Retrospective study on unilateral polyotia combined with microtia utilizing the technique of preserving residual ear tissue

BACKGROUND

The presence of polyotia in individuals with microtia is a rare deformity. Due to the intricate structure of the auricle, uncertain etiology, and challenging corrective techniques, it has always been a focal point in the field of plastic surgery. The present study presents a technique for correcting the combination of polyotia and microtia by utilizing residual ear tissue as graft material.

METHODS

The retrospective study included 23 patients with polyotia and microtia from 2018 to 2022. The residual ear tissue was used to rectify auricular deformities in all patients. The patients were instructed to evaluate the satisfaction of the auricle shape using a visual analog scale (VAS) both before and 6 months after the surgical procedure. The esthetic outcomes of auricle subunits were simultaneously assessed by a senior physician pre- and postoperatively.

RESULTS

The mean duration of follow-up in this study was 8.73 months. The preoperative VAS satisfaction score was recorded as 2.26 ± 0.86, while the post-operative VAS score significantly increased to 7.86 ± 0.86. The preoperative auricle esthetic outcomes score was recorded as 9.95 ± 1.74, while the post-operative score significantly increased to 24.04 ± 2.16. The follow-up period did not present any cases of flap necrosis, hematoma, infection, or wound dehiscence.

CONCLUSION

The study demonstrates that comprehensive utilization of residual auricular tissue can lead to optimal outcomes in correcting polyotia with concha-type microtia. The utilization of residual ear tissue can be maximized to streamline the operation, minimize bodily harm, and enhance patient satisfaction.

A systematic review of otologic injuries sustained in civilian terrorist explosions

PURPOSE

Determine the prevalence of otological symptoms and tympanic membrane perforation, healing rates of tympanic membrane perforation with surgical and conservative management, and hearing function in civilian victims of terrorist explosions.

METHODS

A systematic review was conducted with searches on Medline, Embase, EMCare and CINAHL for publications between the 1st January 1945 and 26th May 2023. Studies with quantitative data addressing our aims were included. This review is registered with PROSPERO: CRD42020166768. Among 2611 studies screened, 18 studies comprising prospective and retrospective cohort studies were included.

RESULTS

The percentage of eardrums perforated in patients admitted to hospital, under ENT follow up and attending the emergency department is 69.0% (CI 55.5-80.5%), 38.7% (CI 19.0-63.0%, I2 0.715%) and 21.0% (CI 11.9-34.3%, I2 0.718%) respectively. Perforated eardrums heal spontaneously in 62.9% (CI 50.4-73.8%, I2 0.687%) of cases and in 88.8% (CI 75.9-96.3%, I2 0.500%) of cases after surgery. Common symptoms present within one month of bombings are tinnitus 84.7% (CI 70.0-92.9%, I2 0.506%), hearing loss 83.0% (CI 64.5-92.9%, I2 0.505%) and ear fullness 59.7% (CI 13.4-93.4%, I2 0.719). Symptomatic status between one and six months commonly include no symptoms 57.5% (CI 46.0-68.3%), hearing loss 35.4% (CI 21.8-51.8%, I2 0.673%) and tinnitus 15.6% (CI 4.9-40.0%, I2 0.500%). Within one month of bombings, the most common hearing abnormality is sensorineural hearing loss affecting 26.9% (CI 16.9-40.1%, I2 0.689%) of ears 43.5% (CI 33.4-54.2%, I2 0.500) of people.

CONCLUSION

Tympanic membrane perforation, subjective hearing loss, tinnitus, ear fullness and sensorineural hearing loss are common sequelae of civilian terrorist explosions.

Relocation of polyotia tissue to reconstruct the tragus and fill the preauricular depression

OBJECTIVES

The present article introduces a lingual composite tissue flap based on the tragus-like structure for correcting polyotia deformity, with the aim of providing a surgical technique that involves relocating polyotia tissue to reconstruct the tragus and fill the preauricular depression.

METHODS

The study included a total of 21 patients with polyotia who underwent lingual composite tissue flap reconstruction between January 2020 to December 2022. Patients were retrospectively assessed through a comprehensive review of their medical records and photographic data. Tragus morphology was evaluated based on the measurements of tragus length and width. The Aesthetic Outcomes Scale (AOS), modified Vancouver Scar Scale (mVSS), and Visual Analogue Scale (VAS) were employed for the assessment of surgical outcomes.

RESULTS

The follow-up period for all patients ranged from 6 to 15 months. The length and width of the normal tragus were not significantly different from those of the reconstructed tragus. The mean preoperative AOS score was 2.73 ± 0.51, while the mean postoperative AOS score increased to 7.61 ± 0.65. The mVSS yielded an average score of 1.80 ± 1.43, indicating inconspicuous scarring post polyotia surgery. The preoperative VAS satisfaction score was recorded as 1.57 ± 0.67, while the postoperative VAS score significantly increased to 8.33 ± 0.91. The flaps all successfully survived post-operation without any occurrences of flap hematoma, necrosis, infection, or wound dehiscence.

CONCLUSION

The reconstruction of the tragus should be given careful consideration when addressing polyotia. The utilization of a lingual composite tissue flap for correction can achieve excellent aesthetic results for the tragus, with high patient satisfaction and minimal complications.

Myofibroma of the pinna: a case report and review of the literature

BACKGROUND

Myofibromas are rare mesenchymal tumors with a predilection for the head, neck, and oral cavity. Primarily affecting infants and young children, these tumors typically manifest as superficial painless nodules. Diagnosis is confirmed through histopathological examination of a biopsy, revealing nodules characterized by spindle cell proliferation. To our knowledge, only two cases of pinna myofibroma have been previously reported in the literature.

CASE PRESENTATION

Here, we present the case of a three-year-old male who developed a myofibroma of the left auricle following trauma to the area one year earlier. The patient underwent surgical resection without any postoperative complications. The patient later returned with a lesion consistent with hypertrophic scar.

CONCLUSIONS

This study aims to provide a comprehensive review of the clinical presentation, histopathologic and immunohistochemical features, and surgical management of this unique case of myofibroma of the pinna.

Perception of cauliflower ear amongst combat sport athletes

OBJECTIVE

Cauliflower ear, or "hematoma auris," is a permanent condition that is typically viewed as a deformity. Despite this, it has anecdotally been observed that combat sport athletes view cauliflower ear as a respected aesthetic trait. This study characterizes and quantifies the differences in initial impressions of subjects with cauliflower ear between combat sport athletes and the general population.

METHODS

In a cross-sectional survey, participants were shown frontal and profile views of four subjects with cauliflower ear and five control subjects. Respondents rated the subjects on a scale of 0-100 in perceived success, attraction, approachability, and affect display. Numeric scores were compared between combat sport athletes and the general population. Additionally, first impressions were categorized into positive, neutral, or negative classes via latent class analysis (LCA).

RESULTS

678 combat sport athletes and 129 general casual observers participated in the survey. Combat sport athletes rated subjects with cauliflower ear significantly more favorably than respondents in the general population in all personal attributes: perceived success (+4.03, 95 % CI:1.8-6.2, p = 0.0003), attractiveness (+4.11, 95 % CI:1.8-6.4, p = 0.0005), approachability (+11.57, 95 % CI: 8.4-14.7, p < 0.0001), and affect display (+4.14, 95 % CI: 1.9-6.3, p = 0.0002). They also had approximately seven times greater odds (95 % CI:4.0-12.6, p < 0.001) of reporting a positive first impression of a person with cauliflower ear than the general population.

CONCLUSION

Confirming anecdotal observation, the combat sports group had a more positive perception of cauliflower ear than the general population. Conditions that are typically viewed as deformities can be looked upon favorably in specific subpopulations.

Cerumenolytic Effects of Carbamide Peroxide in Patients with Ear Wax Obstruction

Introduction

Accumulated and compacted ear wax or cerumen can cause conductive hearing loss, discomfort and vertigo, and infection. This study investigates the effect of Carbamide peroxide (CP) compared with Phenol glycerin (PG) ear drops on cerumen.

Materials and Methods

This experimental study investigated the effect of PG and CP ear drops on cerumen in ex vivo and in vivo phases. In the ex vivo phase cerumen degredation was scored following PG and CP treatments. In the in vivo phase, 29 patients with bilateral cerumen impaction were randomly entered the study. PG and CP were applied 3 times a day (each time 5 drops) for 4 days by patients. After treatments, the time of cerumen removal was measured.

Results

Instant changes showing degredation of cerumen (grade 1) was evident when it was exposed to CP, on the other hand degredation changes (grade 1) in cerumen treated with PG was only evident after 20 min incubation at 37 oC, while grade 3 degredation was evident in cerumen treated with CP after the same time incubation. Although the time needed for removal of cerumen was lower in CP treatment (54.10±31.77) compared to PG treatment (67.10±35.54), the difference was not statistically significant.

Conclusion

Based on the literature and our results, carbamide peroxide is suggested as a proper treatment for patients with EAC obstruction caused by cerumen compaction, because not only it is significantly effective in cerumen degredation, but also no side effects have been reported.

[3D printing in plastic surgery, an accessible tool: Technical note around a case of otopoiesis assisted by 3D model]

3D printing has been used in the medical field since the beginning of the 21st century. Over the years, it has been democratized and has become an accessible tool at almost no cost, provided that a 3D printer is available. The surgeon can thus easily integrate it into his practice and techniques in the operating room, provided that he learns to use 3D image processing software. In order to illustrate the whole process, from the genesis and processing of the 3D image to its application in the operating room, we describe the case of a patient with a left auricle amputation, whose reconstruction was guided by a 3D model printed from his right ear.

Fungal Otitis Externa (Otomycosis) Associated with Aspergillus Flavus: A Case Image

A 48-year-old man presented with a chief complaint of intermittent right ear otorrhea of several-month duration, occasional otalgia and progressive unilateral hearing impairment. He also reported frequent episodes of headache and pressure in the sinuses and maxilla. Previous systemic treatment with antibiotics failed to alleviate the symptoms. A head/neck CT showed completely normal mastoid, middle ear and external auditory canal regions without any evidence of opacification or bone erosion. Otoscopic examination of the right ear disclosed aggregates of dried, brown, fibrillar material and debris occluding the external auditory canal and obstructing the otherwise intact tympanic membrane. Dilation of the external auditory canal or thickening of the tympanic membrane were not appreciated. The canal was debrided and the fibrillar material was placed in formalin. Histopathologic examination revealed numerous branching, septated fungal hyphae organized in densely-packed clusters. In other areas, the fungal hyphae abutted or were attached to lamellated collections of orthokeratin. As highlighted by GMS staining, the fungi were morphologically compatible with Aspergillus species. The clinicopathologic findings supported a diagnosis of fungal otitis externa, while the numerous anucleate squamous cells were compatible with colonization of an underlying, probably developing, cholesteatoma. Culture of material isolated from the external auditory canal confirmed the presence of Aspergillus flavus. In this illustrative case, we present the main clinical and microscopic characteristics of Aspergillus-related otomycosis developing in the setting of a tautochronous cholesteatoma.

Are 3D-printed anatomical models of the ear effective for teaching anatomy? A comparative pilot study versus cadaveric models

PURPOSE

Despite the combination of chalkboard lectures and cadaveric models, the ear remains a complex anatomical structure that is difficult for medical students to grasp. The aim of this study was to evaluate the contribution of a 3D-printed ear model for educating undergraduate medical students by comparing it with a conventional cadaveric model.

METHODS

Models of the ear comprising the outer ear, tympanic membrane, ossicles and inner ear were modeled and then 3D-printed at 6:1 and 10:1 scales based on cadaveric dissection and CT, cone-beam CT and micro/nano CT scans. Cadaveric models included two partially dissected dry temporal bones and ossicles. Twenty-four 3rd year medical students were given separate access to cadaveric models (n = 12) or 3D-printed models (n = 12). A pre-test and two post-tests were carried out to assess knowledge (n = 24). A satisfaction questionnaire focusing solely on the 3D-printed model, comprising 17 items assessed on a 5-point Likert scale, was completed by all study participants. A 5-point Likert scale questionnaire comprising four items (realism, color, quality and satisfaction with the 3D-printed ear model) was given to three expert anatomy Professors.

RESULTS

The test scores on the first post-test were higher for the students who had used the 3D-printed models (p < 0.05). Overall satisfaction among the students and the experts was very high, averaging 4.7 on a 5-point Likert-type satisfaction scale.

CONCLUSION

This study highlights the overall pedagogical value of a 3D-printed model for learning ear anatomy.

Effectiveness of auricular acupuncture and pelvic floor muscle training in the management of urinary incontinence following surgical treatment for prostate cancer: A randomized clinical trial

PURPOSE

To evaluate the effectiveness of auricular acupuncture combined with pelvic floor muscle training to manage urinary incontinence following radical prostatectomy.

METHODS

This is a randomized clinical trial that was conducted between April 2019 and April 2020 with 60 participants allocated into two groups, namely: control (pelvic muscle training) and intervention (auricular acupuncture + pelvic muscle training). Interventions were carried out during eight weekly sessions. Generalized estimating equations and proportion difference tests were applied in the statistical analysis with a significance level of 0.05.

RESULTS

Urinary incontinence severity decreased between pre-test and post-test in both groups. There was a statistically significant difference of the impact of urinary incontinence on quality of life between the groups at post-test in the domain "severity measures" (p = 0.013), and only in the intervention group between pre-test and post-test in the domains "emotions" (p < 0.001) and "sleep and mood" (p = 0.008). The intervention group was 20.8% (p = 0.007) and 25.3% (p = 0.002) less likely to present nocturia and urinary urgency, respectively.

CONCLUSIONS

Auricular acupuncture combined with pelvic floor muscle training was more effective, compared to pelvic floor muscle training alone, in reducing the impact of urinary incontinence on quality of life and reducing the odds of nocturia and urinary urgency.

Shared features in ear and kidney development - implications for oto-renal syndromes

The association between ear and kidney anomalies has long been recognized. However, little is known about the underlying mechanisms. In the last two decades, embryonic development of the inner ear and kidney has been studied extensively. Here, we describe the developmental pathways shared between both organs with particular emphasis on the genes that regulate signalling cross talk and the specification of progenitor cells and specialised cell types. We relate this to the clinical features of oto-renal syndromes and explore links to developmental mechanisms.

Ear identification: A multi-ethnic study sample

The external human ear is considered to be highly variable among individuals. Hence, forensic applications could be explored for human identification. This research compares the usefulness of Cameriere's ear identification method, in samples originating from six different countries (Brazil, India, Japan, Russia, South Africa and Turkey) in order to examine possible differences in their accuracy values. A sample of 2,225 photographs of the external human ear (1,134 left and 1,091 right ears) from 1,411 individuals (633 females and 778 males) was collected. The samples included healthy subjects with no systemic disorders and without any craniofacial trauma, maxillofacial abnormalities, auricular anomalies, ear diseases or previous auricular surgery. Cameriere's ear identification method was applied and measurements were performed on the images of each ear, considering four anatomic regions: helix, antihelix, concha, and lobe. The quantified measurement values were converted into a proposed coded number system. A search for identical codes was accomplished to find out the distinctiveness of the morphology of the human ear. The combined codes of left and right ears of each of the 814 subjects were not repeated in this multi-ethnic study sample. Dirichlet's distribution and the inherent study equation showed that the probability of two different individuals having the same code (false-positive identification) was found to be <0.0007. Because of the distinctive metrics of the ratios of external human ears, studies with Cameriere's ear identification method may be valuable for human identification. Studying the differences between the left and right ears of the same individual and across different ethnic groups could contribute to the development of supplementary tools for human identification.

A Prospective Clinical Study of Foreign Bodies in Ear, Nose and Upper Aerodigestive Tract - Our Experience

A foreign body is an object foreign to location where it found. Foreign body (FB) in ear, nose and aerodigestive tract are common problem seen in children and adults. This study aims to know foreign bodies in terms of type, age, site, gender distribution and method of removal. This prospective study was performed in tertiary care centre from 2020-2022. A total 185 patients with foreign bodies in ear, nose and aero digestive tract who were presented to casualty and OPD were included in study. Their demographic data, age of presentation, clinical presentation, foreign bodies types, site of lodgement and management were included in study. Out of 185 patients, 99 were male [53.51%], 86 were female [46.48%]. FB were found to be maximum in ear (44.32%) followed by nose (37.29%), aerodigestive tract (18.37%). The foreign bodies were removed with or without local anaesthesia in 155 patients and under general anaesthesia in only 30 patients. In some patient foreign bodies like coin, small ear ring was expelled out spontaneously. Left Ear FB (51.21%) was seen most commonly than right ear [45.12%] & both ears (3.67%). Right Side of nasal cavity was frequently involved (69.56%) than left nasal cavity [28.99%] & in both nasal cavities (1.45%). In aerodigestive tract, FB most commonly seen at cricopharynx level [38.23%]. The early childhood group had highest number of patients. Foreign bodies in ENT can be easy as well as difficult at times. Thorough and timely clinical and radiological examination helps in diagnosing and subsequent timely intervention.

Donor site morbidities of concha cartilage harvesting using a retroauricular approach for cleft rhinoplasty: retrospective study

Objectives

Concha cartilage is recommended for correction of cleft nasal deformities. Morbidities at the donor site have been reported in esthetic rhinoplasty cases. Reports on cleft patients are limited, so we investigated the complications of concha cartilage harvesting using the retroauricular approach in cleft rhinoplasty and their management.

Materials and Methods

This was a retrospective review of the charts of 63 patients with cleft deformities who underwent septorhinoplasty with concha cartilage. All cases were harvested using a retroauricular approach. Data on patient demographics, surgery type, amount of cartilage harvested, and complications were gathered.

Results

Sixty-three patients were enrolled (21 males and 42 females). The mean age of patients was 20.2±5.9 years. Complications were observed in 6 cases (9.5%) and included delayed wound healing (4.8%), prolonged postoperative pain (1.6%), postoperative paresthesia (1.6%), and prominauris (1.6%).

Conclusion

The rate of complications associated with concha cartilage harvesting using a retroauricular approach is low. The use of meticulous surgical techniques, especially hemostasis control and adequate wound dressing, is key to minimizing postoperative complications.

Dermal cylindroma of the external auditory canal

External auditory canal (EAC) cylindroma is a rare tumor that mainly presents as a painless mass over the lateral aspect of the ear canal. They have been designated under different nomenclatures in the literature, and controversies persist about their etiology and histogenesis. Moreover, a clinical diagnosis of EAC cylindroma is often challenging because of their rarity and a close resemblance with other adnexal benign and malignant tumors. None of the previous authors have extensively reviewed the dermal cylindroma of the EAC. We provide an extensive review involving PubMed and Google Scholar and report by Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. A total of 8 cases are included in the current study. The mean age is 55.13 years. There are six females and two males. The left and right ear are involved in 62.50% and 37.50% of cases, respectively. The most common sign/symptom is painless mass (50%). Five authors reported a primary lesion (62.50%), while the remaining 3 reported a recurrent tumor (37.50%). Benign versus malignant cylindroma is reported in 87.50% and 12.50% of cases, respectively. All, except one case, reported a solitary swelling. Surgical excision was employed in all the cases. Primary defect closure versus defect closure with local/distant skin graft /flap is utilized in 37.50% and 62.50% of cases, respectively.

Glycerospanlastics: State-of-the-art two-in-one nano-vesicles for boosting ear drug delivery in otitis media treatment

The purpose of this research was to design innovative nanovesicles for ototopical conveyance of triamcinolone acetonide (TA) for otitis media (OM) treatment via incorporating glycerol into nanospanlastics to be termed "Glycerospanlastics". The glycerospanlastics were formulated employing ethanol injection procedure, and central composite design (CCD) was harnessed for optimization of the vesicles. Various attributes of the nanovesicles, viz. particle size distribution, surface charge, TA entrapment efficiency, morphology as well as ex-vivo permeation across the tympanic membrane (TM) were characterized. In vivo implementation of the optimized glycerospanlastics loaded with TA was appraised in OM-induced rats via histopathological and biochemical measurements of the tumor necrosis factor-α (TNF-α) and Interleukin-1β (IL-1β) levels in ear homogenates. The safety and tolerability of optimized TA glycerospanlastics was also investigated in non-OM induced animals. The results demonstrated that the optimized TA-glycerospanlastics were in a nanometer range (around 200 nm) with negative charges, high TA entrapment (>85%), good storage properties and better TM permeation relative to TA suspension. More importantly, TA-glycerospanlastics performed better than marketed drug suspension in OM treatment as manifested by restoration of histopathological alterations in TM and lowered values of IL-1β and TNF-α. Glycerospanlastics could be promising safe ototopical nanoplatforms for OM treatment and other middle ear disorders.

From "self-differentiation" to organoids-the quest for the units of development

As proposed by Wilhelm Roux in 1885, the key goal of experimental embryology ("Entwicklungsmechanik") was to elucidate whether organisms or their parts develop autonomously ("self-differentiation") or require interactions with other parts or the environment. However, experimental embryologists soon realized that concepts like "self-differentiation" only make sense when applied to particular parts or units of the developing embryo as defined both in time and space. Whereas the formation of tissues or organs may initially depend on interactions with surrounding tissues, they later become independent of such interactions or "determined." Moreover, the determination of a particular tissue or organ primordium has to be distinguished from the spatially coordinated determination of its parts-what we now refer to as "patterning." While some primordia depend on extrinsic influences (e.g., signals from adjacent tissues) for proper patterning, others rely on intrinsic mechanisms. Such intrinsically patterned units may behave as "morphogenetic fields" that can compensate for lost parts and regulate their size and proper patterning. While these insights were won by experimental embryologists more than 100 years ago, they retain their relevance today. To enable the generation of more life-like organoids in vitro for studying developmental processes and diseases in a dish, questions about the spatiotemporal units of development (when and how tissues and organs are determined and patterned) need to be increasingly considered. This review briefly sketches this conceptual history and its continued relevance by focusing on the determination and patterning of the inner ear with a specific emphasis on some studies published in this journal.

Various approaches to the round window for cochlear implantation: a systematic review

OBJECTIVE

Round window approaches are used to insert a cochlear implant electrode array into the scala tympani. This study aimed to review the literature to find the reported round window approaches.

METHOD

This review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses ('PRISMA') guidelines. Articles that described their surgical approach to the round window were included. The PubMed, Scopus, Web of Science and Cochrane Library electronic databases were searched through to June 2021. The study protocol was registered on Prospero (reference number: CRD42021226940).

RESULTS

A total of 42 reports were included. The following approaches were documented: the standard facial recess, keyhole, retrofacial, modified suprameatal, transaditus, combined posterior tympanotomy and endomeatal, modified Veria, canal wall down approaches, and endoscopically assisted technique.

CONCLUSION

This review suggested that there are numerous distinct round window approaches, providing alternatives when the round window is inaccessible through the standard facial recess.

An Overview of Acute Otitis Externa

Acute otitis externa, cellulitis of the external auditory canal, is most frequently due to bacteria. Patients may present with otalgia, aural fullness, hearing loss, and otorrhea. Its diagnosis is a clinical one. Treatment is focused on analgesia, treating the underlying infection and preventing recurrence.

Management of Foreign Bodies in the Ear Canal

Using the appropriate instruments and techniques for removing a foreign body from the external auditory canal facilitates the procedure and reduces the risk of complications. Most ear foreign bodies can be addressed on a nonurgent basis, but batteries and caustic materials warrant prompt removal. Referral to an otolaryngologist should be considered for difficult cases or after a failed attempt.

Risk of second primary cancers in patients with rectal neuroendocrine neoplasms: a surveillance, epidemiology, and end results analysis

Background

While an elevated risk of second primary cancers (SPCs) has been observed in many other cancers, risk of SPCs has not been quantified in patients with rectal neuroendocrine neoplasms (NENs).

Methods

Survivors of primary rectal NENs diagnosed between 2000 and 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER)-18 registries. Relative risk of SPCs was estimated as the standardized incidence ratio (SIR), which was calculated using SEER*Stat software.

Results

Between 2000 and 2018, a total of 15836 patients diagnosed with rectal NENs, of whom 1436 (9.1%) received diagnosis of SPCs (SIR: 1.19, 95%CI: 1.13-1.26). The majority of patients were aged 50-69 and had their first cancer diagnosed at the localized stage. Male survivors had a higher propensity for developing SPCs overall, while female survivors exhibited higher risks of specific SPCs. Age at diagnosis of rectal NENs influenced the risk of SPCs, with younger patients having greater risks. A statistically significant increase in the incidence of SPCs was observed among patients aged 30-64 years. Black patients had higher relative risks of certain SPCs, while White patients had a lower risk of subsequent melanoma. Trend analysis revealed that the highest excess burden of SPCs was observed in the years 2000 to 2002. Risk of SPCs remained elevated within the first four years post-diagnosis for survivors of rectal NENs, but diminished thereafter.

Conclusion

The study revealed that individuals who survived rectal NENs were at an elevated risk of developing SPCs compared to the general population. Our results hold important implications for the formulation of lifelong surveillance recommendations for cancer survivors.

Otologic manifestations of IgG4-related disease

IgG4-related disease (IgG4-RD) is a systemic autoimmune fibroinflammatory disease characterized by multiorgan infiltration of IgG4-positive plasma cells, fibrosis and vasculopathy that determine dysfunction of the affected organ. This review aims to characterize the otologic manifestations of the disease. We have conducted a systematic review of the biomedical literature published describing cases of IgG4-RD with otologic manifestations. For the review, the bibliographic databases utilized were Pubmed, Web of Science and Scopus. We selected 48 cases from which we extracted several data collections. About 52% of the patients were male between the ages of 19 and 79 years. Otologic findings were characterized by pseudotumoral lesions that most often caused a clinical presentation similar to otitis media with effusion, with cochlear involvement or sensorineural hearing loss (uni- o bilateral). Less frequent presentations included auricular chondritis, eosinophilic otitis, or hypertrophic pachymeningitis. In 32 patients (67%) the otologic manifestation was the first symptom of the ER-IgG4. Sixteen patients (33%) were treated with mastoidectomies as a result of delayed diagnosis and lack of knowledge about this entity. Two patients needed a cochlear implant. Although the otologic manifestations of IgG4-RD are unusual, it is important for the otorhinolaryngologist to know the otologic manifestations of this entity as it can be the onset of the disease, in order to allow early diagnosis and adequate treatment, avoiding permanent sequelae.

External auditory canal injuries in maxillofacial trauma - Proposal of a symptom-based treatment algorithm with a report of twelve cases

Purpose

Injury to the external auditory canal (EAC) may occur following facial trauma. They manifest as otalgia, ear bleeding, otorrhea, facial palsy, or altered hearing. But literature regarding its management is sparse. The study aimed to identify the incidence and types of EAC injury in facial trauma, grade their severity, and propose a symptom-based treatment algorithm.

Patients and Methods

This was a prospective case series involving patients with signs/symptoms of EAC injury following maxillofacial trauma. The EAC was evaluated by clinical examination, imaging, endoscopy, and audiometry. Clinical findings were graded into mild, moderate, and severe. Treatment was matched to clinical findings according to the proposed algorithm. The outcomes of the study were incidence and types of EAC injury in facial trauma and resolution of presenting signs/symptoms. Data were analyzed for descriptive statistics using SPSS software (v26; IBM, Armonk, NY).

Results

A total of 88 patients reported with maxillofacial trauma during a 6-month period. Signs/symptoms of EAC injury were observed in 41 patients, of which 12 (11 males and 1 female) were confirmed with a diagnosis of EAC injuries. Eight patients demonstrated only cartilaginous injuries while three had bony injuries. Treatment was successful in 11 out of 12 patients, with a best point estimate of 0.86 (Z score-1.959, 95% CI).

Conclusion

Clinical findings of EAC injury mandate thorough investigation to ascertain the site and severity of the injury. Symptom-based treatment of EAC injuries produces an effective resolution of signs/symptoms and improved treatment outcomes.

Meteorological extremes and their impact on tinnitus-related emergency room visits: a time-series analysis

PURPOSE

Extreme weather events are rising due to the accelerating pace of climate change. These events impact human health and increase emergency room visits (EV) for many morbidities. Tinnitus is a common cause of EVs within otolaryngology in Germany and Austria. The effect of extreme weather conditions on tinnitus-related EVs is unknown.

METHODS

A total of 526 tinnitus-related EVs at a tertiary care hospital in Vienna were identified. A distributed lag non-linear model with a maximum lag period of 14 days was fitted to investigate the immediate and delayed effect of single-day and prolonged (three-day) extreme atmospheric pressure, relative humidity, mean temperature, precipitation and mean wind speed on EV rates. Extreme conditions were defined as the 1st, 5th, 95th, and 99th percentile of the meteorological variables. Relative risk (RR) is defined as risk for tinnitus-related EVs at an extreme condition compared to the risk at the median weather condition. Cumulative RR (cRR) is the total cumulated EV risk for a given time period.

RESULTS

High relative humidity increased same-day RR for tinnitus-related EVs to 1.75. Both low and high atmospheric pressure raised cRR as early as three days after an event to a maximum of 3.24. Low temperatures mitigated cRR within 4 days, while high temperatures tended to increase risk. Prolonged precipitation reduced cRR within one day.

CONCLUSION

Extreme meteorological conditions are associated with tinnitus-related EV rates. Further investigation into potential causative links and underlying pathophysiological mechanisms is warranted.

A five year descriptive analysis of potentially preventable hospitalisations for Ear, Nose, and Throat conditions in regional Victoria, Australia, from 2015 to 2020

BACKGROUND

Potentially preventable hospitalisations of ear, nose, and throat conditions in the Murray Primary Health Network region have been found to be higher than the state average of Victoria, Australia. This study aimed to examine the association between selected patient-level characteristics and the likelihood of residing in a Murray PHN postcode with higher than expected numbers of potentially preventable ENT hospitalisations.

METHODS

Unit record hospital separation data were obtained from the Victorian Admitted Episodes Dataset. Postcodes were classified as having higher than expected numbers of potentially preventable hospitalisations across three subgroups of ENT using indirect standardisation techniques. Differences between patients from 'higher than expected' postcodes and 'other' postcodes with respect to the distribution of demographic and other patient characteristics were determined using chi-squared tests for each ENT subgroup. The results were confirmed by logistic regression analyses using resident of a postcode with higher than expected hospitalisations as the outcome variable.

RESULTS

Of the 169 postcodes located in the catchment area, 15 were identified as having higher than expected numbers of upper respiratory tract infection hospitalisations, 14 were identified for acute tonsillitis, and 12 were identified for otitis media. Patients from postcodes with 'higher than expected' hospitalisations for these conditions were more likely than others to be aged between 0 and 9 years, Indigenous, or from a culturally and linguistically diverse background.

CONCLUSION

Further investigation of the identified postcodes is warranted to determine access to and utilisation of primary healthcare services in the management of PPH ENT conditions in the region.

Cartilage grafts mimicking cholesteatoma recurrence on diffusion-weighted magnetic resonance imaging: a case series

BACKGROUND

Cholesteatomas present a high risk for residual and recurrent disease, and the surveillance of post-operative patients can be challenging. Diffusion-weighted magnetic resonance imaging is becoming the preferred method for investigating recidivism; however, false positive imaging findings increase the risk of patients undergoing unnecessary second look surgery.

CASE REPORTS

This study reports two patients with false positive diffusion restriction associated with cartilage grafts that mimicked cholesteatoma and resulted in second look surgery with no disease found at operation. This study also discusses the related medical literature, including potential causes of abnormal diffusion restriction and methods to negate this.

CONCLUSION

Caution should be exercised when considering second look surgery in the presence of a cartilage graft and a high confidence of disease clearance. A multi-disciplinary approach is recommended for the operating surgeon to review the images with a radiologist.

An exploratory study of imaging diagnostic clues for overhanging facial nerve in ultra-high-resolution CT

PURPOSE

Overhanging facial nerve (FN) may be challenging in imaging diagnosis. The purpose of the study is to investigate the imaging clues for overhanging FN near the oval window on ultra-high-resolution computed tomography (U-HRCT) images.

METHODS

Between October 2020 and August 2021, images of 325 ears (276 patients) were included in the analysis obtained by an experimental U-HRCT scanner. On standard reformatted images, the morphology of FN was evaluated and its position was quantitatively measured using the following indices: protrusion ratio (PR), protruding angle (A), position of FN (P-FN), distance between FN and stapes (D-S), and distance between FN and anterior and posterior crura of stapes (D-AC and D-PC). According to the FN morphology in imaging, images were divided into overhanging FN group and non-overhanging FN group. Binary univariate logistic regression analysis was used to identify the imaging indices independently associated with overhanging FN.

RESULTS

Overhanging FN was found in 66 ears (20.3%), which manifested as downwards protrusion of either local segment (61 ears, 61/66) or the entire course near the oval window (5 ears, 5/66). D-AC [odds ratio: 0.063, 95% CI 0.012-0.334, P = 0.001) and D-PC (odds ratio: 0.008, 95% CI 0.001-0.050, P = 0.000) were identified as independent predictors of FN overhang (area under the curve: 0.828 and 0.865, respectively).

CONCLUSION

Abnormal morphology of the lower margin of FN, D-AC and D-PC on U-HRCT images provide valuable diagnostic clues for FN overhang.

An automated parametric ear model to improve frugal 3D scanning methods for the advanced manufacturing of high-quality prosthetic ears

Ear prostheses are commonly used for restoring aesthetics to those suffering missing or malformed external ears. Traditional fabrication of these prostheses is labour intensive and requires expert skill from a prosthetist. Advanced manufacturing including 3D scanning, modelling and 3D printing has the potential to improve this process, although more work is required before it is ready for routine clinical use. In this paper, we introduce a parametric modelling technique capable of producing high quality 3D models of the human ear from low-fidelity, frugal, patient scans; significantly reducing time, complexity and cost. Our ear model can be tuned to fit the frugal low-fidelity 3D scan through; (a) manual tuning, or (b) our automated particle filter approach. This potentially enables low-cost smartphone photogrammetry-based 3D scanning for high quality personalised 3D printed ear prosthesis. In comparison to standard photogrammetry, our parametric model improves completeness, from (81 ± 5)% to (87 ± 4)%, with only a modest reduction in accuracy, with root mean square error (RMSE) increasing from (1.0 ± 0.2) mm to (1.5 ± 0.2) mm (relative to metrology rated reference 3D scans, n = 14). Despite this reduction in the RMS accuracy, our parametric model improves the overall quality, realism, and smoothness. Our automated particle filter method differs only modestly compared to manual adjustments. Overall, our parametric ear model can significantly improve quality, smoothness and completeness of 3D models produced from 30-photograph photogrammetry. This enables frugal high-quality 3D ear models to be produced for use in the advanced manufacturing of ear prostheses.

Exposure to the persistent organic pollutant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD, dioxin) disrupts development of the zebrafish inner ear

Dioxins are a class of highly toxic and persistent environmental pollutants that have been shown through epidemiological and laboratory-based studies to act as developmental teratogens. 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most potent dioxin congener, has a high affinity for the aryl hydrocarbon receptor (AHR), a ligand activated transcription factor. TCDD-induced AHR activation during development impairs nervous system, cardiac, and craniofacial development. Despite the robust phenotypes previously reported, the characterization of developmental malformations and our understanding of the molecular targets mediating TCDD-induced developmental toxicity remains limited. In zebrafish, TCDD-induced craniofacial malformations are produced, in part, by the downregulation of SRY-box transcription factor 9b (sox9b), a member of the SoxE gene family. sox9b, along with fellow SoxE gene family members sox9a and sox10, have important functions in the development of the otic placode, the otic vesicle, and, ultimately, the inner ear. Given that sox9b is a known target of TCDD and that transcriptional interactions exist among SoxE genes, we asked whether TCDD exposure impaired the development of the zebrafish auditory system, specifically the otic vesicle, which gives rise to the sensory components of the inner ear. Using immunohistochemistry, in vivo confocal imaging, and time-lapse microscopy, we assessed the impact of TCDD exposure on zebrafish otic vesicle development. We found exposure resulted in structural deficits, including incomplete pillar fusion and altered pillar topography, leading to defective semicircular canal development. The observed structural deficits were accompanied by reduced collagen type II expression in the ear. Together, our findings reveal the otic vesicle as a novel target of TCDD-induced toxicity, suggest that the function of multiple SoxE genes may be affected by TCDD exposure, and provide insight into how environmental contaminants contribute to congenital malformations.

3D Finite Element Model of Human Ear with 3-Chamber Spiral Cochlea for Blast Wave Transmission from the Ear Canal to Cochlea

Blast-induced auditory trauma is a common injury in military service members and veterans that leads to hearing loss. While the inner ear response to blast exposure is difficult to characterize experimentally, computational models have advanced to predict blast wave transmission from the ear canal to the cochlea; however, published models have either straight or spiral cochlea with fluid-filled two chambers. In this paper, we report the recently developed 3D finite element (FE) model of the human ear mimicking the anatomical structure of the 3-chambered cochlea. The model consists of the ear canal, middle ear, and two and a half turns of the cochlea with three chambers separated by the Reissner's membrane (RM) and the basilar membrane (BM). The blast overpressure measured from human temporal bone experiments was applied at the ear canal entrance and the Fluent/Mechanical coupled fluid-structure interaction analysis was conducted in ANSYS software. The FE model-derived results include the pressure in the canal near the tympanic membrane (TM) and the intracochlear pressure at scala vestibuli, the TM displacement, and the stapes footplate (SFP) displacement, which were compared with experimentally measured data in human temporal bones. The validated model was used to predict the biomechanical response of the ear to blast overpressure: distributions of the maximum strain and stress within the TM, the BM displacement variation from the base to apex, and the energy flux or total energy entering the cochlea. The comparison of intracochlear pressure and BM displacement with those from the FE model of 2-chambered cochlea indicated that the 3-chamber cochlea model with the RM and scala media chamber improved our understanding of cochlea mechanics. This most comprehensive FE model of the human ear has shown its capability to predict the middle ear and cochlea responses to blast overpressure which will advance our understanding of auditory blast injury.

Lipoma Of The Internal Auditory Canal: An Uncommon Cause Of Unilateral Deafness And Dizziness

Lipomas inside the internal auditory canal are infrequent. We describe a 43 years old woman who complains about sudden unilateral deafness, tinnitus and dizziness. With CT and RMN we make a certain diagnosis of lipoma inside the internal auditory canal. Due to the absence of limitations, we offer an annual follow up for assessing the patient's clinical situation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03351-3.

Application of CNN and ANN in assessment the effect of chemical components of biological nanomaterials in treatment of infection of inner ear and environmental sustainability

Nanoparticles (NPs) are a promising alternative to antibiotics for targeting microorganisms, especially in the case of difficult-to-treat bacterial illnesses. Antibacterial coatings for medical equipment, materials for infection prevention and healing, bacterial detection systems for medical diagnostics, and antibacterial immunizations are potential applications of nanotechnology. Infections in the ear, which can result in hearing loss, are extremely difficult to cure. The use of nanoparticles to enhance the efficacy of antimicrobial medicines is a potential option. Various types of inorganic, lipid-based, and polymeric nanoparticles have been produced and shown beneficial for the controlled administration of medication. This article focuses on the use of polymeric nanoparticles to treat frequent bacterial diseases in the human body. Using machine learning models such as artificial neural networks (ANNs) and convolutional neural networks (CNNs), this 28-day study evaluates the efficacy of nanoparticle therapy. An innovative application of advanced CNNs, such as Dense Net, for the automatic detection of middle ear infections is reported. Three thousand oto-endoscopic images (OEIs) were categorized as normal, chronic otitis media (COM), and otitis media with effusion (OME). Comparing middle ear effusions to OEIs, CNN models achieved a classification accuracy of 95%, indicating great promise for the automated identification of middle ear infections. The hybrid CNN-ANN model attained an overall accuracy of more than 0.90 percent, with a sensitivity of 95 percent and a specificity of 100 percent in distinguishing earwax from illness, and provided nearly perfect measures of 0.99 percent. Nanoparticles are a promising treatment for difficult-to-treat bacterial diseases, such as ear infections. The application of machine learning models, such as ANNs and CNNs, can improve the efficacy of nanoparticle therapy, especially for the automated detection of middle ear infections. Polymeric nanoparticles, in particular, have shown efficacy in treating common bacterial infections in children, indicating great promise for future treatments.

Seborrhoeic Keratosis of External Auditory Canal & its Management

Introduction

Seborrhoeic keratosis (SK) is a benign neoplasm of the skin. They are usually found to occur anywhere in the body except palms, soles and mucous membranes. The skin of the external auditory canal is an extremely rare site for the occurrence of this benign neoplasm. Malignant transformation rarely occurs in this benign condition. It should be differentiated from other malignant condition like squamous cell carcinoma, basal cell carcinoma, Bowen's disease, malignant melanoma or keratoacanthoma. Surgery is the mainstay of treatment though recurrence is very common. It can be removed by cryotherapy using liquid nitrogen or curettage, light fulgaration, shave removal or painting with pure TCA if the lesion is small. Diathermy shoul be used as minimal as possible to avoid scar formation.

Case Report

An elderly female presented to ENT OPD with left ear blood-stained discharge. On inspection there was irregular blackish mass filling the entire left external auditory canal, fine needle aspiration cytology came to be seborrhoeic keratosis. Since on imaging the tumor was confined to the external auditory canal, it was excised completely by transcanal route. Surprisingly histopathology came to be squamous cell carcinoma. Considering the age and limited confinement of the tumor, she was kept on regular follow up.

Conclusion

Seborrhoeic keratosis though a common benign tumor, malignant transformation may occur. Treatment is patient specific and may be modified considering the age and comorbidity of the patient.

Focal meato-mastoid fistula closure using bony sigmoid sinus plate

OBJECTIVE

This study aimed to analyse the effectiveness of using the bony sigmoid sinus plate for repair of meato-mastoid fistulae.

METHOD

A retrospective study of all cases between January 2013 and December 2019 at our secondary-tertiary centre was conducted. Inclusion criteria for study were: (1) cases with focal meato-mastoid fistulae and (2) focal meato-mastoid fistulae that were repaired by using bony sigmoid sinus plate using the bony sigmoid sinus plate technique. There were 13 cases that fulfilled these criteria.

RESULTS

The outcome of the repair of meato-mastoid fistulae with bony sigmoid sinus plate was very encouraging. All 13 cases did well. Two patients had delayed epithelialisation at 9 and 12 months after surgery.

CONCLUSION

The technique of repairing meato-mastoid fistulae by using bony sigmoid sinus plate is simple, repeatable and provides effective physiological reconstruction of the posterior canal wall. Bony sigmoid sinus plate is easily and locally available in all cases undergoing cortical mastoidectomy. This plate of bone has a curvature, consistency and structure that match well with that of the posterior or superior canal wall. In addition, this technique is cost-effective with good patient compliance.

Effectiveness of endoscopy in cochlear implantation

OBJECTIVE

Determine the effectiveness of endoscopy in cochlear implantation as compared to microscopy.

METHOD

Study comparing microscopy and endoscopy in cochlear implant placement in 34 patients (23 endoscopic implants and 20 implants via microscopy), between 2014 and 2019, at the Centro Medico Naval, Mexico City. The study was performed under informed consent and according to the Council for International Organizations of Medical Sciences (CIOMS).

RESULTS

Of the 34 patients, 12 were children or adolescents and 22 were adults. The visualization of the round window classified via microscopy per St. Thomas Hospital's classification showed that type IIB prevailed in 30.2% of patients, and type III in 41.9%, and when using the endoscope, the round window was observed in full in 82.6% of patients (type I), and type IIA was only observed in 17.4% (four patients). The number of attempts made to place the cochlear implant was greater with the microscope. The time to insertion of the electrode was 1.6 minutes. No differences were observed (p > 0.05) in the number of inpatient days. Cochleostomy was more frequent when using the microscope.

CONCLUSIONS

Endoscopy is an effective resource in cochlear implantation for posterior tympanotomy, with no complications observed, offering greater safety in inserting the electrode through the round window.

[Role of computed tomography in the preoperative diagnosis of otosclerosis]

BACKGROUND

Otosclerosis is an osteodystrophy of the otic capsule and presents with progressive conductive hearing loss. Imaging studies, especially computed tomography (CT) and cone-beam CT, have gained increased relevance in the diagnosis of otosclerosis.

OBJECTIVE

This study investigated whether there is a correlation between the extent of otosclerosis in high-resolution or cone-beam CT and hearing loss in pure-tone audiometry.

MATERIALS AND METHODS

Based on an existing classification of otosclerotic foci, a classification was established. Preoperative CT scans of patients undergoing stapedotomy between 2015 and 2019 were evaluated and classified by two independent otorhinolaryngologists. The preoperative pure-tone audiograms were analysed and compared to the results of CT.

RESULTS

A total of 168 CT studies (i.e., 168 ears) in 156 patients with intraoperatively confirmed otosclerosis were included in our study. A correlation between the extent of the otosclerotic focus or the calculated scores and hearing loss in pure-tone audiometry (air conduction, bone conduction and air-bone-gap) could not be proven.

CONCLUSION

Preoperative CT is not obligatory. However, preoperative imaging using CT or cone-beam CT can be helpful to confirm the diagnosis and exclude other middle or inner ear pathologies as well as in planning of the surgical procedure in the overall context of otoscopy and audiometry. A correlation with the degree of hearing impairment could not be demonstrated and remains unclear.

Cutaneous Leishmaniasis Lesion on the Ear from Kashan, Central Iran: A Case Report

Cutaneous leishmaniasis (CL) frequently occurs in many rural and urban areas of Iran. Leishmania major and L. tropica are principally two causative agents of CL in Iran. We report here a case of leishmaniasis of the ear in a 61-year-old man referred to the Reference laboratory, Kashan, central Iran, in Jan 2022. He suffered from a 2-month history of a 1×3 cm lesion on the left ear. In the microscopy examination, amastigotes forms of Leishmania spp. were observed. L. tropica was confirmed using a single PCR with species-specific primers. The patient was introduced to a physician to begin the treatment protocol. It is recommended that physicians, especially in an endemic area, investigate any atypical lesion for CL.

Aetiology and management options for secondary referred otalgia: a systematic review and meta-analyses

OBJECTIVES OF REVIEW

To review the literature for the evidence base for the aetiology and management of referred otalgia, looking particularly at non-malignant, neuralgic, structural and functional issues.

TYPE OF REVIEW

Systematic review.

SEARCH STRATEGY

A systematic literature search was undertaken from the databases of EMBASE, CINAHL, MEDLINE®, BNI, and Cochrane Library according to predefined inclusion and exclusion criteria.

EVALUATION METHOD

All relevant titles, abstracts and full text articles were reviewed by three authors who resolved any differences by discussion and consultation with senior author.

RESULTS

44 articles were included in our review. The overall quality of evidence was low, with the vast majority of the studies being case-series with three cohort and four randomised-controlled trials included. The prime causes and management strategies were focussed on temporomandibular joint dysfunction (TMJD), Eagle syndrome and neuralgia. Our meta-analyses found no difference on the management strategies for the interventions found.

CONCLUSIONS

Referred otalgia is common and treatment should be aimed at the underlying pathology. Potential aetiologies are vast given the extensive sensory innervation of the ear. An understanding of this and a structured approach to patient assessment is important for optimal patient management.

Auricular cartilage regeneration using different types of mesenchymal stem cells in rabbits

BACKGROUND

Cartilaginous disorders comprise a wide range of diseases that affect normal joint movement, ear and nose shape; and they have great social and economic impact. Mesenchymal stem cells (MSCs) provide a promising regeneration alternative for treatment of degenerative cartilaginous disorders. This study aimed to compare therapeutic potential of different types of laser activated MSCs to promote auricular cartilage regeneration. Twelve adult rabbit allocated equally in four groups, all animals received a surgical mid auricular cartilage defect in one ear; Group I (Positive control) injected sub-perichondrially with phosphate-buffered saline (PBS), Group II (ADMSC-transplanted group) injected adipose-derived MSCs (ADMSCs), Group III (BMMSCs-transplanted group) received bone marrow-derived MSCs (BMMSCs), and Group IV (EMSC-transplanted group) received ear MSCs (EMSCs) in the defected ear. The auricular defect was analyzed morphologically, histopathologically and immunohistochemically after 4 weeks. In addition, a quantitative real-time polymerase chain reaction was used to examine expression of the collagen type II (Col II) and aggrecan as cartilage growth factors.

RESULTS

The auricles of all treatments appeared completely healed with smooth surfaces and similar tissue color. Histopathologically, defective areas of control positive group, ADMSCs and EMSCs treated groups experienced a small area of immature cartilage. While BMMSCs treated group exhibited typical features of new cartilage formation with mature chondrocytes inside their lacunae and dense extracellular matrix (ECM). In addition, BMMSC treated group showed a positive reaction to Masson's trichrome and orcein stains. In contrary, control positive, ADMSC and EMSC groups revealed faint staining with Masson's trichrome and Orcein. Immunohistochemically, there was an intense positive S100 expression in BMMSCs (with a significant increase of area percentage + 21.89 (P < 0.05), a moderate reaction in EMSCs (with an area percentage + 17.97, and a mild reaction in the control group and ADMSCs (area percentages + 8.02 and + 11.37, respectively). The expression of relative col II and aggrecan was substantially highest in BMMSCs (± 0.91 and ± 0.89, respectively). While, Control positive, ADMSCs and EMSCs groups recorded (± 0.41: ± 0.21, ± 0.6: ± 0.44, ± 0.61: ± 0.63) respectively.

CONCLUSION

BMMSCs showed the highest chondrogenic potential compared to ADMSCs and EMSCs and should be considered the first choice in treatment of cartilaginous degenerative disorders.

Histopathological Evaluation of Platelet-Rich Plasma Effect in Acute Tympanic Membrane Perforation

Platelet-rich plasma (PRP) is a reliable and has low side-effect profile and has beneficial effects on wound healing. Its investigatory effects on wound-healing process were shown on various tissues. This study aims to investigate PRP's local application effects to perforated rat TM in terms of healing and histopatological outcomes. Twenty-two Wistar rats were used in the study. The rats' ears were examined with a pediatric endoscope (2.7 mm, 0°), and the TM posterior quadrant of their right ear was perforated with a 20-gauge needle. After this procedure, the rats were divided into two equal groups. A spongel with PRP was applied on the perforated TM in the first group, and spongel with standard saline solution was applied on the second group. Following the sacrifice, the middle air bullas were carefully dissected and removed for histopathological examination. Hematoxylin eosin (for fibroblasts, lymphocyte, collagen fibers) and immunohistochemical staining were done for epithelial growth factor receptor (EGFR), fibroblast growth factor receptor (FGFR1), and vascular endothelial growth factor (VEGF) staining for histopathologic examinations. There was not a significant difference between the two groups for lymphocyte. There was a significant difference between control and study groups for collagen and EGFR (P < 0.05). Although the mean value of FGF- and VEGF-positive cells was higher in the study group than in the control group, the difference was not significant (P > 0.05). PRP is an effective autologous material for the healing process of acute TM perforations in a rat model, as demonstrated in the present study. We think that the use of PRP for acute TM perforations can have a positive effect on the healing process by increasing the level of growth factors, especially EGFR. In addition, an increase in collagen can also have a positive effect on healing.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-021-02912-2.

Foreign Bodies in Ear, Nose, Throat and Maxillofacial Region: A Study on Their Clinical Profile and Complications

The clinical picture and treatment options of foreign bodies in ENT vary widely depending on the site of involvement. Our study was a comprehensive review of both luminal and extraluminal foreign bodies in Otorhinolaryngology. A hospital based cross-sectional retrospective study was conducted to study the foreign bodies in ear, nose, throat and maxillofacial region in terms of demography, various modes of entry, site of lodgement, clinical features, treatment modalities and complications. While majority of the previous studies have focused on objects entering through natural orifices of ear, nose and throat, our study was a comprehensive review of both luminal and extraluminal foreign bodies in otorhinolaryngology. It was a retrospective study of four years duration on patients who presented with foreign bodies in OPD and emergency ward. Relevant data were tabulated and clinical and radiological documentation of interesting case scenarios have been depicted. The commonest age group affected was 0-10 years with 111 (58.52%) out of 190 cases. The most common site was aerodigestive tract ( 40%), followed by ears (31%), nose (26%) and maxillofacial region (3%). Insects, vegetable seeds and coins were the most common FBs in ear, nose and throat respectively. Foreign bodies have shown seasonal, geographic, socioeconomic and occupational variations in their distribution. Patient's age, type of foreign body, chance of migration to deeper tissue planes, failed unskilled removal attempts, delay in diagnosis and presence of comorbidities can complicate chances of removal.

Causes of Middle Ear Aural Polyps in Adult Patients from Kut and Diwaniyah Cities in Iraq

BACKGROUND

Aural polyps consider as one of the most notable progressive lesions of middle ear. Chronic otitis media can result in development of aural polyps that ascends from the tympanic cavity outwards to the external auditory canal, leading to tympanic membrane perforation and hearing loss. Morbidity and mortality are usually rare, however, failure of diagnosis or prolonged negligence by the patient could increase the likelihood of cholesteatoma or malignant squamous carcinoma.

AIM

To investigate the causes of middle ear aural polyps in adult patients selected from Kut and Diwaniyah cities in Iraq.

METHODOLOGY

40 patients which of those 14 males and 26 females were included in this study based upon the clinical manifestation of the illness and the suffering from a mass in the tympanic cavity, partial or complete hearing loss, otorrhea and dizziness. Otoscope was used to confirm location, shape, size of the polyps, and the status of the tympanic membrane.

RESULTS

The mean age of the involved patients in the study was (44.65 ± 10.9) years. Age range was between (20-60) years. The highest frequency of patients with aural polyps was seen in patients at their third to fifth decade of age. There were 14(35%) men, and 26(65%) women. Findings showed that mean age of men was (44.07 ± 13.7) years, and women was (44.96 ± 9.4) years, (p=0.405). Clinical examination revealed 27(67.5%) patients with cholesteatoma, 10(25%) with inflamed mass in the middle ear, and 3(7.5%) were with cancerous tumor. Correlative analysis showed no significant correlation between age and causes of aural polyps (p=0.664), and no correlation between sex and causes of aural polyps (p=0.524).

CONCLUSION

Aural polyps are rare disease in Iraqi patients. However, treating and monitoring patients with ongoing chronic otitis media is essential in preventing the development of aural masses in middle ear and other complications if left untreated. Early diagnosis and treatment can prevent reoccurrence and other complications.

Metabolic ear disease

Damages to the ear are very diverse and can depend on the type of inherited metabolic diseases (IMD). Indeed, IMDs can affect all parts of the auditory system, from the outer ear to the central auditory process. We have identified 219 IMDs associated with various types of ear involvement which we classified into five groups according to the lesion site of the auditory system: congenital external ear abnormalities, acquired external ear abnormalities, middle ear involvement, inner ear or retrocochlear involvement, and unspecified hearing loss. This represents the ninth issue in a series of educational summaries providing a comprehensive and updated list of metabolic differential diagnoses according to system involvement.

Molecular mechanisms governing development of the hindbrain choroid plexus and auditory projection: A validation of the seminal observations of Wilhelm His

Studies by His from 1868 to 1904 delineated the critical role of the dorsal roof plate in the development of the hindbrain choroid plexus, and of the rhombic lips in the development of hindbrain auditory centers. Modern molecular studies have confirmed these observations and placed them in a mechanistic context. Expression of the transcription factor Lmx1a/b is crucial to the development of the hindbrain choroid plexus, and also regulates the expression of Atoh1, a transcription factor that is essential for the formation of the cochlear hair cells and auditory nuclei. By contrast, development of the vestibular hair cells, vestibular ganglion and vestibular nuclei does not depend on Lmx1a/b. These findings demonstrate a common dependence on a specific gene for the hindbrain choroid plexus and the primary auditory projection from hair cells to sensory neurons to hindbrain nuclei. Thus, His' conclusions regarding the origins of specific hindbrain structures are borne out by molecular genetic experiments conducted more than a hundred years later.

[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.