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Purpose: Atelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient's clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM. Methods: Forty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected. Results: Preoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air–bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery. Conclusion: Atelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes. [ABSTRACT FROM AUTHOR]

Chronic otitis media (COM) poses significant challenges globally, affecting millions with hearing impairment and associated morbidities. This prospective study aimed to compare the surgical outcomes of type I tympanoplasty with and without canaloplasty in adolescent patients with COM, focusing on hearing improvement and graft success rates. Sixty-eight patients aged 11–18 years, diagnosed with inactive mucosal disease and conductive hearing loss, were enrolled from 01 January 2022 to 01 July 2023. They were randomly assigned to Group A (type I tympanoplasty with canaloplasty, n = 34) or Group B (type I tympanoplasty alone, n = 34). Preoperative and postoperative audiometric evaluations were conducted to assess air-bone gap closure and hearing thresholds. Graft uptake was evaluated at three months post-surgery. Both groups showed significant improvement in hearing postoperatively (p < 0.01). Group A exhibited a higher rate of successful graft uptake (94.11%) compared to Group B (91.17%), though this difference was statistically significant (p = 0.01). Canaloplasty in Group A facilitated enhanced visualization of the tympanic membrane and improved graft placement, contributing to favorable outcomes. The study underscores the potential benefits of combining canaloplasty with type I tympanoplasty in adolescent patients with COM, emphasizing improved hearing outcomes and graft success rates. These findings support the incorporation of canaloplasty to optimize surgical outcomes and enhance patient outcomes in chronic otitis media management. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the opposite ear in patients operated for chronic otitis media (COM).Methods: In a cross-sectional study involving three tertiary hospitals, patients who underwent surgery for COM were examined for abnormalities of the contralateral ear at the time of the surgery. Results: Out of 228 patients, 182 (79.8%) were operated on for non-cholesteatomatous or simple chronic pars tensa perforation of the tympanic membrane (PTP), and 46 (20.2%) for cholesteatoma. 113 (49.56%) patients had normal contralateral ears under oto-microscopic exam. PTP was statistically more prevalent in females than males (F/M:118/64), whereas cholesteatoma was more prevalent in males (21/25). In the PTP group, 82 (45.3%) had normal contralateral ears, whereas patients with cholesteatoma had 31 (67.4%) normal opposite ears (P = 0.01). The most frequent abnormal findings in the PTP group were pars tensa perforation and sclerotic plaques, and in the cholesteatoma group were cholesteatoma and pars tensa perforation. Patients with cholesteatoma had significantly lower contralateral ear perforation than patients with tympanic membrane perforation (P = 0.02). The most frequent size of eardrum perforation in the contralateral ear of the PTP group was more than 50 percent. No significant difference existed between the large and small perforations for contralateral abnormality. Conclusion: Bilateral pathophysiology seems to be more prominent in PTPs than in cholesteatomas. Tympanic membrane perforation tends to be accompanied by a large perforation. The larger perforation on one side did not predict having more problems on the opposite side. [ABSTRACT FROM AUTHOR]

Fungal oto-mastoiditis is a rare condition and is often associated with host immunodeficiency. It has to be considered as a differential diagnosis among patients presenting symptoms despite an adequate antibacterial therapy. A 23-year-old female presented to the ENT OPD with complaints of occasional left ear discharge, since 2 years which was associated with itching, pain and reduced hearing. There were no complaints of swelling or pain behind the ear. Otoscopic examination revealed bulging, congested, immobile tympanic membrane in the left ear. Pure tone audiometry revealed 48.33 dB moderate mixed type of hearing loss in the left ear and tympanometry done showed type B curve in the left ear. Patient was taken up for exploratory tympanotomy where middle ear and antrum was filled with granulation tissue and peculiar looking, unusual greenish-brown debris suspicious of fungal otomycotic debris. Ossicular mobility was attained after clearing the disease from the middle ear and cortical mastoidectomy was completed. KOH study of the debris removed was positive for fungal elements as seen. Histopathological examination revealed features suggestive of Chronic suppurative otitis media. Specimen was sent for fungal culture where Aspergillus species was isolated. Patient was started on Voriconazole orally twice a day for 2 weeks. Postoperative period was uneventful and patient's hearing improved. ® Fungal oto-mastoiditis is a rare but reported entity, which is usually seen in immunocompromised patients. A high index of suspicion is required to reach an early diagnosis and administer suitable treatment, especially when it presents in immunocompetent individuals. [ABSTRACT FROM AUTHOR]

Introduction: Grommet insertion is a common procedure in field of Otology. Its outcome depends highly on degree of experience of the surgeon. Materials and methods: Simulation in training and clinical practice is an important facet in a surgeon's life. However, the non-availability of fresh cadavers, pre-existing damaged tympanic membrane in available cadavers and escalating cost of artificial cadaveric materials led us to devise a simple yet effective way of training technique for grommet insertion, utilizing "stretched surgical glove piece over an ear speculum". Result: An observational study was undertaken in our department to assess utility of this technique in training ten trainees. They reported subjective improvement in manual dexterity during performing myringotomy as well as mounting, manipulating and inserting the grommet during actual surgery. Conclusion: Our innovation is cheap, reliable and readily available for training. It closely resembles real-time surgical experience. [ABSTRACT FROM AUTHOR]

The invasion of terrestrial ecosystems by tetrapods (c. 375 million years [Ma]) represents one of the major evolutionary transitions in the history of life on Earth. The success of tetrapods on land is linked to evolutionary novelties. Among these, the evolution of a tympanic ear contributed to mitigating the problem of an impedance mismatch between the air and the fluid embedding sound-detecting hair cells in the inner ear. 1,2,3 Pioneering studies advocated that similarities in the tympanic ear of tetrapods could only result from a single origin of this structure in the group, 4,5 an idea later challenged by paleontological and developmental data. 4,6,7,8 Current evidence suggests that this sensory structure evolved independently in amphibians, mammals, and reptiles, 1,6 but it remains uncertain how many times tympanic hearing originated in crown reptiles. 9,10 We combine developmental information with paleontological data to evaluate the evolution of the tympanic ear in reptiles from two complementary perspectives. Phylogenetically informed ancestral reconstruction analyses of a taxonomically broad sample of early reptiles point to the presence of a tympanic membrane as the ancestral condition of the crown group. Consistently, comparative analyses using embryos of lizards and crocodylians reveal similarities, including the formation of the tympanic membrane within the second pharyngeal arch, which has been previously reported for birds. Therefore, both our developmental and paleontological data suggest a single origin for the tympanic middle ear in the group, challenging the current paradigm of multiple acquisitions of tympanic hearing in living reptiles. [Display omitted] • Fossils reveal that the presence of tympanic membrane is ancestral to crown reptiles • The eardrum of lizards and crocodylians develops within the second pharyngeal arch • Fossils and embryos suggest a single origin of the tympanic ear in crown reptiles The tympanic ear is a key trait related to the evolutionary success of tetrapods on land, as it enhances the hearing capabilities of animals in this environment. Bronzati et al. use data from embryonic development and from the fossil record and provide evidence for a single origin of tympanic hearing in the group of living reptiles. [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. 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]

Artificial ears with intelligence, which can sensitively detect sound—a variant of pressure—and generate consciousness and logical decision‐making abilities, hold great promise to transform life. However, despite the emerging flexible sensors for sound detection, most success is limited to very simple phonemes, such as a couple of letters or words, probably due to the lack of device sensitivity and capability. Herein, the construction of ultrasensitive artificial eardrums enabling intelligent song recognition is reported. This strategy employs novel geometric engineering of sensing units in the soft microstructure array (to significantly reduce effective modulus) along with complex song recognition exploration leveraging machine learning algorithms. Unprecedented pressure sensitivity (6.9 × 103 kPa−1) is demonstrated in a sensor with a hollow pyramid architecture with porous slants. The integrated device exhibits unparalleled (exceeding by 1–2 orders of magnitude compared with reported benchmark samples) sound detection sensitivity, and can accurately identify 100% (for training set) and 97.7% (for test set) of a database of the segments from 77 songs varying in language, style, and singer. Overall, the results highlight the outstanding performance of the hollow‐microstructure‐based sensor, indicating its potential applications in human–machine interaction and wearable acoustical technologies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Study Design Settings Participants Main Outcome Measures Results Conclusions We aimed to assess the outcomes of fat graft myringoplasty augmented with hyaluronic acid in closing large‐sized eardrum perforations compared to the traditional underlay cartilage‐perichondrium composite myringoplasty (CPCM).It was a prospective randomised comparative study.It was held in tertiary referral institutions between May 2020 and April 2022.We included 100 patients with a large‐sized eardrum perforation (50%–75% of the eardrum surface area). Using the endoscopic transcanal approach, 50 patients were managed by fat graft myringoplasty augmented with hyaluronic acid, while CPCM managed the other 50 patients.We evaluated the closure rates 1, 6 months and 1 year after surgery. Also, we assessed the audiological performance of the patients with a successful closure before and 1 year after the operation.Fat graft myringoplasty operation was statistically shorter than the CPCM. The closure rate 1 year after surgery was 92% in the first group and 86% in the second group, without a statistically significant difference between both groups. Successful air‐bone gap closure to less than 10 dB occurred in 93.5% of group A and 81.4% of group B without a statistically significant difference. The mean postoperative air‐bone gap was 5.3 ± 3.95 dB in the first group and 7.95 ± 5.17 dB in the second group, with a statistically significant difference.Fat graft myringoplasty augmented with hyaluronic acid was a reliable, safe, simple, and effective manoeuvre to close large‐sized eardrum perforations compared to the conventional CPCM. [ABSTRACT FROM AUTHOR]

Otitis media (OM), a condition stemming from the proliferation of various bacteria within the tympanic cavity (TC), is commonly addressed through the administration of ofloxacin (OFL), a fluoroquinolone antibiotic. Nevertheless, the escalating issue of antibiotic resistance and the challenge of drug leakage underscore the exploration of an alternative, more effective treatment modality in clinical practice. Here, we introduce a simple and easily implementable fluid-regulated strategy aimed at delivering immunomodulatory hydrogels into the TC, ensuring conformal contact with the irregular anatomical surfaces of the middle ear cavity to more effectively eliminate bacteria and treat OM. This innovative strategy exhibits expedited therapeutic process of antibiotic-resistant, acute and chronic OM rats, and significant reductions in the severity of tympanic membrane (TM) inflammation, residual bacteria within the TC (0.12 *105 CFU), and the thickness of TM/TC mucosa (17.63/32.43 μm), as compared to conventional OFL treatment (3.6, 0.76 *105 CFU, 48.70/151.26 μm). The broad-spectrum antibacterial and antibiofilm properties of this strategy against a spectrum of OM pathogens are demonstrated. The strategy is validated to bolster the host's innate immune response through the stimulation of antibacterial protein synthesis, macrophage proliferation and activation, thereby accelerating bacterial eradication and inflammation resolution within the TC. This facile, cost-effective and in vivo degradable technology exhibits promising prospects for future clinical implementation. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations. Methods: This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared. Results: Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported. Conclusion: Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts. [ABSTRACT FROM AUTHOR]

Objectives: The aim is to investigate the influence of an active otitis media on the success rate of tympanoplasty in patients with a chronic otitis media (COM) and a tympanic membrane perforation. Databases Reviewed: PubMed, Embase and the Cochrane Library. Methods: The inclusion criteria were studies on closure rates of tympanoplasty performed in COM patients of any age with a tympanic membrane perforation caused by COM. The exclusion criteria were studies on patients undergoing concomitant mastoidectomy, ossicular chain reconstruction, tuboplasty, adenoidectomy, revision tympanoplasty, patients with perforations due to other conditions than COM, and letters to editors, commentaries, conference abstracts and case reports. The included articles were critically appraised using the QUIPS tool. Data on tympanic membrane closure rate were extracted, odds ratio (OR) and 95% confidence intervals (CI) of the closure rate with a wet versus a dry ear were calculated. Results: The search was performed on 1 February 2023. Of 4671 articles, 16 studies were included and critically appraised. Of these observational studies (nine prospective, seven retrospective), with a total of 1509 patients (dry ear group n = 1003; wet ear group n = 506), two studies stated a significant difference in success rate, one in favour of a dry ear and one in favour of a wet ear at time of surgery. All other studies did not show a statistically significant difference. Overall, the risk of bias was considered moderate to high. Conclusions: We found no significant prognostic value of having an active otitis media during tympanoplasty on tympanic membrane closure rates. Because the overall risk of bias was considered moderate to high, no strong conclusions can be made. To be able to answer this question with higher levels of evidence, high‐quality prospective or randomized studies are needed. [ABSTRACT FROM AUTHOR]

Objectives: Tinnitus is one of the irritating symptoms that should be addressed in adolescents. Since tinnitus affects mental health, it is important to treat it. However, identifying the cause of tinnitus is very challenging and the treatment strategies of tinnitus are controversial. The objective of this study was to identify the prevalence of tinnitus in adolescents and systemic diseases as risk factors of adolescent tinnitus to find evidence for new treatment strategies. Materials and Methods: We extracted the subjects and data using the 5th Korea National Health and Nutrition Examination Survey from 2010 to 2012. One thousand five hundred ninety‐three adolescents with bilateral normal tympanic membranes and availability of the results of physical, laboratory and audiological examinations, were selected. We evaluated their systemic diseases based on these results and assessed the association of tinnitus with demographic factors, systemic diseases and hearing levels. Results: The prevalence of tinnitus in Korean adolescents was 21.7%. The hearing level was not associated with tinnitus. Tinnitus was significantly associated with age (p = 0.005), 25(OH)‐D level (p = 0.007) and anaemia (p = 0.003). After controlling the other factors, age (p = 0.045), 25(OH)‐D level (p = 0.041) and anaemia (p = 0.019) were independently related to tinnitus. Conclusion: Tinnitus in adolescents was significantly associated with age, vitamin D and anaemia. Physicians should consider the higher likelihood of these deficiencies or diseases in adolescent tinnitus patients. Additionally, recognizing these associations may be helpful in developing treatment strategies for adolescent tinnitus. [ABSTRACT FROM AUTHOR]

Chronic tympanic membrane (TM) perforation is a tubotympanic disease caused by either traumatic injury or inflammation. A recent study demonstrated significant progress in promoting the regeneration of chronic TM perforations through the application of nanofibers with radially aligned nanostructures and controlled release of growth factors. However, radially aligned nanostructures with stem cell-stimulating factors have never been used. In this study, insulin-like growth factor binding factor 2 (IGFBP2)-incorporated radially aligned nanofibrous patches (IRA-NFPs) were developed and applied to regenerate chronic TM perforations. The IRA-NFPs were prepared by electrospinning 8 wt% polycaprolactone in trifluoroethanol and acetic acid (9:1). Random nanofibers (RFs) and aligned nanofibers (AFs) were successfully fabricated using a flat plate and a custom-designed circular collector, respectively. The presence of IGFBP2 was confirmed via Fourier transform infrared spectroscopy and the release of IGFBP2 was sustained for up to 20 days. In vitro studies revealed enhanced cellular proliferation and migration on AFs compared to RFs, and the incorporation of IGFBP2 further promoted these effects. Quantitative real-time PCR revealed mRNA downregulation, correlating with accelerated migration and increased cell confluency. In vivo studies showed IGFBP2-loaded RF and AF patches increased regeneration success rates by 1.59-fold and 2.23-fold, respectively, while also reducing healing time by 2.5-fold compared to the control. Furthermore, IGFBP2-incorporated AFs demonstrated superior efficacy in healing larger perforations with enhanced histological similarity to native TMs. This study, combining stem cell stimulating factors and aligned nanostructures, proposes a novel approach potentially replacing conventional surgical methods for chronic TM perforation regeneration. Chronic otitis media (COM) affects approximately 200 million people worldwide due to inflammation, inadequate blood supply, and lack of growth factors. Current surgical treatments have limitations like high costs and anesthetic risks. Recent research explored the use of nanofibers with radially aligned nanostructures and controlled release of growth factors to treat chronic tympanic membrane (TM) perforations. In this study, insulin-like growth factor binding protein 2 (IGFBP2)-incorporated radially aligned nanofibrous patches (IRA-NFPs) were developed and applied to regenerate chronic TM perforations. We assessed their properties and efficacy through in vitro and in vivo studies. IRA-NFPs showed promising healing capabilities with chronic TM perforation models. This innovative approach has the potential to improve COM management, reduce surgery costs, and enhance patient safety. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion In Australia, middle ear disease disproportionately affects Indigenous children, leading to poor hearing outcomes. This study aimed to determine the natural history of untreated chronic otitis media in Indigenous children in remote South Australia.Baseline and 3 year follow‐up data was collected from Indigenous children aged 5–18 years living on the Anangu Pitjantjatjara Yankunytjatjara Lands. 4‐frequency pure‐tone audiometry was used to determine hearing levels. Middle ear pathology was determined by video‐otoscopy with tympanometry and classified at baseline as group 1 (normal), group 2 (abnormal with intact tympanic membrane), or group 3 (perforated tympanic membrane).A total of 253 children were included in this study. Children in group 1 (20.6 ± 1.5 dBHL; Mean ± SD) had significantly better hearing outcomes at 3 year follow‐up than children with abnormal ears (groups 2 and 3) (23.8 ± 7.0 dBHL), P < 0.001. The difference was greatest for group 1 versus 3 (27.6 ± 8.4 dBHL), P < 0.001, followed by 1 versus 2 (22.4 ± 5.8 dBHL), P = 0.009, and between 2 (22.4 ± 5.8 dBHL) and 3 (27.6 ± 8.4 dBHL), P < 0.001.Hearing in Indigenous children with untreated middle ear pathology remains poor at follow‐up compared to those without pathology. Intervention is therefore critical to prevent persisting poor hearing outcomes. [ABSTRACT FROM AUTHOR]

Background: The Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world-wide especially in developing countries where large percentage of the population lacks specialized medical care. With a large number of patients frequently undergoing tympanoplasty for chronic suppurative otitis media (CSOM), it is important to assess the severity of the disease and predict the outcome of the surgical management. Materials and Methods: This was a prospective study of 90 cases of chronic otitis media, carried out over one year, who underwent various types of tympanoplasty, carried out in the Department of Ear, Nose, and Throat (ENT), Tertiary Care Teaching Hospital. The selection of cases was by convenience sampling method. All the cases of Chronic Otitis Media (COM), mucosal and squamous, in the age group of 10–80 years, irrespective of gender were included. Patients above 80 years, sensorineural or mixed hearing loss, COM with complications, any co morbid medical condition and unwilling patients were excluded. Result: The clinical profile of cases in present study. Almost all patients (97.8%) have complaint of on and off ear discharge followed by 91.1% cases having complaint of HOH followed by tinnitus (in 24.4% cases). In this study, 11.1% of the patients had active discharge. Maximum patients (48.9%) had ear dry for less than 3 months, rest had dry ear for more than 3 months. Three patients had history of trauma and no history of ear discharge. Ossicular involvement was seen in only 18.9% cases while in 81.1% cases, there was no ossicular involvement. In majority of cases (80%) middle ear mucosa was dry followed by wet mucosa in 13.3% cases. Total number of patients with score 1-3 (mild score) were 64.2%, with score 4-6 (moderate disease) were 27.1% and with score 7-12 (severe disease) were 8.7%. Conclusion: This study concludes that the MERI can be a useful tool in the preoperative evaluation in order to assess the probability of success of tympanoplasty. [ABSTRACT FROM AUTHOR]

Background: Accurate core temperature measurement in children is crucial; however, measuring esophageal temperature (TE) using a supraglottic airway device (SAD) can be challenging. Second-generation SADs, which have a gastric channel, can measure TE, and reduce gastric air volume. This study aimed to compare TE, measured using a probe inserted through the SAD gastric channel, with tympanic membrane (TTM) and forehead (TZHF) temperatures, measured using a zero-heat-flux cutaneous thermometer, with rectal temperature (TR). Methods: Temperature was recorded at 10-min intervals from 10 min after probe insertion until completion of surgery. We performed an equivalence test to evaluate whether the TE, TTM, and TZHF were equivalent to TR, with a margin of 0.3°C. Additionally, intraclass correlation coefficients (ICC) were calculated to assess the reliability of TE and TR at each time point. Results: We included 41 patients in the final analysis. In all patients, the esophageal probe was successfully inserted through the gastric channel of the SAD. When assessing agreement with TR as a reference, TE demonstrated equivalent results at all time points (P < 0.001 at 0, 10, 20, 30, and 40-min intervals and P = 0.018 at the 50-min interval), except at the completion of surgery (P = 0.697). TE also demonstrated good reliability with TR as a reference throughout the surgery (ICC > 0.75). Conclusions: In children with SAD insertion, TE can be accurately and feasibly measured through the SAD’s gastric channel, making it suitable for routine application. [ABSTRACT FROM AUTHOR]

The main experiment concerned time-domain measurements of the acoustical reflection function (RF) of the human ear in adults and children (aged 5 to 8 years) using a probe inserted into the ear canal. This RF was used to calculate the area function of the ear canal versus distance along its centerline. Acoustical reflectance was calculated in the frequency domain from the RF, as was the difference in sound pressure level near the tympanic membrane relative to the probe tip. Group responses in area function, total ear-canal length, absorbance and group delay, and admittance magnitude and phase were analyzed based on sex, ear, and age. Responses were compared between children/adults and younger/older adults relative to age 50 years. Ear and sex were never significant. Significant differences were observed in children compared to adults in the area function, absorbance and group delay, and admittance magnitude and phase (0.25–4 kHz). Group delay differed between younger and older adults. A second experiment assessed level dependence of responses to better understand limitations in probe performance observed in the main experiment. These results show the utility of time-domain measurements of the area function and derived reflectance to understand sound-transmission differences across age at frequencies important to middle-ear function. [ABSTRACT FROM AUTHOR]

Introduction Fat grafts have been in used since 1962 for small central perforations, with a success rate ranging from 86 to 100%. Platelet-rich plasma (PRP) containing platelet concentrations greater than 1 million platelets/μL assist the healing process by various means. Current data suggests improved healing when tympanoplasty is performed using temporalis fascia grafts if PRP is added during surgery. Objective To assess the effect of PRP on fat grafts in small and moderate-sized central perforations. Methods The present prospective observational study was conducted with 36 patients who underwent fat graft tympanoplasty with PRP under local anesthesia. Clinical and audiological observations were carried out after 4, 8, and 12 weeks, and a statistical analysis of the observations was performed. Results We assessed 23 patients with small central perforations and 11 patients with moderate central perforations. An overall success rate of 76.4% was observed, with an 82.6% success rate among patients with small central perforations and 63.6% among those with moderate central perforations. There was no statistically significant difference in the uptake regarding the location of the perforation, but a statistically significant difference was found in terms of hearing improvement following the procedure. Conclusion The morbidity of conventional tympanoplasty in cases of small-to-moderate central perforations in patients with chronic otitis media vis a vis the results of the procedure needs to be revisited, as in the present study fat grafts placed with PRP under local anesthesia could lead to surgical and audiological outcomes that are as good as those reported in the literature. [ABSTRACT FROM AUTHOR]

Background Chronic otitis media is classically defined as an irreversible inflammation of mucoperiosteal lining of the middle ear cleft, entirely or in parts. The pathological factors that cause otitis media in one ear may also cause it in the other since both ears share the aeration and drainage. The fact that persistent otitis media can develop into chronic otitis media (COM) is another unresolved issue. This study was carried out to evaluate the anatomical and functional alterations of the contralateral ear in patients with unilateral chronic otitis media. Objectives The objectives of this study were to identify the anatomical findings of contralateral ear in patients with unilateral chronic otitis media with otoscopy and X-ray mastoids/HRCT Temporal bone and to find out the functional findings of contralateral ear with pure tone audiometry, tympanometry and Eustachian tube function. Methods A prospective observational study was conducted over a period of ten months from September 2022 to June 2023 among 90 patients with unilateral ear chronic otitis media attending the ENT OPD of Sri MuthuKumaran Medical College and Research Institute, Chennai. Patients above 18 years of age with chronic otitis media in one ear, irrespective of gender and those who gave informed consent were included in the study. The history and clinical examination were recorded. Otoscopy, pure tone audiometry, tympanometry, X-ray mastoids/HRCT Temporal bone and Eustachian tube function testing were done for all the patients. The data was entered in MS Excel and was analyzed using SPSS version 24. Descriptive statistics and inferential statistics such as Chi square test were used. P value < 0.05 was considered significant. Results The mean age of the study participants was 39.73 ± 14.64 years. Majority of participants (n=26) were in 31 to 40 years age group. Majority of the participants (n= 57, 63.3%) were females and 33 participants (36.7%) were males. Among the findings of unilateral ear, 69 participants (76.7%) had mucosal type and 21 participants (23.3%) had squamous type of COM. Regarding tympanic membrane findings in contralateral ear, in mucosal type, 21 participants had retracted tympanic membrane and in squamous type, 16 participants had retracted tympanic membrane which was statistically significant. In mucosal type, 63.8% had dysfunction in Eustachian tube and in squamous type 9.5% had dysfunction in Eustachian tube which was statistically significant by Chi square test. Conclusion The findings of this study indicate that diverse variations were observed in the contralateral ear of the patients with unilateral chronic otitis media so it should not be thought of as a condition that only affects one ear because it frequently affects both ears. Therefore, in patients with unilateral COM, this study shows the importance of continuous monitoring of the contralateral ear in order to diagnose any changes and, if necessary, give prompt therapeutic intervention. These observations can substantially aid in adding information in understanding the disease evolution in chronic otitis media. [ABSTRACT FROM AUTHOR]

Cartilage tympanoplasty is a fast growing technique used to restore hearing in chronic suppurative otitis media. The technique has misnomers such as limited applicability in only small size perforations, interference with sound conducting mechanism and durability. Our experience in out tertiary care Institution with over 100 retrospective study cases prove that there is a scope of proving it to be well established technique. That could be used in par with other tympanoplasty techniques. Our retrospective case series of 100 operated between 2021 and 2024 were taken, having unilateral perforation convenience data collection purpose. The overall success rates of cartilage / button tympanoplasty of varying perforation sizes, having a wide range of pure tone audiometry statuses having successful results were discussed, which is indicated as a percentage format. In our retrospective case series, out of our 100 cases we had 90 successful graft uptake cases. The 10% cases were later followed up in our study. It was analysed and concluded that the technique was not the inhibiting factor but the post operative care had prevented the patients from having the desired results. Our results are in accordance with previous case studies for support. Pure tone audiometry were taken pre operatively and post operatively that support cartilage / button tympanoplasty. Cartilage tympanoplasty is a commonly misunderstood technique which if corrected has a wide scope to be used a s a common treatment modality. Data collected and inference were in concordance with previous studies conducted. Tragal cartilage due to its durability, low inflammatory reaction to tympanic membrane, lesser chances of retraction and long term assurance of withstanding environmental conditions has proven to be technique which can be used in regular basis. Cartilage / button tympanoplasty is a technique that has a shorter learning curve for surgeons. With a high demand of cases in chronic suppurative otitis media-Tubotympanic type, button tympanoplasty technique is an assest. [ABSTRACT FROM AUTHOR]

Aim: This study is aimed to compare the outcomes of the two techniques (endoscopic single flap tympanoplasty- ESFT versus endoscopic double flap tympanoplasty - EDFT) of endoscopic tympanoplasty for repairing large tympanic membrane (TM)perforations with limited anterior remnant. Methodology: In this randomised controlled trial, forty patients with large sized TM perforations were included and randomised in the ESFT and EDFT arms with twenty patients in each group. Both the groups underwent endoscopic tympanoplasty using temporalis fascia graft. The graft uptake rates and hearing results were compared. Results: Graft success rate was 85% (17/20 cases) in the ESFT group and 90%(18/20 cases) in the EDFT group. The ABG (air-bone gap) improvement median with interquartile range(IQR) was 5 dB (3.12 dB-10 dB) in the ESFT group and 8.75 dB (5dB-11.87 dB) in the EDFT group. The difference was not statistically significant. Conclusions: In our study, there was no statistically significant difference in the graft success rate or hearing gain in ESFT or EDFT group. Moreover, there was longer operative time and need for an extra incision while raising the anterior flap. This lack of statistically significant results in our study may be since the study has a very small sample size. Whether the same conclusion is reproducible needs to be further explored by a larger sized randomised controlled trial. [ABSTRACT FROM AUTHOR]

The perforation characteristics and fracture-related mechanical properties of the tympanic membrane (TM) greatly affect surgical procedures like myringotomy and tympanostomy performed on the middle ear. We analyzed the most important features of the gerbil TM perforation using an experimental approach that was based on force measurement during a 2-cycle needle insertion/extraction process. Fracture energy, friction energy, strain energy, and hysteresis loss were taken into consideration for the analysis of the different stages of needle insertion and extraction. The results demonstrated that (1) although the TM shows viscoelastic behavior, the contribution of hysteresis loss was negligible compared to other irreversible dissipated energy components (i.e., fracture energy and friction energy). (2) The TM puncture force did not substantially change during the first hours after animal death, but interestingly, it increased after 1 week due to the drying effects of soft tissue. (3) The needle geometry affected the crack length and the most important features of the force-displacement plot for the needle insertion process (puncture force, puncture displacement, and jump-in force) increased with increasing needle diameter, whereas the insertion velocity only changed the puncture and jump-in forces (both increased with increasing insertion velocity) and did not have a noticeable effect on the puncture displacement. (4) The fracture toughness of the gerbil TM was almost independent of the needle geometry and was found to be around 0.33 ± 0.10 kJ/m2. [ABSTRACT FROM AUTHOR]

Tympanic membrane (TM) perforation is a serious ear discomfort that can cause hearing loss and make the middle ear vulnerable to infections. In this study, a unique TM patch is designed to mimic the structure of the natural eardrum for tissue engineering of TM perforations. Gelatin methacryloyl (GelMA)‐based TM patches are equipped with microneedles (MNs) to better adhere to the perforation site and developed using the digital light processing (DLP) based 3D printing technique. To impart biofunctionality to the 3D‐printed patches, their surfaces are coated with gentamicin (GEN) loaded poly(vinyl alcohol) (PVA) nanoparticles (NPs) using the Electrohydrodynamic Atomization (EHDA) method. The physicochemical characteristics, drug release behaviour, antimicrobial properties and biocompatibility of GelMA, PVA NP‐coated GelMA, and GEN@PVA NP‐coated GelMA patches are investigated. Morphological analyses confirmed that 3D‐printed GelMA patches are fabricated in desired sizes and geometries and successfully coated with NPs. In vitro antibacterial tests revealed that GEN@PVA NP‐coated GelMA patches have antibacterial activities against Staphylococcus aureus and Escherichia coli. Moreover, in vitro cell culture studies indicated that all GelMA‐based patches have no cytotoxic effect on L929 mouse fibroblast cells. Considering all, these specially designed biofunctional 3D‐printed GelMA patches can be an effective therapeutic approach for repairing TM perforations. [ABSTRACT FROM AUTHOR]

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]

Whereas mammals are characterized by the presence of three middle ear ossicles, reptiles have only one, the columella (stapes). Nevertheless, there is a great diversity of columellar anatomy among sauropsids, especially in the unique and cartilaginous “extracolumella”‐portion. Molecular studies revealed the “columella” of chicken and quails to be formed within the second pharyngeal arch, although conflicting evidence exists for the columellar footplate and distal parts of the columella in these birds. We studied columellar development in four turtles, one lizard, and one caiman species and argue, using early blastematous stages, that, distally, the so‐called “extracolumella” in turtles is mainly of quadrate, that is, first pharyngeal arch origin. Differently, the dorsal aspect of the “extracolumella” of the lizard and a part of the “dorsal columella process” of the caiman are likely quadrate‐derived. This indicates only a partial homology of the distal columellar compartments among reptiles. Moreover, we observed in most species that, at early stages, the footplate differentiates from the otic capsule, which confirms widespread experimental findings of mesodermal cells contributing to the proximal part of the columella. We provide a hypothetical framework for the changes in the columella and quadrate morphology in reptilian evolution. Originally, as evidenced by the fossil record, the columella served as a stabilizing brace between the quadrate and braincase. Associated with changes in the feeding mode of late Permian taxa, the quadrate was integrated along the stress flows from biting, and in early development part of the quadrate differentiated to differently contribute to the distal part of the “columella‐complex,” which now contacts the tympanic membrane. In addition, part of the original otic capsule contributes to the footplate of the mobile columella, providing a connection with the inner ear. [ABSTRACT FROM AUTHOR]

Simple Summary: Temporal bone paragangliomas are rare neuroendocrine tumors that typically arise from the parasympathetic nervous system. Since they are not a common pathology in the daily practice of an otorhinolaryngologist, we would like to provide an overview of current treatment strategies for patients with tympanomastoid paragangliomas. In addition, we present our approach for patients with class A and B tympanomastoid paragangliomas and reiterate that surgical therapy is an effective and safe treatment modality. In cases where surgery is refused and the tumor has grown to class C or more, radiotherapy is an alternative method to control tumor growth. (1) Background: Head and neck paragangliomas are neuroendocrine tumors that typically originate from the parasympathetic nervous system and are predominantly non-secretory. Their clinical manifestations result from their mass effect on the surrounding tissues. The approach to treating these tumors depends on factors such as their location, size, impact on adjacent structures, and the patient's overall health and preferences. (2) Methods: A retrospective analysis of the management of temporal bone paraganglioma classes A and B (according to the modified Fisch classification) was performed at the University Medical Centre, Ljubljana, between 2011 and 2023. (3) Results: We analyzed 23 cases, 19 of which underwent surgery; complete tumor removal was achieved in 18 of them. Four patients were irradiated due to tumor progression to class C. Three of these four patients initially refused surgery and were treated with radiotherapy (RT) 7, 13, and 18 years after diagnosis. In the fourth patient, complete surgical resection was not achieved and she was treated with RT four years after surgery, due to the growth of the tumor to class C. The average follow-up time from diagnosis was 8.9 years (median 6 years; range 1–26 years). (4) Conclusions: The surgical treatment of patients with class A and B paragangliomas is effective and safe. In cases where surgery is refused but the tumor continues to grow to class C, RT is an alternative and efficient method of controlling tumor growth. [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]

BACKGROUND: The aim is to analyze Literature concerning mastoid obliteration in adults with either autologous or heterologous grafts in the last 10 years. Data Source: Databases such as NIH PubMed, Bookshelf, NLM Catalog, Cochrane Library, and Embase were consulted. METHODS: Thirty-seven studies were selected (22 concerning autologous materials, 15 about heterologous ones). Only studies with more than 12 months of follow-up were considered. A statistical analysis with random-effects models was performed to allow the true effect sizes to differ from study to study. RESULTS: The present literature review and meta-analysis does not allow to establish the supremacy of one technique over the other, but underlines the advantages of each reconstructive choice and the importance of mastoid obliteration in cholesteatoma surgery. The total number of obliterated ears was 2882. Overall otorrhea rate was 5% (5.2% for heterologous grafts; 4.9% for autologous materials; P < .05). Recurrent and residual cholesteatoma rate was 4.5% (3.4% in heterologous materials; 5.2% in autologous grafts; P < .05). Recurrent cholesteatoma rate was 1.8% (1.6% when using heterologous grafts, 1.9% with autologous; P < .05). Residual cholesteatoma rate was 1.5% (1.6% with heterologous materials, 1.5% with autologous; P < .05). TM (tympanic membrane) retraction pockets rate was 5.3% (3.6% with heterologous materials; P >.05; 7% with autologous materials; P < .05). TM perforations rate was 2.9% (4.3% with heterologous materials, 2.5% with autologous; P < .05). Infection rate was 2.3% (2.3% with heterologous materials, 2.2% with autologous; P < .05). CONCLUSION: Heterologous materials are associated with significantly lower rates of recurrent and residual cholesteatoma and retraction pockets development, although they are associated with higher rates of otorrhea and TM perforation. [ABSTRACT FROM AUTHOR]

Granular myringitis is a chronic inflammatory condition of the tympanic membrane that does not involve the middle ear. Various treatment modalities have been proposed for the treatment of granular myringitis, but there is no standard treatment regime. A 60-year-old woman had left persistent ear discharge for 4 months. Examination revealed diffuse granulation tissue, forming a pseudomembrane at the medial aspect of the ear canal and obstructing the tympanic membrane. An audiogram revealed mild-to-moderate left-sided conductive hearing loss. She was treated with multiple courses of ear drop antibiotics but had no improvement. The decision for surgical intervention was driven by the presence of a grade IV medial meatal stenosis, the potential risks associated with prolonged medical management, the distressing impact on the patient's life, and a shared decision-making process. A combined transcanal and postauricular endoscopic approach whereby excision of the granulation tissue, canalplasty, and myringoplasty were performed. She exhibited complete symptom resolution and reported an improved quality of life. This approach yielded successful symptom resolution, highlighting its potential in managing refractory chronic granular myringitis. We aimed to carefully weigh the risks of surgery against its potential benefits in a refractory chronic case, acknowledging the inherent risks and disadvantages of surgical interventions. Further studies are warranted to evaluate the long-term outcomes and benefits of this approach. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to identify and clinically characterize patients treated in an Otoneurology Unit who experienced vestibular ototoxicity as a result of using aminoglycoside ear drops during outbreaks of superinfection in chronic otitis media. Material and Methods: An observational retrospective study was conducted, including patients with perforated eardrums who developed vestibular ototoxicity within the past 10 years following the application of topical ear aminoglycosides in a tertiary referral center. The study encompassed the assessment of the clinical presentation, treatment, quality of life, and evolution after treatment of the identified individuals. Results: During the study period, 6 patients, aged between 33 and 71 years, developed vestibular ototoxicity following the use of topical aminoglycoside drops due to infection flares in chronic otitis media. All cases involved the use of gentamicin. Two cases were unilateral, and 4 were unilateral. The onset of symptoms occurred within one to four weeks of using the drops, resulting in all patients experiencing instability without vertigo attacks. After discontinuing the drops and undergoing vestibular rehabilitation, 4 patients experienced sequelae, with 2 patients (both with bilateral vestibular hypofunction) suffering significant impairment in their quality of life. Conclusions: Vestibular ototoxicity due to the topical application of aminoglycosides during acute exacerbations of chronic otitis media is a rare occurrence. However, given its potential for severe consequences and the fact that we are still encountering patients with this condition, healthcare professionals should explore alternative antibacterial agents that offer similar efficacy. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the impact of central and marginal tympanic membrane perforations (TMP) on wideband absorbance (WBA) and compare it with normal ears. Material and methods: Three groups of individuals, aged 18 to 50 years: Group I with central TMP (n = 65), Group II with marginal TMP (n = 13), and Group III with normal middle ears (n = 20) were considered. WBA measurements were performed at peak and ambient pressure conditions across frequencies. Results: Significant differences in WBA were observed between the groups with central and marginal TMP and the normal ear group across all frequencies. Central TMP exhibited decreased absorbance at low frequencies and increased absorbance at high frequencies, peaking at 5000 Hz. Marginal TMP showed peaks at 600, 4000, and 6000 Hz with decreased absorbance at 2000 Hz. Central TMP exhibited lower absorbance than marginal TMP at lower frequencies, while marginal TMP showed decreased absorbance at mid and high frequencies. Conclusions: These findings highlight the role of WBA in differentiating normal ears from those with TMP. Understanding TM vibration patterns and frequency-dependent variations in absorbance enhances diagnostic accuracy and clinical management. [ABSTRACT FROM AUTHOR]

Background: Cochlear implant (CI) electrode insertion can change the mechanical state of the ear whereby wideband tympanometry absorbance (WBTA) may serve as a sensitive tool to monitor these mechanical changes of the peripheral auditory pathway after CI surgery. In WBTA, the amount of acoustic energy reflected by the tympanic membrane is assessed over a wide frequency range from 226 Hz to 8000 Hz. The objective of this study was to monitor changes in WBTA in CI recipients before and after surgery. Methods: Following otoscopy, WBTA measurements were conducted twice in both ears of 38 standard CI recipients before and in the range of 4 to 15 weeks after CI implantation. Changes from pre- to postoperative absorbance patterns were compared for the implanted as well as the contralateral control ear for six different frequencies (500 Hz, 750 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz). Furthermore, the influence of the time point of the measurement, surgical access, electrode type, sex and side of the implantation were assessed for the implanted and the control ear in a linear mixed model. Results: A significant decrease in WBTA could be observed in the implanted ear when compared with the contralateral control ear for 750 Hz (p < 0.01) and 1000 Hz (p < 0.05). The typical two-peak pattern of WBTA measurements was seen in both ears preoperatively but changed to a one-peak pattern in the newly implanted ear. The linear mixed model showed that not only the cochlear implantation in general but also the insertion through the round window compared to the cochleostomy leads to a decreased absorbance at 750 and 1000 Hz. Conclusions: With WBTA, we were able to detect mechanical changes of the acoustical pathway after CI surgery. The implantation of a CI led to decreased absorbance in the lower frequencies and the two-peak pattern was shifted to a one-peak pattern. The result of the linear mixed model indicates that WBTA can detect mechanical changes due to cochlear implantation not only in the middle ear but also in the inner ear. [ABSTRACT FROM AUTHOR]

Purpose: Retrospective evaluation of bilateral same-day myringoplasty outcomes. Methods: Patients who underwent bilateral same-day myringoplasty from 2005 to 2019. Results: Thirty-eight patients underwent bilateral myringoplasty. Mean age was 44.5 years and 55.3% patients were male. Tragal perichondrium-cartilage composite graft was the most frequently used graft material (82.9%). Perforation closure was achieved in 78.9%. Postoperative Pure Tone Average and Air–Bone Gap decreased significantly (p < 0.05), except for the Air–Bone Gap of the right ear (p = 0.058). The complications were cholesteatoma (1.3%), otorrhea (6.6%) and tympanic membrane retraction (1.3%). Conclusions: Bilateral same-day myringoplasty is a feasible procedure in selected patients. Good anatomic and functional outcomes, as well as a low rate of complications, are achieved with this procedure, improving patient comfort and allowing for a reduction in operation time and costs. [ABSTRACT FROM AUTHOR]

Background Chronic Otitis Media (COM) is one of the leading causes of hearing loss in the world. Tympanoplasty is the surgical treatment to repair the defective tympanic membrane in such patients. Aim To compare the healing and graft uptake using temporalis fascia versus cartilage perichondrium grafts in tympanoplasty type-1. Method A prospective randomized comparative cohort trial was conducted in the Department of Otorhinolaryngology at a Private Medical College in South India in the year 2020. This study compared the effect of two graft materials, tragal cartilage perichondrium and temporalis fascia, in tympanoplasty and evaluated the post-operative healing, among 60 patients randomized into 2 groups. Results 93% cases belonging to the cartilage perichondrium graft group had formation of neotympanum compared to only 53% cases in Temporalis fascia group. Statistically significant difference between the two groups in terms of formation of neotympanum suggests cartilage perichondrium was better in the aspect of healing and graft uptake. Conclusion Results of this study conclude that tragal cartilage perichondrium is significantly better than temporalis fascia in terms of graft uptake in cases of Type I Tympanoplasty. [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: Otitis is an inflammation and infection of the inner lining of the middle ear. The problem known as suppurative otitis media if there are droplets and holes in the tympanic membrane due to this inflammation and infection of the mucous membrane. The present study focused on specific genes suspected to be associated with otitis media in 60 subjects clinically diagnosed with OM The study focuses on two genes, MUC5B and IL-1RN, whose genes mutations by variable number of tandem repeat (VNTR) regions Methods: Variable numbers of tandem repeats (VNTR) regions were used to genotype 60 patients with otitis media and 30 healthy individuals for genotypic polymorphisms for the MUC5B and IL-1RN genes by number of tandem repeats (VNTR) regions on a variable basis Blood samples were collected from participants, and three milliliters were placed directly into EDTA tubes. Subsequently, PCR products were detected by agarose gel electrophoresis and visualized by ethidium bromide staining. The size of amplified DNA fragments was determined by comparison with a 100-bp DNA ladder molecule size marker Results: About the same, the paper represents the association of gene polymorphisms with otitis media by genotyping a total of 60 patients as OM, and, on the other hand, 30 individuals were noted to be healthy. This was to determine genotypic polymorphisms for the two genes, that is, MUC5B and IL1RN, within the VNTR region. The results showed that the carriers of allele 2 in the genotypic position had a risk of nearly twofold getting otitis media. Conclusion: Polymorphism of the MUC5B and IL-1RN genes can be responsible for the severity of the inflammatory process in the middle ear, complicated by otitis media or hearing loss. [ABSTRACT FROM AUTHOR]

Aim: To determine the effect of platelet rich plasma among patients undergoing type I tympanoplasty with and without topical use of platelet-rich Plasma (PRP) over the graft. Materials and Methods: A randomized, prospective, comparative study was conducted among 60 patients divided into two groups: Cases and control consisting of 30 patients each, having inactive mucosal Chronic otitis media who underwent type I tympanoplasty with the use of PRP for enhancing the graft uptake versus patients without use of PRP: 28 (93%) as compared to control 25(83%). Results: Preoperative and postoperative air-bone gap (A-B gap) was calculated at the end of 3 months and compared, and it was found to be statistically significantly better both in the case and control group (P < 0.05) and mean healing time of 4.64+/- 1.57 in cases in comparison to control group with mean healing time of 6.2+/-1.98. Conclusion: Our study shows that PRP is cheap, easy to prepare, autologous and cost effective. This platelet concentrate is enriched with various growth and healing factors, which helps in faster tympanic membrane closure following tympanoplasty and hence overall improving successful outcomes rate of tympanoplasty by preventing graft migration, with little to no perceivable side effects. [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]

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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]

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]

Background: There 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. Aims/Objectives: 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. Material and Methods: 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. Results: 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. Conclusions and Significance: 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]

A horse with head trauma induced by falling can have a traumatic brain injury or a fracture of the ossea part of the external ear canal. The aim of this study is to find the complications of a head trauma. The aim of the second study is to verify the deafness as a cause of behavioral disorder in horses. A three-year-old Hannoverian gelding fell down and injured the left lateral region of his head. After getting up the gelding had a bloody discharge out of the left ear. The neurological exam had shown slowly ear movements, painful left ear basis and left head tilt. The endoscopy of the guttural pouches was normal. The CT image detected a transversal fractur of the left osseus part of the external ear canal. Thirteen weeks after falling down the otoscopy of the cartilaginous and osseus part including the tympanic membrane of the right ear were normal (grading I/III). The protrusion caused by the fracture in the osseus part of the left ear prevented the view to the tympanic membrane. The epithelium of the osseus part was severe reddened and swollen which are signs of an acute external otitis. The threshold of normal hearing level of the right ear was 30 dB. The brainstem auditory evoked response (BAER) of the right ear showed prolonged latencies of wave III (2.95 ms, normal 2.86) and V (5.80 ms, normal 4.62) and interpeak latencies I-III (1.65 ms, normal 1.33) and I-V (4.50 ms, normal 1.76) which were showing a mild sensorineurale hearing deficit based on traumatic brain injury. This traumatic brain injury could induce an axonal damage of the brainstem auditory pathway. The threshold of normal hearing level of the left ear was 80 dB. BAER of left ear had no identifiable peaks and therefore no measurable latencies and interpeak latencies. These findings concluded to the diagnosis of sever conductive hearing deficit based on the protrusion in the left osseus part in this gelding with head trauma. The behavioral disorders of American Paint Horses were observed by the owners and these horses were refered to the equine medical clinic. The otoscopical findings of all horses were normal in the cartilaginous and osseus part (grading I/III). Achromodermia was found in all cartilaginous parts of the external ear canals. Only one horse had keratin scales around the entrance of the osseus part in both ears. All tympanic membranes were intact and transparent. The thresholds of normal hearing level on both ears of all horses were 100 dB. Absent peaks of the BAER and isoelectric lines were seen which characterize the sensorineurale deafness in all American Paint Horses. The sensorineural deafness was the reason of the behavioral disorder described by the owners. Horses with head trauma suffer from a traumatic brain injury. These horses could have a hearing deficit based on either due to a fracture of the osseus part of the external ear canal or an acute external otitis or both. Endoscopy of the guttural pouches, external ear canals and BAER should be done. Hearing deficit or deafness induce behavioral disorders which should know the owner. Horses with white head and blue eyes could have the genetical deafness. Deafness will be diagnosed with BAER. [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]