Primary Health Care Interventions for Potentially Preventable Ear, Nose, and Throat Conditions in Rural and Remote Areas: A Systematic Review

Background:Primary and secondary level preventive primary health care programs providing early detection and timely management of ear, nose, and throat (ENT) conditions in rural and remote regions are fundamental to preventing downstream impacts on health, social, and educational outcomes. However, the range and quality of evidence is yet to be reviewed. Objectives: The study objectives were to identify and synthesize the evidence of primary health care interventions for detection and management of ENT conditions in rural and remote areas, and evaluate the quality of the research and effectiveness of interventions. Methods: A systematic literature search of 6 databases (February 2023). The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, and the quality appraisal of studies was evaluated using the Mixed Methods Appraisal Tool (initial screening questions: Are there clear research questions? Do the collected data allow to address the research questions?). Results: Ten studies met the inclusion criteria. The results describe interventions for detection and management of respiratory tract infections, otitis media, and ear disease in primary health care settings. No studies met the inclusion criteria for tonsillitis. The role of community-based programs and allied health workers in the detection and management of ENT conditions was found to be effective in rural and remote regions. Only 2 of the studies met the screening criteria for quality appraisal. Conclusions: The study findings may inform future programs and policy development to address detection and management of ENT conditions in rural and remote primary care settings, and supports the need for further research on innovative models of care targeting potentially preventable hospitalizations through primary and secondary level prevention.

Bilateral intracochlear hemorrhage: A rare onset of chronic myelogenous leukemia

Acute onset of vertigo and hearing loss is rare in leukemic disorders. MRI can diagnose intracochlear hemorrhage as the underlying cause. The hearing can improve but if severe hearing loss preserves, cochlear implantation can be considered.

Coronavirus disease 2019 pandemic related chondrodermatitis nodularis helicis: the role of masks

BACKGROUND

Chondrodermatitis nodularis helicis is a benign, but painful inflammatory condition of the ear, characterised by a tender nodule located on the helix or antihelix. This study aimed to investigate the occurrence of chondrodermatitis nodularis helicis associated with the use of coronavirus disease 2019 masks during the pandemic.

METHOD

A retrospective single-centre study was performed from February 2020 to February 2022 in the Maxillo-Facial Unit at the University Hospital of Siena, Italy.

RESULTS

During the indexed period, 11 patients were affected by chondrodermatitis nodularis helicis. All patients wore a mask for more than 8 hours a day, every day for several months.

CONCLUSION

Although there is no certain proof of the correlation between masks and chondrodermatitis nodularis helicis, an increase in the incidence of this condition was highlighted in our single-centre experience in the pandemic period. The prolonged use of coronavirus disease 2019 masks may explain this correlation.

Tympanic membrane perforations cannot be reliably detected using computed tomography based on 15 cadaver dogs

The integrity of the tympanic membrane is an important factor when deciding treatment and therapeutic recommendations for dogs with ear disease; however, otoscopic examination may be difficult to perform due to features of external ear canal disease or patient compliance. CT is useful for the evaluation of middle ear disease, including cases in which middle ear disease is detected incidentally. The tympanic membrane is detectable using CT, but anecdotally, apparent focal defects or discontinuities of the tympanic membrane are often seen in patients with and without ear disease. The purpose of this prospective, observer agreement study was to determine if perforations of the tympanic membrane are reliably detectable on CT. Fifteen cadaver dogs underwent CT and video otoscopy to verify the integrity of each tympanic membrane. Cadavers were randomly assigned to have the tympanic membranes left intact or to undergo a myringotomy on either the left, the right, or both sides. CT was performed immediately following the myringotomies. Four blinded evaluators evaluated the pre- and post-myringotomy scans for a total of 30 scans (60 tympanic membranes). Average accuracy was low (44%), and interobserver agreement for all four evaluators was fair. Although the tympanic membrane is visible on CT, perforations of the tympanic membrane are unlikely to be accurately detected or excluded. The appearance of an intact tympanic membrane or defect in the membrane on CT should not be used as criteria to guide clinical treatment recommendations based on this cadaver model.

Non-foliar photosynthesis and nitrogen assimilation influence grain yield in durum wheat regardless of water conditions

There is a need to generate improved crop varieties adapted to the ongoing changes in the climate. We studied durum wheat canopy and central metabolism of six different photosynthetic organs in two yield-contrasting varieties. The aim was to understand the mechanisms associated with the water stress response and yield performance. Water stress strongly reduced grain yield, plant biomass and leaf photosynthesis, and downregulated C/N-metabolism genes and key protein levels, which occurred mainly in leaf blades. By contrast, higher yield was associated with high ear dry weight and lower biomass and ears per area, highlighting the advantage of reduced tillering and its consequent improvement in sink strength that promoted C/N metabolism at the whole plant level. An improved C metabolism in blades and ear bracts and N assimilation in all photosynthetic organs facilitated C/N remobilisation to the grain and promoted yield. Therefore, we propose that further yield gains in Mediterranean conditions could be achieved by considering the source-sink dynamics and the contribution of non-foliar organs, particularly N assimilation and remobilisation during the late growth stages. We highlight the power of linking phenotyping with plant metabolism to identify novel traits at the whole plant level to support breeding programmes.

Tissue engineering in otology: a review of achievements

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

A Novel Ear Impression-Taking Method Using Structured Light Imaging and Machine Learning: A Pilot Proof of Concept Study with Patients' Feedback on Prototype

INTRODUCTION

Taking an ear impression is a minimally invasive procedure. A review of existing literature suggests that contactless methods of scanning the ear have not been developed. We proposed to establish a correlation between external ear features with the ear canal and with this proof of concept to develop a prototype and an algorithm for capturing and predicting ear canal information.

METHODS

We developed a novel prototype using structured light imaging to capture external images of the ear. Using a large database of existing ear impression images obtained by traditional methods, correlation analyses were carried out and established. A deep neural network was devised to build a predictive algorithm. Patients undergoing hearing aid evaluation undertook both methods of ear impression-taking. We evaluated their subjective feedback and determined if there was a close enough objective match between the images obtained from the impression techniques.

RESULTS

A prototype was developed and deployed for trial, and most participants were comfortable with this novel method of ear impression-taking. Partial matching of the ear canal could be obtained from the images taken, and the predictive algorithm applied for a few sample images was within good standard of error with proof of concept established.

DISCUSSION

Further studies are warranted to strengthen the predictive capabilities of the algorithm and determine optimal prototype imaging positions so that sufficient ear canal information can be obtained for three-dimensional printing. Ear impression-taking may then have the potential to be automated, with the possibility of same-day three-dimensional printing of the earmold to provide timely access.

Gaze Patterns of Normal and Microtia Ears Pre- and Post-Reconstruction

OBJECTIVES

To understand attentional preferences for normal and microtia ears.

METHODS

Eye-tracking technology was used to characterize gaze preferences. A total of 71 participants viewed images of 5 patients with unilateral microtia. Profile images of patient faces and isolated ears including normal, microtia, and post-reconstruction microtia ears were shown. Total time of fixation in predefined areas of interest (AOI) was measured. Inferential statistics were used to assess significance of fixation differences between AOIs within and between facial or auricular features.

RESULTS

The ear received most visual attention in lateral view of the face (1.91 s, 1.66-2.16 s) [mean, 95% CI], followed by features of the "central triangle"-the eyes (1.26 s, 1.06-1.46), nose (0.48 s, 0.38-0.58), and mouth (0.15 s, 0.15-0.20). In frontal view, microtia ears received less attention following surgical reconstruction (0.74 s vs. 0.4 s, p < 0.001). The concha was the most attended feature for both normal (2.97 s, 2.7-3.23) and reconstructed microtia ears (1.87 s, 1.61-2.13). Scars on reconstructed ears altered the typical visual scanpath.

CONCLUSION

The ear is an attentional gaze landmark of the face. Attention to microtia ears, both pre- and post-reconstruction, differs from gaze patterns of normal ears. The concha was the most attended to subunit of the ear. Attentional gaze may provide an unbiased method to determine what is important in reconstructive surgery.

LEVEL OF EVIDENCE

N/A Laryngoscope, 2024.

Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery

Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.

Cocaine-associated Eustachian tube stenosis causing chronic 'glue ear': a rare cocaine-induced destructive lesion

BACKGROUND

Cocaine is one of the most used recreational drugs. Whilst medical uses exist, chronic recreational nasal use of cocaine is associated with progressive destruction of the osseocartilaginous structures of the nose, sinuses and palate - termed cocaine-induced midline destructive lesions.

CASE REPORT

A 43-year-old male with a history of chronic cocaine use, presented with conductive hearing loss and unilateral middle-ear effusion. Examination under anaesthesia revealed a completely stenosed left Eustachian tube orifice with intra-nasal adhesions. The adhesions were divided and the hearing loss was treated conservatively with hearing aids. Whilst intra-nasal cocaine-induced midline destructive lesions are a well-described condition, this is the first known report of Eustachian tube stenosis associated with cocaine use.

CONCLUSION

This unique report highlights the importance of thorough history-taking, rhinological and otological examination, and audiometric testing when assessing patients with a history of chronic cocaine use. This paper demonstrates the complexity of managing hearing loss in such cases, with multiple conservative and surgical options available.

An Initial Validation of Community-Based Air-Conduction Audiometry in Adults With Simulated Hearing Impairment Using a New Web App, DigiBel: Validation Study

BACKGROUND

Approximately 80% of primary school children in the United States and Europe experience glue ear, which may impair hearing at a critical time for speech acquisition and social development. A web-based app, DigiBel, has been developed primarily to identify individuals with conductive hearing impairment who may benefit from the temporary use of bone-conduction assistive technology in the community.

OBJECTIVE

This preliminary study aims to determine the screening accuracy and usability of DigiBel self-assessed air-conduction (AC) pure tone audiometry in adult volunteers with simulated hearing impairment prior to formal clinical validation.

METHODS

Healthy adults, each with 1 ear plugged, underwent automated AC pure tone audiometry (reference test) and DigiBel audiometry in quiet community settings. Threshold measurements were compared across 6 tone frequencies and DigiBel test-retest reliability was calculated. The accuracy of DigiBel for detecting more than 20 dB of hearing impairment was assessed. A total of 30 adults (30 unplugged ears and 30 plugged ears) completed both audiometry tests.

RESULTS

DigiBel had 100% sensitivity (95% CI 87.23-100) and 72.73% (95% CI 54.48-86.70) specificity in detecting hearing impairment. Threshold mean bias was insignificant except at 4000 and 8000 Hz where a small but significant overestimation of threshold measurement was identified. All 24 participants completing feedback rated the DigiBel test as good or excellent and 21 (88%) participants agreed or strongly agreed that they would be able to do the test at home without help.

CONCLUSIONS

This study supports the potential use of DigiBel as a screening tool for hearing impairment. The findings will be used to improve the software further prior to undertaking a formal clinical trial of AC and bone-conduction audiometry in individuals with suspected conductive hearing impairment.

A Novel Evaluation Model for Assessing ChatGPT on Otolaryngology-Head and Neck Surgery Certification Examinations: Performance Study

BACKGROUND

ChatGPT is among the most popular large language models (LLMs), exhibiting proficiency in various standardized tests, including multiple-choice medical board examinations. However, its performance on otolaryngology-head and neck surgery (OHNS) certification examinations and open-ended medical board certification examinations has not been reported.

OBJECTIVE

We aimed to evaluate the performance of ChatGPT on OHNS board examinations and propose a novel method to assess an AI model's performance on open-ended medical board examination questions.

METHODS

Twenty-one open-ended questions were adopted from the Royal College of Physicians and Surgeons of Canada's sample examination to query ChatGPT on April 11, 2023, with and without prompts. A new model, named Concordance, Validity, Safety, Competency (CVSC), was developed to evaluate its performance.

RESULTS

In an open-ended question assessment, ChatGPT achieved a passing mark (an average of 75% across 3 trials) in the attempts and demonstrated higher accuracy with prompts. The model demonstrated high concordance (92.06%) and satisfactory validity. While demonstrating considerable consistency in regenerating answers, it often provided only partially correct responses. Notably, concerning features such as hallucinations and self-conflicting answers were observed.

CONCLUSIONS

ChatGPT achieved a passing score in the sample examination and demonstrated the potential to pass the OHNS certification examination of the Royal College of Physicians and Surgeons of Canada. Some concerns remain due to its hallucinations, which could pose risks to patient safety. Further adjustments are necessary to yield safer and more accurate answers for clinical implementation.

Complete Salvage of Third-degree Burn of Ear by Repairing Gel-PRP-Fibrin Glue, A Case Report

The ear is a very important facial feature and enhances the overall look of the face. Usually, patients with entire ear burns also have large areas of burn in their bodies. To save the patient, skin grafting to reduce the injured body surface area is prioritized and the treatment of the ears may be inevitably delayed, which results in minor to very severe cosmetic deformity. This has a deep effect on the life quality of a patient who survives a burn injury. Therefore, any step that decreases ear deformity or loss is very crucial for the patient. There are different challenging procedures for ear reconstruction which are very tedious works. In this study, for one patient, repairing gel-platelet-rich plasma-fibrin glue was applied for the treatment of a deep dermal burned ear as a novel, non-invasive, and simple approach to give a normal shape to the ear to prevent extensive morbidity during the acute phase and deformities later as a consequence of burns. No keloid is observed after treatment.

Laterality and otorhinolaryngology: a review

BACKGROUND

Laterality of paired organs involves the function of the eyes, ears, hands and feet. Whilst most people have a right-handed preference, about 10 per cent are left-handed. Similarly, the right eye is usually preferred to the left. Medicine is both taught and practised for those with right hand and eye preference, and left-handed medical students and doctors must negotiate the right-handed world.

OBJECTIVE

This brief review looks at society's attitudes, medical training and the practice of otolaryngology in the UK towards laterality and handedness.

METHOD

Literature review.

RESULTS

Studies suggest that left-handers are more versatile and so are more ambidextrous. Conversely, this may result in problems when a right-hander tries to undertake a procedure with the non-dominant hand.

CONCLUSION

Cultures and attitudes are changing towards those who are left-handed. Left-handed surgeons may encounter difficulties in the clinical environment throughout their training.

An electronic nose can identify humans by the smell of their ear

Terrestrial mammals identify conspecifics by body odor. Dogs can also identify humans by body odor, and in some instances, humans can identify other humans by body odor as well. Despite the potential for a powerful biometric tool, smell has not been systematically used for this purpose. A question arising in the application of smell to biometrics is which bodily odor source should we measure. Breath is an obvious candidate, but the associated humidity can challenge many sensing devices. The armpit is also a candidate source, but it is often doused in cosmetics. Here, we test the hypothesis that the ear may provide an effective source for odor-based biometrics. The inside of the ear has relatively constant humidity, cosmetics are not typically applied inside the ear, and critically, ears contain cerumen, a potent source of volatiles. We used an electronic nose to identify 12 individuals within and across days, using samples from the armpit, lower back, and ear. In an identification setting where chance was 8.33% (1 of 12), we found that we could identify a person by the smell of their ear within a day at up to ~87% accuracy (~10 of 12, binomial P < 10-5), and across days at up to ~22% accuracy (~3 of 12, binomial P < 0.012). We conclude that humans can indeed be identified from the smell of their ear, but the results did not imply a consistent advantage over other bodily odor sources.

Clinical Observations of a Surgical Method Comprising a Combination of Cross Flap and Autologous Auricular Cartilage Transplantation in the Treatment of Type I to III Congenital Concha-Type Microtia

OBJECTIVES

The present study attempted to investigate the clinical efficacy of a surgical method involving a combination of cross flap with autologous auricular cartilage transplantation in the treatment of type I to III congenital concha-type microtia.

METHODS

The present retrospective study was conducted on the clinical and postoperative data of 50 patients with unilateral type I to III concha-type microtia treated with a combination of cross flap and autologous auricular cartilage transplantation at the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2018 to December 2021.

RESULTS

The postoperative perimeters of malformed ears were significantly larger than the preoperative perimeters (P < .05). Of the total, 2 patients exhibited incision dehiscence, 3 patients exhibited incision infection, 2 patients exhibited flap hematoma, and 1 patient exhibited ischemic necrosis at the flap tip. The satisfaction rate of the patients and their families was 100%.

CONCLUSIONS

The surgical method involving a combination of cross flap and autogenous auricular cartilage transplantation was effective in treating patients with type I to III congenital concha-type microtia, and therefore, this surgical approach can be applied widely to correct this deformity.

Rare oto-tricho-tussia/tinnitus: A case report

Key clinical message

Oto-tricho is associated with the symptoms of gag reflex and non-neuropathic tinnitus, which can be treated by removing the hair and its follicle.

Abstract

Oto-tricho refers to a disorder of hair growth in the tympanic membrane (TM). In its early stages, it can manifest as symptoms such as tinnitus, chronic pain, cough, and nausea. If left untreated, it can potentially lead to tympanosclerosis, TM micro-perforation, and hearing loss. In this report, we present a case study of a 33-year-old male with hair and follicle growth observed on the left TM. Over the course of the past year, the patient experienced various symptoms including tinnitus, dry cough, and chronic pain. An examination with an otoscope revealed the presence of oto-tricho-tussia/tinnitus. To address the issue, the hair and hair follicles were surgically removed using direct visual guidance. Subsequent follow-up was conducted over a period of 5 months, during which no pain or infection was observed at the site of the TM. The patient's previous symptoms were successfully resolved. Furthermore, further observation of the TM revealed no evidence of hair follicles or hair regrowth.

Single-stage reconstruction of a large defect of the ear

To reconstruct a large anterior skin and cartilage defect of the upper half of the external ear in an elderly patient after cancer surgery, different techniques are possible, but single-stage procedures should be advised. Combining flaps with reliable vascular supply, like the revolving door post-auricular flap and a mastoid advancement flap, is an attractive single-stage reconstructive option to rebuild a sturdy auricle.

Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications-Pictorial Review

Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.

Endoscopic-Indocyanine Green Angiography Assisted Microtia Reconstruction

Described herein is an innovative, minimally-invasive technique to harvest temporoparietal fascia flap used in implant-based ear reconstruction for children with microtia. This technique utilizes a never previously described application of intra-operative Indocyanine Green Angiography to optimize flap viability and minimizing the risk of facial nerve injury. Laryngoscope, 133:3615-3618, 2023.

Aural myiasis in Ancient Rome: Celsus and the ear maggots

OBJECTIVE

Although today there is extensive scientific literature on aural myiasis, a historical study of the subject has yet to appear. This short article reports the first description of aural myiasis in the Western medical literature.

METHODS

Methods involved: (1) scholarship review of ear diseases within Ancient Greek and Roman medical texts (L'Année philologique); (2) linguistic analysis for text identification through the Library of Latin Texts, the Thesaurus Linguae Latinae and the Loeb Classical Library; and (3) translation of the Latin texts that described cases of aural myiasis with commentary.

RESULTS

To our knowledge, the earliest case of aural myiasis in Latin medical literature is reported by the Roman encyclopaedist Celsus (first century CE). In his De Medicina, he describes cases of Wohlfahrtia magnifica maggot infestation of the ear and how to treat affected patients.

CONCLUSION

Despite present advances in otology, we believe that much insight can still be gained from this ancient example of medical history in ear diseases. A more comparative analysis of the subject is to be considered in the future, which will provide more data from different cultures and times.

Relationship Between Dermoscopic Capillary-Related Features of the Auricle and Earlobe and Rosacea Subtype and Disease Severity: A Cross-Sectional Analysis

Background and Aim

Clinical manifestations of rosacea include transient or persistent facial erythema, telangiectasia, papules, and pustules. The existing assessment tools primarily evaluate the facial area to assess the severity of rosacea. However, in addition to the face, telangiectasia, erythema, and flushing can occur in the ear. Here, we investigated the correlation between the dermoscopic characteristics of capillaries in the earlobe and auricle and the types and severity of rosacea.

Materials and Methods

Experienced dermatologists evaluated the clinical type, medical history, severity, and distribution pattern of facial erythema. The clinical severity of rosacea was assessed using the standard grading system (SGS), clinician's erythema assessment (CEA), and investigator's global assessment (IGA). Relationships of the clinical types and severity with the dermoscopic characteristics of capillaries in the earlobe and auricle were further analyzed.

Results

In total, 145 patients with rosacea were enrolled in this study. We found that SGS, CEA, and IGA correlated well with the dermoscopic features of capillaries in the earlobe (R = 0.357, 0.357, and 0.314, respectively) (p < 0.001) and auricle (R = 0.423, 0.443, and 0.374, respectively) (p < 0.001). However, there was no significant correlation between the features and types of rosacea.

Conclusion

The dermoscopic characteristics of capillaries in the earlobe and auricle can be used as indicators of the clinical severity of rosacea, regardless of the clinical subtype.

Early life programming by diet can play a role in risk reduction of otitis in dogs

Introduction

Otitis in dogs is often chronic while local treatment primarily consists of flushing, antibiotics, and/or antifungals. We were interested in finding early life variables that associate with otitis later in life, preferably some that could be modified.

Methods

A cross-sectional hypothesis-driven study with longitudinal data was performed to search for associations between pre- and postnatal exposures, and the incidence of owner-reported otitis in dogs at over 1 year of age. The multivariate logistic regression analysis study included data from 3,064 dogs and explored 26 different early life variables at four early life stages: prenatal, neonatal, postnatal, and puppyhood. We compared two feeding patterns, a non-processed meat-based diet (NPMD, raw) and an ultra-processed carbohydrate-based diet (UPCD, dry).

Results

We report that eating a NPMD diet significantly decreased the risk of otitis later in life, while eating a UPCD diet significantly increased the risk. This was seen in different life stages of mother or puppy: The maternal diet during pregnancy (p=0.011) and the puppies' diet from 2 to 6 months of age (p=0.019) were both significantly associated with otitis incidence later in life, whereas the puppies' first solid diet, was associated in the same way, but did not reach significance (p=0.072). Also, analyzing food ratios showed that when puppies were consuming >25% of their food as NPMD it significantly decreased their incidence of otitis later in life, while a ratio of >75% UPCD in their diet significantly increased their risk of otitis. Also, if the dog was born in the current family, was exposed to sunlight for more than 1 hour daily, and was raised on a dirt floor during puppyhood, there was a lower risk of otitis development later in life.

Discussion

The findings only suggest causality, and further studies are required. However, we propose that veterinarians, breeders, and owners can impact otitis risk by modifying factors such as diet and environment.

Curettage and colour-A technique for defining tumour depth on the ear in the Mohs and non-Mohs setting

For tumours of the ear that are suspected to involve auricular cartilage, precise definition of the extent of involved deep margin can be difficult. As large resections of cartilage can be cosmetically disfiguring with limited repair options, we propose a simple and effective technique to facilitate a targeted deep margin resection using a curette and a surgical marking pen.

A Systematic Review on Metabolomics Analysis in Hearing Impairment: Is It a Possible Tool in Understanding Auditory Pathologies?

With more than 466 million people affected, hearing loss represents the most common sensory pathology worldwide. Despite its widespread occurrence, much remains to be explored, particularly concerning the intricate pathogenic mechanisms underlying its diverse phenotypes. In this context, metabolomics emerges as a promising approach. Indeed, lying downstream from molecular biology's central dogma, the metabolome reflects both genetic traits and environmental influences. Furthermore, its dynamic nature facilitates well-defined changes during disease states, making metabolomic analysis a unique lens into the mechanisms underpinning various hearing impairment forms. Hence, these investigations may pave the way for improved diagnostic strategies, personalized interventions and targeted treatments, ultimately enhancing the clinical management of affected individuals. In this comprehensive review, we discuss findings from 20 original articles, including human and animal studies. Existing literature highlights specific metabolic changes associated with hearing loss and ototoxicity of certain compounds. Nevertheless, numerous critical issues have emerged from the study of the current state of the art, with the lack of standardization of methods, significant heterogeneity in the studies and often small sample sizes being the main limiting factors for the reliability of these findings. Therefore, these results should serve as a stepping stone for future research aimed at addressing the aforementioned challenges.

Sinonasal and ear manifestations of Erdheim-Chester disease

To calculate the prevalence of sinonasal and ear involvement in an Erdheim-Chester disease (ECD) population, to describe the different ear, nose and throat (ENT) manifestations and to study the association between ENT involvement, other organ involvement, and BRAF mutations. We led a retrospective monocentric study in the national referral center for ECD. One hundred and sixty-two patients with ECD and ENT data were included between January 1, 1980 and December 31, 2020. Ear and nose clinical and radiological findings were noted. We described and studied the prevalence of ENT involvement in ECD population. The association between sinonasal and ear involvement, other organ involvement, and BRAF mutations was calculated. The prevalence of ENT manifestations is around 45%. No clinical rhinologic or otologic signs were specific to ECD. Sinus imaging was abnormal in 70% of cases. A bilateral maxillary sinus frame osteosclerosis was highly specific of ECD. Associations were found between the sinus MRI imaging type and BRAF status, central nervous system involvement, cerebellum involvement and xanthelasma. Sinonasal or ear involvement is frequent in ECD and has specific imaging features for sinuses. Trial registration: #2011-A00447-34.

External Auditory Canal: Computed Tomography Analysis and Classification

Introduction  Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective  To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods  The CT scans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results  At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ± 0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ± 1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ± 0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion  This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.

Comparison of the quantity and antimicrobial activity of host defence peptides in ear canals between healthy and atopic dogs: A preliminary study

BACKGROUND

Host defence peptides (HDPs) are involved in cutaneous immune defence. The secretion of HDPs in the ears of healthy normal and noninfected atopic dogs has not been measured.

HYPOTHESES/OBJECTIVES

The aim of this study was to quantify the concentrations of β-defensins (cBD3)-like and cathelicidin (cCath) HDPs in ears of healthy and atopic dogs without infectious otitis, additionally to evaluate the antimicrobial effect of the HDPs obtained.

ANIMALS

Ten healthy and 20 atopic dogs with mild inflammatory, noninfectious otitis were included.

MATERIALS AND METHODS

Absence of infection was determined by cytological evaluation, and the severity of clinical signs, if present, was assessed by a previously validated score (Otitis Externa Scoring System for Clinical Study, OTIS-3). The left ear canal of each dog was rinsed with 2 mL of sodium phosphate buffer. The solution obtained was analysed by enzyme-linked immunosorbent assay to quantify HDPs. Additionally, aural secretions were incubated with two concentrations (5 × 105 and 5 × 104 colony-forming units/mL) of Staphylococcus pseudintermedius and the bacterial density measured after 24 h of incubation. Data were statistically analysed. Significance was set as p ≤ 0.05.

RESULTS

There was a significantly lower concentration of HDPs from atopic ears when compared with those from normal healthy dogs (cBD3-like: p = 0.0007; cCath: p = 0.049). There was minimal to variable antimicrobial activity in the aural secretions of both groups.

CONCLUSIONS AND CLINICAL RELEVANCE

This study showed, for the first time, that the ear canals of atopic dogs with mild noninfectious otitis contain a lower concentration of cBD3-like and cCath HDPs than those of healthy dogs with normal ears. A consistent antimicrobial activity was not present in the aural secretions from either group.

Clinical Observation on Auricular Acupressure for Primary Dysmenorrhea: A Study Protocol for a Randomized Clinical Trial

Purpose

The objective of this study is to evaluate the immediate and time-dependent effects of AA in treating PD and assess its safety.

Methods/Design

This study is a randomized, single-blinded, controlled trial that will enroll 92 patients in a 1:1 allocation ratio. Patients will be assigned to either the treatment group (n=46) or the control group (n=46). During the first menstrual period, the treatment group will receive AA treatment, while the control group will receive sham AA treatment for 7 days. The second menstrual period will serve as the follow-up period. The primary outcome measure is the Visual Analog Scale (VAS) score 30 min after the first treatment. Secondary outcome measures include the VAS score immediately after the first treatment, onset time of analgesic effect, duration of pain, extra dosing rate of ibuprofen, and change of the Menstrual Distress Questionnaire (MDQ) score. The outcomes will be assessed at baseline, during the intervention period, and during the follow-up period.

Conclusion

The study results will provide evidence on the efficacy and safety of AA in managing PD by analyzing its immediate effect, time-effect relationship, and reduction of painkiller use.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR2300069741).

Are artificial intelligence large language models a reliable tool for difficult differential diagnosis? An a posteriori analysis of a peculiar case of necrotizing otitis externa

Key Clinical Message

Large language models have made artificial intelligence readily available to the general public and potentially have a role in healthcare; however, their use in difficult differential diagnosis is still limited, as demonstrated by a case of necrotizing otitis externa.

Abstract

This case report presents a peculiar case of necrotizing otitis externa (NOE) with skull base involvement which proved diagnostically challenging. The initial patient presentation and the imaging performed on the 78-year-old patient suggested a neoplastic rhinopharyngeal lesion and only after several unsuccessful biopsies the patient was transferred to our unit. Upon re-evaluation of the clinical picture, a clinical hypothesis of NOE with skull base erosion was made and confirmed by identifying Pseudomonas aeruginosa in biopsy specimens of skull base bone and external auditory canal skin. Upon diagnosis confirmation, the patient was treated with culture-oriented long-term antibiotics with complete resolution of the disease. Given the complex clinical presentation, we chose to submit a posteriori this NOE case to two large language models (LLM) to test their ability to handle difficult differential diagnoses. LLMs are easily approachable artificial intelligence tools that enable human-like interaction with the user relying upon large information databases for analyzing queries. The LLMs of choice were ChatGPT-3 and ChatGPT-4 and they were requested to analyze the case being provided with only objective clinical and imaging data.

Tomodensitometric and histological age-related changes in the normal feline middle and inner ear

Deafness in cats may be due to acquired causes such as aging. Similar age-related morphological changes in the cochlea have been noted in several animal species. However, little is known about the effects of age on the morphology of the middle and inner ear in cats. The aim of the present study was to compare these structures in middle-aged and geriatric cats using computed tomography and histological morphometric analysis. Data were obtained from 28 cats, aged 3-18 years, with no hearing or neurological disorders. Computed tomography showed an increase in tympanic bulla (middle ear) volume with aging. Histological morphometric analysis revealed thickening of the basilar membrane and atrophy of the stria vascularis (inner ear) in older cats, similar to what has been observed in older humans and dogs. Nevertheless, histological procedures could be improved to provide more data for comparison with different forms of presbycusis in humans.

Successful Treatment of Recurrent Earlobe Keloid Through Removal of Concealed Underlying Epidermoid Cysts: A Case Report

In modern clinical practice, earlobe keloids demonstrate a high cure rate through surgical intervention and suitable adjuvant therapies. Furthermore, the concurrence of keloids and epidermoid cysts is uncommon, potentially attributed to the lack of skin appendages within keloid tissue. This case report presents the successful treatment of a recurrent earlobe keloid through the removal of concealed underlying epidermoid cysts. The lesion recurred even after the second excision and proper adjuvant treatments. It was finally stabilized following the removal of epidermoid cysts within the earlobe at the third surgical procedure. These findings emphasize the importance of identifying underlying conditions associated with keloids and addressing inflammation, as these factors significantly influence treatment outcomes and resistance.

Laryngeal tuberculosis: about 04 cases

The purpose of this study is to present epidemiological, clinical, radiological, histological characteristics and treatment of laryngeal tuberculosis. It is also aimed at making the point about diagnosis difficulties. This retrospective study was conducted over three years; it concerned 4 cases, 3 males and one female. The average age was 35 years. Three of the 4 cases have had a cervical CT scan. All patients have had a laryngoscopy with biopsy and anatomopathological study. The onset modes of the disease have been progressive for all the patients. Topographical study has shown two epiglottic locations, one at the vocal cords and the other one at the posterior commissure. The diagnosis was orientated in the 3 cases by the CT scan and confirmed by anatomopathological exam in all cases. All patients have received anti-TB drugs with good evolution. The laryngeal location of tuberculosis is unusual. The clinical picture is nonspecific, raising the issue of differential diagnosis with tumor pathology. Sectional imaging and CT scan can guide the diagnosis and a positive diagnosis is often discovered on the occasion of a tumor biopsy of a pseudo-tumor lesion. Treatment is based on anti-TB drugs.

A Continuously Worn Dual Temperature Sensor System for Accurate Monitoring of Core Body Temperature from the Ear Canal

The objective of this work was to develop a temperature sensor system that accurately measures core body temperature from an ear-worn device. Two digital temperature sensors were embedded in a hearing aid shell along the thermal gradient of the ear canal to form a linear heat balance relationship. This relationship was used to determine best fit parameters for estimating body temperature. The predicted body temperatures resulted in intersubject limits of agreement (LOA) of ±0.49 °C over a range of physiologic and ambient temperatures without calibration. The newly developed hearing aid-based temperature sensor system can estimate core body temperature at an accuracy level equal to or better than many devices currently on the market. An accurate, continuously worn, temperature monitoring and tracking device may help provide early detection of illnesses, which could prove especially beneficial during pandemics and in the elderly demographic of hearing aid wearers.

Staging System Performance and Clinical Outcomes for Cutaneous Squamous Cell Carcinoma of the Ear: A Single-Center Retrospective Study

BACKGROUND

Cutaneous squamous cell carcinoma (cSCC) of the ear is associated with poor outcomes. No studies have evaluated current staging system performance in this specific location.

OBJECTIVE

Describe clinicopathologic characteristics and outcomes of ear cSCC and evaluate the performance of current staging systems.

METHODS

Retrospective study including cases diagnosed and treated at a cancer center from January 2000 to December 2014. Demographic, clinical, and pathologic data were collected from clinical records. Biopsy slides were rereviewed and patients were staged according to the American Joint Committee on Cancer (AJCC) seventh, eighth, and Brigham Women's Hospital (BWH) staging.

RESULTS

Of 125 patients, the mean age at diagnosis was 71.9 years (SD 12.5), with most men (89.6%, n = 112). Median follow-up was 22.3 months. Local recurrence and survival risk factors were similar to cSCC outside the ear. The Akaike's Information Criterion (AIC) estimates showed that the BWH system better predicted outcomes than the AJCC seventh, and the AJCC eighth, with AIC values of 189.9, 270.5, and 274.1, respectively. Limitations of the study include retrospective design, single center study, and no control group.

CONCLUSION

Current staging systems perform well at stratifying risk in ear cSCC.

Concurrent Occurrence of Ear Tag With Posterior Talon Cusp, Fissured Tongue, and Ankyloglossia: A Case Report

Ear tags or accessory auricles are branchial cleft remnants that clinically appear as asymptomatic nodules or papules in the preauricular region. They occur in various syndromes affecting the first and branchial arches during embryogenesis. The presence of an ear tag can have a psychological impact on one's life due to its unesthetic appearance, thereby affecting their quality of life. Talon cusp usually occurs in the maxillary central or lateral incisor. A fissured tongue or cerebriform tongue is characterized by the presence of horizontal or vertical grooves, usually affecting the dorsum of the tongue. Ankyloglossia or tongue-tie is a developmental anomaly in which the lingual frenum is abnormally attached to the ventral surface of the tongue. It can cause difficulties in breastfeeding in infants and in the pronunciation of certain vowels in adults. The concurrent occurrence of the ear tag along with the talon cusp in the mandibular second molar has not been reported in previous literature. We present a unique case of a 24-year-old non-syndromic individual with the concurrent occurrence of the ear tag along with a rare clinical occurrence of talon cusp in the mandibular second molar, fissured tongue, and ankyloglossia.

Assessment of the efficacy of auricular conchal cartilage graft in repairing orbital floor fractures and its effect on diplopia: a nonrandomized clinical trial

Orbital fractures are a common sequela of maxillofacial zone trauma. Rapid assessment and management are essential for successful reconstruction. The selected treatment method depends on fracture types, accompanied injuries, and intervention time. Implantable grafts used to be from autologous materials. The study aimed to evaluate the effectiveness of using the auricular conchal cartilage taken from the ear to repair orbital floor fractures in cases of minimal bone loss, less than (2×2) cm.

Material and Methods

A prospective single-arm, nonrandomised clinical trial was conducted during the past 4 years (from 2018 to 2022). A total of 15 cases, who had visited the department of oral and maxillofacial surgery department with orbital floor fractures, were enrolled. The participants underwent conchal cartilage grafting for orbital floor fracture reconstruction. The time factor to perform the surgery after trauma had been considered. Patients were closely monitored for the development of double vision (diplopia) at 15 days, 1 month, and 3 months postsurgery.

Results

The results showed statistically significant differences during the follow-up period following the surgical procedure. They appeared to have complete restoration of eye movements, restoration of the normal positioning of the eyeball affected by the orbital floor fracture compared to the healthy eyeball, and regression of double vision (diplopia) throughout the follow-up period.

Conclusion

Using the auricular conchal cartilage graft in repairing fractures of the orbital floor resulted in the improvement of the functional aspect of the eyeball and the restoration of the esthetic aspect.

Clinical spectrum of ear, nose and throat foreign bodies at a tertiary hospital: a cross-sectional study

Presence of foreign bodies (FBs) in the ears and upper aerodigestive tract is a common encounter in children unlike adults in otorhinolaryngology practice. FBs form a major part of emergencies in otorhinolaryngology. Studies on ear, nose and throat FBs in Tanzania are scarce.

Objective

To determine the clinical spectrum of ear, nose and throat FBs at the largest tertiary hospital.

Methods

A descriptive hospital based cross-sectional study was conducted where 95 patients were recruited at the Hospital from December 2019 to May 2020. Data were collected using semi-structured questionnaires and analyzed using Statistical Package for the Social Sciences (SPSSs) version 24.

Results

In this study, there were more females, 56 (58.9%) than males, 39 (41.1%) with female to male ratio being 1.4:1. Children aged younger than 10 years predominated in this study, 69 (72.6%). The nose, 36 (37.9%) and ear, 29 (30.5%) were the commonest sites where FBs lodged followed by the pharynx, 22 (23.2%) and oesophagus, 10 (8.4%). Regarding types of FBs, inorganic types, 49 (51.6%) predominated and were mostly coins, 17 (17.9%). Majority of FBs were removed in less than 24 h (53.7%) and complications were found in 29 (30.5%) patients and being more pronounced with nasal FBs. Majority of those with complications presented to the hospital 24-72 h post lodging of FBs.

Conclusion

FBs were encountered more commonly in children aged younger than 10 years. The nose was the commonly affected anatomical site followed by the ear, pharynx and oesophagus. The commonest FB was a coin. The inorganic FB type predominated and the most common inorganic type was a coin while the commonest organic type was a seed. Complications were encountered in those who presented between 24 and 72 h post FB lodgment.

Middle ear cholesteatoma in two cats diagnosed with the aid of video-otoscopy

Case series summary

The present report describes middle ear cholesteatoma in two cats and also the use of video-otoscopy and flushing to assist with the diagnosis. CT and video-otoscopic examination and flushing were performed in two cats, a 13-year-old mixed breed spayed female cat and a 1-year-old mixed breed male cat, with middle ear cholesteatomas. During the procedure, keratinous material from the middle ears was collected for histopathological evaluation, demonstrating findings consistent with cholesteatoma, and the middle ears were flushed extensively.

Relevance and novel information

There is little information about middle ear cholesteatoma in cats, and to the authors' knowledge, there are no reports in cats investigating the use of video-otoscopy to aid in the diagnosis of aural cholesteatoma, and this report demonstrates that it can aid in the diagnosis of this condition in cats. In addition, one of the cats had a concurrent otic polyp, which has not been previously reported in cats with cholesteatoma. Additionally, this is the first report of cholesteatoma in a young cat. The access to the cholesteatoma material was via ventral bulla osteotomy in one cat and via external canal without video-otoscopy in the other. More information regarding cholesteatoma in cats will help identify potential similarities and differences of this condition in cats compared with humans and dogs.

Fluctuations in emergency department visits related to acute otitis media are associated with extreme meteorological conditions

Background

Climate change has been associated with a higher frequency of extreme weather events, resulting in an overall increase in morbidity and mortality. Acute otitis media (AOM) is one of the most common otolaryngological infections and accounts for 1.5% of emergency department visits. This study aimed to identify associations between extreme weather events and the immediate and delayed risks for AOM-related emergency department visits (EV).

Methods

A total of 1,465 AOM-related EVs were identified in the Vienna General Hospital between 2015 and 2018. A distributed lag non-linear model was applied to evaluate the relationship between extreme weather conditions and the total number of AOM-related EVs per day. The relative risk (RR) and cumulative RR (cRR) of single-day events and extended weather events over three days were analyzed over a lag period of 14 days.

Results

AOM-related EVs showed a pronounced seasonality, with the highest occurrence during winter. Single-day weather events affected AOM-related EVs only at high relative humidity. Prolonged extreme weather conditions over three days, however, significantly increased the cRR for AOM-related EVs to 3.15 [1.26-7.88; p = 0.014] and 2.14 [1.14-4.04; p = 0.018] at mean temperatures of -4°C (1^st-percentile - p₁) and 0°C (p₅) on the same day. Relative humidity of 37% (p₁) decreased RR to 0.94 [0.88-0.99; p = 0.032] on day 7, while extremely high humidity of 89% (p₉₉) led to an increased cRR of 1.43 [1.03-2.00; p = 0.034] on day 7. Heavy prolonged precipitation of 24mm (p₉₅) reduced cRR beginning day 4 up until day 14 to 0.52 [0.31-0.86; p = 0.012]. Prolonged low atmospheric pressure events of 985hPa (p₅) reduced the RR to 0.95 [0.91-1.00; p = 0.03], whereas extremely high atmospheric pressure events of 1013hPa (p₉₉) increased the RR to 1.11 [1.03-1.20; p = 0.008]. Extremely low wind speeds significantly diminished the RR of AOM-related EVs.

Conclusions

While single-day extreme weather events had little impact on the occurrence of AOM-related EVs, extended periods of extreme temperatures, relative humidity, precipitation, wind speeds and atmospheric pressure significantly impacted the RR for AOM-related EVs. These findings could help improve healthcare resource allocation in similar climates and aid in educating patients about the role of environmental factors in AOM.

Long-standing laryngeal rhinoscleroma with rare Mikulicz cells

Rhinoscleroma is an infectious granulomatous disease. It is important to identify pathognomonic Mikulicz cells on microscopy, as these can be rare and the chronic inflammatory infiltrate can appear otherwise nonspecific on biopsies.

Hospital Admission Profile Related to Inner Ear Diseases in England and Wales

BACKGROUND

Due to an expansion in the usage of medications (such as anticancer therapies), increased exposure to noise, and an increase in life expectancy, the prevalence of inner ear disease-related hearing loss is rising. Diseases of the inner ear are frequently accompanied by other conditions, such as chronic heart failure, systemic inflammation, arterial hypertension, and cerebrovascular disease. The aim of this study was to investigate the profile of hospital admissions linked to inner ear diseases in England and Wales.

METHOD

This was an ecological descriptive study using public medical databases in England and Wales. Diagnostic codes for diseases of the inner ear (H80-H83) were used to identify all hospital admissions. Between 1999 and 2020, the chi-squared test was used to assess the difference between the admission rates.

RESULTS

From 5704 in 1999 to 19,097 in 2020, the total annual number of hospital admissions increased by 234.8%, which corresponds to a 192.3% increase in the admission rate [from 10.94 (95% CI 10.66-11.22) in 1999 to 31.98 (95% CI 31.52-32.43) in 2020 per 100,000 people, p < 0.01]. "Disorders of vestibular function" and "other inner ear diseases" were the most frequent causes of hospital admissions due to inner ear diseases, accounting for 47.6% and 43.6%, respectively. The age range of 15 to 59 years accounted for 42.3% of all diseases of the inner ear hospital admissions. Around 59.6% of all admissions were made by females. The female admission rate increased by 210.1% (from 12.43 (95% CI 12.01-12.85) in 1999 to 38.54 (95% CI 37.84-39.24) in 2020 per 100,000 people). The male admission rate for diseases of the inner ear increased by 169.6% [from 9.37 (95% CI 9.00-9.75) in 1999 to 25.26 (95% CI 24.69-25.84) per 100,000 people] in 2020.

CONCLUSION

Inner ear disease admissions increased markedly in England and Wales during the past two decades. Females and the middle-aged population were at higher risk of being admitted for inner ear diseases. Further cohort studies are warranted to identify other risk factors and develop effective prevention strategies.

Skull base osteomyelitis with extensive bony erosion complicated by venous sinus thrombosis

Skull base osteomyelitis (SBO) mimics the presentation of various conditions, including solid tumors. Computed tomography-guided core biopsy for culture informs antibiotic selection, and with intravenous corticosteroids, may minimize chronic neurologic dysfunction. Although SBO predominantly affects individuals who are diabetic or immunocompromised, it is important to be able to recognize SBO presenting in an otherwise healthy individual.

A Rare Presentation of Donkey Bites Involving the Cheek and Ear: A Case Report and Literature Review

Although animal bites account for a fair number of emergency department visits, donkey bites account for a very limited proportion. A 12-year-old boy presented to our department with a severe donkey bite involving his face. The injury included his left cheek with a laceration of the left ear cartilage. The examination revealed no serious morbidity (no vascular or nerve involvement). The patient received prophylactic antibiotics and anti-rabies/anti-tetanus vaccination. The wound was cleaned thoroughly with copious irrigation. Afterward, the patient underwent surgery to correct the defect in the cheek using a rotational advancement cervicofacial flap, while the penetrated ear cartilage was repaired and the skin margins were approximated and sutured. During the follow-up period, no complications were observed and the functional and cosmetic outcomes were satisfactory. Donkey bites are rarely encountered and they can result in different presentations and morbidities/outcomes. It is suggested that the timing from the bite injury to presentation, the stage/extent of the bite, the use of anti-tetanus and anti-rabies vaccines, and the prophylactic use of antibiotics may play a role in determining the outcomes and/or complications of donkey bites.

Stage-dependent localization of F-actin and Na+ /K+ -ATPase in zebrafish embryos detected using optimized cryosectioning immunostaining protocol

The increasing use of the zebrafish model in biomedical and (eco)toxicological studies aimed at understanding the function of various proteins highlight the importance of optimizing existing methods to study gene and protein expression and localization in this model. In this context, zebrafish cryosections are still underutilized compared with whole-mount preparations. In this study, we used zebrafish embryos (24-120 hpf) to determine key factors for the preparation of high-quality zebrafish cryosections and to determine the optimal protocol for (immuno)fluorescence analyses of Na⁺ /K⁺ -ATPase and F-actin, across developmental stages from 1 to 5 dpf. The results showed that the highest quality zebrafish cryosections were obtained after the samples were fixed in 4% paraformaldehyde (PFA) for 1 h, incubated in 2.5% bovine gelatin/25% sucrose mixture, embedded in OCT, and then sectioned to 8 μm thickness at -20°C. Fluorescence microscopy analysis of phalloidin-labeled zebrafish skeletal muscle revealed that 1-h-4% PFA-fixed samples allowed optimal binding of phalloidin to F-actin. Further immunofluorescence analyses revealed detailed localization of F-actin and Na⁺ /K⁺ -ATPase in various tissues of the zebrafish and a stage-dependent increase in their respective expression in the somitic muscles and pronephros. Finally, staining of zebrafish cryosections and whole-mount samples revealed organ-specific and zone-dependent localizations of the Na⁺ /K⁺ -ATPase α1-subunit. RESEARCH HIGHLIGHTS: This study brings optimization of existing protocols for preparation and use of zebrafish embryos cryosections in (immuno)histological analyses. It reveals stage-dependent localization/expression of F-actin and Na⁺ /K⁺ -ATPase in zebrafish embryos.

Intratympanic Botulinum Toxin Injection as a New Therapeutic Modality for Middle Ear Myoclonic Tinnitus

OBJECTIVE

Middle ear myoclonic tinnitus (MEMT) is a disease caused by myoclonus or abnormal contractive movement of middle ear muscles (MEMs). This translational study was conducted to propose intratympanic botulinum toxin (IT-BTX) injection as a new therapeutic modality to treat MEMT.

STUDY DESIGN

Animal experiment and nonrandomized controlled clinical trial.

SETTING

Laboratory and medical center of an academic tertiary medical institution.

METHODS

For the animal study, male Sprague-Dawley rats were divided into 4 subgroups according to the sacrificing day after IT-BTX injection. After initial hearing tests, randomly assigned experimental ears were intratympanically injected with 1 unit/100 μL of BTX-A, whereas control ears were injected with normal saline. Changes in the hearing thresholds, morphometry of the cochleae, electron microscopy study, and immunofluorescence analysis of MEMs were evaluated. For the human study, 10 intractable MEMT patients were enrolled. The hearing thresholds and the degree of tinnitus distress were observed for changes after IT-BTX injection. All patients were followed up for 3 months.

RESULTS

As for the animal study, there were no significant changes in hearing thresholds and cochlear morphologies in all 4 subgroups of the rats. Significant MEM degenerations and immuno-detection of cleaved synaptosome-associated protein of 25 kDa (cSNAP-25) indicated the efficacy of IT-BTX. MEMT patients enrolled for the pilot clinical trial showed statistically significant improvement in tinnitus after IT-BTX injection. No major complications were noted.

CONCLUSION

The new therapeutic modality of IT-BTX injection for the treatment of MEMT seems highly promising with an excellent result.

Nodular Fasciitis of the Nose and External Auditory Canal: Two Rare Case Reports

Nodular fasciitis(NF) is a proliferative disease of fibroblasts and myofibroblasts that generally affects subcutaneous tissue, muscle tissue, and fascia. NF usually occurs in young adults aged 20-40 and is more common in the upper extremities and relatively rare in the region of the head and neck. Here, we report on two patients with NF in the ear and nose. Under general anesthesia, the masses of NF were completely resected along the safety margin. The patients recovered well after surgery and there was no recurrence after more than half a year of follow-up.

A Typical but Rare Case of Solitary Tinea Auricularis

Tinea auricularis is a rare superficial fungal infection, which is easily ignored in clinic due to its atypical clinical symptoms or being accompanied with tinea capitis. In this study, a case of annular erythema with scales around the ear canal orifice was reported. After fungal culture and identification, the patient was diagnosed with Trichophyton rubrum infection, and was cured after 3 weeks of topical use of clotrimazole cream.