic and radiographic examinations are effective tools to diagnose the ear affections like otitis externa, chronic hypertropic otitis externa, neoplasia, pathological changes of ear canal, etc. The otoscopic examination of 84 dogs revealed presence of different types of texture and colour of exudates in the ear canal. It revealed that the inner wall of external ear canal suffered with erythema, ulceration, hyperplasia of inner wall, hyperplasia of ceruminous glands, presence of excessive hair and polyp. Radiography revealed stenosis, calcification of ear canal, bilateral involvement of ear and increased opacity of the tympanic bulla. Otoscopy and radiography are thus practical and accessible tools for detecting changes in the ear canal and other related structures. [ABSTRACT FROM AUTHOR]

Introduction: The temporal bone, a part of the skull, is the most complex single bone in the human body and carries various nerves, muscles, tendons and bones which help in hearing and balance. Diseases of the temporal bone are a common entity in daily practice. Chronic Suppurative Otitis Media (CSOM) and complications of CSOM account for a large section of diseases which need surgery in the Department of Otorhinolaryngology. Computed Tomography is an important tool in drawing the surgical plan. Material and Methods: 100 patients presenting to the ENT OPD with hard of hearing, ear discharge, headache and/or vertigo and tinnitus were taken to be part of study. Special attention was given to otoscopic/endoscopic examination and radiological assessment by means of High Resolution Computed Tomography. A strict inclusion and exclusion criteria was used. All patients taken up for Mastoid Exploration under General Anaesthesia. All surgeries were performed by the same surgeon using the same instruments to avoid bias. Results: The average age of presentation was 42.3. The most common finding on the CT was erosion of the Incus which was seen in 43 cases and the least common finding was fistula of LSCC which was seen in 1 case. 48 patients underwent surgery in Right ear and 52 in Left ear. 100% of cases showed the same status of the Incus on table which was the most and only 62% of the cases showed positive association for disease in the attic. Conclusions: HRCT is a very easy tool in today's age and generation. It helps to see the extent of disease, predict complications and also help understand anatomy better. It should be performed on the patient 48 hours before surgery (whenever available) to make sure that the findings do not change grossly because of the issued medical management. [ABSTRACT FROM AUTHOR]

This study aimed to describe the tinnitus severity in patients with chronic otitis media (COM) and describe the sociodemographic and clinical variables associated with tinnitus severity. Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Sociodemographic, clinical associated factors and quality of life questionnaires were applied. Otoscopic evaluation and audiometric data were collected. About 231 adults with COM. Up to 51.5% of the patients reported severe tinnitus discomfort, 21.7% moderate discomfort, and 26.8% minor discomfort. Factor associated with increased tinnitus severity in patients with COM were older age (aOR: 1.02; 95% CI: 1.01–1.05), higher education (aOR: 2.24; 95% CI: 1.03–4.87), ear discharge during childhood (aOR: 1.88; 95% CI: 1.02–3.45), cholesteatoma in one ear (aOR: 2.26; 95% CI: 1.05–4.88), and pure-tone air average over 15 dB (aOR: 2.08; 95% CI: 1.28–3.36). Differences of 10-points in symptoms severity and 15-points in the total score of the "Chronic Suppurative Otitis Media Questionnaire-12" were found between the tinnitus severity groups. Our results highlight the need for further research on the associated factors of tinnitus severity on COM patients. COM patients with higher tinnitus severity presented worse audiometric results and worse quality of life outcomes. [ABSTRACT FROM AUTHOR]

Background and Aim: Real-Ear Measurement (REM) enables proper fitting of the hearing aids to achieve the required level of amplification. This study aims to investigate the relationship between aural/oral performance and fit-to-target gain of hearing aids in children with moderate-to-profound hearing loss. Methods: This cross-sectional study was conducted on 30 children with moderate-to-profound hearing loss aged 5-10 years. First, the parents' evaluation of aural/oral performance of children (PEACH) questioanire was completed. Then, REM was performed using digital speech at 50, 65, 80, and 90 dB SPL at 250--8000 Hz to obtain the fit to the desired sensation level, version 5 (DSL v5) target gain. Results: A significant negative correlation was found between the total score of the PEACH (51.66) and the fit-to-target gain at high frequencies (r=-0.482, p=0.01). The maximum fit-to-target gain was 77.5 dB for 65 dB SPL at 6000 Hz. Most of the cases (75%) failed to come within ±5 dB of the target gain. There was a significant difference in the fit-to-target gain between low and high frequencies and between high frequencies with similar input levels. Conclusion: A negative correlation between aural/oral performance of children with moderate-to-profound hearing loss and fit-to-target gain of their hearing aids may indicate that a low fit-to-target gain can improve their aural/oral performance. Regular use of REM is recommended in prescribing hearing aids to these children. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study is to share our experience in managing high-grade posttraumatic facial nerve paralysis using both surgical as well as nonsurgical approaches. Materials and Methods: A retrospective analysis of 31 cases of high-grade (House–Brackmann [HB]: V/VI) facial nerve paralysis following undisplaced temporal bone fracture treated at our tertiary care hospital between 2016 and 2019 was done. Patients' assessment included clinical, audiological, computer tomography scans, and electromyography (EMG) evaluation. Fourteen of the cases presenting between February 2016 and November 2017 underwent surgical decompression of the facial nerve based on our prevailing institutional protocol during that period. However, the next 17 patients presenting between January 2018 and May 2019 were managed conservatively on the basis of our surgical experience in managing such patients before this period and some contemporary data suggesting good results with conservative management, using oral steroids and facial physiotherapy. The patients were assessed clinically and using EMG at 4 weekly intervals as a standard institutional protocol. Results: Among the 14 patients who underwent surgical decompression, lesions were predominantly found in the perigeniculate region. Analysis of results after 12 months revealed 86% (12 out of 14) of cases who underwent surgery had a satisfactory recovery (HB Grade I-II). A satisfactory recovery was achieved in 94% (16 out of 17) of conservatively managed patients (HB Grade I-II). However, there was no statistically significant difference identified between the outcomes of the two groups. Conclusion: The outcome of patients presenting with high-grade facial paralysis with unfavorable EMG findings secondary to undisplaced temporal bone fractures is generally good with or without surgical intervention. The recovery may take around 2–3 months to initiate. We recommend giving nonsurgical conservative management to such patients with regular clinical and electrophysiological monitoring. Clinical Significance: The outcomes and our experience of managing such cases may be useful for clinicians in deciding the course of action in patients presenting with high-grade facial nerve palsy following temporal bone fractures. [ABSTRACT FROM AUTHOR]

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Key Clinical Message Color changes of the tympanic membranes without an inflammatory component or perforation are rarely described. They may result from hemorrhage after barotrauma or spontaneously. Other explanatory models include discoloration due to otomycosis. Abstract This is a case of a 61‐year‐old patient with an unexplained incidental of black dots located almost symmetrically on the antero‐inferior quadrant of both tympanic membranes. This harmless anatomical rarity has not been published before. Underlying pathologies should be excluded in the case of discoloration of the tympanic membranes.

Objective: The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation. Methods: This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard. Results: 176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %–98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3–98.3), specificity of 98.8% (95% CI 97.7–99.9) and accuracy of 98.6% (95% CI 97.4–99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p

ObjectivesTo develop a multiclass-classifier deep learning model and website for distinguishing tympanic membrane (TM) pathologies based on otoscopic images.MethodsAn otoscopic image database developed by utilizing publicly available online images and open databases was assessed by convolutional neural network (CNN) models including ResNet-50, Inception-V3, Inception-Resnet-V2, and MobileNetV2. Training and testing were conducted with a 75:25 breakdown. Area under the curve of receiver operating characteristics (AUC-ROC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to compare different CNN models' performances in classifying TM images.ResultsOur database included 400 images, organized into normal (n = 196) and abnormal classes (n = 204), including acute otitis media (n = 116), otitis externa (n = 44), chronic suppurative otitis media (n = 23), and cerumen impaction (n = 21). For binary classification between normal versus abnormal TM, the best performing model had average AUC-ROC of 0.902 (MobileNetV2), followed by 0.745 (Inception-Resnet-V2), 0.731 (ResNet-50), and 0.636 (Inception-V3). Accuracy ranged between 0.73-0.77, sensitivity 0.72-0.88, specificity 0.58-0.84, PPV 0.68-0.81, and NPV 0.73-0.83. Macro-AUC-ROC for MobileNetV2 based multiclass-classifier was 0.91, with accuracy of 66%. Binary and multiclass-classifier models based on MobileNetV2 were loaded onto a publicly accessible and user-friendly website (https://headneckml.com/tympanic). This allows the readership to upload TM images for real-time predictions using the developed algorithms.ConclusionsNovel CNN algorithms were developed with high AUC-ROCs for differentiating between various TM pathologies. This was further deployed as a proof-of-concept publicly accessible website for real-time predictions.

Marie Cavuoto Petrizzo,1 Doreen M Olvet,2 Roya Samuels,3 Aleena Paul,4 Janice T John,5 Melissa Pawelczak,1 Shara D Steiner6 1Departments of Science Education and Pediatrics, Zucker School of Medicine, Hempstead, NY, USA; 2Department of Science Education, Zucker School of Medicine, Hempstead, NY, USA; 3Department of Pediatrics, Zucker School of Medicine, Hempstead, NY, USA; 4Departments of Pediatrics and Family and Community Medicine, New York Medical College, Valhalla, NY, USA; 5Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA; 6Specialized Programs in Education, Zucker School of Medicine, Hempstead, NY, USACorrespondence: Marie Cavuoto Petrizzo, Departments of Science Education and Pediatrics, Zucker School of Medicine, 500 Hofstra University, W227, Hempstead, NY, 11549, USA, Tel +1 516 463-7476, Fax +1 516.463.5631, Email Marie.C.Petrizzo@hofstra.eduPurpose: Effective teaching and assessment of otologic examinations are challenging. Current methods of teaching otoscopy using traditional otoscopes have significant limitations. We hypothesized that use of all-in-one video otoscopes provides students with an opportunity for real-time faculty feedback and re-practicing of skills, increasing self-reported confidence.Methods: An otoscopy microskills competency checklist was provided to third-year medical students during their pediatric clerkship to self-assess otoscopy technique during patient examinations, and to clinical preceptors to assess and provide feedback during exams. Over the course of two years, we collected data from students randomly assigned to train on a video otoscope or a traditional otoscope during the clerkship. Pre- and post-clerkship surveys measured confidence in performing otoscopy microskills, making a diagnosis and documentation of findings. For those students who trained on the video otoscope, we solicited post-clerkship feedback on the experience of using a video otoscope.Results: Pre-clerkship confidence did not differ between the groups, but the video otoscope trained group had significantly higher scores than the traditional otoscope trained group on all self-reported technical and diagnostic microskills confidence questions items post-clerkship. Students trained on video otoscopes had a significant increase in confidence with all microskills items (p-values< 0.001), however confidence in the traditional otoscope trained group did not change over time (p-values> 0.10). Qualitative feedback from the video otoscope trained group reflected positive experiences regarding “technique/positioning” and “feedback from preceptors.”.Conclusion: Teaching otoscopy skills to pediatric clerkship medical students using a video otoscope significantly enhanced confidence compared to those training on a traditional otoscope by 1. enabling preceptors and students to simultaneously visualize otoscopy findings 2. allowing preceptors to provide real-time feedback and 3. providing opportunity for deliberate practice of microskills. We encourage the use of video otoscopes to augment student confidence and self-efficacy when training in otoscopy.Keywords: medical students, technology, physical diagnosis, otoscopy

Facial nerve schwannomas are rare, benign, slow-growing tumors that can occur in any segment of the facial nerve, although 71% of cases are intratemporal. Surgical resection can lead to facial nerve injury. Facial function recovery after reanimation is usually not better than House-Brackmann (HB) grade III. Thus, for cases of intratemporal facial nerve schwannomas (IFNSs) with favorable facial function (HB grade I or II), observation by periodic magnetic resonance imaging is the mainstay of management. Here, we present a case of a large IFNS with normal facial function in which the mass fully occluded the external auditory canal. The occlusion caused squamous debris to accumulate, potentially leading to cholesteatoma. Faced with this therapeutic dilemma, we chose surgical resection with the patient's informed consent. Stripping surgery was achieved with normal postoperative facial function. There was no postoperative facial paralysis or recurrence at 2-year follow-up. We describe the experience of diagnosis and treatment process for this case, and discuss the possibility of total resection of the tumor with preserving the integrity of facial nerve. [ABSTRACT FROM AUTHOR]

Purpose: Hyperacusis is an uncommon hearing disorder, known as increased sensitivity to daily surrounding sounds. This disorder can profoundly affect people's daily activities. The studies conducted about hyperacusis are very limited in Iran. The purposes of this study are the psychometric evaluation of the Persian version of the Hyperacusis Questionnaire (PHQ) and the investigation of its prevalence. Method: This cross-sectional study was accomplished on 203 young university students with normal hearing sensitivity. After translating the questionnaire, the psychometric properties of the PHQ were evaluated by content validity ratio (CVR) and index (CVI) and exploratory factor analysis (EFA). Students were evaluated by clinical audiology tests, the loudness discomfort level (LDL) measurement, and answering the PHQ. The research data collection was done from April to November 2022. Otoscopy, clinical and speech audiometry, and LDL were all executed, respectively. The participants directly answered the PHQ. All statistical analyses were performed using SPSS software Version 26. Results: The PHQ demonstrated acceptable validity and reliability, Cronbach's alpha (.81), CVI (> 0.88), and CVR (> 0.98). EFA revealed four dimensions of the questionnaire. Of the participants, four (2%) were identified as suffering from hyperacusis. The PHQ showed the possibility of differences between genders. Conclusions: The psychometric evaluations of the PHQ were found to be acceptable and can be used in future studies. The prevalence of hyperacusis in our sample was 2%, and estimated to be higher in females. These findings suggest the need for further research on hyperacusis in Iranian population and specified studies to compare the two genders. [ABSTRACT FROM AUTHOR]