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Objective: To compare the outcomes of patients with unilateral otosclerosis treated consecutively by a hearing aid then stapedotomy., Study Design: Monocentric, nonrandomized, prospective, longitudinal, cohort study., Setting: Tertiary university hospital., Patients: Adult patients with a unilateral conductive hearing loss of at least 30 dB caused by otosclerosis., Interventions: Consecutive treatment by an external hearing aid followed by stapedotomy., Main Outcome Measures: Differences between hearing aids and stapedotomy in quality of life, pure-tone audiometry, binaural hearing, tinnitus severity, and patient satisfaction., Results: Twenty-two patients were included, of which 20 (91%) underwent stapedotomy. Stapedotomy demonstrated increased quality of life according to Glasgow Health Status Inventory scores versus hearing aids (+10.4 ± 9.4 [p = 0.0001]). Stapedotomy versus hearing aids showed improved pure-tone averages (-11.1 ± 11.0 dB [p = 0.002]) and air-bone gaps (-11.8 ± 10.7 dB [p = 0.0006]). Stapedotomy was superior to hearing aids for speech-in-noise recognition in the reverse dichotic condition (-8.4 ± 26.9 dB [p = 0.004]) and showed improved sound localization accuracy in root mean square error (-14.5 ± 24.5 degrees [p = 0.02]). Stapedotomy, but not hearing aids, showed improved patient self-evaluated tinnitus after baseline adjustment according to the Tinnitus Handicap Inventory (-8.0 ± 13.4 [p = 0.02]) and visual analog scale for tinnitus intensity (-28.7 ± 34.1 [p = 0.006]). Overall, patients were more satisfied with surgery versus hearing aids., Conclusions: Stapedotomy remains more effective compared with hearing aids with greater improvements in quality of life, patient satisfaction, hearing outcomes, and self-evaluated tinnitus., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Bell's Palsy is the most frequent acute neuropathy of cranial nerves; it has been associated in various reports to herpes viruses. In a prospective study we searched the presence of DNA from five herpes viruses (HSV-1 and 2, VZV, EBV and HHV-6) in 79 patients at the acute phase of Bell's Palsy. Results were related with various parameters; age, gender and clinical outcome. We found the significant presence (p˂0.001) of HSV-1 and VZV in 39% and 42% of patients. However, a large percentage of cases were negative. When comparisons were made between subgroups according to gender and age no differences were found with viral findings nor with clinical outcome of palsy, which was of clinical remission in most cases (78%). Our results suggest that herpes viruses might participate in the complex mechanisms of autoimmunity of Bell's Palsy but not as determinant etiological element., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To demonstrate the different neuro-otologic clinical presentations of tuberculosis., Study Design: Retrospective clinical analysis., Result: 83.3% of the cases of ear or central nervous system TB were without concomitant lung disease. 2 cases had primary infection in the central nervous system. The neuro-otologic manifestation was as follows: 85.7% sensorineural hearing loss; 42% polyneuropathy. 71.4% had granulation tissue. 2 had normal otoscopy. In 6 patients the histopathology and Ziehl Neelsen were confirmatory. One case was confirmed by the positive response to treatment with antituberculosis drugs., Conclusions: Tuberculosis has a wide variety of neurotologic manifestations from chronic otitis media cadres to vestibular, audiological and neurological manifestations as well as a large variability in imaging studies., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Scanning electron microscopy of atheromatous material revealed flat rhombic cholesterol crystals piled one upon the other. The fate of cholesterol crystals in the atheromatous material was followed after injection intra-arterially into the left renal arteries and left common carotid arteries of rabbits. The lipid and membranous component of the atheromatous material disappeared from the lumen of the vessels in 2-3 days after injection. Macrophages engulfed small cholesterol crystals and exposed surfaces attracted a layer of platelets. Larger cholesterol crystals evoked a giant cell response while within the lumen. Some cholesterol crystals penetrated the vessel walls or were included in the vessel wall reaction and induced a covering of endothelial cells sequestrating them from the lumen. The cholesterol crystals contained in some of the macrophages showed fracture lines and in some instances there were associated myelin figures. Large cholesterol crystals eventually elicited a fibroblastic response from the vessel wall (at about 1-4 weeks after injection) which could give rise to partial or almost complete occlusion of the vessel lumen.

Atheromatous material was removed from human atheromas, suspended in sterile saline in the ratio of 1 g to 5 ml and ground to allow passage through a needle; 0-5 ml of this suspension was injected into the left common carotid artery of 16 rabbits. Six animals died after the injection. The remaining animals were killed after various time intervals and the occluded arteries studied by electron microscopy. The general pattern of the embolic event in the cerebral arteries was that there were 3 groups of changes. Firstly, an immediate period of atherothrombotic occlusion occurred, which was followed by some resolution of the obstruction so as to leave the cholesterol crystals of the embolus stuck in the vessel walls as the only remaining element of the embolus in some cases. Finally, there was a late period in which the cholesterol crystals were isolated from the lumen of the vessel and surrounded by macrophages, fibroblastic cells and collagen. Endothelial lined channels developed in the original obstruction.