Vulvar Dermatofibrosarcoma protuberance in Iran and a narrative review of literature: A first case report.

Background: Pott's Puffy tumor (PPT) is a complicated frontal sinusitis that is also described as frontal bone osteomyelitis and a localized sub periosteal abscess. Early diagnosis and immediate active treatment are necessary to prevent severe neurologic sequelae. Case Presentation: Here, we report on a case of Pott's puffy tumor in a previously healthy 13-year-old girl with a worsening headache and swelling of the frontal bone accompanied by vomiting and fever. Magnetic resonance imaging revealed osteomyelitis of the frontal bone. A foreign body was discovered and removed via endoscopy which was then followed by 6 weeks of parenteral and enteral antibiotic therapy, resulting in resolution of all symptoms. Conclusion: A complete history in terms of trauma and insect bite or foreign body in the nose is paramount for a correct diagnosis, and performing a full examination of ear, nose and throat (ENT) to rule out a foreign body is advised.

Laryngeal schwannoma masquerading as malignancy.

Laryngeal schwannoma is a rare type of neurogenous tumour with a non-specific presentation. We present a case of a middle-aged man with issues of hoarseness, globus sensation and intermittent episodes of throat pain. The Hopkins examination showed right vocal fold irregularity with fullness in the right ventricle. The contrast-enhanced CT neck revealed an ill-defined lesion with contrast uptake extending into the paraglottic region with no neck node involvement. Considering the clinical presentation of hoarseness, throat pain and globus with imaging revealing contrast enhancement of lesion, direct laryngoscopy and biopsy were planned to rule out malignancy. Intraoperatively, a well-defined submucosal capsulated swelling became apparent after incision and dissection of the mucosa over the right vocal fold. A complete excision of the swelling was done with microlaryngeal instruments without tracheostomy. The histopathological report was suggestive of schwannoma. The literature review discusses clinical presentation, location, imaging features and management strategy.

Open-fitting hearing aids: a comparative analysis between open behind-the-ear and open completely-in-the-canal instant-fit devices.

PURPOSE: Our study aims to assess the open-fitting capabilities and vent properties of traditional open-fitting behind-the-ear (open BTE) hearing aids to instant-fit open-fitting completely-in-the-canal (open CIC) systems. METHODS: The study analysed data from 40 patients grouped in two groups based on the used hearing aids. Free field pure tone and speech audiometry were performed to obtain the free-field pure tone average and free-field word recognition score (WRS). The matrix sentence test was employed to evaluate the auditory performance and functional outcomes of patients. The Satisfaction with Amplification in Daily Life (SADL) and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire were used to assess the personal satisfaction and benefit provided by the hearing aid. Real ear measurements were conducted to objectively evaluate the Real-Ear Unaided Gain (REUG) and Real-Ear Occluded Gain (REOG) of the two groups. For this purpose, six frequency bands (band 1 from 125 to 200 Hz, band 2 from 250 to 400 Hz, band 3 from 500 to 800 Hz, band 4 from 1000 to 1600 Hz, band 5 from 2000 to 3150 Hz, and band 6 from 4000 to 6300 Hz) were defined and compared. RESULTS: Free-field WRS exhibited a significant difference (p-value = 0.004) between open BTE and open CIC, with better results for the open BTE. Matrix test speech reception threshold scores did not differ significantly between groups. No statistical significant difference were observed between APHAB and SADL total scores. Correlation tests revealed a negative correlation between SRT and APHAB scores in the open BTE group, not seen in the open CIC. No statistically significant difference was observed for all bands of REUG values, demonstrating comparability in terms of acoustic resonance of the external auditory canal. Comparing the REOG recorded in the two groups a significant difference was observed for bands 2 through 6. While the average REOG values for bands 5 and 6 were higher in patients with traditional open BTE aids, in contrast, for bands 2, 3, and 4, the REOG values for the open CIC group were higher and statistically significant compared to patients wearing traditional open-fitting BTE hearing aids. CONCLUSION: Patients with open CIC seem to perform worse in quiet environments compared to noisy ones, as indicated by the free field WRS score. However, the absence of differences in functional performance assessed with the matrix sentence test, and in the psychosocial aspects, makes these devices a good solution for individuals who reject hearing aids due to aesthetic concerns. The differences in terms of real ear measurements, while statistically significant, do not negatively impact overall performance.

CTHNet: a network for wheat ear counting with local-global features fusion based on hybrid architecture.

Accurate wheat ear counting is one of the key indicators for wheat phenotyping. Convolutional neural network (CNN) algorithms for counting wheat have evolved into sophisticated tools, however because of the limitations of sensory fields, CNN is unable to simulate global context information, which has an impact on counting performance. In this study, we present a hybrid attention network (CTHNet) for wheat ear counting from RGB images that combines local features and global context information. On the one hand, to extract multi-scale local features, a convolutional neural network is built using the Cross Stage Partial framework. On the other hand, to acquire better global context information, tokenized image patches from convolutional neural network feature maps are encoded as input sequences using Pyramid Pooling Transformer. Then, the feature fusion module merges the local features with the global context information to significantly enhance the feature representation. The Global Wheat Head Detection Dataset and Wheat Ear Detection Dataset are used to assess the proposed model. There were 3.40 and 5.21 average absolute errors, respectively. The performance of the proposed model was significantly better than previous studies.

Outcomes of Minimally Invasive Tympanoplasty: Fat Graft Myringoplasty.

Introduction: Fat tympanoplasty is repair of small dry tympanic membrane perforations using fat as graft material. It is a simple office procedure with minimal morbidity and manipulation of the middle ear. Materials and Methods: The present study was a prospective review of 60 patients who underwent fat tympanoplasty over the period of 15 months. In all the patients fat was harvested from ear lobule. Results: Patients were kept on follow up for 3 months and evaluated for graft uptake and hearing gain. 86.66% closure rate of tympanic membrane defect was achieved. Postoperative air conduction was 29.6 ± 5.3 while air bone gap was 13.2 ± 6.1. Conclusion: The study concludes that fat plug myringoplasty is a simple, quick, less invasive method to repair small tympanic membrane defects.

Evaluating the Reliability of 'AudiClick': A Click-Based Mobile App for Hearing Loss.

Introduction: To develop and validate a click-based mobile "Audiclick" app employing click noises for hearing assessments. Materials and Methods: This prospective comparative study compares the "AudiClick" app as a hearing screening tool to pure tone audiometry. Participants listened to sounds through wired earbud headphones that were connected to an Android or iOS device. Results: The study involved 110 participants aged between 18 to 80 years old. All degrees of hearing loss severity corresponds to pure tone average (p < 0.01) results. The app was also found to be effective at identifying hearing loss (80-99% sensitivity, specificity, positive predictive value, and accuracy). Test-retest reliability had also shown excellent ICC scores of 0.93. Conclusions: This study demonstrates that a mobile app using click sounds can be as efficient as pure tone audiometry for field screenings, while being more cost-effective and easier to develop.

Complete genome sequence of Pseudomonas aeruginosa strain NCTR 501 isolated from the inner ear of a laboratory mouse (Mus musculus) diagnosed with otitis media.

We report the circularized 6,427,509-bp genome of Pseudomonas aeruginosa isolated from the inner ear of a laboratory mouse (Mus musculus) diagnosed with otitis media. The genome of P. aeruginosa NCTR 501 has a circular chromosome of 6,420,288 bp and two plasmids of 4,042 and 3,179 bp, respectively.

[The population morbidity with diseases of ear and mastoid and accessibility of otorhinolaryngological care].

The article analyses level and dynamics of morbidity of diseases of ear and mastoid in the Sakha Republic (Yakutia) in 2020-2021 and availability of otorhinolaryngological care. The methods of comparative statistics and mathematical analysis were applied to analyze official data provided by the Yakut Republic Medical Information and Analytical Center, the specialized Department of Otorhinolaryngology, the Republic Hospital № 2 - Center for Emergency Medical Care and the Federal State Statistics Service of Russia. The study established increasing trend of increasing morbidity of these diseases in both the adult and child population. In 2021, the growth rate of overall morbidity of adult population reached 17.7% and 8.8% in children, as compared to 2020. The primary morbidity of adults made up to 22.3%, in children - 15.7%. The comparative analysis demonstrated higher rates of general morbidity in the Republic: by 0.5% as compared with the Russian Federation and by 14.1% as compared with the Far Eastern Federal Okrug. The level of primary morbidity was lower than similar indicators of the compared territories by 17.1% and 3.0%, respectively. It is worth noting that analyzed morbidity of diseases of ear and mastoid reflects prevalence of ENT diseases in the region only indirectly, as the statistical data do not allow to estimate separately rate of upper respiratory tract lesions. Meanwhile, respiratory diseases rank first in the structure of population diseases in Yakutia. The growth of disability in children due to diseases of ear and mastoid requires attention. Among children of 0-17 years old, the indicator of primary disability increased from 0.38 to 0.8 per 10,000 of children population (increase of 110.5%); in children 0-3 years old - from 0.9 to 2.3 per 10,000 of the child population (an increase of 155.6%). The analysis of the number of beds in otorhinolaryngology wards established that that the bed capacity per 10,000 population was 0.6 that is significantly lower than the established standards. The article emphasizes need to adjust the Federal standards for hospital bed capacity, taking into account climatic and geographical conditions of the region, which contribute to spread and chronization of ENT diseases.

Melanoma of the external auditory canal: case report and systematic literature review.

Melanoma of the external auditory canal (EAC) is particularly rare and poorly understood, with limited available data on management and survival. This systematic review aims to analyze existing data and provide insights into the management and prognosis the beginning of EAC melanoma. It is conducted using Pubmed and Scopus databases from the beginning to July 2023 and it follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Searches are performed using the search string "(melanoma) AND (external auditory canal)".The review includes a total of 30 patients diagnosed with EAC melanoma, supplemented by an additional case from the authors' clinical experience. The role of Breslow thickness as a determining factor for the choice of surgery remains inconclusive due to limited available data. Sentinel lymph node biopsy and adjuvant therapy are sparingly employed, indicating the need for standardized guidelines. Patients in the study demonstrate a 50% overall survival rate at 5 years.EAC Melanoma is a rare and aggressive malignancy with limited therapeutic guidelines. Surgical interventions, including wide local excision and lateral temporal bone resection, are the primary treatment options for patients without distant metastases.

N6-methyladenosine methylation analysis of circRNAs in acquired middle ear cholesteatoma.

Introduction: Middle ear cholesteatoma is a chronic middle ear disease characterized by severe hearing loss and adjacent bone erosion, resulting in numerous complications. This study sought to identify pathways involved in N6-methyladenosine (m6A) modification of circRNA in middle ear cholesteatoma. Methods: A m6A circRNA epitranscriptomic microarray analysis was performed in middle ear cholesteatoma tissues (n = 5) and normal post-auricular skin samples (n = 5). Bioinformatics analyses subsequently explored the biological functions (Gene Ontology, GO) and signaling pathways (Kyoto Encyclopedia of Genes and Genomes, KEGG) underlying middle ear cholesteatoma pathogenesis. Methylated RNA immunoprecipitation qPCR (MeRIP-qPCR) was performed to verify the presence of circRNAs with m6A modifications in middle ear cholesteatoma and normal skin samples. Results: Microarray analysis identified 3,755 circRNAs as significantly differentially modified by m6A methylation in middle ear cholesteatoma compared with the normal post-auricular skin. Among these, 3,742 were hypermethylated (FC ≥ 2, FDR < 0.05) and 13 were hypomethylated (FC ≤ 1/2, FDR < 0.05). GO analysis terms with the highest enrichment score were localization, cytoplasm, and ATP-dependent activity for biological processes, cellular components, and molecular functions respectively. Of the eight hypermethylated circRNA pathways, RNA degradation pathway has the highest enrichment score. Peroxisome Proliferator-Activated Receptor (PPAR) signaling pathway was hypomethylated. To validate the microarray analysis, we conducted MeRIP-qPCR to assess the methylation levels of five specific m6A-modified circRNAs: hsa_circRNA_061554, hsa_circRNA_001454, hsa_circRNA_031526, hsa_circRNA_100833, and hsa_circRNA_022382. The validation was highly consistent with the findings from the microarray analysis. Conclusion: Our study firstly presents m6A modification patterns of circRNAs in middle ear cholesteatoma. This finding suggests a direction for circRNA m6A modification research in the etiology of cholesteatoma and provides potential therapeutic targets for the treatment of middle ear cholesteatoma.

Influence of climatic variables on maize grain yield and its components by adjusting the sowing date.

Yield and its components are greatly affected by climate change. Adjusting the sowing date is an effective way to alleviate adverse effects and adapt to climate change. Aiming to determine the optimal sowing date of summer maize and clarify the contribution of climatic variables to grain yield and its components, a consecutive 4-year field experiment was conducted from 2016 to 2019 with four sowing dates at 10-day intervals from 5 June to 5 July. Analysis of historical meteorological data showed that more solar radiation (SR) was distributed from early June to mid-August, and the maximum temperature (Tmax) > 32°C appeared from early July to late August, which advanced and lasted longer in 1991-2020 relative to 1981-1990. Additionally, the precipitation was mainly distributed from early June to late July. The climate change in the growing season of summer maize resulted in optimal sowing dates ranging from 5 June to 15 June, with higher yields and yield stability, mainly because of the higher kernel number per ear and 1,000-grain weight. The average contribution of kernel number per ear to grain yield was 58.7%, higher than that of 1,000-grain weight (41.3%). Variance partitioning analysis showed that SR in 15 days pre-silking to 15 days post-silking (SS) and silking to harvest (SH) stages significantly contributed to grain yield by 63.1% and 86.4%. The extreme growing degree days (EDD) > 32°C, SR, precipitation, and diurnal temperature range (DTR) contributed 20.6%, 22.9%, 14.5%, and 42.0% to kernel number per ear in the SS stage, respectively. Therefore, we concluded that the early sowing dates could gain high yield and yield stability due to the higher SR in the growing season. Meanwhile, due to the decreasing trend in SR and increasing Tmax trend in this region, in the future, new maize varieties with high-temperature resistance, high light efficiency, shade tolerance, and medium-season traits need to be bred to adapt to climate change and increased grain yield.

GGA1 interacts with the endosomal Na+/H+ Exchanger NHE6 governing localization to the endosome compartment.

Mutations in the endosomal Na+/H+ exchanger (NHE6) cause Christianson Syndrome (CS), an X-linked neurological disorder. NHE6 functions in regulation of endosome acidification and maturation in neurons. Using yeast two-hybrid screening with the NHE6 carboxyl-terminus as bait, we identify Golgi-associated, Gamma adaptin ear containing, ARF binding protein 1 (GGA1) as an interacting partner for NHE6. We corroborated the NHE6-GGA1 interaction using: co-immunoprecipitation (co-IP); over-expressed constructs in mammalian cells; and co-IP of endogenously-expressed GGA1 and NHE6 from neuroblastoma cells, as well as from mouse brain. We demonstrate that GGA1 interacts with organellar NHEs (NHE6, NHE7 and NHE9), and that there is significantly less interaction with cell-surface localized NHEs (NHE1 and NHE5). By constructing hybrid NHE1/NHE6 exchangers, we demonstrate that the cytoplasmic tail of NHE6 interacts most strongly with GGA1. We demonstrate the co-localization of NHE6 and GGA1 in cultured, primary hippocampal neurons, using super-resolution microscopy. We test the hypothesis that the interaction of NHE6 and GGA1 functions in the localization of NHE6 to the endosome compartment. Using subcellular fractionation experiments, we show that NHE6 is mis-localized in GGA1 knockout cells, wherein we find less NHE6 in endosomes, but more NHE6 transport to lysosomes, and more Golgi retention of NHE6, with increased exocytosis to the surface plasma membrane. Consistent with NHE6 mis-localization, and Golgi retention, we find the intra-luminal pH in Golgi to be alkalinized in GGA1-null cells. Our study demonstrates a new interaction between NHE6 and GGA1 which functions in the localization of this intra-cellular NHE to the endosome compartment.

Assessing the Efficacy of Tragal Pumping in a Novel Tympanostomy Tube-Rat Model.

Objective: Tragal pumping (TP) is a practice of pushing on the tragus to raise pressure within the external auditory canal and is a commonly recommended adjunctive maneuver believed to facilitate the introduction of ototopical medications into the middle ear cavity via a tympanostomy tube. To investigate the efficacy of TP in the penetration of eardrops into the middle ear cavity via tympanostomy tube, we established the novel tympanostomy tube-rat model. We investigated the histology of the middle ear to determine the efficacy in moving fluid into the middle ear. Study Design: Prospective controlled animal study. Setting: Animal laboratory in a university hospital. Methods: Ten rats were recruited, and a tympanostomy tube insertion and green dye eardrops into outer ears were performed on bilateral ears. TP was performed only on 1 ear and was not applied on the other ear in each rat. Green dye in a middle ear cavity in hematoxylin and eosin-stained temporal bone sections was evaluated by blinded experts in microscopic anatomy (staining grade) and by using Image J software (staining level). The results of these 2 methods were statistically validated. Results: The staining grade (P < .001) and the staining level (P < .001) were significantly higher in the ears which we applied TP than in the control ears. The results of 2 methods were significantly and positively correlated (r = .898, P < .001). Conclusion: Our results showed that the TP accelerate the penetration of eardrops into the middle ear cavity in the tympanostomy tube-rat model.

Ergonomics of Various Modalities for Ear Surgery.

Objective: Evaluate ergonomic differences of various modalities for performing middle ear surgery. Study Design: Observational study. Setting: Two academic tertiary care centers. Methods: Attending physicians and residents performing middle ear surgery were photographed intraoperatively. Intraoperative photographs were analyzed using the validated Rapid Upper Limb Assessment (RULA) tool to measure musculoskeletal disease (MSD) risk. Descriptive statistics and significance testing were used to characterize and compare ergonomic differences between surgical modalities. Multivariable ordinal regression was performed to assess factors associated with increased MSD risk, as determined by the final RULA score. Results: Most of our 110 intraoperative photos featured attendings (82.7%) performing combined middle ear surgery and mastoidectomy (60.0%). Body angles and the final RULA score varied significantly among modalities. On subset analysis, microscopic surgery exhibited significantly worse wrist, trunk, and neck angles compared to endoscopic and exoscopic surgery. Exoscopic surgery had significantly lower final RULA scores than both endoscopic and microscopic surgery, indicating significantly lower MSD risk. Microscopic and endoscopic surgery final scores did not vary significantly. In a multivariable ordinal regression of factors associated with increased RULA score, exoscopic surgery had statistically significantly less ergonomic risk relative to microscopic surgery (odds ratio = 0.12, 95% confidence interval = [0.03-0.43]). Conclusion: Exoscopic, endoscopic, and microscopic surgery all featured low ergonomic risk, although exoscopic middle ear surgery demonstrated the lowest risk profile among studied surgical modalities. This demonstrates the importance of using each modality in combination with other ergonomic interventions to provide meaningful musculoskeletal benefits.

A Clinicopathological Study of Aural Polyps: A Retrospective Analysis in a Tertiary Care Hospital.

Introduction Aural polyps are a misnomer. Any lesion can present as a mass in the external auditory canal. Aural polyps are proliferation of the granulation tissue due to long standing inflammatory process with associated otalgia and otorrhea. Objectives To document the clinicoradiological presentations, intraoperative findings, and histopathological diagnosis of aural polyp, correlating them. Methods In our study 81 patients underwent treatment for aural polyps in the department of Ear, Nose, and Throat (ENT) from April 1997 to April 2022. Results were tabulated, a simple descriptive analysis was done using the Statistical Package Social Sciences software, and the results obtained were represented as percentages and presented in tables. Results The majority (38) of the patients presenting with aural polyps were diagnosed with mucosal and squamous type of CSOM, and 22 with simple granulation polyps. There were also 5 patients with malignant otitis externa, 3 patients had glomus tumors, 2 patients with retained foreign bodies, and 3 patients with brain herniation. We also identified aberrant internal carotid artery, high jugular bulb, one patient had facial nerve neuroma, one patient had polyp from the tragus diagnosed with tuberculosis, one patient with keratosis obturans, and one with exostosis. Conclusion A thorough detailed examination and mastoid exploration with radiological and histopathological evaluation is mandatory for better defining the definitive treatment. Utmost care and meticulousness are advised for the surgeons while dealing with aural polyps to avoid any complications.

Pediatric Myringoplasty using the Periosteum: An Institutional Overview.

Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB ( p < 0.001). Conclusion We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes.

Preliminary results of classifying otosclerosis and disarticulation using a convolutional neural network trained with simulated wideband acoustic immittance data.

Current noninvasive methods of clinical practice often do not identify the causes of conductive hearing loss due to pathologic changes in the middle ear with sufficient certainty. Wideband acoustic immittance (WAI) measurement is noninvasive, inexpensive and objective. It is very sensitive to pathologic changes in the middle ear and therefore promising for diagnosis. However, evaluation of the data is difficult because of large interindividual variations. Machine learning methods like Convolutional neural networks (CNN) which might be able to deal with this overlaying pattern require a large amount of labeled measurement data for training and validation. This is difficult to provide given the low prevalence of many middle-ear pathologies. Therefore, this study proposes an approach in which the WAI training data of the CNN are simulated with a finite-element ear model and the Monte-Carlo method. With this approach, virtual populations of normal, otosclerotic, and disarticulated ears were generated, consistent with the averaged data of measured populations and well representing the qualitative characteristics of individuals. The CNN trained with the virtual data achieved for otosclerosis an AUC of 91.1 %, a sensitivity of 85.7 %, and a specificity of 85.2 %. For disarticulation, an AUC of 99.5 %, sensitivity of 100 %, and specificity of 93.1 % was achieved. Furthermore, it was estimated that specificity could potentially be increased to about 99 % in both pathological cases if stapes reflex threshold measurements were used to confirm the diagnosis. Thus, the procedures' performance is comparable to classifiers from other studies trained with real measurement data, and therefore the procedure offers great potential for the diagnosis of rare pathologies or early-stages pathologies. The clinical potential of these preliminary results remains to be evaluated on more measurement data and additional pathologies.

Trends in research on cochlear implantation with inner ear malformation: a bibliometric and visualization analysis from 1986 to 2024.

OBJECTIVE: The aim of this study was to conduct a bibliometric and visualization analysis of research on cochlear implantation (CI) for inner ear malformations (IEMs) from 1986 to 2024. METHODS: A comprehensive literature search was performed using the Web of Science Core Collection Database, resulting in the identification of 431 relevant publications. Various data analysis and visualization tools, including VOSviewer, CiteSpace, and Bibliometrix, were utilized to analyze annual publication outputs, countries/regions and institutions, authors, journals and studies, keywords, and theme evolution. RESULTS: The study revealed an overall increasing trend in research output on CI for IEMs, with significant contributions from countries such as the United States, China, Turkey, Germany, and Italy. The analysis also identified key authors, research teams, journals, and studies that have made substantial contributions to the field. Furthermore, the study highlighted important research hotspots and trends, such as the classification of IEMs, outcomes of CI for IEMs, and the management of pediatric patients with IEMs. CONCLUSION: The findings of this study provide a comprehensive overview of the research landscape surrounding CI for IEMs. The results serve as a basis for future research topic selection and emphasize the need for enhanced international collaboration and the publication of high-impact research to further advance this field.