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The efficacy of chimeric antigen receptor T cell (CAR-T) therapy has been limited against brain tumors to date. CAR-T cells infiltrating syngeneic intracerebral SB28 EGFRvIII gliomas revealed impaired mitochondrial ATP production and a markedly hypoxic status compared with ones migrating to subcutaneous tumors. Drug screenings to improve metabolic states of T cells under hypoxic conditions led us to evaluate the combination of the AMPK activator metformin and the mTOR inhibitor rapamycin (Met+Rap). Met+Rap-pretreated mouse CAR-T cells showed activated PPAR-γ coactivator 1α (PGC-1α) through mTOR inhibition and AMPK activation, and a higher level of mitochondrial spare respiratory capacity than those pretreated with individual drugs or without pretreatment. Moreover, Met+Rap-pretreated CAR-T cells demonstrated persistent and effective antiglioma cytotoxic activities in the hypoxic condition. Furthermore, a single intravenous infusion of Met+Rap-pretreated CAR-T cells significantly extended the survival of mice bearing intracerebral SB28 EGFRvIII gliomas. Mass cytometric analyses highlighted increased glioma-infiltrating CAR-T cells in the Met+Rap group, with fewer Ly6c+CD11b+ monocytic myeloid-derived suppressor cells in the tumors. Finally, human CAR-T cells pretreated with Met+Rap recapitulated the observations with murine CAR-T cells, demonstrating improved functions under in vitro hypoxic conditions. These findings advocate for translational and clinical exploration of Met+Rap-pretreated CAR-T cells in human trials.

Post/Long COVID (syndrome) is defined as a condition with symptoms persisting for more than 12 weeks after the onset of SARS-CoV-2 infection that cannot be explained otherwise. The prevalence of self-reported otorhinolaryngological Post/Long COVID symptoms is high. The aim of this review was to analyze the current literature regarding the actual prevalence, knowledge of the etiopathology, and evidence-based treatment recommendations of otorhinolaryngology-related Post/Long COVID symptoms. A systematic literature search of articles published since 2019 in PubMed and ScienceDirect was performed and resulted in 108 articles. These were the basis for this review and formed a comprehensive series of consented therapy statements on the most important of otorhinolaryngology-related Post/Long COVID symptoms. Otorhinolaryngological symptoms did not appear isolated but as part of a multi-organ syndrome. Self-reported otorhinolaryngology-related Post/Long COVID symptoms were often not confirmed by objective testing. The confirmed prevalence estimated for anosmia, dysgeusia, cough, facial palsy, hoarseness/dysphonia, acute hearing loss, tinnitus, and vertigo/dizziness was about 4%, 2%, 4–19%, 0%, 17–20%, 8%, 20%, and 5–26%, respectively. There are manifold theoretical concepts of the etiopathology of different symptoms, but there is no clear evidence-based proof. This certainly contributes to the fact that there is no effective specific treatment option for any of the symptoms mentioned. Healthcare pathways must be established so that otorhinolaryngological Post/Long COVID symptoms can be recognized and evaluated and otorhinolaryngologists can provide counseling. This would also help to establish and selectively include patients in clinical trials investigating specific therapeutic concepts. [ABSTRACT FROM AUTHOR]

Background: The brainstem auditory-evoked response (BAER) is an established electrophysiological measure of neural activity from the auditory nerve up to the brain stem. The BAER is used to diagnose abnormalities in auditory pathways and in neurophysiological human and animal research. However, normative data for BAERs in sheep, which represent an adequate large animal model for translational and basic otological research, are lacking. Objective: The aim of this study was to assess the function of the ovine auditory nervous system by determining normative values for the BAER and to compare sheep with human BAER data. Methods: In this retrospective study, BAER data for click stimuli at a range of sound pressure levels (SPLs) were analyzed. A series of 15 samples from six sheep with a mean age of 41.8 months was included. Results: The mean BAER threshold was 45.3 dB SPL. At 100 dB SPL, the mean (±standard deviation, SD) latency of wave V was 4.35 (±0.18) ms, that of wave III was 2.44 (±0.15) ms, and that of wave I was 0.88 (±0.13) ms. At 100 dB SPL, the mean interpeak latency of waves I–III was 1.56 (±0.18) ms, that of waves III–V was 1.91 (±0.16) ms, and that of waves I–V was 3.47 (±0.20) ms. The mean amplitudes at 100 dB SPL were 0.04 (±0.03) µV for wave I, 0.50 (±0.24) µV for wave III, and 0.40 (±0.25) µV for wave V. Conclusions: The normative values for sheep BAERs were reproducible and similar to those of humans. The normative BAER values further support sheep as an adequate animal model for otological research. [ABSTRACT FROM AUTHOR]

Background: Recurrence rate of necrotising otitis externa (NOE) after treatment is 15-20%. This is mainly due to a lack of reliable clinical indicator for the resolution of disease. Aims: We aim to assess the predictability of the otalgia, otorrhoea and C-reactive protein (CRP) levels in a large cohort of sixty-two patients for treatment outcome. Methods: Consecutive patients treated for NOE in our Nottingham tertiary ENT referral unit were retrospectively reviewed from January 2017 to June 2020. Diagnoses were made based on clinical findings and imaging. Good response to treatment was defined as those who required treatment of not longer than the standard six weeks of systemic antibiotics. Results: Average age at presentation was 78.4 years. 75.8% of patients were male. 62.9% had diabetes. Ten patients received more than the standard six weeks of systemic antibiotics. Complications from disease progression included cranial nerve neuropathies (14.5%), meningitis (3.2%), and sigmoid sinus thrombosis (3.2%). Two patients had recurrent or persistent NOE and died while on treatment. Delays in normalization of CRP (p = 0.015) and resolution of otorrhoea (p = 0.014) were associated with an increased need for prolonged antibiotic treatment. Conclusion: Normalisation of CRP and resolution of otorrhea can assist in identifying patients who will likely benefit from a prolonged course of systemic antibiotics. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this article was to systematically review the literature on the pediatric population surgically treated for cholesteatoma and describe the applied post-operative follow-up strategies. Methods: A systematic review was conducted following the Primary Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. After running the selected search string in PubMed, Scopus and Google Scholar, studies in English, reporting on surgically treated pediatric cholesteatoma patients (age younger or equal to 18 year-old) were retrieved. Both primary and revision cholesteatoma surgeries were included. Articles lacking specific data on post-surgical follow-up and case series with less than 10 patients were excluded. Results: Nineteen papers, published between 2000 and 2023, were included for final analysis. Fourteen studies were retrospective and five prospective, for a total of 1319 patients and 1349 operated ears. Male to female ratio was 1.8:1, with a mean age at surgery of 10.4 years (range 1–18). The mean length of the follow-up after surgery was 4.4 ± 1.7 years (range 1–6.9). Clinical follow-up was detailed in 9 studies (47%) with otomicroscopy being the most common evaluation. In most articles (n = 8, 50%), MRI alone was utilized for radiological follow-up, while in 3 studies (19%), CT scans were employed exclusively. In 5 studies (31%), MRI was combined with CT scans. The timing of radiological investigations varied widely (ranging from 6 months to 3 years). A second-look strategy was reported in 14 studies (74%). Conclusion: This systematic review highlights the heterogeneity of the follow-up strategies applied to pediatric patients after cholesteatoma surgery, both in terms of timing and types of investigations. [ABSTRACT FROM AUTHOR]

Objective: Otolaryngologists are at a significantly greater risk of being sued than most other physicians. To date, there is a lack of studies characterizing trends in otolaryngology malpractice claims. To assess these trends and risk variables, this study examined malpractice claims against otolaryngologists. Study Design: Retrospective database review. Setting: LexisNexis Jury Verdicts and Settlements. Methods: The LexisNexis legal database was used to locate jury verdicts and settlements related to medical malpractice in otolaryngology, from 2018 to 2024. The study did not include any claims covered by the Social Security Disability Insurance, Workers' Compensation, Healthcare Law, or Criminal Law and Procedure categories. Temporal trends were evaluated, and logistic regression was used to identify independent risk factors. Results: Out of 903 items, 79 reported malpractice cases were included (mean age 44.5; 60.3% female). The most sued subspecialty was head and neck oncology (32.5%). Negligence (93.7%) was the primary cause of action. Of cases sent to the jury, 87.7% of them resulted in a verdict in favor of the defendant. The mean plaintiff verdict payout was $7,432,508.06 and the mean identified settlement amount was $1,562,500.00. Physical injury (62.0%) was the highest type of harm. Regional analysis indicated a higher percentage of cases from New York favored the defendant (21.1% vs 13.6%; P =.034). Conclusion: This study highlights key trends in otolaryngology malpractice claims, emphasizing the prevalence in cases of head and neck surgery, primarily attributed to negligence. By identifying trends and risk factors, otolaryngologists can get a better understanding of the dynamics surrounding malpractice. [ABSTRACT FROM AUTHOR]

Objectives: California has the most surfers in the United States and a high prevalence of external auditory canal exostoses (EACEs) among them. We aimed to characterize their EACE knowledge, use of earplugs, and barriers toward earplug use. Methods: A RedCap survey was distributed to online surfing forums and surfers at California beaches. Descriptive statistics and regression analyses were used to characterize responses. Results: Our cohort included 334 primarily male (n = 269, 81.52%), college‐educated (n = 237, 71.17%) surfers who were on average 30.79 years old (SD = 11.07). Two hundred and ninety‐seven (90.00%) heard of EACE and 317 (96.06%) believed earplugs prevent EACE. However, 214 (64.85%) had never used earplugs. Multivariable logistic regression found increased age (OR = 1.04, 95% CI = [1.00–1.08], p = 0.03), higher EACE knowledge quiz scores (OR = 1.47, 95% CI = [1.19–1.80], p < 0.001), and primarily surfing in Southern California (OR = 2.19, 95% CI = [1.15–4.16], p = 0.02) increased the likelihood of earplug use. Common reasons against earplug use included reduced hearing, discomfort, and social hindrance. Two hundred and eighty‐seven (86.45%) would wear earplugs following more EACE knowledge. They preferred learning from surf community members, doctors, and surf events. Conclusion: Low earplug use despite awareness of EACE preventability suggests a need for EACE education among California surfers and more accessible, user‐friendly earplugs. Younger, less‐skilled surfers who were more commonly unaware of EACE may represent a key intervention group. Education could be promoted through partnerships between health professionals and renowned surf organizations, as most participants indicated a willingness to use earplugs post‐education. Level of Evidence: NA Laryngoscope, 135:286–292, 2025 [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the trends in otology, rhinology, and head and neck (H&N) operations over the past decade in England. These trends will allow for predictive modelling to forecast the demand over the coming years to aid workforce and resource planning in ENT. Methods: Hospital Episode Statistics data were extracted between April 2012 and April 2023. A total of 121 otology, 114 rhinology, and 122 H&N procedure codes were included. Correlation and linear regression analyses were conducted to examine trends and produce a forecast model for the volume of operations. Results: A gradual upward trend in the volume of operations was observed in rhinology, with a positive correlation coefficient (R = 0.74). In contrast, otology (R = −0.67) and H&N (R= −0.75) showed negative trends, indicating a moderate decline in operational volumes over time. The COVID-19 pandemic significantly disrupted operating activity in rhinology and otology. To address the backlog and reach the pre-pandemic forecasted levels within the next five years, surgical capacity must increase by an additional 33,807 rhinology 25,486 otology, and 10,300 head procedures per year in England. Conclusions: This analysis highlights a need for prioritization and expansion of the ENT workforce and resources to manage the current backlog and anticipated increase in demand over the next five years. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) is a concept whose goal is to imitate human intellectual activity in computers. It emerged in the 1950s and has gone through three booms. We are in the third boom, and it will continue. Medical applications of AI include diagnosing otitis media from images of the eardrum, often outperforming human doctors. Temporal bone CT and MRI analyses also benefit from AI, with segmentation accuracy improved in anatomically significant structures or diagnostic accuracy improved in conditions such as otosclerosis and vestibular schwannoma. In treatment, AI predicts hearing outcomes for sudden sensorineural hearing loss and post-operative hearing outcomes for patients who have undergone tympanoplasty. AI helps patients with hearing aids hear in challenging situations, such as in noisy environments or when multiple people are speaking. It also provides fitting information to help improve hearing with hearing aids. AI also improves cochlear implant mapping and outcome prediction, even in cases of cochlear malformation. Future trends include generative AI, such as ChatGPT, which can provide medical advice and information, although its reliability and application in clinical settings requires further investigation. [ABSTRACT FROM AUTHOR]

When an ENT surgeon plans on starting the endoscopic technique for ear surgery, type I tympanoplasty is the first intervention to master. We wish to discuss the advantages and difficulties of the use of the endoscope, and offer a description of type I tympanoplasty as we realize it. [ABSTRACT FROM AUTHOR]

Endoscopic ear surgery is developing rapidly. This article aimed to review the rationale with advantages and disadvantages of endoscopic ear surgery compared to microscopic ear surgery as well as the current indications in the field of otology and neurotology, limitations, terminologies, and approaches. A review of the literature on PubMed was performed using the keywords "endoscopic ear surgery," "ear surgery," "endoscopy," and "ear endoscope" to select relevant published articles. The main advantage of endoscopic ear surgery is an improved visualization of the surgical field. It provides a high-resolution, wider, and more magnified view of the middle ear and the ability to look "around the corners" to visualize otherwise "hidden areas." Transcanal endoscopic ear surgery allows minimally invasive technique by transforming the external auditory canal into a natural access point to the middle ear. It also allows a better understanding of the middle ear physiology (the ventilation pathways and middle ear folds). Endoscopic ear surgery has, however, some disadvantages, with it being a 1-handed surgical technique as the main limitation. Other limitations are an easily impaired visual field by bleeding or fogging on the lens, a narrow surgical space, and a steep learning curve. Endoscopic ear surgery is a safe and effective technique and a valid alternative to the microscope. It allows for improved surgical visualization and the ability to look "around the corners" with minimally invasive access. It holds a great promise in otology, and the indications for endoscopic ear surgery are constantly evolving. [ABSTRACT FROM AUTHOR]

Objective: To explore the historical evolution of surgical techniques for otosclerosis treatment, viewed through the lens of human temporal bone pathology to aid in understanding the disease and refining surgical interventions. Data sources: A review of historical literature on otosclerosis, surgical techniques, and otopathological findings was conducted. Eight temporal bone specimens from the Paparella Otopathology & Pathogenesis Laboratory, University of Minnesota, and one from the University of California, Los Angeles, were analyzed. Review methods: We selected two temporal bones from donors who underwent four different types of surgical procedures for otosclerosis: stapes mobilization, fenestration, stapedectomy, and stapedotomy. One successful and one complication case was selected for each procedure. Histopathological analysis was performed to assess the outcomes and complications associated with each technique. Results: The study chronicles the progression of otosclerosis surgery from the stapes mobilization to modern stapedectomy and stapedotomy techniques. Initial procedures, like stapes mobilization and fenestration, yielded limited and temporary results with significant complications. The introduction of stapedectomy marked a significant improvement, with better long‐term outcomes. Histopathological analysis revealed insights into the causes of surgical failures and complications. Conclusion: Otosclerosis surgery has evolved significantly, driven by advances in otopathology and surgical technology. While earlier techniques offered limited success, modern procedures like stapedectomy and stapedotomy provide improved outcomes and fewer complications. Ongoing research promises further advancements in the field, improving patient care and surgical efficacy. Level of evidence: NA. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a referral‐based, tele‐otology service in rural and remote areas of the Northern Territory, Australia. Methods: A retrospective observational cohort study was performed of a tele‐otology service in 93 Aboriginal and Torres Strait Islander communities (2011 to 2019). Assessments included face‐to‐face examinations performed by Clinical Nurse Consultants and audiologists, and asynchronous reviews performed by otolaryngologists. Multivariable logistic regression was performed to determine the likelihood of ear disease, adjusted for age and gender. Intra‐ and inter‐rater agreement was assessed between otolaryngologists. Results: A total of 3,950 patients were reviewed (6,838 encounters, 13,726 ear assessments). The median age of patients was 9.8 years (interquartile range: 7.2 years). Overall, 62.2% of patients were identified with ear disease and 62.5% identified with hearing loss. Substantial intra‐ and inter‐rater agreement in diagnosis was found between otolaryngologists (κ = 0.71 and κ = 0.78, respectively). The most common ear conditions identified were chronic otitis media (COM, 28.1%) and otitis media with effusion (OME, 16.5%). Topical or oral antibiotics were initiated in 14.1% of all encounters, most often for acute otitis media or COM. Surgery was recommended in 27.7% of all encounters, most often myringoplasty, adenoidectomy, and myringotomy with insertion of tympanostomy tubes. Conclusion: Tele‐otology is a critical component of an integrated approach to evaluating ear disease in Indigenous people living in rural and remote areas. The high prevalence of OME, COM, and surgical recommendations highlights the need for community engagement, regular follow‐up, and early interventions to prevent long‐term hearing loss. Level of Evidence: NA Laryngoscope, 134:5096–5102, 2024 [ABSTRACT FROM AUTHOR]

Objectives: To compare patient access to urgent care centers (UCCs) with a diagnosis of sudden hearing loss based on insurance. Methods: One hundred twenty‐five random UCCs in states with Medicaid expansion and 125 random UCCs in states without Medicaid expansion were contacted by a research assistant posing as a family member seeking care on behalf of a patient with a one‐week history of sudden, unilateral hearing loss. Each clinic was called once as a Medicaid patient and once as a private insurance (PI) patient for 500 total calls. Each phone encounter was evaluated for insurance acceptance and self‐pay price. Secondary outcomes included other measures of timely/accessible care. Chi‐square/McNemar's tests and independent/paired sample t‐tests were performed to determine whether there were statistically significant differences between expansion status and insurance type. Calls ended before answering questions were not included in the analysis. Results: Medicaid acceptance rate was significantly lower than PI (68.1% vs. 98.4%, p < 0.001). UCCs in Medicaid expansion states were significantly more likely to accept Medicaid (76.8% vs. 59.2%, p = 0.003). The mean wage‐adjusted self‐pay price was significantly greater in states with Medicaid expansion at $169.84 than in states without at $145.34 when called as a Medicaid patient (mean difference: $24.50, 95% Confidence Interval: $0.45–$48.54, p = 0.046). The rates of referral to an emergency department and self‐pay price nondisclosure rates were greater for Medicaid calls than for private insurance calls (8.2% vs. 0.4% and 17.4% vs. 5.8%; p < 0.001 for both). Conclusion: Medicaid patients with otologic emergencies face reduced access to care at UCCs. Level of Evidence: NA Laryngoscope, 134:5066–5072, 2024 [ABSTRACT FROM AUTHOR]

Background: The mucopolysaccharidoses (MPSs) are very rare lysosomal diseases. MPSs belong to inherited diseases; however, newborns are usually asymptomatic. A deficiency of one of the enzymes, which is responsible for glycosaminoglycan (GAG) catabolism, results in the accumulation of this material. GAGs lead to progressive damage to tissues. More than 90% of patients with MPS suffer from otitis media with effusion or recurrent otitis media, craniofacial dysmorphia, obstructive sleep apnea, different types of hearing loss, and progressive upper and lower airway dysfunction. Patients visit otolaryngologists often before the diagnosis of MPS. Thus, the awareness of symptoms of MPS is crucial for otolaryngologists and pediatricians. The earlier the diagnosis is made, the more effective treatment is. Ineffective or delayed treatment leads to premature death. Two principal treatments for MPS are currently available: hematopoietic stem cell transplantation (HSCT) and enzyme replacement therapy (ERT). In recent years, there has been a growing interest in gene therapy as a potential treatment for patients with MPS. Mortality in patients with MPS typically occurs during childhood and early adolescence as a consequence of upper and lower respiratory diseases. Methods: This systematic review is based on papers available in the following scientific databases: MEDLINE (via PubMed), Web of Science, Scopus, and the Cochrane Library. Results: After screening, 72 articles met our inclusion criteria. Conclusions: It is of paramount importance that otolaryngologists are involved in this field. This narrative review examines and synthesizes the otolaryngologic issues encountered in patients with MPS. [ABSTRACT FROM AUTHOR]

Objective: Eustachian tube dysfunction is prevalent in both paediatric and adult populations. Current clinical guidelines recommend observation over topical intranasal corticosteroids for Eustachian tube dysfunction management, which remains controversial. This study aimed to systematically review randomised, controlled trials assessing topical intranasal corticosteroid efficacy in Eustachian tube dysfunction, and analyse effect through tympanometric normalisation. Methods: PubMed, EMBASE, Web of Science and Cochrane Library databases were searched. All randomised, controlled trials assessing intranasal corticosteroids in adult or paediatric Eustachian tube dysfunction patients were included. A meta-analysis of proportions was used to evaluate tympanogram normalisation. Results: Of 330 results, eight randomised, controlled trials met inclusion criteria and underwent qualitative data synthesis and risk-of-bias analysis. Meta-analysis of tympanometry data from four eligible trials (n = 512 ears) revealed no significant difference in tympanometric normalisation between intranasal corticosteroids and control (odds ratio 1.21, 95% confidence interval 0.65–2.24). Conclusion: Study results do not strongly support intranasal corticosteroids for Eustachian tube dysfunction. Data were limited, emphasising the need for larger, higher quality, randomised, controlled trials. [ABSTRACT FROM AUTHOR]

BACKGROUND: Paecilomyces spp. are thermo-tolerant fungi found in decaying vegetables and soil. They can cause ocular, cutaneous, and miscellaneous infections. In otorhinolaryngology, most infections occur in the paranasal sinuses, while otological infection is uncommon. METHODS: We report a case of 41-year-old diabetic, male army officer with warm, fluctuant left temporal swelling and reduced hearing. Otoscopy revealed an edematous external auditory canal (EAC) with posterior wall sagging and bulging tympanic membrane. Computed tomography revealed subperiosteal temporal abscess extending intracranially. The pus was drained surgically via an otological and a neurosurgical approach, and pus sent for culture grew paecilomyces. He showed clinical improvement after receiving oral antifungal treatment postoperatively. Retrospectively, his occupation as an army officer and his diabetic immunocompromised state may have predisposed him to the infection. RESULTS: Paecilomyces middle ear infection leading to intracranial involvement of such magnitude is yet to be reported, and we showcase its successful management through a combined surgical neuro-otology approach and oral antifungal therapy. Fungal ear infections can lead to severe extracranial and intracranial complications if inadequately treated. Differentiating it from cholesteatoma also presents a diagnostic challenge clinically and radiologically. While both can lead to intracranial complications, our patient's brief history and lack of prior ear symptoms contrast with that of cholesteatoma. CONCLUSION: The rarity of neuro-otological paecilomyces infections emphasizes the need for awareness and early identification. It is vital to recognize such infections, and prompt surgical management with appropriate antifungal drugs is warranted to prevent disastrous outcomes. [ABSTRACT FROM AUTHOR]

Introduction Platelet-rich plasma (PRP) contains high platelet concentration and growth factors that help in rapid wound healing, hemostasis, and decreased scarring. It has been used in various conditions to aid in healing, but its use in ear, nose, and throat (ENT) is not yet common.

Transmembrane and tetratricopeptide repeat 4 (Tmtc4) is a deafness gene in mice. Tmtc4-KO mice have rapidly progressive postnatal hearing loss due to overactivation of the unfolded protein response (UPR); however, the cellular basis and human relevance of Tmtc4-associated hearing loss in the cochlea was not heretofore appreciated. We created a hair cell-specific conditional KO mouse that phenocopies the constitutive KO with postnatal onset deafness, demonstrating that Tmtc4 is a hair cell-specific deafness gene. Furthermore, we identified a human family in which Tmtc4 variants segregate with adult-onset progressive hearing loss. Lymphoblastoid cells derived from multiple affected and unaffected family members, as well as human embryonic kidney cells engineered to harbor each of the variants, demonstrated that the human Tmtc4 variants confer hypersensitivity of the UPR toward apoptosis. These findings provide evidence that TMTC4 is a deafness gene in humans and further implicate the UPR in progressive hearing loss.

Objective: Otoscopy is a key clinical examination used by multiple healthcare providers but training and testing of otoscopy skills remain largely uninvestigated. Simulator-based assessment of otoscopy skills exists, but evidence on its validity is scarce. In this study, we explored automated assessment and performance metrics of an otoscopy simulator through collection of validity evidence according to Messick's framework. Methods: Novices and experienced otoscopists completed a test program on the Earsi otoscopy simulator. Automated assessment of diagnostic ability and performance were compared with manual ratings of technical skills. Reliability of assessment was evaluated using Generalizability theory. Linear mixed models and correlation analysis were used to compare automated and manual assessments. Finally, we used the contrasting groups method to define a pass/fail level for the automated score. Results: A total of 12 novices and 12 experienced otoscopists completed the study. We found an overall G -coefficient of.69 for automated assessment. The experienced otoscopists achieved a significantly higher mean automated score than the novices (59.9% (95% CI [57.3%-62.6%]) vs. 44.6% (95% CI [41.9%-47.2%]), P <.001). For the manual assessment of technical skills, there was no significant difference, nor did the automated score correlate with the manually rated score (Pearson's r =.20, P =.601). We established a pass/fail standard for the simulator's automated score of 49.3%. Conclusion: We explored validity evidence supporting an otoscopy simulator's automated score, demonstrating that this score mainly reflects cognitive skills. Manual assessment therefore still seems necessary at this point and external video-recording is necessary for valid assessment. To improve the reliability, the test course should include more cases to achieve a higher G-coefficient and a higher pass/fail standard should be used. [ABSTRACT FROM AUTHOR]

Introduction: Tinnitus, the perception of sound without an external auditory stimulus, affects approximately 10–15% of the population and is often associated with significant comorbidities such as headaches. These conditions can severely impact the quality of life. The aim of this study was to evaluate the efficacy of a food supplement in reducing the symptoms of both tinnitus and headache in patients experiencing these conditions concurrently. Methods: This prospective study included 32 patients (21 males and 11 females) aged between 23 and 68 years (mean age 49.38 years) who were experiencing both tinnitus and headache. The study assessed the impact of a food supplement on tinnitus and headache over a 90-day treatment period using three main instruments: the Tinnitus Handicap Inventory (THI), the Headache Impact Test (HIT-6), and a Visual Analog Scale (VAS) for discomfort. Statistical analyses, including paired t tests, were conducted to compare pre- and posttreatment scores. In the same dataset, Ridge Regression, a linear regression model with L2 regularization, was used to predict posttreatment scores (THI90, HIT90, VAS90). Results: The results indicated a statistically significant reduction in all three measures after 90 days of treatment. The mean THI score decreased from 29.81 to 27.06 (p = 0.011), the mean HIT-6 score decreased from 50.41 to 48.75 (p = 0.019), and the mean VAS score for discomfort decreased from 7.63 to 7.13 (p = 0.033). The optimal Ridge Regression model was found with an “alpha” value of approximately 3.73. The performance metrics on the test set were as follows: Mean Squared Error (MSE) of 13.91 and an R-squared score of 0.61, indicating that the model explains approximately 61% of the variance in the posttreatment scores. These results indicate that pretreatment scores are significant predictors of posttreatment outcomes, and gender plays a notable role in predicting HIT and VAS scores posttreatment. Conclusion: This study demonstrates that a food supplement is effective in reducing the symptoms of tinnitus and headache in patients suffering from both conditions. The significant improvements in THI, HIT-6, and VAS scores indicate a positive impact on patient quality of life. Further research with larger sample sizes and more detailed subgroup analyses is recommended to fully understand the differential impacts of treatment across various demographics. [ABSTRACT FROM AUTHOR]

Cerebral cavernous malformation (CM) is a rare benign vascular lesion of the brain, accounting for only 0.3–0.5% incidence in the population. Among them, only a small portion of the patients have multiple lesions (3–33%). While most lesions are asymptomatic, some patients present with seizures and hemorrhagic events. We present an atypical case of multiple cerebral CM in a patient who presented with vertigo. He did not have apparent neurological signs and symptoms until it was detected through imaging studies. His MRI showed multiple CM, with the largest lesion located in the cerebellopontine angle. A neurological consult was obtained and the patient opted for conservative treatment. He was discharged well on medications and was under active monitoring by both the neurosurgery and otorhinolaryngology teams. Intracranial cavernoma can present as vertigo without classic neurological manifestations. Any atypical presentations should alert the physician to perform further imaging to rule out sinister causes in the brain. To date, there is no reported case of intracranial cavernoma presenting as vertigo in the literature. Main Points: Cerebral cavernous Malformation (cavernoma) is a rare benign vascular lesion of the brain, accounting for only 0.3–0.5% incidence in the population. To date There is no reported case of intracranial cavernoma presenting as vertigo in the literature. Intracranial cavernoma can rarely present as vertigo without classic neurological manifestations. Any atypical presentations Should alert the physician to perform further imaging to rule out sinister causes in the brain. [ABSTRACT FROM AUTHOR]

The study was aimed at determining the effectiveness of transcutaneous electrical nerve stimulation in treatment of tinnitus using Tinnitus handicap inventory (THI) and Visual analogue scale (VAS). 60 patients with bilateral, non-pulsatile, chronic subjective tinnitus; aged 18–65 years were subjected to 8 sessions (2 sessions/week) of TENS therapy given over a total period of 4 weeks. Pre-treatment and Post-treatment VAS, THI scores were compiled and analyzed statistically. A significant decrease in Tinnitus severity was seen after TENS Therapy (VAS: Loudness, Annoyance, Duration, Hampering of daily activities) (P value < 0.001). Moreover THI (Functional, Emotional & catastrophic) showed significant improvement (P value < 0.001). TENS is safe, effective, noninvasive therapeutic option for treatment of tinnitus. [ABSTRACT FROM AUTHOR]

The article examines the ethical considerations of introducing school-based hearing and vision screening programs in Samoa and the Pacific Islands. Topics discussed include the importance of early detection of hearing and vision impairments, the use of mobile technology in low-resource settings, and the collaboration needed among healthcare and educational stakeholders to ensure effective program implementation.

Objectives: This study aimed to characterize the information delivery during preoperative consultations for cholesteatoma removal surgery in 2024. The secondary objective was to identify any factors influencing the information delivered. Methods: This study was a practice survey which included 33 closed-ended questions and 1 open-ended question. Seven questions concerned the participants' characteristics and 2 questions concerned the physiopathology of cholesteatoma. Nine questions focused on surgical information, six questions focused on the procedure modalities and ten questions focused on the risks of complications from the intervention. Results: Eighty-two surgeons answered the survey. In 75% of the cases, an information form written by a professional society was provided. The risk of recurrence or residual post-operative cholesteatoma was systematically stated in 78% of cases (n = 64), while the risk of aesthetic sequelae was only stated in 1% (n = 1). Participants working in a university hospital were more likely to inform patients about the risks of vertigo (p = 0.04), aesthetic risks (p = 0.04), poor functional outcomes (p = 0.04), surgical revision (p = 0.05) and the risk of peripheral facial paralysis (p = 0.05). Surgeons who mainly practiced otology were more likely to inform patients about the risks of recurrence and/or residual cholesteatoma (p = 0.02) and taste disturbances (p = 0.02). Conclusions: Cholesteatoma surgery was well explained to patients during the preoperative consultation, mostly with written support, even if the information given was not the same for all complication risks. It could be useful to create an information form dedicated to cholesteatoma surgery to improve comprehensive information and maintain a trustworthy relationship with patients. [ABSTRACT FROM AUTHOR]

Background/aim: There are insufficient tools to assist in the diagnosis and treatment of vestibular migraine. Hence, the aim of this study was to perform the Turkish adaptation of the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI). Materials and methods: After the language and content validity was completed, a pilot study was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to test construct validity, and as a result of the validity analyses, Cronbach's alpha internal consistency coefficient and test-retest analyses were conducted for reliability. Results: In the study, in which 289 participants were evaluated, the Kaiser-Meyer-Olkin coefficient was calculated as 0.903. The percentage of variance explained by the EFA was 67.246% and the range of factor load change was 0.433-0.828. The scale structure was tested with CFA and the model was confirmed with adequate goodness of fit index values. The Cronbach's alpha internal consistency coefficient of the scale was 0.931. Conclusion: The VM-PATHI is a valid and reliable tool for the subjective evaluation of vestibular migraine in Türkiye. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the accuracy and comprehensiveness of answers provided by the artificial intelligence (AI) models ChatGPT 3.5 and Gemini in response to medical inquiries concerning sudden sensorineural hearing loss (SSHL). Materials and Methods: The researchers created a series of 20 open-ended questions derived from the 2019 guidelines of the American Academy of Otolaryngology-Head and Neck Surgery and evaluated the accuracy and completeness of the AI-generated responses. Results: Gemini achieved higher average scores in both completion and accuracy compared to ChatGPT. While the difference in accuracy scores was not statistically significant, the difference in completion scores was found to be statistically significant. Both AI models were able to provide accurate answers (scoring 5 or 6 on a 6-point scale) to the majority of the questions, with Gemini achieving a higher success rate than ChatGPT. Conclusion: The study highlights the potential of AI models to provide useful medical information, but also emphasizes the need for caution and oversight when relying on these technologies, particularly in the medical field. The authors recommend educating healthcare professionals about the limitations of AI, obtaining patient consent for AIassisted medical decisions, and integrating ethical principles into the development and deployment of these technologies. [ABSTRACT FROM AUTHOR]

Introduction: Pathway innovation using smartphone otoscopy and tablet‐based audiometry technologies to deliver ear and hearing services via trained audiologists may improve efficiency of the service. An ENT‐integrated‐community‐ear service (ENTICES—combining community audiology management, remote ENT review and novel technologies) was piloted. We aimed to assess the efficiency and safety of ENTICES. Method: ENTICES was a community‐based and audiologist‐led pathway. Patients with otological symptoms were self‐referred to this service. Smartphone otoscopy and tablet‐based audiograms were performed. Two otologists reviewed all decisions made in the community by audiologists based on video‐otoscopy, hearing tests and chart reviews. Data on the first 50 consecutive new patients attending either consultant‐led hospital otology clinics (HOC), audiologist‐led hospital advanced audiology diagnostics (AAD) or ENTICES clinics were collected between 1 August 2021 and 31 December 2021. Data were collected through chart reviews and questionnaires to compare the three pathways with respect to efficiency, patient satisfaction, technology utility and safety. Results: No audiology‐led ENTICES decisions were amended by hospital otologists following remote review. Remote review of video‐otoscopy with history was sufficient for a diagnosis in 80% of cases. Adding hearing tests and standardised history increased the diagnostic yield to 98%. Patient satisfaction scores showed 100% service recommendation. The cost per patient, per visit, was £83.36, £99.07 and £69.72 for AAD, HOC or ENTICES, respectively. Conclusion: ENTICES provides a safe ear and hearing service that patients rated highly. Thirty‐two per cent of hospital otology patients were eligible for this service. For those patients, ENTICES is 20% more cost‐effective and can reduce the number of clinic visits by up to 60% compared with HOC. [ABSTRACT FROM AUTHOR]

The study concerns the lateralization of complex sound sources (horizontal plane, a step of 45° and above the listener's head) from which came the sound of simple two musical instruments, i.e. a rattle and a drum. The recordings were made with using a dummy head and reproduced binaurally by open headphones. Forty young, otologically healthy subjects were divided into 2 groups: auditory-trained and no-auditory trained. The lateralization skills for the instruments were the best to the right and left side of the listener's head. The research shown that temporal variability and spectrum of tested musical instrument had no significant effect on lateralization skills for almost all tested angles. The one exception was the azimuth of 0°, for which listeners from no-auditory trained group more easily localized the rattle. Auditorytrained subjects obtained significant better results than no-auditory trained subjects for azimuth angles: 135°, 180° and 225°. [ABSTRACT FROM AUTHOR]

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Background Otitis is commonly associated with community-acquired bacterial meningitis, but the role of ear surgery as treatment is debated. In this study, we investigated the impact of otitis and ear surgery on outcome of adults with community-acquired bacterial meningitis. Methods We analyzed episodes of adults with community-acquired bacterial meningitis from a nationwide prospective cohort study in the Netherlands, between March 2006 and July 2021. Results A total of 2548 episodes of community-acquired bacterial meningitis were evaluated. Otitis was present in 696 episodes (27%). In these patients the primary causative pathogen was Streptococcus pneumoniae (615 of 696 [88%]), followed by Streptococcus pyogenes (5%) and Haemophilus influenzae (4%). In 519 of 632 otitis episodes (82%) an ear-nose-throat specialist was consulted, and surgery was performed in 287 of 519 (55%). The types of surgery performed were myringotomy with ventilation tube insertion in 110 of 287 episodes (38%), mastoidectomy in 103 of 287 (36%), and myringotomy alone in 74 of 287 (26%). Unfavorable outcome occurred in 210 of 696 episodes (30%) and in 65 of 696 episodes was fatal (9%). Otitis was associated with a favorable outcome in a multivariable analysis (odds ratio 0.74; 95% confidence interval [CI].59–.92; P =.008). There was no association between outcome and ear surgery. Conclusions Otitis is a common focus of infection in community-acquired bacterial meningitis in adults, with S. pneumoniae being the most common causative pathogen. Presence of otitis is associated with a favorable outcome. Ear surgery's impact on the outcome of otogenic meningitis patients remains uncertain. [ABSTRACT FROM AUTHOR]

Background: The Ear Outcome Survey‐16 (EOS‐16) has been validated according to the health‐related quality of life (HRQol) survey guidelines. It has important compatible aspects in evaluating patients with chronic otitis media (COM) suitable for consultation. This study aimed to develop and standardize the Arabic version of the EOS‐16 to be used by clinicians in the Arab world while maintaining the conceptual equivalence. Methods: A prospective cross‐sectional study was conducted in Damascus between July 2023 and November 2023 to develop an Arabic version of the EOS‐16. The translation was produced according to the cross‐cultural adaptation guidelines. Both experts' and participants' opinions as regards face validity were obtained in this study. Internal consistency was evaluated by the Cronbach alpha coefficient. Test–retest reliability was assessed using the intraclass correlation coefficient (ICC) and Pearson correlation. Results: A total of 81 patients enrolled in the study, with an average age of 34.75 years and a standard deviation of 11.84 years with a sex ratio of 0.62 for females. All had inactive mucosal COM (dry perforation). The overall score of the EOS‐16 survey was 31.72 with a standard deviation of 13.42 suggesting bothering and influencing symptoms in COM patient's daily life. Excellent internal consistency was noted (Cronbach α =.89). Robust correlation was found between test–retest overall scores (r =.90). Reallocation of the items of the EOS‐16 improved the internal consistency of the subdivisions in COM patients. Conclusion: The Arabic version of the EOS‐16 is a simple, clear, reliable, reproducible, and valid HRQoL survey. It is a useful and important instrument that helps physicians in making decisions regarding the patient's treatment and follow‐up. This study aimed to develop and standardize the Arabic version of the Eare Outcome Survey‐16 to be in use by the clinician in the Arab world while maintaining the conceptual equivalence. [ABSTRACT FROM AUTHOR]

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

This review presents a comprehensive history of Artificial Intelligence (AI) in the context of the revolutionary application of machine learning (ML) to medical research and clinical utilization, particularly for the benefit of researchers interested in the application of ML in otology. To this end, we discuss the key components of ML—input, output, and algorithms. In particular, some representation algorithms commonly used in medical research are discussed. Subsequently, we review ML applications in otology research, including diagnosis, influential identification, and surgical outcome prediction. In the context of surgical outcome prediction, specific surgical treatments, including cochlear implantation, active middle ear implantation, tympanoplasty, and vestibular schwannoma resection, are considered. Finally, we highlight the obstacles and challenges that need to be overcome in future research. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic ear surgery is no longer a promising technique, but a well‐established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature evidence, in terms of their efficacy and safety characteristics. Data Sources: We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty. Review Methods: Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS‐I and RoB‐II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group. Results: Thirty‐three studies, with 2646 patients in total, were included in the meta‐analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:−0.23; 95% CI: −0.61, 0.14, I2 = 33.42%), and air‐bone gap improvement (pooled mean difference:−0.05; 95% CI:−0.23, 0.13, I2 = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: −1.72; 95% CI: −3.39, −0.04, I2 = 0%), dysgeusia (OR: −1.47; 95% CI: −2.47, −0.47, I2 = 0%), otitis externa development (OR: −1.96; 95% CI: −3.23, −0.69, I2 = 0%), auricular numbness (OR: −2.56; 95% CI: −3.93, −1.19, I2 = 0%), as well as surgical duration (OR: −1.86; 95% CI: −2.70, −1.02, I2 = 43.95%), when compared to the postauricular microscopic approach. Conclusion: Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach. Level of Evidence: NA Laryngoscope, 134:3466–3476, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Bibliometrics, such as the Hirsch index (h‐index) and the more recently developed relative citation ratio (RCR), are utilized to evaluate research productivity. Our study evaluates demographics, research productivity, and National Institutes of Health (NIH) funding in academic otology. Methods: Academic otologists were identified, and their demographics were collected using institutional faculty profiles (N = 265). Funding data were obtained using the NIH Research Portfolio Online Reporting Tools Expenditures and Reports Database. The h‐index was calculated using Scopus and mean (m‐RCR) and weighted RCR (w‐RCR) were calculated using the NIH iCite tool. Results: H‐index (aOR 1.18, 95% CI 1.10–1.27, p < 0.001), but not m‐RCR (aOR 1.50, 95% CI 0.97–2.31, p = 0.069) or w‐RCR (aOR 1.00, 95% CI 0.99–1.00, p = 0.231), was associated with receiving NIH funding. Men had greater h‐index (16 vs. 9, p < 0.001) and w‐RCR (51.8 vs. 23.0, p < 0.001), but not m‐RCR (1.3 vs. 1.3, p = 0.269) than women. Higher academic rank was associated with greater h‐index and w‐RCR (p < 0.001). Among assistant professors, men had greater h‐index than women (9.0 vs. 8.0, p = 0.025). At career duration 11–20 years, men had greater h‐index (14.0 vs. 8.0, p = 0.009) and w‐RCR (52.7 vs. 25.8, p = 0.022) than women. Conclusion: The h‐index has a strong relationship with NIH funding in academic otology. Similar h‐index, m‐RCR, and w‐RCR between men and women across most academic ranks and career durations suggests production of similarly impactful research. The m‐RCR may correct some deficiencies of time‐dependent bibliometrics and its consideration in academic promotion and research funding allocation may promote representation of women in otology. Level of Evidence: N/A Laryngoscope, 134:3786–3794, 2024 [ABSTRACT FROM AUTHOR]

It is my great honor to share my experiences as we celebrate the life of Dr. Nikolo Ariel Ansaldo. Cole was not just a trusted colleague, he was a good friend and a remarkable individual who has left an indelible mark on all who knew him. His warmth, generosity and unwavering positivity were among the traits I sincerely admire about him. Please allow me to share three important life lessons I learned from him. Lesson 1: The Value of Kindness I first met Cole when applying for residency training in Otorhinolaryngology – Head and Neck Surgery at the Southern Philippines Medical Center in October 2011. He was a dependable partner during the highs and lows of residency training and helped me get through all those tasks, sanctions, and difficult surgeries. He was the king of small talk and was incredibly warm to anyone he met. You felt at ease talking to him because of his humorous banter and amusing anecdotes. Throughout his medical career, he helped many patients and did not hesitate to extend his assistance to anyone who needed it. Cole showed us that no act of kindness is ever too small or inconsequential. Lesson 2: The Power of Resilience After we passed the diplomate board exams in 2016, we wanted to contribute more to the department by pursuing fellowship training. He ended up doing his Otology fellowship at the University of Santo Tomas Hospital which he completed in 2018 then came back to help improve the audiology services of our department and the surgical competencies of our residents. He did these while pursuing his private practice and giving lectures to national and international medical students of his alma mater, Davao Medical School Foundation. Life was not always easy for Cole, especially with his physical health, but he faced every challenge with courage and a positive disposition. Cole faced those struggles head-on, never losing hope or his sense of humor. He made it a point to be present during his clinic duties and the weekly department conferences even when he could barely walk. He taught us that resilience is about finding strength in our vulnerabilities and courage in our fears. I hope that we also learn to find our strengths and overcome our toughest obstacles by staying positive and true to ourselves. Lesson 3: The Relevance of Essentialism Cole lived his life with an envious amount of energy and enthusiasm which was truly inspiring. He embraced every moment with joy and gratitude whether it was attending a soccer game with Mason, going to pediatric visits with Mari, or spending an adventurous weekend with Christie and their families. I know that he was making the most of every experience as he always shared those stories with us with fondness. He taught us to cherish the present, to find beauty in the everyday, and to never take a single moment for granted. In his memory, let us strive to live our lives with the same passion and appreciation for the here and now. Let us celebrate the memories we have with Cole. Each memory brings to mind the impact he had on our lives. His untimely passing allows us not only to reflect on our own mortality but also to decide on what to do with the time that is given to us. I truly regret not knowing him more because his life was cut painfully short, but the memories I had with him during our time together during residency training, in the operating room, and outside the confines of the hospital will be cherished for many years. Rest with God, dear Cole, and please know you will be missed by the many people who loved and admired you.

Ear- and hearing-related conditions pose a significant global health burden, yet public health policy surrounding ear and hearing care (EHC) in low- and middle-income countries is poorly understood. The present study aims to characterize the inclusion of EHC in national health policy by analysing national health policies, strategies and plans in English, French, Spanish, Portuguese and Arabic. Three EHC keywords were searched, including ear*, hear* and deaf*. The terms human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis and malaria were included as comparison keywords as these conditions have historically garnered political priority in global health. Of the 194 World Health Organization Member States, there were 100 national policies that met the inclusion criteria of document availability, searchable format, language and absence of an associated national EHC strategy. These documents mentioned EHC keywords significantly less than comparison terms, with mention of hearing in 15 documents, ears in 11 documents and deafness in 3 documents. There was a mention of HIV/AIDS in 92 documents, tuberculosis in 88 documents and malaria in 70 documents. Documents in low- and middle-income countries included significantly fewer mentions of EHC terms than those of high-income countries. We conclude that ear and hearing conditions pose a significant burden of disease but are severely underrepresented in national health policy, especially in low- and middle-income countries.

Abstract Introduction 3D-printed temporal bone models enable the training and rehearsal of complex otological procedures. To date, there has been no consolidation of the literature regarding the developmental process of 3D-printed temporal bone models. A brief review of the current literature shows that many of the key surgical landmarks of the temporal bone are poorly represented in models. This study aims to propose a novel design and production workflow to produce high-fidelity 3D-printed temporal bone models for surgical simulation. Methods Developmental phases for data extraction, 3D segmentation and Computer Aided Design (CAD), and fabrication are outlined. The design and fabrication considerations for key anatomical regions, such as the mastoid air cells and course of the facial nerve, are expounded on with the associated strategy and design methods employed. To validate the model, radiological measurements were compared and a senior otolaryngologist performed various surgical procedures on the model. Results Measurements between the original scans and scans of the model demonstrate sub-millimetre accuracy of the model. Assessment by the senior otologist found that the model was satisfactory in simulating multiple surgical procedures. Conclusion This study offers a systematic method for creating accurate 3D-printed temporal bone models for surgical training. Results show high accuracy and effectiveness in simulating surgical procedures, promising improved training and patient outcomes.

Background: Despite the proven audiological benefits of Percutaneous Bone Anchored Hearing Aids (BAHAs) in paediatric patients with conductive or mixed hearing loss, their adoption has been limited due to concerns over implant failure and associated complications. This paper conducts a systematic review and meta-analysis to assess the prevalence of implant failure in paediatric populations, combined with a case series from our tertiary referral centre. Methods: A comprehensive literature search identified 562 articles, from which 34 were included in the review, covering 1599 implants in 1285 patients. Our retrospective case series included consecutive patients from our tertiary referral centre who underwent percutaneous BAHA implantation from 2003–2019. Results: Meta-analysis revealed an overall implant failure rate of 11%, predominantly attributed to traumatic extrusion. Our retrospective case series comprised 104 implantations in 76 patients, with a 4.8% failure rate. Discussion: Factors contributing to the lower-than-expected failure rates in the case series likely included consistent use of 4 mm fixtures from a single manufacturer and older age at implantation. The study underscores the need for standardised reporting formats in bone conduction implants research, given the systematic review's limitations in study design heterogeneity, especially with the expected rise in the adoption of novel active devices. [ABSTRACT FROM AUTHOR]

Objectives: During the COVID-19 pandemic, various non-pharmaceutical interventions such as individual hygiene practices like hand washing, social distancing, and mandates for the use of masks in public spaces were implemented to reduce the spread of the disease. Otitis media (OM) is a common infectious disease. How the changed environment due to the COVID-19 pandemic has influenced the prevalence of infectious diseases like OM is not known. This study aimed to investigate how OM prevalence and trends changed during COVID-19 in Korea. Methods: OM patient data from 2017 to 2021 were extracted from the Health Insurance Review and Assessment Service database. Patients diagnosed with disease code H66 (suppurative and unspecified otitis media) were selected for analysis. Data on OM prevalence, gender, region, medical institution, and number of ventilating-tube prescriptions were analyzed. All age groups were included, and ages were categorized into 5-year ranges Results: The number of patients diagnosed with the OM disease code decreased continuously from 2017 to 2021 (1 598 205, 1 560 178, 1 520 948, 983 701, and 734 901). The average OM prevalence per 1000 persons decreased by 45.0% from 30.2 in 2017 to 2019 to 16.6 in 2020 to 2021. The change of OM prevalence was greater for the 0 to 5 age group than other age groups. The decrease in average prevalence per 1000 persons was greatest in the 0 to 5 age group (48.6% decrease from 358.2 in 2017-2019 to 184.1 in 2020-2021). The impact of environmental changes on ventilation-tube insertion was smaller than on OM prevalence. The average number of ventilating-tube insertions decreased by 28.1% from 27 311 in 2017 to 2019 to 19 650 in 2020 to 2021. Conclusions: OM prevalence decreased by 45.0%, and the number of ventilating-tube insertions decreased by 28.1% in Korea during COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: To establish audiological and other outcomes following cochlear implantation in humans and animals with eluting electrodes. Methods: Systematic review and narrative synthesis. Databases searched (April 2023): MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and Web of Science. Studies reporting outcomes in either humans or animals following cochlear implantation with a drugeluting electrode were included. No limits were placed on language or year of publication. Risk of bias assessment was performed on all included studies using either the Brazzelli or Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) assessment tools. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Results: Searches identified 146 abstracts and 108 full texts. Of these, 18 studies met the inclusion criteria, reporting outcomes in 523 animals (17 studies) and 24 humans (1 study). Eluting electrodes included dexamethasone (16 studies), aracytine (1 study), nicotinamide adenine dinucleotide (1 study), the growth factors insulinlike growth factor 1 (IGF1) and hepatocyte growth factor (HGF) (1 study), and neurotrophin-3 (1 study). All included studies compare outcomes following implantation with an eluting electrode with a control non-eluting electrode. In the majority of studies, audiological outcomes (e.g., auditory brainstem response threshold) were superior following implantation with an eluting electrode compared with a standard electrode. Most studies which investigated post-implantation impedance reported lower impedance following implantation with an eluting electrode. The influence of eluting electrodes on other reported outcomes (including post-implantation cochlear fibrosis and the survival of hair cells and spiral ganglion neurons) was more varied across the included studies. Conclusions: Eluting electrodes have shown promise in animal studies in preserving residual hearing following cochlear implantation and in reducing impedance, though data from human studies remain lacking. Further in-human studies will be required to determine the clinical usefulness of drug-eluting cochlear implants as a future treatment for sensorineural hearing loss. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of piston diameter in patients undergoing primary stapes surgery on audiometric results and postoperative complications. Methods: A retrospective single-center cohort study was performed. Adult patients who underwent primary stapes surgery between January 2013 and April 2022 and received a 0.4-mm-diameter piston or a 0.6-mm-diameter piston were included. The primary and secondary outcomes were pre- and postoperative pure-tone audiometry, pre- and postoperative speech audiometry, postoperative complications, intraoperative anatomical difficulties, and the need for revision stapes surgery. The pure-tone audiometry included air conduction, bone conduction, and air–bone gap averaged over 0.5, 1, 2 and 3 kHz. Results: In total, 280 otosclerosis patients who underwent 321 primary stapes surgeries were included. The audiometric outcomes were significantly better in the 0.6 mm group compared to the 0.4 mm group in terms of gain in air conduction (median = 24 and 20 dB, respectively), postoperative air–bone gap (median = 7.5 and 9.4 dB, respectively), gain in air–bone gap (median = 20.0 and 18.1 dB, respectively), air–bone gap closure to 10 dB or less (75% and 59%, respectively) and 100% speech reception (median = 75 and 80 dB, respectively). We found no statistically significant difference in postoperative dizziness, postoperative complications and the need for revision stapes surgery between the 0.4 and 0.6 mm group. The incidence of anatomical difficulties was higher in the 0.4 mm group. Conclusion: The use of a 0.6-mm-diameter piston during stapes surgery seems to provide better audiometric results compared to a 0.4-mm-diameter piston, and should be the preferred piston size in otosclerosis surgery. We found no statistically significant difference in postoperative complications between the 0.4- and 0.6-mm-diameter piston. Based on the results, we recommend always using a 0.6-mm-diameter piston during primary stapes surgery unless anatomical difficulties do not allow it. [ABSTRACT FROM AUTHOR]

Background: Sheep have been proposed as a large-animal model for studying cochlear implantation. However, prior sheep studies report that the facial nerve (FN) obscures the round window membrane (RWM), requiring FN sacrifice or a retrofacial opening to access the middle-ear cavity posterior to the FN for cochlear implantation. We investigated surgical access to the RWM in Hampshire sheep compared to Suffolk-Dorset sheep and the feasibility of Hampshire sheep for cochlear implantation via a facial recess approach. Methods: Sixteen temporal bones from cadaveric sheep heads (ten Hampshire and six Suffolk-Dorset) were dissected to gain surgical access to the RWM via an extended facial recess approach. RWM visibility was graded using St. Thomas' Hospital (STH) classification. Cochlear implant (CI) electrode array insertion was performed in two Hampshire specimens. Micro-CT scans were obtained for each temporal bone, with confirmation of appropriate electrode array placement and segmentation of the inner ear structures. Results: Visibility of the RWM on average was 83% in Hampshire specimens and 59% in Suffolk-Dorset specimens (p = 0.0262). Hampshire RWM visibility was Type I (100% visibility) for three specimens and Type IIa (> 50% visibility) for seven specimens. Suffolk-Dorset RWM visibility was Type IIa for four specimens and Type IIb (< 50% visibility) for two specimens. FN appeared to course more anterolaterally in Suffolk-Dorset specimens. Micro-CT confirmed appropriate CI electrode array placement in the scala tympani without apparent basilar membrane rupture. Conclusions: Hampshire sheep appear to be a suitable large-animal model for CI electrode insertion via an extended facial recess approach without sacrificing the FN. In this small sample, Hampshire specimens had improved RWM visibility compared to Suffolk-Dorset. Thus, Hampshire sheep may be superior to other breeds for ease of cochlear implantation, with FN and facial recess anatomy more similar to humans. [ABSTRACT FROM AUTHOR]

Introduction: 3D-printed temporal bone models enable the training and rehearsal of complex otological procedures. To date, there has been no consolidation of the literature regarding the developmental process of 3D-printed temporal bone models. A brief review of the current literature shows that many of the key surgical landmarks of the temporal bone are poorly represented in models. This study aims to propose a novel design and production workflow to produce high-fidelity 3D-printed temporal bone models for surgical simulation. Methods: Developmental phases for data extraction, 3D segmentation and Computer Aided Design (CAD), and fabrication are outlined. The design and fabrication considerations for key anatomical regions, such as the mastoid air cells and course of the facial nerve, are expounded on with the associated strategy and design methods employed. To validate the model, radiological measurements were compared and a senior otolaryngologist performed various surgical procedures on the model. Results: Measurements between the original scans and scans of the model demonstrate sub-millimetre accuracy of the model. Assessment by the senior otologist found that the model was satisfactory in simulating multiple surgical procedures. Conclusion: This study offers a systematic method for creating accurate 3D-printed temporal bone models for surgical training. Results show high accuracy and effectiveness in simulating surgical procedures, promising improved training and patient outcomes. [ABSTRACT FROM AUTHOR]