[Antenatal ear examination: When, how and why?]

Antenatal ear examination is an integral part of the thorough examination of the fetal face. The discovery of an anomaly, whether it is made by chance or during a complementary in-depth examination, leads the practitioner to determine its isolated or associated character, in order to characterise its possible belonging to a syndromic entity. In this context, the realization of genetic analysis more precise and wider allowing a return of the results in a time compatible with an evolutive pregnancy, gives to the geneticist a central role in the management of these couples. The main challenge lies in obtaining a set of concordant clinical and biological clues, enabling the genetic results identified to be interpreted correctly, the optimised functioning of the ultrasound practitioner - geneticist duo is therefore fundamental. This results in a complex information to deliver, in the fact that the clinical translation of an ear anomaly in antenatal can go from an isolated aesthetic anomaly to a genetic syndrome with neurodevelopmental disorder. The objective of this work is to describe, from a methodological analysis of antenatal ears, the accessible malformative entities, isolated or associated, and to discuss the problems in the need or not to propose their screening.

Indicators of pediatric peripheral vestibular disorder: A retrospective study in a tertiary referral center

OBJECTIVES

This study aims to present characteristics of pediatric patients with peripheral vertigo and dizziness and their clinical workup results in the tertiary otorhinolaryngology center. We wanted to investigate whether the detailed history could replace the extensive vestibular testing and whether the clinical presentation could guide the first contact physician to appropriately directed specialist referral.

METHODS

Retrospective case review of consecutive pediatric vertigo and dizziness patients referred to the tertiary otorhinolaryngology center from 2015 to 2020. The data about the signs and symptoms of vertigo and dizziness and the results of audiological and vestibular tests were collected.

RESULTS

Of 257 children aged 10.9±4.3 years (R: 1-17 years), 32 (12.5%) had peripheral, and 49 (19%) had central vertigo and dizziness. Acute vestibulopathy was diagnosed in 22/257 (8.5%) children, sudden sensorineural hearing loss and benign paroxysmal positional vertigo in 5/257 (2%) children each. 60% of children with peripheral vertigo and dizziness had emesis, and 55.6% had nausea. 8% of children had spontaneous horizontal-rotatory nystagmus that followed Alexander's law. Goodman and Kruskal's л for determining whether the type of nystagmus could predict the type of vertigo and dizziness (central or peripheral) was 0.481 (p = 0.001). 12/26 (60%) of children with peripheral vertigo and dizziness had emesis compared to 14 (30.04%) children without emesis, a difference in proportions of 0.296 (p = 0.024, chi-square test of homogeneity). Binomial logistic regression to ascertain the effects of duration, nausea and emesis on the likelihood of the presence of peripheral vertigo was statistically significant (χ2(3) = 10.626, p = 0.014).

CONCLUSION

Unlike adults, peripheral vestibular causes of vertigo and dizziness in children may be rare but have the same typical signs and symptoms. The detailed history and careful clinical examination are crucial in differentiating between peripheral and central causes. This guides the first contact physician for further referral to appropriate specialists included in a multidisciplinary workup. Namely, nausea, emesis, horizontal nystagmus and a longer duration of symptoms in a child with vertigo and dizziness indicate a peripheral etiology. Therefore, a referral to an otorhinolaryngologist is reasonable.

Audio-Vestibular Profile of COVID-19; Systematic Review and Meta-analysis

Introduction

After more than a year of the COVID-19 pandemic, audio-vestibular problems have been reported as consequences. Several limited case report studies with different methodologies were published. This study aimed to describe the impact of COVID-19 on the auditory-vestibular system and communication problems in subjects with hearing impairment.

Materials and Methods

The current systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. PubMed, Web of Science, and Google Scholar were searched to find relevant articles using combined keywords.

Results

Out of 26 final studies, 20 studies dealt with the effects of COVID-19 on the auditory and vestibular system, and six articles examined the COVID-19 effects on hearing-impaired people and patients. In these studies, dizziness (17.8%), tinnitus (8.1%), and vertigo (2.8%) were common symptoms. Most studies were case reports (42.30%), and in terms of quality, nine studies (34.61%) were in the suitable quality group.

Conclusions

COVID-19 might cause auditory-vestibular system problems by directly affecting the structures or functions of the inner ear or by weakening the immune system. The need for taking preventive measures during the COVID-19 pandemic has caused communication and social challenges, particularly for people with hearing loss.

The function of the tensor tympani muscle: a comprehensive review of the literature

The tensor tympani muscle is structurally important in the middle ear, specifically through its involvement in the impedance of sound in response to intense auditory and non-auditory stimuli. Despite numerous studies, its true function has been debated for many years; questions still remain about its role in auditory and non-auditory reflexes and in sound damping. Some studies suggest that the tensor tympani muscle contracts as a result of non-auditory stimulation such as facial or head movements; others suggest that it contracts due to input from the cochlear nucleus, therefore by way of auditory stimulation. Whatever the cause, contraction of the tensor tympani muscle results in low frequency mixed hearing loss, either to protect the inner ear from loud sounds or to desensitize the ear to self-generated sounds. A review of these studies indicated that the tensor tympani muscle has a wide range of functions, yet the mechanisms of some of them have not been clearly demonstrated. One major question is whether the tensor tympani muscle contributes to sound damping; and if it does, what specific role it serves. The primary purpose of this review article is to explore the functions of the tensor tympani muscle in light of recent research advances.

Distinct proliferative and middle ear skeletal-patterning functions for SHH-expressing epithelia in the chick hyoid arch

During chick craniofacial development, the second (hyoid) pharyngeal arch expands to close the neck and gives rise to skeletal elements, including the columella of the middle ear (a homologue of the mammalian stapes). Sonic hedgehog (SHH) signalling has been implicated in hyoid arch expansion and columella formation, but spatial and temporal aspects of these signalling interactions within the hyoid arch remain poorly understood. Here, we show that SHH is initially expressed in the posterior endoderm of the hyoid arch, and that this domain subsequently splits into a distal domain at the site of arch expansion (the posterior epithelial margin, PEM), and a proximal domain that lines the foregut (the proximal hyoid epithelium, PHE). Pharmacological manipulations and heterotopic grafting experiments demonstrate that SHH signalling is required for hyoid arch expansion and skeletogenesis, and reveal distinct roles for the PEM and PHE in these processes. The PEM promotes mesenchymal cell proliferation during arch expansion but is not sufficient to repattern the columella. Conversely, the PHE promotes mesenchymal cell survival, and PHE grafts induce partial duplication of the columella. This work demonstrates crucial and distinct roles for endodermal SHH signalling in hyoid arch morphogenesis and patterning of the middle ear skeleton.

A 3D Printed Human Ear Model for Standardized Testing of Hearing Protection Devices to Blast Exposure

Hypothesis

A 3D printed human temporal bone (TB) that is anatomically accurate would cost-effectively reproduce the responses observed in blast testing of human cadaveric TBs with and without passive hearing protection devices (HPDs).

Background

HPDs have become critical personal protection equipment against auditory damage for service members. Acoustic test fixtures and human TBs have been used to test and develop HPDs; however, the lack of a cost-effective, standardized model impedes the improvement of HPDs.

Methods

In this study, the 3D printed TB model was printed with flexible and rigid polymers and consisted of the ear canal, tympanic membrane (TM), ossicular chain, middle ear suspensory ligaments/muscle tendons, and middle ear cavity. The TM movement under acoustic stimulation was measured with laser Doppler vibrometry. The TB model was then exposed to blasts with or without HPDs and pressures at the ear canal entrance (P0) and near the TM in the ear canal (P1) were recorded. All results were compared with that measured in human TBs.

Results

Results indicated that in the 3D printed TB, the attenuated peak pressures at P1 induced by HPDs ranged from 0.92 to 1.06 psi (170-171 dB) with blast peak pressures of 5.62-6.54 psi (186-187 dB) at P0, and measured results were within the mean and SD of published data. Vibrometry measurements also followed a similar trend as the published results.

Conclusions

The 3D printed TB model accurately evaluated passive HPDs' protective function during blast and the potential for use as a model for acoustic transmission was investigated.

Otomyiasis caused by Musca domestica in a child: A case report

Introduction

Myiasis is the infestation of humans and vertebrate animals with dipterous larvae. It is a rare clinical condition, mainly observed in vulnerable people living in tropical and subtropical regions.

Case presentation

We reported a 2-year-old boy, with history of anemia and psoriasis who was admitted to our department after discovering larvea coming out from the left ear 6 weeks ago. Ear examination revealed a few maggots in the left concha and external auditory canal. A larvea was removed and identified as Musca domestica. Management of this otomyiasis was based on manual maggot removal and regular auditory toilets with povidone iodine.

Discussion

Although rarely reported, clinicians should still suspect aural myiasis in the event of an unexplained otalgia in children, mainly if they are from rural area with poor hygienic conditions.

Conclusion

Otomyiasis is mainly reported in tropical rural location in debilitated individuals with low socioeconomic conditions and poor hygiene. Thus prophylactic measures are the most effective means to reduce its incidence.

•

Human myiasis is a rare clinical condition primarily seen in vulnerable people living in tropical regions.

•

Otomyiasis is exceptional and quite challenging for physicians.

•

It is commonly caused by larvae from Sarcophagidae and Calliphoridae families. Muscidae's family is rarely involved.

•

Larvae must be removed manually when possible.

•

Prophylactic measures are the most effective means to reduce the incidence of human myiasis.

Non-Surgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes

INTRODUCTION

Congenital ear anomalies result from cartilage and skin compression in utero. They can be corrected in infancy before the cartilage hardens and loses its malleability. Caretaker burden of ear molding and its impact on esthetic outcomes has not been studied.

METHODS

Demographic and procedural variables were retrospectively collected for infants who underwent ear molding. Parents were surveyed regarding their experience, caretaker burden, and esthetic outcome. Outside physicians were provided with pre- and post-treatment photographs and asked to rate outcomes. A Likert scale was developed for responses and converted to a numeric score from 1 to 5 with 5 as the most desirable.

RESULTS

Seventy-four patients comprising 121 ears were included. Mean age at treatment was 20.1 ± 21.4 days with treatment duration of 21.1 ± 7.7 days. Parental participation in the survey was 70.1%. Questions that queried parents' experiences revealed a "very positive" experience with minor burden related to bathing and cleaning (Mean Likert Score 4.1, Range 1-5). Favorable parent-reported outcomes were obtained regarding anticipated social distress (4.28, 1-5), satisfaction with results (4.27, 1-5), and perception of final appearance (4.18, 1-5). Physician assessments of esthetic outcomes were slightly lower, but favorable between "somewhat effective" and "very effective" (3.46, 1-5). Earlier treatment trended favorably, but did not reach significance. Ear malformations had higher parent-reported satisfaction than ear deformations (4.75 ± 0.46 vs 4.21 ± 1.25, p = 0.025).

CONCLUSION

Despite the additional obligation for new parents, infant ear molding is rated low in terms of caretaker burden. Esthetic outcomes are excellent as assessed by parents and physicians. However, caretakers reported higher esthetic outcomes than physician evaluations.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Hyaluronic Acid Dermal Filler Promotes Cartilage Reshaping in Rabbit Ears

BACKGROUND

Neonatal ear is more malleable and soft, allowing the correction of deformities by using external molding. This is mainly attributed to high concentration of the proteoglycan aggregate and hyaluronic acid. In this study, HA dermal filler was injected in rabbit ear as a long acting HA source to investigate the biological impact of HA in reshaping the ear cartilage.

MATERIALS AND METHODS

Ears of twelve rabbits were divided into 4 groups. Control group was the left ears of 6 animals which were left intact. Group 2 was the right ears of the same animals, which received saline solution injection. Group 3 was the left ears of the other 6 animals, which were given 1 mL of HA. Group 4 was the right ears of them, which were given 2 mL of HA in both sites of the ear. All ears were folded and splinted for 4 weeks. Then, the angle of each ear was calculated. Following an additional 4 weeks, a cartilage biopsy was taken for histological examination.

RESULTS

The ear angles did not show any statistical difference at week 4. There was a significant difference among the groups at the 8th week. In the 3rd and 4th groups, mean angles were higher than the group 1 and group 2. Thickening in the cartilage and ectopic cartilage formation was observed in the contact areas to hyaluronic acid. Significant difference was also found between the peak and mean cartilage thicknesses.

CONCLUSION

HA dermal filler can stimulate cartilage regeneration by increasing the synthesis of extracellular matrix and chondrogenesis especially where it is in direct contact with the ear cartilage.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Checklist for the evaluation of magnetic resonance imaging in otological pathology

Otolaryngology specialists must be familiar with radiological studies that allow the diagnosis of different otological pathologies. Magnetic resonance imaging is a complement to computed tomography, which allows a better evaluation of soft tissues and contributes to the differential diagnosis of space-occupying lesions located in the temporal bone and lateral skull base. It is also the technique of choice for the evaluation of the inner ear and the anatomical structures located in the cerebellopontine angle. In this article we present a checklist for magnetic resonance imaging of the ear with different sections that will allow a systematic review of all structures of interest in otological practice, as well as the preferred sequences for each situation.

Primary fungal laryngitis mimicking recurrent laryngeal carcinoma

A 79-year-old smoker with a background history of a treated glottic carcinoma and chronic obstructive pulmonary disease presented with progressive hoarseness, symptoms of aspiration and shortness of breath for 6 months. Examination revealed an ulcero-fungating mass over the posterior commissure of the larynx. A tracheostomy, direct laryngoscopy and biopsy of the mass was performed to secure his airway and to exclude recurrent glottic carcinoma. Reassuringly, a histopathological examination of the mass revealed numerous fungal yeast bodies. He was then treated with itraconazole for 4 weeks and was followed up as and outpatient with complete resolution and no recurrence of the disease.

Clinical characteristics of nodular fasciitis of the ear in children

The rate of early misdiagnosis in patients with nodular fasciitis of the ear is high. To provide a basis for clinical diagnosis and treatment, we aimed to summarise the clinical manifestations, imaging results, pathological findings, treatment strategies, and postoperative follow-up results for three cases of paediatric nodular fasciitis (two girls, one boy) treated in the Department of Otorhinolaryngology, Head and Neck Surgery, at Beijing Children's Hospital of Capital Medical University from 2018 to 2020. The average age at diagnosis was 24 months. Lesions occurred in the left ear in two cases and right ear in one case. All patients had a history of biopsy before surgery. Rapid growth was observed following biopsy in two patients, and anti-inflammatory treatment was ineffective in all three cases. Fluorescence in situ hybridisation analysis of ubiquitin-specific peptidase 6 (USP6) was performed in two of the three cases, with positive results. The lesions exhibited hypo-intensity or iso-intensity on T1-weighted magnetic resonance imaging (MRI) and heterogeneous hyper-intensity on T2-weighted MRI. "Fascial tail" signs were observed on imaging in all cases. Surgical resection was performed in all cases. Intact ear appearance was observed at follow-up, and there were no cases of recurrence.Conclusion: Combining clinical features with imaging findings may improve the accuracy of preoperative diagnosis in patients with nodular fasciitis. In addition to pathological findings, genetic testing for USP6 may aid in diagnosis. The final diagnosis should be based on comprehensive assessment. Complete surgical resection can prevent recurrence. What is Known: • Paediatric NF around the ear is rare and is easily misdiagnosed as other inflammatory masses that have a higher incidence in children. • Most previous reports of NF were case reports. What is New: • Combining clinical and imaging findings with genetic testing for USP6 rearrangement may improve the accuracy of preoperative diagnosis in patients with NF. Nonetheless, the final diagnosis should be based on comprehensive assessment. • The present paper is significant in that it represents the only report of three cases of ear NF in children with a complete medical history and prognosis.

A comprehensive survey and deep learning-based approach for human recognition using ear biometric

Human recognition systems based on biometrics are much in demand due to increasing concerns of security and privacy. The human ear is unique and useful for recognition. It offers numerous advantages over popular biometrics traits face, iris, and fingerprints. A lot of work has been attributed to ear biometric, and the existing methods have achieved remarkable success over constrained databases. However, in unconstrained environment, a significant level of difficulty is observed as the images experience various challenges. In this paper, we first have provided a comprehensive survey on ear biometric using a novel taxonomy. The survey includes in-depth details of databases, performance evaluation parameters, and existing approaches. We have introduced a new database, NITJEW, for evaluation of unconstrained ear detection and recognition. A modified deep learning models Faster-RCNN and VGG-19 are used for ear detection and ear recognition tasks, respectively. The benchmark comparative assessment of our database is performed with six existing popular databases. Lastly, we have provided insight into open-ended research problems worth examining in the near future. We hope that our work will be a stepping stone for new researchers in ear biometrics and helpful for further development.

Concomitant therapy of surgical shave excision and intralesional injections for ear keloids: Early results from a retrospective cohort study

Introduction

Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ objectives were to (1) evaluate effectiveness of surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections; and (2) evaluate safety and patient satisfaction.

Methods and Materials

This study was a retrospective chart review of patients who received treatment of extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections to treat ear keloids at a single outpatient dermatology clinic. A prospective patient questionnaire was administered to the same patient population to collect recurrence and patient satisfaction.

Results

A total of 45 patients were included, consisting of 84.4% females (n = 38) and 15.6% males (n = 7) with a mean age of 25.5 years. Through retrospective chart review, early recurrence was seen in 6.7% of patients (n = 3), and via the prospective patient questionnaire, 11.1% of patients noted early keloid recurrence (n = 5). Of the patients who expressed their level of satisfaction in-clinic, 96.0% (n = 24) reported being satisfied or very satisfied and 4.0% (n = 1) were dissatisfied. Satisfaction was also assessed through the prospective patient questionnaire; of those who consented to the questionnaire, 100.0% (n = 24) were satisfied or very satisfied. Only 20.0% (n = 9) of all patients reported experiencing side effects, consisting of pruritus (11.1%; n = 5), tenderness (4.4%; n = 2), pain (2.2%; n = 1), and mild atrophy (2.2%; n = 1).

Conclusion

Extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections may represent a promising treatment option for ear keloids.

Evidence Level: 3 retrospective cohort study.

Lay Summary

Keloids are a type of raised scar, which can be painful and itchy for patients. Keloids can occur on various part of the body, including on the ear. They are challenging to treat and tend to come back. There are many treatment options, however, there is not one universal best treatment for keloids on the ear. We hoped to discover if shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections is effective at treating keloids on the ear. In order to answer this we completed a chart review of clinic patients, who have already completed the following combination treatment for keloids on the ear. The keloids were treated first by physically removing the bulk of the keloid with a scalpel, which is called shave excision. After the removal, triamcinolone acetonide and onabotulinumtoxinA were injected directly into the keloid. The rate of patient satisfaction and the rate of the keloid returning were collected during in-clinic visits and an optional post-clinic patient questionnaire. The treatment effectiveness and side effects experienced were reported during in-clinic visits. This indicated that with the low rate of side effects, high patient satisfaction, and low rate of keloid return, this treatment combination should be considered as an option for keloids on the ear. However, since this review was completed at one clinic with a small population of patients, it is not fully known if this treatment combination will work for all patients.

Fish hearing "specialization" - A re-valuation

Investigators working with fish bioacoustics used to refer to fishes that have a narrow hearing bandwidth and poor sensitivity as "hearing generalists" (or "non-specialists"), while fishes that could detect a wider hearing bandwidth and had greater sensitivity were referred to as specialists. However, as more was learned about fish hearing mechanism and capacities, these terms became hard to apply since it was clear there were gradations in hearing capabilities. Popper and Fay, in a paper in Hearing Research in 2011, proposed that these terms be dropped because of the gradation. While this was widely accepted by investigators, it is now apparent that the lack of relatively concise terminology for fish hearing capabilities makes it hard to discuss fish hearing. Thus, in this paper we resurrect the terms specialist and non-specialist but use them with modifiers to express the specific structure of function that is considered a specialization. Moreover, this resurrection recognizes that hearing specializations in fishes may not only be related to increased bandwidth and/or sensitivity, but to other, perhaps more important, aspects of hearing such as sound source localization, discrimination between sounds, and detection of sounds in the presence of masking signals.

A randomised trial of single or extended dosing ciprofloxacin versus no intervention for Prevention of Ventilation Tube Otorrhoea and Obstruction (PreVenTO2)

OBJECTIVES

To determine the effectiveness of ciprofloxacin 0.3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children.

DESIGN

3-arm parallel assessor-blinded randomised controlled trial. Randomisation in 1:1:1 ratio to single intraoperative application of ciprofloxacin drops, extended 5-day postoperative application and no drops. Patients were assessed by blinded assessors at 6 weeks postoperatively.

SETTING

The study was conducted in a large tertiary health network in Melbourne, Australia.

PARTICIPANTS

All children, 17 years and under, undergoing bilateral MEVT surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached.

MAIN OUTCOME MEASURES

Presence of postoperative otorrhoea and ventilation tube obstruction at 6 weeks postoperatively.

RESULTS

256 paediatric patients completed the study with a median age of 4.02 years. 153 participants were male. By ear-analysis (n=512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR=0.341, 95%CI 0.158-0.738, NNT= 11.25, p=.006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR=0.424, 95%CI 0.193 to 0.930, NNT=14.7 p=.032).

CONCLUSION

Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost-effectiveness.

Awake Rhinology Surgery in Response to the COVID-19 Pandemic in Europe

BACKGROUND

European health-care systems are faced with a backlog of surgical procedures following the suspension of routine surgery during the COVID-19 crisis. Routine rhinology surgery under general anaesthetic (GA) is now faced with significant challenges which include limited theatre capacity, the negative ramifications of surgical prioritization, reduced patient throughput in secondary care, and additional personal protective equipment requirements. Delayed surgery in rhinology, particularly with regards to chronic rhinosinusitis, has previously been shown to have poorer surgical outcomes, a detrimental effect on quality of life and long-term negative health socio-economic effects. Awake rhinology surgery under local anaesthetic (LA) provides an ideal alternative to GA. It provides a means of operating on patients in a setting alternative to currently oversubscribed main theatres, by utilizing satellite facilities, while ensuring identical surgical outcomes for patients who may otherwise have been forced to wait a long time for their procedure. It also confers additional benefits in terms of shorter recovery time and hospital stay for patients.

OBJECTIVES

We have developed a set of recommendations that are intended to help support clinicians and managers to better adopt LA rhinology protocols and minimize the risk to the patient and health-care professionals involved.

METHODOLOGY

International roundtable forums were conducted and supplemented by individual interviews. The international board consisted of 12 rhinologists experienced in awake rhinology surgery. Feedback was analysed and shared to develop a consensus of best practice.

RECOMMENDATIONS

Local and national guidelines need to be adhered to with specific focus on patient and clinician safety. When performing awake rhinology procedures in the COVID-19 recovery process, consider implementing specific safety measures and workflow practices to safeguard patients and staff and minimize the risk of infection.

CONCLUSION

Awake surgery potentially provides quicker access to routine rhinology surgery in the post-COVID-19 recovery phase, ensuring patients are treated in a timely matter, thereby avoiding higher downstream costs, and improving outcomes.

Checklist for the evaluation of magnetic resonance imaging in otological pathology

Otolaryngology specialists must be familiar with radiological studies that allow the diagnosis of different otological pathologies. Magnetic resonance imaging is a complement to computed tomography, which allows a better evaluation of soft tissues and contributes to the differential diagnosis of space-occupying lesions located in the temporal bone and lateral skull base. It is also the technique of choice for the evaluation of the inner ear and the anatomical structures located in the cerebellopontine angle. In this article we present a checklist for magnetic resonance imaging of the ear with different sections that will allow a systematic review of all structures of interest in otological practice, as well as the preferred sequences for each situation.

A change in clinical practice for aural foreign bodies - what we learnt from the coronavirus disease 2019 pandemic

Objective

This case series, conducted during the coronavirus disease 2019 pandemic, investigates the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications and success rates of subsequent removal attempts.

Method

A retrospective study of aural foreign body referrals over a six-month period was carried out.

Results

Thirty-four patients with 35 foreign bodies were identified (6 organic and 29 inorganic). The duration of foreign bodies left in situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts. First attempts made by non-ENT specialists (68.8 per cent) all failed and were associated with a high risk of trauma (36.4 per cent).

Conclusion

Because of the coronavirus disease 2019 pandemic, this is the first case series to specifically investigate the relationship between the duration of aural foreign bodies left in situ and the risk of complications. Our data suggest that prolonged duration does not increase the incidence of complications.

LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme): a feasibility study protocol for a community pharmacy-based ear health intervention

BACKGROUND

Ear disease is a major cause of preventable hearing loss and is very common in rural communities, estimated to affect 1.3 million Australians. Rural community pharmacists are well placed to provide improved ear health care to people who are unable to easily access a general practitioner (GP). The purpose of this study is to apply an ear health intervention to the rural community-pharmacy setting in Queensland, Australia, to improve the management of ear disease. The aims are the following: (1) to evaluate the feasibility, potential effectiveness and acceptability of a community pharmacy-based intervention for ear health, (2) to evaluate the use of otoscopy and tympanometry by pharmacists in managing ear complaints in community pharmacy and (3) to evaluate the extended role of rural pharmacists in managing ear complaints, with the potential to expand nationally to improve minor ailment management in rural communities.

METHODS/DESIGN

This is a longitudinal pre- and post-test study of a community-pharmacy-based intervention with a single cohort of up to 200 patients from two rural community pharmacies. Usual care practices pertaining to the management of ear complaints will be recorded prior to the intervention for 8 weeks. The intervention will then be piloted for 6 weeks, followed by a 12 month impact study. Patients aged > 13 years presenting to the pharmacies with an ear complaint will be invited to participate. Trained pharmacists will conduct an examination including a brief history, hearing screening, otoscopy and tympanometry assessments. Patients will be referred to a general practitioner (GP) if required, according to the study protocol. Patients will complete a satisfaction survey and receive a follow-up phone call at 7 days to explore outcomes including prescribed medications and referrals. Pharmacists and GPs will complete pre- and post- intervention interviews. Patient, pharmacist and GP data will be analysed using descriptive statistics and thematic analysis for the qualitative data.

DISCUSSION

This study will demonstrate the implementation of a screening and referring ear health intervention in rural community pharmacy. Feasibility, potential effectiveness and acceptability of the intervention will be assessed.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry Number: ACTRN12620001297910 .

Long-term treatment outcomes from a patient's perspective with Treacher Collins syndrome

The management of patients with Treacher Collins Syndrome (TCS) is complex and involves many different specialists within multidisciplinary teams (MDT). The treatment pathway extends from birth well into adulthood and is associated with a heavy burden of care. Due to the extensive nature of the interaction with these patients, MDT members have opportunities to provide enhanced patient-centred care and support.This case report provides an overview of the current knowledge of the aetiology of TCS, the management of these patients and provides a unique perspective from one of the coauthors who has TCS and reports on his treatment experiences and long-term treatment outcomes. By having a better understanding of the impact of TCS and treatment provided, MDT members can not only provide improved clinical treatment but also offer improved patient experiences for those with craniofacial anomalies in particular an increased awareness of the psychosocial challenges they endure.

A novel approach to earlobe reconstruction using the V to Y advancement flap

Background

The V to Y advancement flap offers an excellent option for reconstructing defects of the lobule and adjacent structures of the external ear. We demonstrate its utility for small defects of the earlobe including those extending to the antitragal and conchal bowl regions. To our knowledge use of this technique for earlobe reconstruction has not been reported.

Methods

A review of the literature was performed on the use of the V to Y flap for earlobe reconstruction. We then described its use in reconstructing lobular defects in 6 patients. All patients had a non-melanoma skin cancer involving the earlobe. All surgeries were performed under local anesthetic at a tertiary care centre in Halifax, Canada. Defects ranged in size from 1.0 to 1.4 cm. All defects were reconstructed with only a V to Y advancement flap. Patient photographs were taken intra-operatively and post-operatively. For all patients, satisfaction of the final aesthetic result was assessed on a 10 point scale in follow-up at 6 months.

Results

A review of the literature did not reveal any reports of the V to Y flap used in isolation for lobular reconstruction. At our centre from 2018 to 2020, this method was well tolerated under local anesthetic in 6 patients with non-melanoma skin cancers of the earlobe. All patients reported an aesthetically satisfying result at 6 months with scores ranging between 8 and 10. Scarring in all cases was minimal.

Conclusion

The V to Y advancement flap is a simple technique for reconstructing small defects of the lobule. This method is technically straight-forward, poses minimal risk to the patient, and in our experience, yields a favourable cosmetic outcome.

Graphical abstract