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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]

AbstractBackgroundAims/ObjectivesMaterial and MethodsResultsConclusions and SignificanceThere is a need for a simpler and accessible intervention to heal tympanic membrane perforations than myringoplasty that is todaýs golden standard. Experimental studies have identified plasminogen as a promising agent for medical treatment of chronic tympanic membrane perforation.This was a phase 1, prospective, randomized, placebo-controlled study with the main objective to evaluate the safety of injecting plasminogen in the vicinity of the tympanic membrane in subjects with chronic tympanic membrane perforation.Adults diagnosed with a dry chronic tympanic membrane perforation were recruited for an injection schedule with Human plasminogen 10. Adverse events, audiometry, VAS fluctuations and size of perforation, were monitored throughout the length of the study.It was possible to perform the injections according to schedule in all subjects. None of the subjects experienced any severe adverse events. Most common adverse event was ear pain. No signs of ototoxicity were reported.This pilot study suggests that plasminogen injections close to the tympanic membrane as treatment for chronic tympanic membrane injections are safe and feasible, encouraging further dose-escalating studies. [ABSTRACT FROM AUTHOR]

Background: Conductive or mixed hearing loss with an intact tympanic membrane is a group of diseases characterized by similar clinical symptoms. Definitive diagnosis depends on the findings of exploratory tympanic surgery. Cone-beam computed tomography (CBCT) has great potential for middle ear imaging. This study evaluated the diagnostic value of CBCT for conductive or mixed hearing loss with an intact tympanic membrane. Methods: CBCT and high-resolution computed tomography (HRCT) imaging data were collected from patients with an intact eardrum who received medical treatment in our hospital for conductive or mixed hearing loss from October 2020 to May 2023. The imaging characteristics and diagnostic values of CBCT and HRCT were analyzed. Results: A total of 137 patients who met the inclusion criteria and underwent CBCT were enrolled, including 89 with otosclerosis, 41 with ossicular chain interruption, and 7 with tympanosclerosis. CBCT clearly displayed a middle ear focus, such as low-density lesions located in the fissula ante fenestram, ossicular chain malformation or dislocation, and tympanic calcification foci. The area under the curve values for otosclerosis, ossicular chain interruption, and tympanic sclerosis were 0.934, 0.967, and 0.850, respectively. CBCT was more effective than HRCT for visualizing the lenticular process, incudostapedial joint, and stapes footplate. Conclusions: CBCT of the middle ear demonstrated higher-quality imaging to improve the diagnosis of conductive or mixed hearing loss with an intact tympanic membrane. Therefore, CBCT is recommended for further investigation of noninflammatory diseases of the middle ear with no special findings on HRCT. [ABSTRACT FROM AUTHOR]

Introduction Auditory disabilities like tinnitus and hearing loss caused by exposure to blast overpressures are prevalent among military service members and veterans. The high-pressure fluctuations of blast waves induce hearing loss by injuring the tympanic membrane, ossicular chain, or sensory hair cells in the cochlea. The basilar membrane (BM) and organ of Corti (OC) behavior inside the cochlea during blast remain understudied. A computational finite element (FE) model of the full human ear was used by Bradshaw et al. (2023) to predict the motion of middle and inner ear tissues during blast exposure using a 3-chambered cochlea with Reissner's membrane and the BM. The inclusion of the OC in a blast transmission model would improve the model's anatomy and provide valuable insight into the inner ear response to blast exposure. Materials and Methods This study developed a microscale FE model of the OC, including the OC sensory hair cells, membranes, and structural cells, connected to a macroscale model of the ear to form a comprehensive multiscale model of the human peripheral auditory system. There are 5 rows of hair cells in the model, each row containing 3 outer hair cells (OHCs) and the corresponding Deiters' cells and stereociliary hair bundles. BM displacement 16.75 mm from the base induced by a 31 kPa blast overpressure waveform was derived from the macroscale human ear model reported by Bradshaw et al. (2023) and applied as input to the center of the BM in the OC. The simulation was run for 2 ms as a structural analysis in ANSYS Mechanical. Results The FE model results reported the displacement and principal strain of the OHCs, reticular lamina, and stereociliary hair bundles during blast transmission. The movement of the BM caused the rest of the OC to deform significantly. The reticular lamina displacement and strain amplitudes were highest where it connected to the OHCs, indicating that injury to this part of the OC may be likely due to blast exposure. Conclusions This microscale model is the first FE model of the OC to be connected to a macroscale model of the ear, forming a full multiscale ear model, and used to predict the OC's behavior under blast. Future work with this model will incorporate cochlear endolymphatic fluid, increase the number of OHC rows to 19 in total, and use the results of the model to reliably predict the sensorineural hearing loss resulting from blast exposure. [ABSTRACT FROM AUTHOR]

Introduction: The modified nine‐step test is a classical method for evaluating Eustachian tube function. However, clinical interpretation of the increased maximal difference in middle ear pressure (mdMEP) in the modified nine‐step test is unknown. We hypothesised that the different reservoir effects of the mastoid cavity can bias the results of the modified nine‐step test. Methods: A total of 108 consecutive participants (216 ears) were retrospectively screened. Of these, 55 participants (82 ears) who met the inclusion/exclusion criteria were enrolled. The volumetric results of the mastoid cavity, parameters of the modified nine‐step test (mdMEP, middle ear pressure, tympanic membrane compliance), and demographic data were analysed. Results: A significant negative correlation was found between mdMEP and mastoid cavity volume (R =.467, p <.001). Ears with mdMEP >70 daPa showed poor pneumatization in the mastoid cavity, with volumes less than 3000 mm3 (10th percentile of all ears analysed). Ears with mastoid cavity volumes lower than the 25th percentile showed a significantly higher mdMEP (p <.001). Patients with mastoid cavity volumes higher than the 75th percentile were significantly younger (p <.001). Multivariate regression analysis for mdMEP showed a good fit (R =.854) using factors including middle ear pressure, admittance and, most importantly, the reciprocal of mastoid volume (Beta = 0.752, p <.001). Conclusions: The mdMEP, the main parameter of the modified nine‐step test, was negatively correlated with the mastoid cavity volume. Therefore, the results of the modified nine‐step test should be interpreted with consideration of mastoid cavity volume. [ABSTRACT FROM AUTHOR]

Background: Rigid telescopes, which provide wider surgical feld imaging, improved resolution, and high magnifcation capabilities, have recently found widespread use in ear surgery. This study aimed to review the outcomes and duration of operations in endoscopic transcanal tympanoplasty and to guide surgeons who have just started endoscopic ear surgery (EES). Methods: This study included 47 outpatient or inpatient volunteers who underwent endoscopic transcanal tympanoplasty surgery at the Otolaryngology clinic between March 2021 and March 2023. The age and sex of the patients, the surgery duration, and the side of the operated ear were reviewed. The first 23 operated patients were compared with the last 24 operated patients in terms of the duration of the operation. Postoperative graft success (anatomical success) in the patients at 6 months was reviewed. Hearing gain in patients was examined postoperatively at 6 months using an audiometry test with hearing thresholds at 0.5, 1, 2, and 4 kHz. Results: Upon examination of the patients at 6 months, the graft success was 89.4%. There was a statistically signifcant recovery in all 4 frequencies based on the preoperative and postoperative hearing tests (P=.00). There was a signifcant decrease in the duration of the operation in patients who were operated in the later stages of the study (P=.00). Conclusion: Although there is a learning curve associated with EES, this type of operation is based on team effort, and the surgery duration decreases over time, with the experience acquired by each healthcare provider included in the team. [ABSTRACT FROM AUTHOR]

To assess the effectiveness of the autologous plasma-rich fibrin plug technique for repairing small tympanic membrane perforations. Platelet rich fibrin (PRF) is also called second generation platelet rich plasma due to its high amount of growth factors which could be used in tympanic perforation closure. Being autologous, it is readily available with no immunogenic reactions. PRF membrane has a strong elastin fibrin structure containing growth factors and hence can be considered as an ideal sealing material or an adjuvant to the graft in repairing tympanic membrane perforations. Ours is a prospective study. A total of 52 patients with dry small tympanic membrane perforation were included in the study. In this technique, 10 ml of blood is withdrawn from the patient, processed in a centrifuge machine, and platelet-rich fibrin (PRF) is separated from the mixture for use in the repair of small tympanic membrane defects. Out of the 52 patients, 42 experienced successful repair (full closure) of the tympanic membrane. The mean time of closure of the perforation was around 2 weeks. However, five of them encountered failure. Although the size of the perforation decreased compared to the preoperative size. Additionally, two patients developed granulations on the tympanic membrane. No major side effects were noted. Autologous PRF is a product derived from whole blood through the process of centrifugation. It is safe and effective in promoting the natural process of wound healing by incorporating a high concentration of platelet-derived growth factors as well as fibrin into the graft mixture. This facilitates the rapid healing of tympanic membrane perforation. [ABSTRACT FROM AUTHOR]

Background: Although remarkable progress has been made in conventional hearing aids, patients with hearing loss are still reluctant to use them due to cosmetic or functional reasons, such as the feedback phenomenon or the occlusion effect. In the late 20th century, implantable hearing aids were developed and used as an alternative. Current Concepts: Several devices have been developed, with three currently available on the international market (Vibrant Soundbridge [Med-El Corporation], MAXUM [SOUNDTEC Inc.], and Esteem [Envoy Medical Corporation]). Electromagnetic and piezoelectric transduction systems enable the devices to transmit external sounds to the internal auditory system, enabling sounds to be heard without amplifying the sound source. Although not an implantable hearing aid, Earlens (Earlens Corporation), which attaches to the eardrum and transmits sound, has also been developed and is commercially available. This manuscript briefly describes these devices, evaluates their benefits and limitations, and considers future research directions in the field of implantable hearing aids. Discussion and Conclusion: Implantable or attachable hearing aids are innovative technologies that compensate for the shortcomings of conventional hearing aids while providing comparable or better results. The demand for them is expected to continue to increase in the future owing to the continued increase in the population with hearing loss and the trend toward quality of life and external beauty. [ABSTRACT FROM AUTHOR]

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Introduction: The assessment of the integrity of the tympanic membrane (TM) can be a diagnostic challenge in patients with otitis externa and/or otitis media (OM) under an otoscopic examination. In computed tomography (CT), the TM is not always visualized. However, a positive contrast canalography using conventional radiography has been previously described to evaluate the TM integrity. Objective: This single-center study aimed to describe the positive contrast canalography technique in CT and its usefulness in identifying TM integrity in 11 dogs. Methods: Dogs with clinical signs of ear disease underwent CT canalography following a systematic protocol. Result: The presence of contrast medium and contrast homogeneity within the tympanic cavity was assessed, confirming TM rupture when contrast medium was present in the tympanic cavity. CT canalography was performed in 16 ears, and in 7 of the 16 ears (44%), there was a contrast in the tympanic cavity, confirming TM rupture (positive CT canalography result). In two of the seven cases (29%), rupture of the TM was identified in both otoscopic and CT canalography. In the remaining five of the seven (71%) positive CT canalography results, tympanic membrane rupture was identified only by CT canalography. Discussion: In conclusion, a positive contrast CT canalography is a complementary and safe technique to assess TM integrity, with a potentially higher sensitivity than otoscopic examination for the diagnosis of TM rupture in dogs. [ABSTRACT FROM AUTHOR]

The combination of piezoelectric ceramics with silicon nanomembranes can provide a unique combination of electronic and mechanical functionality. For example, an integrated remotely accessible sensor/actuator can serve as a sound transducer to be placed on the tympanic membrane of the human ear. Such an implant would enable direct sound transmission in the kHz range via down‐conversion of a modulated carrier signal at radio frequency. The viability of this concept is demonstrated via a specific design of the nanomembrane bonded over a hole in the piezoelectric chip as well as driving this chip to create a strong nonlinear mechanical response in the nanomembrane. The response in the audible‐frequency range and the result is demonstrated by modulating the piezoelectric chip with a C‐major audible tune—the tone ladder—and retrieving this sound by an optical readout method are centered. Finally, to prove the possibility of remote actuation of the nanomembrane, an antenna on the chip is integrated and the wide‐band transmission from a mobile source is simulated. It is concluded that a remotely actuated invisible hearing aid is possible. [ABSTRACT FROM AUTHOR]

Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB (p < 0.001). Conclusion We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: We investigated whether the quality of high-resolution computed tomography (CT) images of the temporal bone improves with deep learning reconstruction (DLR) compared with hybrid iterative reconstruction (HIR). Methods: This retrospective study enrolled 36 patients (15 men, 21 women; age, 53.9 ± 19.5 years) who had undergone high-resolution CT of the temporal bone. Axial and coronal images were reconstructed using DLR, HIR, and filtered back projection (FBP). In qualitative image analyses, two radiologists independently compared the DLR and HIR images with FBP in terms of depiction of structures, image noise, and overall quality, using a 5-point scale (5 = better than FBP, 1 = poorer than FBP) to evaluate image quality. The other two radiologists placed regions of interest on the tympanic cavity and measured the standard deviation of CT attenuation (i.e., quantitative image noise). Scores from the qualitative and quantitative analyses of the DLR and HIR images were compared using, respectively, the Wilcoxon signed-rank test and the paired t-test. Results: Qualitative and quantitative image noise was significantly reduced in DLR images compared with HIR images (all comparisons, p ≤ 0.016). Depiction of the otic capsule, auditory ossicles, and tympanic membrane was significantly improved in DLR images compared with HIR images (both readers, p ≤ 0.003). Overall image quality was significantly superior in DLR images compared with HIR images (both readers, p < 0.001). Conclusion: Compared with HIR, DLR provided significantly better-quality high-resolution CT images of the temporal bone. [ABSTRACT FROM AUTHOR]

Introduction: Fat tympanoplasty is repair of small dry tympanic membrane perforations using fat as graft material. It is a simple office procedure with minimal morbidity and manipulation of the middle ear. Materials and Methods: The present study was a prospective review of 60 patients who underwent fat tympanoplasty over the period of 15 months. In all the patients fat was harvested from ear lobule. Results: Patients were kept on follow up for 3 months and evaluated for graft uptake and hearing gain. 86.66% closure rate of tympanic membrane defect was achieved. Postoperative air conduction was 29.6 ± 5.3 while air bone gap was 13.2 ± 6.1. Conclusion: The study concludes that fat plug myringoplasty is a simple, quick, less invasive method to repair small tympanic membrane defects. [ABSTRACT FROM AUTHOR]

This article explores the evolution of mammalian teeth, jaw joints, and middle ear structures. It presents new evidence from fossil studies that sheds light on the earliest tooth diversification of mammaliaforms and the transformation of the reptilian jaw joint into the middle ear apparatus of mammals. The findings challenge previous understandings of tooth patterns and phylogenetic relationships among mammaliaforms. The article discusses the development of the dual jaw joint and the transition to the middle ear ossicles in mammals, as well as the role of Meckel's cartilage in this process. Overall, the available fossil evidence supports the gradual evolution from the dual jaw joint to the separate hearing and chewing apparatuses in mammals. [Extracted from the article]

Purpose: Although recommendations for effective heat acclimation (HA) strategies for many circumstances exist, best-practice HA protocols specific to elite female team-sport athletes are yet to be established. Therefore, the authors aimed to investigate the effectiveness and retention of a passive HA protocol integrated in a female Olympic rugby sevens team training program. Methods: Twelve elite female rugby sevens athletes undertook 10 days of passive HA across 2 training weeks. Tympanic temperature (TTymp), sweat loss, heart rate, and repeated 6-second cycling sprint performance were assessed using a sport-specific heat stress test Pre-HA, after 3 days (Mid-HA), after 10 days (Post-HA), and 15 days post-HA (Decay). Results: Compared with Pre-HA, submaximal TTymp was lower Mid-HA and Post-HA (both by −0.2 [0.7] °C; d ≥ 0.71), while resting TTymp was lower Post-HA (by −0.3 [0.2] °C; d = 0.81). There were no differences in TTymp at Decay compared with Pre-HA, nor were there any differences in heart rate or sweat loss at any time points. Mean peak 6-second power output improved Mid-HA and Post-HA (76 [36] W; 75 [34] W, respectively; d ≥ 0.45) compared with Pre-HA. The observed performance improvement persisted at Decay by 65 (45) W (d = 0.41). Conclusions: Ten days of passive HA can elicit some thermoregulatory and performance benefits when integrated into a training program in elite female team-sport athletes. However, such a protocol does not provide a sufficient thermal impulse for thermoregulatory adaptations to be retained after 15 days with no further heat stimulus. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic tympanoplasty includes various surgical methods, such as internal repair, interlayer repair, and external overlay. This technique requires autologous materials, allografts, and xenografts, which are used to repair tympanic membrane (TM) perforation. To obtain good results, appropriate surgical methods and repair materials should be selected. This study aims to assess the efficacy of repairing refractory TM perforations in the porcine small intestinal submucosa (SIS) during transcanal endoscopic type I tympanoplasty. Method: A retrospective chart review was performed on patients who underwent TM perforation repair with porcine SIS and tragus cartilage between January 2022 and September 2022 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Perforation size, tympanic status, pre- and postoperative symptoms, follow-up data, wound healing rates, and hearing improvement were analysed. Results: Of the 115 patients included in the study, 56 underwent interlayer repair with porcine SIS of the TM, and 59 patients underwent internal repair with tragus cartilage. No significant difference was found between the two groups at baseline in terms of age, sex, disease course, perforation side, tympanic status, underlying disease, or preoperative infection. The total postoperative effective rate of interlayer implantation with porcine SIS was 91.07% (51 patients), and that of internal implantation with tragus cartilage was 88.14% (52 patients). No significant difference was found in terms of the graft success rate between the two surgical methods (p = 0.887). Postoperative pure tone auditory (PTA) and air-bone gap (ABG) density significantly increased in both groups compared with before surgery (p 0.05). Compared to those in the internal implantation group, the patients in the interlayer group had a shorter operation duration (51.36 ± 6.76 min vs. 59.71 ± 7.45 min, t = 6.298, p

Finite Element modeling has been an extended methodology to build numerical model to simulate the behavior of the hearing system. Due to the complexity of the system and the difficulties to reduce the uncertainties of the geometric data, they result in computationally expensive models, sometimes generic, representative of average geometries. It makes it difficult to validate the model with direct experimental data from the same specimen or to establish a patient‐oriented modeling strategy. In the present paper, a first attempt to automatize the process of model building is made. The source information is geometrical information obtained from CT of the different elements that compose the system. Importing that data, we have designed the complete procedure to build a model including tympanic membrane, ossicular chain and cavities. The methodology includes the proper coupling of all the elements and the generation of the corresponding finite element model. The whole automatic procedure is not complete, as we need to make some human‐assisted decisions; however, the model development time is reduced from 4 weeks to approximately 3 days. The goal of the modeling algorithm is to build a Finite Element Model with a limited computational cost. Several tasks as contour identification or model decimation are designed and integrated in order to follow a semi‐automated process that allows generating a patient‐oriented model. [ABSTRACT FROM AUTHOR]

The tympanic membrane forms a barrier between the external auditory canal and the middle ear. In the inactive mucosal type of chronic otitis media, there is a perforation in the tympanic membrane which is surgically managed by Myringoplasty. Estrogen as a growth factor has been shown to have a mitogenic effect on keratinocytes thus hastening the rate of epithelialization following injury. This property of estrogen is being studied in this study for its role in the outcomes of myringoplasty. This study was carried out from January 2021 to December 2022 in the Department of Otorhinolaryngology, of a tertiary teaching hospital in North India. Patients were assessed by history, examination, otoscopy, Audiometry, and oto-endoscopy. A total of 88 patients were taken out of which 44 patients underwent myringoplasty in which topical estrogen (estradiol valerate solution) was used, and the remaining 44 patients were taken as controls. Patients were then assessed post-operatively based on Audiometry results and graft uptake status. In the estrogen group successful Graft uptake was in seen 40 (90.9%) patients and failed in 4 (9.1%), while in the control group, it was successful in 37 (84.1%) patients and failed in 7 (15.9%), statistically there was no significant difference between two groups in terms of graft uptake (p value = 0.334). Post-operatively, in the estrogen group, the mean change in Air Conduction (AC) was 15.5 dB, the change in the air-bone gap (ABG) was 11.5 dB and for Bone Conduction (BC) it was 3.2 dB. However, in the control group mean post-operative changes in Air Conduction, Air-Bone Gap, and Bone Conduction were 12 dB, 10.7 dB, and 0.8 dB respectively. Statistically, there was a significant difference in postoperative changes in AC (p value = 0.011) and BC (p value = 0.009) between the two groups. There was no significant difference in post-operative changes in Air-Bone Gap (p value = 0.571). Topical Estrogen (Estradiol valerate) solution is cost-effective, with enriched growth factors that accelerate tympanic membrane perforation closure following myringoplasty and resulted in significant improvement in hearing thresholds both for Air Conduction and Bone Conduction. [ABSTRACT FROM AUTHOR]

To publish a rare case of Kimura's Disease in Temporal Bone. A 27 year-old male presenting with history of right ear pain and discharge for 2 months was thoroughly evaluated by clinical evaluation, hematological, radiological and histopathological study. Clinical examination revealed a bulge in posterior-inferior quadrant right side of tympanic membrane. HRCT temporal bone revealed a heterogeneous attenuating focal lesion is noted in the region of right middle ear cavity, mastoid antrum mastoid air cells in continuation with the superior aspect of right jugular foramen with erosions and bone destructions, involving the mastoid air cells and sinus plate. Patient was managed surgically with right side canal wall down mastoidectomy and Type 1 Tympanoplasty. Histopathological examination showed focal ulcerated stratified epithelium, dilated elongated congested blood vessels and hemorrhage. Diagnosis was made as Kimura's disease. [ABSTRACT FROM AUTHOR]

The current work investigated the effects of mass-loading the eardrum on wideband absorbance in humans. A non-invasive approach to mass-loading the eardrum was utilized in which water was placed on the eardrum via ear canal access. The mass-loaded absorbance was compared to absorbance measured for two alternative middle ear states: normal and stiffened. To stiffen the ear, subjects pressurized the middle ear through either exsufflation or insufflation concurrent with Eustachian tube opening. Mass-loading the eardrum was hypothesized to reduce high-frequency absorbance, whereas pressurizing the middle ear was hypothesized to reduce low- to mid-frequency absorbance. Discriminant linear analysis classification was performed to evaluate the utility of absorbance in differentiating between conditions. Water on the eardrum reduced absorbance over the 0.7- to 6-kHz frequency range and increased absorbance at frequencies below approximately 0.5 kHz; these changes approximated the pattern of changes reported in both hearing thresholds and stapes motion upon mass-loading the eardrum. Pressurizing the middle ear reduced the absorbance over the 0.125- to 4-kHz frequency range. Several classification models based on the absorbance in two- or three-frequency bands had accuracy exceeding 88%. [ABSTRACT FROM AUTHOR]

Purpose: Patient-to-image registration is a preliminary step required in surgical navigation based on preoperative images. Human intervention and fiducial markers hamper this task as they are time-consuming and introduce potential errors. We aimed to develop a fully automatic 2D registration system for augmented reality in ear surgery. Methods: CT-scans and corresponding oto-endoscopic videos were collected from 41 patients (58 ears) undergoing ear examination (vestibular schwannoma before surgery, profound hearing loss requiring cochlear implant, suspicion of perilymphatic fistula, contralateral ears in cases of unilateral chronic otitis media). Two to four images were selected from each case. For the training phase, data from patients (75% of the dataset) and 11 cadaveric specimens were used. Tympanic membranes and malleus handles were contoured on both video images and CT-scans by expert surgeons. The algorithm used a U-Net network for detecting the contours of the tympanic membrane and the malleus on both preoperative CT-scans and endoscopic video frames. Then, contours were processed and registered through an iterative closest point algorithm. Validation was performed on 4 cases and testing on 6 cases. Registration error was measured by overlaying both images and measuring the average and Hausdorff distances. Results: The proposed registration method yielded a precision compatible with ear surgery with a 2D mean overlay error of 0.65 ± 0.60 mm for the incus and 0.48 ± 0.32 mm for the round window. The average Hausdorff distance for these 2 targets was 0.98 ± 0.60 mm and 0.78 ± 0.34 mm respectively. An outlier case with higher errors (2.3 mm and 1.5 mm average Hausdorff distance for incus and round window respectively) was observed in relation to a high discrepancy between the projection angle of the reconstructed CT-scan and the video image. The maximum duration for the overall process was 18 s. Conclusions: A fully automatic 2D registration method based on a convolutional neural network and applied to ear surgery was developed. The method did not rely on any external fiducial markers nor human intervention for landmark recognition. The method was fast and its precision was compatible with ear surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare the audiological outcomes, tympanic membrane (TM) healing rates and complication rates in patients undergoing endoscopic underlay and over–under tympanoplasty type I (TTI). Methods: The study includes 95 patients who underwent endoscopic TTI in the period between 2018 and 2023: 56% of the patients had the underlay technique and 41% had the over–under technique. Data regarding pre- and postoperative hearing, perforation characteristics, surgical procedures, graft types and complications were retrospectively analyzed. Audiometrical assessment included air conduction (AC) and bone conduction (BC) pure tone averages (PTA) and air–bone gap (ABG), pre- and postoperatively. Results: Both underlay and over–under techniques significant improved AC PTA, with a mean ABG improvements of 5.9 dB and 7.2 dB, respectively. There was no significant difference in BC PTA between pre- and post-operative, indicating no inner ear damage in both techniques. The over–under technique showed a significantly higher TM closure rate (94.4%) compared to the underlay technique (80.6%). Complications were rare, with only one case of TM lateralization requiring revision surgery. Conclusions: Endoscopic TTI is an effective treatment in improving auditory function in chronic middle ear diseases. In our cohort, the detachment of the umbo does not negatively influence the postoperative hearing results and does not increase rate of complications. Moreover, the over–under technique demonstrates superior TM closure rates, making it a valuable option for specific cases. However, future prospective studies with larger sample sizes and longer term follow-up are needed to validate these findings and provide more comprehensive insights. [ABSTRACT FROM AUTHOR]

In middle ear ailments, the thickness of tympanic membrane (TM) could change due to biofilm depositions. It is useful to measure the vibrations of the TM as well as its thickness and curvature. In the presence of unavoidable human motion, this becomes challenging and requires the use of expensive devices. We demonstrate a low-cost method for measuring these in real-time using a custom-built line-field spectral-domain optical coherence tomography device. Linearity of the amplitude response of the TM as well as its frequency response over the 1–2.5 kHz region is demonstrated. While an in-vivo sensitivity of 2 nm is achieved for the TM, a sensitivity of 200 pm is demonstrated on a membrane phantom. Our device enables a depth range of 6.2 mm using a line-field B-scan that covers a lateral extent of 3 mm with a lateral and depth resolution of 18 µm each. [ABSTRACT FROM AUTHOR]

Purpose: Several treatment methods for hearing disorders rely on attaching medical devices to the tympanic membrane. This study aims to systematically analyze the effects of the material and geometrical properties and location of the medical devices attached to the tympanic membrane on middle-ear vibrations. Methods: A finite-element model of the human middle ear was employed to simulate the effects of attachment of medical devices. Various types of material and geometrical properties, locations, and modeling scenarios were investigated for the medical device. Results: The attachment of the device magnifies the effects of anti-resonances of the middle ear. Additionally, the variations of the material properties of the device significantly alter the middle-ear resonance frequency while changes in the umbo and stapes footplate motions are negligible at frequencies above 5 kHz. Furthermore, modeling the device as a point mass cannot accurately represent the implanted middle-ear behavior. The variations of the diameter and height of the medical device have negligible effects on the middle-ear vibrations at frequencies below 200 Hz but can have considerable impacts at higher frequencies. The effects of changing the device height were negligible at frequencies above 2 kHz. We also discuss the effects of medical device attachment on the vibration patterns of the tympanic membrane as well as the impacts of the variations of the location of the device on the stapes footplate responses. Conclusion: The findings of our study aid the development and optimization of new therapeutic devices, attached to the tympanic membrane, to have the least adverse effects on middle-ear vibrations. [ABSTRACT FROM AUTHOR]

BACKGROUND: In recent years, there have been many novel tympanic membrane repair materials, including patches and 3D-printed scaffolds. However, the tympanic membrane repaired by these materials is different from the natural tympanic membrane in terms of thickness and internal structure. OBJECTIVE: To explore the efficacy of bone marrow mesenchymal stem cells-loaded high-porosity polycaprolactone/collagen nanofiber membrane scaffolds in repairing chronic tympanic membrane perforation. METHODS: Polycaprolactone, polycaprolactone-collagen, and high-porosity polycaprolactone-collagen nanofiber membranes were prepared by electrospinning technology, and the surface morphology, porosity and cell compatibility of the scaffolds were characterized. The tympanic membrane perforation model of 50 male SD rats was established by puncturing the posterior lower part of both eardrums with a sterile 23-measure needle combined with mitomycin C and hydrocortisone. After 12 weeks of modeling, the rats were divided into five groups by the random number table method. The blank control group did not receive any treatment. In the other four groups, polycaprolactone nanofiber membrane (polycaprolactone group), polycaprolactone-collagen nanofiber membrane (polycaprolactone-collagen group), high-porosity polycaprolactone-collagen nanofiber membrane (high-porosity polycaprolactone-collagen group) and high-porosity polycaprolactone-collagen nanofiber membrane containing bone marrow mesenchymal stem cells (high-porosity polycaprolactone-collagen group) were implanted at the perforation of the tympanic membrane, respectively. Each group consisted of 10 animals. The healing of the tympanic membrane was examined by otoendoscopy after 1, 2, 3 and 4 weeks of stent implantation. Hematoxylin-eosin staining, Masson staining, and Ki-67 immunohistochemical staining were performed on the tympanic membrane after 4 weeks of implantation. RESULTS AND CONCLUSION: (1) Scaffold characterization: Scanning electron microscopy showed that compared with other nanofiber membranes, the highporosity polycaprolactone-collagen nanofiber membranes had more orderly nanofiber structure, larger surface pore size, and higher porosity (P < 0.001). Live/ dead staining showed that bone marrow mesenchymal stem cells adhered well on the three scaffolds, and the number of living cells on the high-porosity polycaprolactone-collagen nanofiber membrane was more than that on the other two scaffolds. Almarin staining showed that the proliferation rate of bone marrow mesenchymal stem cells on the high-porosity polycaprolactone-collagen nanofiber membrane was higher than that of the other two fiber membranes. (2) Animal experiments: Except for the blank control group, the tympanic membrane of the other four groups healed gradually with the extension of the time of fibrous membrane implantation, among which the healing speed of the cell-loaded high-porosity polycaprolactone-collagen group was the fastest. Hematoxylin-eosin staining, Masson staining, and Ki-67 immunohistochemical staining showed that the tympanic membrane of rats in the cell-carrying highporosity polycaprolactone-collagen group was moderate in thickness and a three-layer structure with uniform collagen fiber layers, similar to the normal tympanic membrane, and the repair quality of tympanic membrane was better than that of other fiber membrane groups. (3) The results showed that the high-porosity polycaprolactone-collagen nanofiber membrane containing bone marrow mesenchymal stem cells could not only rapidly repair the perforation of the tympanic membrane, but also the newly healed tympanic membrane was similar to normal tympanic membrane in structure and thickness. [ABSTRACT FROM AUTHOR]

Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation. [ABSTRACT FROM AUTHOR]

Chronic tympanic membrane perforation represents a prevalent otological condition, necessitating a reliable animal model for the validation and safety assessment of surgical techniques and materials employed in myringoplasty. This prospective study involved the establishment of chronic tympanic membrane perforation animal models in 16 chinchillas. A thermic myringotomy was conducted on the right ear (study group), followed by cold instrument myringotomy, coupled with the topical application of mitomycin C and dexamethasone solution on the left ear (control group). Results revealed that tympanic membrane perforations in the study group persisted for a minimum of 4 weeks in 93.7% of cases and extended to 12 weeks in 62.5% of the cases. In contrast, all tympanic membrane perforations in the control group were present at 4 weeks, with only 37.5% persisting after 12 weeks, although statistical tests did not find significant differences between the two groups (chi-square: p-value = 0.157, Kruskal–Wallis: p-value = 0.093, Mann–Whitney: p-value = 0.121). The thermic myringotomy employed to induce chronic tympanic membrane perforation in animals demonstrated efficiency and sustainability. This model, characterized by stability and reproducibility, holds promise for future experimental applications in the field. [ABSTRACT FROM AUTHOR]

The tympanic membrane (TM), located at the end of the ear canal, is a collagenous multi-layer soft tissue membrane with fibers highly aligned in radial and circumferential orientations. This unique multi-layer fiber ultrastructure makes TM's mechanical behavior display both anisotropy and nonlinearity, which is important in sound transmission. However, the constitutive model of TM which includes both features has not been proposed. In this study, we develop a fiber-reinforced mesoscale constitutive model of TM which captures both anisotropic and nonlinear elastic mechanical behaviors. The TM is considered a continuum fiber-reinforced composite with two families of collagen fibers. Its overall properties are built up by integrating its heterogeneous material properties through the thickness. The homogenized mechanical properties are assumed to be uniformly distributed through TM's thickness and superposed by three uncoupled elastic contributions of radial collagen fibers, circumferential collagen fibers, and an equivalent isotropic matrix. The model is calibrated using literature data through the inverse method. Simulation results indicate that specific collagen fibers alignment is responsible for the significant spatial and directional variation of deformation of the TM strip. With the appropriate strength criteria related to fiber deformation, the anisotropic localized failure mode of the TM strip observed in the experiment can be captured. The nonlinear nature and rotation of collagen fiber bundles are the origin of the nonlinear mechanical behavior of TM strips under uniaxial loading. The mesoscale constitutive model offers a different perspective on TM's anisotropic and nonlinear elastic mechanical behavior. This research improves our understanding of the mechanical behavior of the TM and could help biomimetic graft development. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is one of the leading causes of conductive hearing loss with an intact tympanic membrane in adults. The stapedius tendon is routinely transected during stapes surgery. This study aimed to evaluate the success rates of stapedectomy with preservation of the stapedial muscle tendon compared to stapedectomy without preservation of the stapedial muscle tendon in the operative management of otosclerosis. Methods: This is a retrospective study. It was conducted in the Otorhinolaryngology Department, Faculty of Medicine, Zagazig University, from October 2018 to January 2021. The sample size was 36 cases, arranged into two groups: the first group with preservation, and the second group with a cut of the stapedial tendon. The size of each group is 18 cases. Results: There was no significant difference between both groups in hearing improvement, but there was a significant difference between both groups in post-operative tinnitus improvement and acoustic reflex preservation. Conclusions: Preservation of the stapedial tendon in the surgical treatment of otosclerosis is associated with improvement in functional outcomes as well as providing the patient with a stapedial reflex that has a primary protective effect against strong acoustic stimuli. [ABSTRACT FROM AUTHOR]

Purpose: Necrotizing otitis externa (OEN) is an aggressive and morbid infection of the external acoustic meatus. What are the risk factors for OEN extension? Methods: French monocentric retrospective study (2004–2021), including patients with OEN defined by the association of an inflamed EAM, a positive nuclear imaging, the presence of a bacteriological sample and the failure of a well-followed local and/or general antibiotic treatment. OEN was extensive if it was associated with vascular or neurological deficits, if nuclear imaging fixation and/or bone lysis extended beyond the tympanic bone. Results: Our population (n = 39) was male (74%), type 2 diabetic (72%), aged 75.2 years and pseudomonas aeruginosa was found in 88% of cases. Complications for 43% of patients were extensive fixation on nuclear imaging, for 21% of them the presence of extensive bone lysis, for 13% the appearance of facial palsy, for 5.3% the presence hypoglossal nerve palsy and for 2.5% the presence of thrombophlebitis or other nerves palsies. 59% of our population had extensive OEN. The diagnosis of the extensive OEN was made 22 days later (p = 0.04). The clinical presentation was falsely reassuring due to easier identification of the tympanic membrane (70% vs 46%, p = 0.17) but associated with periauricular oedema (42% vs 0%), bone exposure (16% vs 0%) and a temporomandibular joint pain (41% vs 12%). Conclusion: Delayed treatment of OEN, identification of clinical bone lysis, especially when the tympanic membrane is easily visualized, and the presence of unbalanced diabetes are potential risk factors for extension of OEN. [ABSTRACT FROM AUTHOR]

Objectives: To analyze and compare the available data about the outcomes of endoscopic and microscopic type I tympanoplasty. Data sources: PubMed, Cochrane library Ovid, Scopus, Google scholar, and ClinicalTrials. Methods: We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included comparative studies describing type I tympanoplasty, and comparing surgical outcomes of the endoscope with the microscope in terms of efficacy and safety. Results: Our systematic search yielded 22 studies meeting the inclusion criteria and eligible for analysis. The pooled graft uptake rates and audiological results of endoscopic and microscopic tympanoplasty demonstrated non-significant differences. In contrast, endoscopic type I tympanoplasty outperforms microscopic tympanoplasty regarding a highly significant decrease not only in pooled mean operative time but also in the pooled complications rate. Conclusions: Based on our meta-analysis, the surgical outcomes of endoscope-assisted and microscope-assisted type I tympanoplasty in terms of postoperative hearing outcomes and the graft uptake rate were comparable. On the contrary, operative time and complications rate proved to be significantly reduced with endoscopy compared to microscopy. Hence, the endoscope is as efficient as the microscope in type I tympanoplasty but less invasive, fewer in complications and shorter in operative time. Key Points: Can the endoscope be a good alternative to the microscope in type I tympanoplasty? Using the microscope in tympanoplasty has been the conventional procedure for repairing perforated tympanic membranes since the 1950s. However, ear surgeons have increasingly practised endoscope-assisted tympanoplasty since the late 1990s. In this study, surgical outcomes of both techniques in terms of postoperative audiological results and the graft uptake rate were comparable. In contrast, the endoscopic technique was superior to the microscopic one in terms of operative time and complications rate. According to our study, the endoscope-Assisted type I tympanoplasty proved to be as effective as the microscopic technique but safer and less invasive. [ABSTRACT FROM AUTHOR]

Background: As autophony can be accompanied by several conditions, it is important to find co-morbidities. This paper reports a patient with Kennedy's disease (spinobulbar muscular atrophy, an X-linked, hereditary, lower motor neuron disease) having autophony as the first symptom. Case report: A 62-year-old male presented to the otorhinolaryngology department with autophony that began 2 years previously and worsened after losing weight 3 months prior to presentation. Otoscopic examination demonstrated inward and outward movement of the tympanic membrane, synchronised with respiration. Although he had no other symptoms, facial twitching was found on physical examination. In the neurology department, lower motor neuron disease, with subtle weakness of the tongue, face and upper limbs, and gynaecomastia, were confirmed. He was diagnosed with Kennedy's disease based on genetic analysis. Conclusion: Autophonia was presumed to be attributed to bulbofacial muscle weakness due to Kennedy's disease, and worsened by recent weight loss. Patients with autophony require a thorough history-taking and complete physical examination to assess the nasopharynx and the integrity of lower cranial function. [ABSTRACT FROM AUTHOR]

Tissue engineering application in otology spans a distance from the pinna to auditory nerve covered with specialized tissues and functions such as sense of hearing and aesthetics. It holds the potential to address the barriers of lack of donor tissue, poor tissue match, and transplant rejection through provision of new and healthy tissues similar to the host and possesses the capacity to renew, to regenerate, and to repair in-vivo and was shown to be a bypasses for any need to immunosuppression. This review aims to investigate the application of tissue engineering in otology and to evaluate the achievements and challenges in external, middle and inner ear sections. Since gaining the recent knowledge and training on use of different scaffolds is essential for otology specialists and who look for the recovery of ear function and aesthetics of patients, it is shown in this review how utilizing tissue engineering and cell transplantation, regenerative medicine can provide advancements in hearing and ear aesthetics to fit different patients' needs. Regenerative medicine by utilizing tissue engineering and cell transplantation was shown to provide advancements in hearing and ear aesthetics to fit different patients' needs. Gaining the necessary knowledge and training on use of different scaffolds is essential for otology specialists and patients who search for hearing and ear aesthetics. It is crucial that patients are instructed for differences exist between various scaffolds for hearing and ear aesthetics. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are different ways to analyze energy absorbance (EA) in the human auditory system. In previous research, we developed a complete finite element model (FEM) of the human auditory system. OBJECTIVE: In this current work, the external auditory canal (EAC), middle ear, and inner ear (spiral cochlea, vestibule, and semi-circular canals) were modelled based on human temporal bone histological sections. METHODS: Multiple acoustic, structure, and fluid-coupled analyses were conducted using the FEM to perform harmonic analyses in the 0.1–10 kHz range. Once the FEM had been validated with published experimental data, its numerical results were used to calculate the EA or energy reflected (ER) by the tympanic membrane. This EA was also measured in clinical audiology tests which were used as a diagnostic parameter. RESULTS: A mathematical approach was developed to calculate the EA and ER, with numerical and experimental results showing adequate correlation up to 1 kHz. Another published FEM had adapted its boundary conditions to replicate experimental results. Here, we recalculated those numerical results by applying the natural boundary conditions of human hearing and found that the results almost totally agreed with our FEM. CONCLUSION: This boundary problem is frequent and problematic in experimental hearing test protocols: the more invasive they are, the more the results are affected. One of the main objectives of using FEMs is to explore how the experimental test conditions influence the results. Further work will still be required to uncover the relationship between middle ear structures and EA to clarify how to best use FEMs. Moreover, the FEM boundary conditions must be more representative in future work to ensure their adequate interpretation. [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]

Introduction: The acoustic reflex is the active response of the middle ear to loud sounds, altering the mechanical transfer function of the acoustic energy into the inner ear. Our goal was to observe the effect of the acoustic reflex on the tympanic membrane by identifying a significant nonlinear increase in membrane oscillations. Methods: By using interferometric spectrally encoded endoscopy, we record the membrane oscillations over time in response to a loud, 200-ms-long acoustic stimulus. Results: A gradual reflex activation is measured between approximately 40 and 100 ms, manifested as a linear 42% increase in the umbo oscillation amplitude. Conclusion: The measured oscillations correlate well with those expected from a mechanical model of a damped harmonic oscillator, and the results of this work demonstrate the potential of interferometric spectrally encoded endoscopy to observe unique dynamical processes in the tympanic membrane and in the middle ear. [ABSTRACT FROM AUTHOR]

Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43], P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result. [ABSTRACT FROM AUTHOR]

Objective Tympanometry is widely used for diagnosing Eustachian tube dysfunction (ETD). However, in clinical practice, it is not uncommon to come across patients with symptoms of ETD with a normal tympanogram. Dynamic slow motion video endoscopy (DSMVE) of Eustachian tube (ET) and Eustachian tube dysfunction questionnaire-7 (ETDQ-7) are other tools to diagnose ETD. Primary aim of the study was to compare DSMVE and tympanometry in diagnosing ETD. Secondary objective was to find an association between DSMVE and ETDQ-7. It was a prospective diagnostic validity study in the department of Otorhinolaryngology at a tertiary care centre. Patients with symptoms suggestive of ETD with intact tympanic membrane (TM) and aged above 12 years were evaluated. The study duration was 17 months. The parameters assessed were tympanic membrane(TM) retraction by otoscopy, DSMVE, tympanometry and ETDQ-7 questionnaire. To test the significance of association and difference between tympanogram and nasopharyngoscopy, Chi-Square t test and McNemar's tests were applied. Out of 107 ears, DSMVE, tympanometry, ETDQ- 7 and otoscopy detected ETD in 51, 31,70 and 57 ears respectively. DSMVE and tympanometry together detected ETD in 29 ears and did not detect in 54 ears. Both these diagnostic methods were not comparable statistically (moderate agreement- Kappa value- 0.542). Comparison of DSMVE with ETDQ-7 was statistically significant (p-value- 0.004). Video nasopharyngoscopy cannot be a stand- alone diagnostic aid for ETD. ETDQ-7 questionnaire showed higher concordance with nasopharyngoscopy than tympanometry. Diagnostic accuracy was more when all four parameters were assessed together. Keynote: The gold standard for the diagnosis of eustachian tube dysfunction is tympanometry (ETD). It is not uncommon to see patients with clinical features of ETD with a normal tympanogram. Video nasopharyngoscopy (DSMVE) may be used as an adjunct to tympanometry in assessing ET functions. Tympanometry, DSMVE, otoscopy and Eustachian tube dysfunction questionnaire-7 (ETDQ-7) could not always diagnose ETD. Combination of video nasopharyngoscopy, tympanometry, ETDQ- 7 and otoscopy will increase the diagnostic accuracy of ETD. [ABSTRACT FROM AUTHOR]

The Objective of the study was to assess the ossicular status in chronic otitis media (COM)—mucosal and squamosal type and statistically evaluate the extent of ossicular destruction intraoperatively in COM patients. The findings of this study could help us to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. The study was carried out in ENT department of tertiary health care hospital, between January 2019 to January 2020. All patients of all age groups and both genders, diagnosed with COM Mucosal and Squamosal Type with complaints of ear discharge and hearing loss with good cochlear reserve and requiring surgery were included in the study, after taking informed written consent in vernacular language. All the patients included in the study were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for ear surgery and the middle ear status and ossicular chain status were assessed using a microscope intraoperatively. Out of 98 patients, 45(45.9%) had mucosal and 53 (54.08%) had squamosal disease. Ossicular chain was eroded in 69 cases (70.5%). 23 out of 45 (51.1%) mucosal cases and 46 out of 53 squamosal cases (86.7%) reported ossicular erosion. Most frequently involved was long process of incus > stapes > malleus. From our study, we concluded that there is a significant relationship between type of disease pathology in middle ear and ossicular erosion being higher in Squamosal type of COM, with malleus being the most resistant and incus being the most susceptible ossicle. [ABSTRACT FROM AUTHOR]

Assuming plane waves, ear-canal acoustic quantities, collectively known as wideband acoustic immittance (WAI), are frequently used in research and in the clinic to assess the conductive status of the middle ear. Secondary applications include compensating for the ear-canal acoustics when delivering stimuli to the ear and measuring otoacoustic emissions. However, the ear canal is inherently non-uniform and terminated at an oblique angle by the conical-shaped tympanic membrane (TM), thus potentially confounding the ability of WAI quantities in characterizing the middle-ear status. This paper studies the isolated possible confounding effects of TM orientation and shape on characterizing the middle ear using WAI in human ears. That is, the non-uniform geometry of the ear canal is not considered except for that resulting from the TM orientation and shape. This is achieved using finite-element models of uniform ear canals terminated by both lumped-element and finite-element middle-ear models. In addition, the effects on stimulation and reverse-transmission quantities are investigated, including the physical significance of quantities seeking to approximate the sound pressure at the TM. The results show a relatively small effect of the TM orientation on WAI quantities, except for a distinct delay above 10 kHz, further affecting some stimulation and reverse-transmission quantities. [ABSTRACT FROM AUTHOR]

Tympanic membrane (TM) perforations, primarily induced by middle ear infections, the introduction of foreign objects into the ear, and acoustic trauma, lead to hearing abnormalities and ear infections. We describe the design and fabrication of a novel composite patch containing photocrosslinkable gelatin methacryloyl (GelMA) and keratin methacryloyl (KerMA) hydrogels. GelMA-KerMA patches containing conical microneedles in their design were developed using the digital light processing (DLP) 3D printing approach. Following this, the patches were biofunctionalized by applying a coaxial coating with PVA nanoparticles loaded with gentamicin (GEN) and fibroblast growth factor (FGF-2) with the Electrohydrodynamic Atomization (EHDA) method. The developed nanoparticle-coated 3D-printed patches were evaluated in terms of their chemical, morphological, mechanical, swelling, and degradation behavior. In addition, the GEN and FGF-2 release profiles, antimicrobial properties, and biocompatibility of the patches were examined in vitro. The morphological assessment verified the successful fabrication and nanoparticle coating of the 3D-printed GelMA-KerMA patches. The outcomes of antibacterial tests demonstrated that GEN@PVA/GelMA-KerMA patches exhibited substantial antibacterial efficacy against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Furthermore, cell culture studies revealed that GelMA-KerMA patches were biocompatible with human adipose-derived mesenchymal stem cells (hADMSC) and supported cell attachment and proliferation without any cytotoxicity. These findings indicated that biofunctional 3D-printed GelMA-KerMA patches have the potential to be a promising therapeutic approach for addressing TM perforations. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability. [ABSTRACT FROM AUTHOR]

Purpose: Achromobacter xylosoxidans is an emerging pathogen mainly associated with resistant nosocomial infections. This bacteria had been isolated in the ear together with other pathogens in cultures from patients with chronic otitis media, but it had never been reported as a cause of osteomyelitis of the external auditory canal. Case presentation: We present a unique case of a healthy 81-year-old woman who presented with left chronic otorrhea refractory to topical and oral antibiotic treatment. Otomicroscopy revealed an erythematous and exudative external auditory canal (EAC) with scant otorrhea. The tympanic membrane was intact, but an area of bone remodeling with a small cavity anterior and inferior to the bony tympanic frame was observed. Otic culture isolated multi-drug-resistant A. xylosoxidans, only sensitive to meropenem and cotrimoxazole. Temporal bone computed tomography showed an excavation of the floor of the EAC compatible with osteomyelitis. Targeted antibiotherapy for 12 weeks was conducted, with subsequent resolution of symptoms and no progression of the bone erosion. Conclusions: Atypical pathogens such as A. xylosoxidans can be the cause of chronic otitis externa. Early diagnosis and specific antibiotherapy can prevent the development of further complications, such as osteomyelitis. In these cases, otic cultures play an essential role to identify the causal germ. This is the first case of EAC osteomyelitis due to A. xylosoxidans reported to date. [ABSTRACT FROM AUTHOR]

A 49-year-old man visited a local otolaryngology clinic with left hearing loss. He was diagnosed as left middle ear tumor and referred to us. The tumor was protruding from the left tympanic membrane. Computed tomography (CT) revealed thickening of the tympanic membrane, space-occupying lesions in the middle ear cavity and mastoid air cells, and no bone destruction in the left middle ear. Magnetic resonance imaging confirmed the CT findings, and the lesions were hyperintense on T1- and T2-weighted imaging. He was diagnosed as middle ear adenomatous neuroendocrine tumor (MEANT) with a pathological result. The patient underwent postauricular approach and canal wall-down mastoidectomy. The tumor occupied the mastoid air cells and extended into the middle ear mucosa. To prevent perilymphatic fistula, the tumor was excised as extensively as possible, while preserving the tumor around and adjacent to the stapes footplate. MEANT is extremely rare and long-term follow-up is necessary due to be potential for tumor regrowth or recurrence. Herein, we propose a new staging system for MEANT. [ABSTRACT FROM AUTHOR]

Background: Otitis media with effusion, a typical condition characterized by fluid in the middle ear area, has a significant negative influence on both the health and economy of the entire world. In children, hearing loss brought on by otitis media with effusion can hinder the development of language and conduct. This study aimed to assess how local dexamethasone affects human tympanic membranes' ability to resist myringosclerosis brought on by ventilation tubes. Patients and Methods: This prospective case-control study was conducted at Benha University Hospital, on 50 patients of both sexes and different ages complained of hearing loss due to persistent otitis media with effusion that has been resistant to therapy for nearly three months. The patients were subdivided into two equal groups: 25 patients were participants in group (A), which underwent myringotomy with breathing tube insertion only. 25 patients were participants in group (B), who had myringotomy, breathing tube insertion, and local dexamethasone instillation. Results: As far as myringosclerosis was concerned, there was no statistically significant variation between the two groups (P-value > 0.05). As determined by the quadrants under otomicroscopic examination, there was a significant variation between the two groups (P-value < 0.01) in relation to myringosclerosis findings. The histopathological assessment of myringosclerosis revealed a significant variation between the two groups with regard to the condition's symptoms (P-value < 0.01). Conclusion: Topical dexamethasone use may be helpful in avoiding the development of myringosclerosis. Dexamethasone's anti-inflammatory and immunosuppressive properties may be responsible for this impact. [ABSTRACT FROM AUTHOR]

Background: Exploratory tympanotomy in cases of traumatic ossicular disruption with intact tympanic membrane is crucial for both diagnostic and therapeutic purposes. Performing this procedure using the endoscope is gaining popularity. Hence, this study aimed to demonstrate varieties of ossicular pathology and their management in our institution. Methods: A retrospective evaluation was conducted of 136 ears in patients with traumatic ossicular disruption with an intact tympanic membrane, who underwent endoscopic exploratory tympanotomy. A proposed algorithm was followed, to incorporate different traumatic ossicular possibilities. Assessment of hearing outcomes and surgical complications was performed six months post-operatively. Results: Incudostapedial dislocation was the most commonly encountered type of traumatic ossicular disruption (35.3 per cent). Air conduction threshold improved significantly following endoscopic ossiculoplasty, from 50.9 ± 6.35 dB pre-operatively to 22.35 ± 3.27 dB post-operatively, with successful air–bone gap closure. Conclusion: Endoscopic ear surgery is effective in the diagnosis and management of challenging cases of post-traumatic ossicular disruption with an intact tympanic membrane. [ABSTRACT FROM AUTHOR]