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Abstract Background In otosurgical training, cadaveric temporal bones are primarily used to provide a realistic tactile experience. However, using cadaveric temporal bones is challenging due to their limited availability, high cost, and potential for infection. Utilizing current three-dimensional (3D) technologies could overcome the limitations associated with cadaveric bones. This study focused on how a 3D-printed middle ear model can be used in otosurgical training. Methods A cadaveric temporal bone was imaged using microcomputed tomography (micro-CT) to generate a 3D model of the middle ear. The final model was printed from transparent photopolymers using a laser-based 3D printer (vat photopolymerization), yielding a 3D-printed phantom of the external ear canal and middle ear. The feasibility of this phantom for otosurgical training was evaluated through an ossiculoplasty simulation involving ten otosurgeons and ten otolaryngology–head and neck surgery (ORL-HNS) residents. The participants were tasked with drilling, scooping, and placing a 3D-printed partial ossicular replacement prosthesis (PORP). Following the simulation, a questionnaire was used to collect the participants' opinions and feedback. Results A transparent photopolymer was deemed suitable for both the middle ear phantom and PORP. The printing procedure was precise, and the anatomical landmarks were recognizable. Based on the evaluations, the phantom had realistic maneuverability, although the haptic feedback during drilling and scooping received some criticism from ORL-HNS residents. Both otosurgeons and ORL-HNS residents were optimistic about the application of these 3D-printed models as training tools. Conclusions The 3D-printed middle ear phantom and PORP used in this study can be used for low-threshold training in the future. The integration of 3D-printed models in conventional otosurgical training holds significant promise.

Abstract 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.

ABSTRACTBackground The etiology behind different types of chronic sialadenitis (CS), some of which exhibit IgG4 overexpression, is unknown. Further, IgG4-related disease (IgG4-RD) commonly affects the submandibular gland, but its relationship to IgG4-overexpressing CS, and the antigen triggering IgG4 overexpression, remain unknown.Materials and Methods By qPCR, we assessed the presence of 21 DNA-viruses causing IgG4 overexpression in submandibular gland tissue from patients with IgG4-positive and IgG4-negative CS. Healthy submandibular glands and glands with sialolithiasis without CS were used as controls. We examined the distribution of HHV-7, HHV-6B and B19V DNA, within virus PCR-positive tissues with RNAscope in-situ hybridization (RISH).Results We detected DNA from seven viruses in 48/61 samples. EBV DNA was more prevalent within the IgG4-positive samples (6/29; 21%) than the IgG4-negative ones (1/19; 5.3%). B19V DNA was more prevalent within the IgG4-negative samples (5/19; 26%) than the IgG4-positive ones (4/29; 14%). The differences in virus prevalence were not statistically significant. Of the IgG4-RD samples (n = 3) one contained HHV-6B DNA. RISH only showed signals of HHV-7.Conclusions None of the studied viruses are implicated as triggering IgG4-overexpression in CS. Although our results do not confirm viral etiology in the examined conditions, they provide valuable information on the prevalence of viruses in both diseased and healthy submandibular gland tissue.

Abstract Background Multi slice computed tomography (MSCT) is the most common used method in middle ear imaging. However, MSCT lacks the ability to distinguish the ossicular chain microstructures in detail resulting in poorer diagnostic outcomes. Novel cone beam computed tomography (CBCT) devices’ image resolution is, on the other hand, better than MSCT resolution. The aim of this study was to optimize imaging parameters of a novel full body CBCT device to obtain optimal contrast to noise ratio (CNR) with low effective dose, and to optimize its clinical usability. Methods Imaging of five anonymous excised human cadaver temporal bones, the acquisition of the effective doses and the CNR measurements were performed for images acquired on using Planmed XFI® full body CBCT device (Planmed Oy, Helsinki, Finland) with a voxel size of 75 µm. All images acquired from the specimens using 10 different imaging protocols varying from their tube current exposure time product (mAs) and tube voltage (kVp) were analyzed for eight anatomical landmarks and evaluated by three evaluators. Results With the exception of protocol with 90 kVp 100 mAs, all other protocols used are competent to image the finest structures. With a moderate effective dose (86.5 µSv), protocol with 90 kV 450 mAs was chosen the best protocol used in this study. A significant correlation between CNR and clinical image quality of the protocols was observed in linear regression model. Using the optimized imaging parameters, we were able to distinguish even the most delicate middle ear structures in 2D images and produce accurate 3D reconstructions. Conclusions In this ex vivo experiment, the new Planmed XFI® full body CBCT device produced excellent 2D resolution and easily created 3D reconstructions in middle ear imaging with moderate effective doses. This device would be suitable for middle ear diagnostics and for e.g., preoperative planning. Furthermore, the results of this study can be used to optimize the effective dose by selecting appropriate exposure parameters depending on the diagnostic task.

Multiple myeloma (MM), the most common plasmacell neoplasm, manifests relatively often in the head and neck region, but rarely in the ear. We present a patient with fluctuating hearing loss, otalgia, persistent otitis externa and occipital swelling. CT imaging showed a large mass of cranium and the initial radiological diagnosis was plasmacytoma. Multiple osteolytic bone lesions, monoclonal serum protein with serum M component concentration of 35.2 g/L and bone marrow biopsy with abnormal, clonal plasma cells population confirmed the diagnosis of multiple myeloma. Although a rare manifestation in the external ear canal and its surroundings, plasmacytoma or multiple myeloma should be considered as a possible diagnosis in the presence of a scalp mass or a treatment resistant swelling of the external ear canal.

Abstract Background Gelsolin amyloidosis (AGel amyloidosis) is a hereditary form of systemic amyloidosis featuring ophthalmological, neurological and cutaneous symptoms. Previous studies based mainly on patients’ self-reporting have indicated that hearing impairment might also be related to the disease, considering the progressive cranial neuropathy characteristic for AGel amyloidosis. In order to deepen the knowledge of possible AGel amyloidosis-related hearing problems, a clinical study consisting of the Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire, clinical examination, automated pure-tone audiometry and a speech-in-noise test was designed. Results Of the total 46 patients included in the study, eighteen (39%) had self-reported hearing loss. The mean scores in the SSQ were 8.2, 8.3 and 8.6 for the Speech, Spatial and Qualities subscales, respectively. In audiometry, the mean pure tone average (PTA) was 17.1 (SD 12.2) and 17.1 (SD 12.3) dB HL for the right and left ears, respectively, with no difference to gender- and age-matched, otologically normal reference values. The average speech reception threshold in noise (SRT) was − 8.2 (SD 1.5) and − 8.0 (SD 1.7) dB SNR for the right and left ears, respectively, which did not differ from a control group with a comparable range in PTA thresholds. Conclusion Although a significant proportion of AGel amyloidosis patients experience subjective difficulties in hearing there seems to be no peripheral or central hearing impairment at least in patients up to the age of 60 years.

Abstract Objective To describe the characteristics, diagnostics, treatment, and outcome of severe acute otitis media (AOM) and acute mastoiditis (AM) caused by group A beta‐hemolytic streptococcus (GAS). Study design A retrospective cohort study. Methods The yearly incidence of inpatient care‐needing GAS AOM/AM patients in our hospital catchment area between 2002 and 2018 was investigated. A detailed analysis was performed for cases treated during the last GAS epidemic in 2017‐2018. Anamnesis, signs and symptoms, pure‐tone audiometry results, treatment, complications, and outcome were collected from medical charts. Patients responded to an otology‐specific health‐related quality of life survey (EOS‐16) 1.5 to 3 years after their treatment. Results The number of GAS infections peaks at approximately 7‐year intervals. During 2017 and 2018, altogether 37 patients (29 adults and 8 children) were hospitalized due to GAS AOM/AM. AM was diagnosed in 14 (38%) patients. The disease progression was typically very rapid. At presentation, all patients had severe ear pain, 68% tympanic membrane perforation and discharge, 43% fever, and 43% vertigo. In pure‐tone audiometry, there was usually a marked mixed hearing loss at presentation. There was a significant recovery in both air and bone conduction thresholds; the pure tone average improvement from presentation was 32.3 ± 14.8 dB. Rapid strep tests (RST) proved to be more sensitive than bacterial culture in identifying GAS as a cause of AOM/AM. Conclusion GAS AOM/AM has a rapid onset. Hearing loss usually includes a sensorineural component, which is usually reversible with adequate treatment. RST seems to be useful in detecting GAS from middle ear discharge. Level of Evidence 4.

A limiting factor of cochlear implant (CI) technology is the electrode-contact overlapping spread of the electrode-generated intracochlear electrical field (EF). While the extent of the spread can be reduced with intracochlear ground electrodes, the stimulation level must be increased to reach similar loudness as with monopolar stimulation utilizing an extracochlear ground. In this study, we investigated the relationship between the monopolar intracochlear EF and the minimum stimulation level required for a measurable neural response assessed with electrically evoked compound action potential (eCAP) thresholds in intraoperative settings. Also, the effect of cochlear diameter on the intracochlear EF was evaluated, as narrower intracochlear EFs were found from larger than smaller cochleae in an earlier study.A total of 171 ears of severely-to-profoundly hearing-impaired patients (ages 0.7–89 years; 42.5 ± 27.8 years, mean ± SD) implanted with a Cochlear Nucleus CI522 or CI622 implant and Slim Straight electrode array or with a Med-El Synchrony implant and Flex 28 electrode array were included in the study. Normal anatomy was established and cochlear diameter was measured for all patients from preoperative imaging. Intraoperative intracochlear EF and eCAP threshold measurements were measured for both Cochlear and Med-El devices with the CIs’ back-telemetry options, and EF and eCAP were compared for Cochlear devices.The peak and width of the intracochlear EF correlated with each other (r = 0.46, p < 0.001), and both had an inverse relationship with eCAP thresholds (r = –0.41, p < 0.001 and r = –0.29, p < 0.001, respectively). The peak amplitudes of the intracochlear EF increased towards the apical part of the electrode array with both Cochlear (r = 0.97, p < 0.001) and Med-El (r = 0.80, p = 0.002) devices. The peak amplitudes of the intracochlear EF were shallower across the electrode array in large than in small cochleae (p < 0.05).Our results indicate that the responsiveness of the cochlear nerve is not only dependent on neural health but is also affected by the physical environment of the electrode array, which can be assessed by measuring the intracochlear EF. Further studies are warranted to investigate the detailed characteristics of the intracochlear current spread in CI recipients with varying anatomical features of the cochlea and with electrode arrays with different locations in the scalae or related to the modiolus in the cochleae.

Purpose: An important outcome measure of patient care is the impact on the patient’s health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases. Methods: A preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients’ responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis. Results: The relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months. Conclusions: EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.

The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics. We retrospectively analyzed presenting symptoms, pure tone audiometry and MRI finding from 246 VS patients and 442 controls were collected to test screening protocols (AAO-HNS, AMCLASS-A/B, Charing Cross, Cueva, DOH, Nashville, Oxford, Rule3000, Schlauch, Seattle, Sunderland) for sensitivity and specificity. Results were pooled with data from five other studies, and analysis of sensitivity, specificity and positive likelihood ratio (LR+) for each protocol was performed. Our results show that protocols with significantly higher sensitivity (AMCLASS-A/B, Nashville) show also significantly lowest specificity, and tend to have low association (positive likelihood ratio, LR+) to the VS. The highest LR+ was found for protocols AAO-HNS, Rule3000 and Seattle. In conclusions, knowing their properties, screening protocols are simple decision-making tools in VS diagnostic. To use the advantage of the highest sensitivity, protocols AMCLASS-A + B or Nashville can be of choice. For more reasonable approach, applying the protocols with high LR+ (AAO-HNS, Rule3000, Seattle) may reduce the overall number of MRI scans at expense of only few primarily undiagnosed VS.

Introduction: In recent decades, the lack of educational resources for cadaveric dissections has complicated the hands-on otological surgical training of otorhinolaryngology residents due to the poor availability of cadaver temporal bones, facilities, and limited hours for practice. Since students must gain adequate and patient-safe surgical skills, novel training methods need to be considered. In this proof-of-concept study, a new virtual reality (VR) software is described; this was used during a national temporal bone dissection course where we investigated its feasibility for otological surgical training.Methods: A total of 11 otorhinolaryngology residents attended the annual 2-day hands-on temporal bone dissection course; they were divided into two groups with similar experience levels. Both groups received a lecture on temporal bone anatomy. A total of 22 cadaver temporal bones were harvested for the course; 11 of these bones were imaged by computed tomography. VR software designed for preoperative planning was then used to create 3D models of the imaged temporal bones. Prior to dissection training, the first group underwent a 30-min VR session, where they identified 24 surgically relevant anatomical landmarks on their individual temporal bone. The second group proceeded directly to dissection training. On the second day, the groups were switched. The feasibility of VR training was assessed with three different metrics: surgical performance evaluation using a modified Hopkins objective structured assessment of technical skill (OSATS), time for the surgical exposure of anatomical landmarks, and the user experience collected with a Likert scale questionnaire.Results: No differences were noted in the overall performance between the groups. However, participants with prior VR training had a lower mean time for surgical exposure of anatomical landmarks (antrum 22.09 vs. 27.64 min, p = 0.33; incus 60.00 vs. 76.00, p = 0.03; PSCC 71.83 vs. 88.50, p = 0.17) during dissection training. The participants considered VR beneficial for anatomy teaching, surgery planning, and training.Conclusion: This study demonstrated the feasibility of implementing VR training in a temporal bone dissection course. The VR training demonstrated that even short expert-guided VR sessions are beneficial, and VR training prior to the dissections has a positive effect on the time needed to perform surgical tasks while maintaining comparable performance scores.

There is no unanimous consensus for indications of eustachian tube balloon dilation (ETBD). Nordic countries have relatively similar hospital organizations and treatment guidelines. Therefore, it was logical to organize a consensus meeting of ETBD. The symposium: Nordic Experiences on Eustachian Tube Balloon Dilation, in Copenhagen, 30–31 March, 2017. The panellists from Denmark, Finland, Norway and Sweden and the attendees of the meeting agreed a consensus on the following issues: Candidates, Definition of Eustachian Tube Dysfunction, Diagnostic Work up, Differential Diagnosis, Contraindications, ETBD Procedure, Complications, Follow-up, and Outcomes. The article also presents the status for ETBD in each of these countries. Thereafter the consensus statement has been discussed in the national societies and meetings for ear surgeons in each of these countries. It can be assumed that surgeons in the hospitals of these Nordic countries generally follow the recommendations from the consensus meeting. Keywords: Eustachian tube, Eustachian tube dysfunction, Balloon dilation, Nordic consensus

IntroductionTinnitus can become a strong stressor for some individuals, leading to imbalance of the autonomous nervous system with reduction of parasympathetic activity. It can manifest itself as sleep disturbances, anxiety and even depression. This condition can be reversed by bioelectrical vagal nerve stimulation (VNS). Conventional invasive VNS is an approved treatment for epilepsy and depression. Transcutaneous VNS (taVNS) stimulating the auricular branch of the vagus nerve has been shown to activate the vagal pathways similarly as an implanted VNS. Therefore, taVNS might also be a therapeutic alternative in health conditions such as tinnitus-related mental stress (TRMS). This retrospective study in 171 TRMS patients reports the clinical features, psychophysiological characteristics, and results of the heart rate variability (HRV) tests before and after test-taVNS. This study also reports the therapy outcomes of 113 TRMS patients treated with taVNS, in combination with standard tinnitus therapy.MethodsDiagnostic tinnitus and hearing profiles were defined. To detect possible cardiac adverse effects, test-taVNS with heart rate monitoring as well as pre- and post-stimulation HRV tests were performed. Daily taVNS home therapy was prescribed thereafter. To assess therapeutic usefulness of taVNS, 1-year follow-up outcome was studied. Results of HRV tests were retrospectively analyzed and correlated to diagnostic data.ResultsThe large majority of patients with TRMS suffer from associated symptoms such as sleep disturbances and anxiety. Baseline HRV data showed that more than three quarters of the 171 patients had increased sympathetic activity before test-taVNS. Test-taVNS shifted mean values of different HRV parameters toward increased parasympathetic activity in about 80% of patients. Test-taVNS did not cause any cardiac or other side effects. No significant adverse effects were reported in follow-up questionnaires.ConclusionTRMS is an example of a stress condition in which patients may benefit from taVNS. As revealed by HRV, test-taVNS improved parasympathetic function, most efficiently in patients with a low starting HRV level. Our tinnitus treatment program, including taVNS, effectively alleviated tinnitus stress and handicap. For wider clinical use, there is a great need for more knowledge about the optimal methodology and parameters of taVNS.

Bilateral cochlear implantation is increasing worldwide. In adults, bilateral cochlear implants (BICI) are often performed sequentially with a time delay between the first (CI1) and the second (CI2) implant. The benefits of BICI have been reported for well over a decade. This study aimed at investigating these benefits for a consecutive sample of adult patients. Improvements in speech-in-noise recognition after CI2 were followed up longitudinally for 12 months with the internationally comparable Finnish matrix sentence test. The test scores were statistically significantly better for BICI than for either CI alone in all assessments during the 12-month period. At the end of the follow-up period, the bilateral benefit for co-located speech and noise was 1.4 dB over CI1 and 1.7 dB over CI2, and when the noise was moved from the front to 90 degrees on the side, spatial release from masking amounted to an improvement of 2.5 dB in signal-to-noise ratio. To assess subjective improvements in hearing and in quality of life, two questionnaires were used. Both questionnaires revealed statistically significant improvements due to CI2 and BICI. The association between speech recognition in noise and background factors (duration of hearing loss/deafness, time between implants) or subjective improvements was markedly smaller than what has been previously reported on sequential BICI in adults. Despite the relatively heterogeneous sample, BICI improved hearing and quality of life.

We report on a previously healthy 11-year-old male presenting with meningoencephalitis and otitis media. Computed tomography demonstrated opacification of the right middle ear and mastoid ear cells, but no destructive changes. Anti-Mycoplasma pneumoniae IgG and IgM were positive in serum and at high concentrations in cerebrospinal fluid (CSF), and its nucleic acid was detected in the middle ear fluid and in a throat swab, but not in CSF. EEG showed generalized slowing and right temporal sharp waves. Brain MRI imaging remained normal. After a 3-week treatment with doxycycline and a tympanostomy tube, the patient recovered, and no long-term neurological sequelae have appeared. Diagnostics and pathogenetic mechanisms in meningoencephalitis caused by M. pneumoniae are discussed.

The temporal difference limen (TDL) can be measured with noninvasive electrical ear canal stimulation. The objective of the study wa to determine the role of preoperative TDL measurements in predicting patients’ speech perception after cochlear implantation. We carried out a retrospective chart analysis of fifty-four cochlear implant (CI) patients with preoperative TDL and postoperative bisyllabic word recognition measurements in Helsinki University Central Hospital between March 1994 and March 2011. Our results show that there is no correlation between TDL and postoperative speech perception. However, patient’s advancing age correlates with longer TDL but notdirectly with poorer speech perception. The results are in line with previous results concerning the lack of predictive value of preoperativ TDL measurements in CI patients.

In angiosperms, endosperm development comprises a series of developmental transitions controlled by genetic and epigenetic mechanisms that are initiated after double fertilization. Polycomb repressive complex 2 (PRC2) is a key component of these mechanisms that mediate histone H3 lysine 27 trimethylation (H3K27me3); the action of PRC2 is well described in Arabidopsis thaliana but remains uncertain in cereals. In this study, we demonstrate that mutation of the rice (Oryza sativa) gene EMBRYONIC FLOWER2a (OsEMF2a), encoding a zinc-finger containing component of PRC2, causes an autonomous endosperm phenotype involving proliferation of the central cell nuclei with separate cytoplasmic domains, even in the absence of fertilization. Detailed cytological and transcriptomic analyses revealed that the autonomous endosperm can produce storage compounds, starch granules, and protein bodies specific to the endosperm. These events have not been reported in Arabidopsis. After fertilization, we observed an abnormally delayed developmental transition in the endosperm. Transcriptome and H3K27me3 ChIP-seq analyses using endosperm from the emf2a mutant identified downstream targets of PRC2. These included >100 transcription factor genes such as type-I MADS-box genes, which are likely required for endosperm development. Our results demonstrate that OsEMF2a-containing PRC2 controls endosperm developmental programs before and after fertilization.

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]

BackgroundUnderstanding the genetic architecture of cardiac structure and function may help to prevent and treat heart disease. This investigation sought to identify common genetic variations associated with inter-individual variability in cardiac structure and function.MethodsA GWAS meta-analysis of echocardiographic traits was performed, including 46,533 individuals from 30 studies (EchoGen consortium). The analysis included 16 traits of left ventricular (LV) structure, and systolic and diastolic function.ResultsThe discovery analysis included 21 cohorts for structural and systolic function traits (n = 32,212) and 17 cohorts for diastolic function traits (n = 21,852). Replication was performed in 5 cohorts (n = 14,321) and 6 cohorts (n = 16,308), respectively. Besides 5 previously reported loci, the combined meta-analysis identified 10 additional genome-wide significant SNPs: rs12541595 near MTSS1 and rs10774625 in ATXN2 for LV end-diastolic internal dimension; rs806322 near KCNRG, rs4765663 in CACNA1C, rs6702619 near PALMD, rs7127129 in TMEM16A, rs11207426 near FGGY, rs17608766 in GOSR2, and rs17696696 in CFDP1 for aortic root diameter; and rs12440869 in IQCH for Doppler transmitral A-wave peak velocity. Findings were in part validated in other cohorts and in GWAS of related disease traits. The genetic loci showed associations with putative signaling pathways, and with gene expression in whole blood, monocytes, and myocardial tissue.ConclusionThe additional genetic loci identified in this large meta-analysis of cardiac structure and function provide insights into the underlying genetic architecture of cardiac structure and warrant follow-up in future functional studies.FundingFor detailed information per study, see Acknowledgments.

Introduction: Balloon Eustachian tuboplasty (BET) is used to treat obstructive Eustachian tube dysfunction (OETD) and recurrent otitis media with effusion (OME). However, there are no indisputable evidence of its efficacy. Here, we present a multicenter, double‐blinded, randomized, placebo‐controlled trial (MDRCT) design to evaluate the efficacy of BET, and the results of a pilot trial with 3‐ and 12‐months' follow‐up. Material and Methods: This was a prospective MDRCT. For a pilot study, OETD (n = 10) and OME (n = 5) patients were recruited and followed. Detailed inclusion and exclusion criteria were used. Participants were randomized at beginning of the operation to active or sham surgery. All procedures were performed under local anesthesia. Controls were performed in double‐blinded manner (both patient and physician), at 3 and 12 months after the procedure. Results: Altogether, 20 ears were treated and followed for 12 months, including 14 active BETs and 6 sham surgeries. Both the active and sham surgery were performed under local anesthesia without problems or deviations from the protocol. There were no differences in the preoperative symptoms (ETDQ‐7) or objective measures (tympanometry, Valsalva and Toynbee maneuvers, tubomanometry, Eustachian tube score) between active and sham surgery arms. During follow‐up, we noticed largely similar reduction in subjective symptoms and improvement in Eustachian tube score both in active and sham surgery arms. Conclusions: The pilot study demonstrates that our MDRCT protocol is feasible, and that blinded RCTs are dearly needed to objectively measure the efficacy of BET. Level of Evidence: 2 Laryngoscope, 134:1874–1881, 2024 [ABSTRACT FROM AUTHOR]