Comment on "Embolization of Ophthalmic Artery Induced by Ear Hyaluronic Acid Injection".

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

Reprogramming with Atoh1, Gfi1, and Pou4f3 promotes hair cell regeneration in the adult organ of Corti.

Cochlear hair cells can be killed by loud noises, ototoxic drugs, and natural aging. Once lost, mammalian hair cells do not naturally regenerate, leading to permanent hearing loss. Since the mammalian cochlea lacks any intrinsic ability to regenerate, genetic reprogramming of cochlear supporting cells that lie adjacent to hair cells is a potential option for hearing restoration therapies. We targeted cochlear supporting cells with three hair cell transcription factors: Atoh1, or Atoh1 + Gfi1, or Atoh1 + Gfi1 + Pou4f3 and found that 1- and 2-factor reprogramming is not sufficient to reprogram adult supporting cells into hair cells. However, activation of all three hair cell transcription factors reprogrammed some adult supporting cells into hair cell-like cells. We found that killing endogenous hair cells significantly improved the ability of supporting cells to be reprogrammed and regenerated numerous hair cell-like cells throughout the length of the cochlea. These regenerated hair cell-like cells expressed myosin VIIa and parvalbumin, as well as the mature outer hair cell protein prestin, were innervated, expressed proteins associated with ribbon synapses, and formed rudimentary stereociliary bundles. Finally, we demonstrate that supporting cells remained responsive to transcription factor reprogramming for at least 6 weeks after hair cell damage, suggesting that hair cell reprogramming may be effective in the chronically deafened cochlea.

Current Trends in Clinico-Bacteriological Profile and Antimicrobial Susceptibility Pattern in Active Chronic Suppurative Otitis Media (Safe and Unsafe) at a Tertiary Care Center in Uttarakhand: An Observational Study.

INTRODUCTION: Otitis media is defined as inflammation of the middle ear due to any cause that may also involve any contiguous pneumatized portion of the temporal bone. It is also one of the most common diseases of childhood after viral upper respiratory tract infection. As a result of the widespread availability of over-the-counter topical antibiotics and the irrational use of these agents, there is a development of multidrug-resistant bacteria. AIM: The aim of this study was to assess the current bacteriological profile and antimicrobial susceptibility pattern in clinically diagnosed cases of active chronic otitis media (COM) at a tertiary care center in Uttarakhand. MATERIALS AND METHODS: The proposed observational cross-sectional study was conducted in the Department of Otolaryngology and Head and Neck Surgery and Department of Microbiology of Government Doon Medical College Hospital, Dehradun, over a period of 18 months from August 2022 to January 2024. One hundred and thirty-seven cases of active COM fulfilling the inclusion criteria were recruited in the study. Under strict aseptic conditions, pus samples were collected from the middle ear using two sterile cotton swabs under microscopic examination and sent to the microbiology lab for pathogen identification and isolation. The isolated organisms were subjected to antibiotic susceptibility testing using VITEK-2 as per the latest Clinical and Laboratory Standards Institute (CLSI) guidelines.  Results: In the present study, the most common age group affected by COM was between 18 and 30 years with female predominance. Pseudomonas aeruginosa (33.6%) was the predominantly isolated organism followed by Staphylococcus aureus (17.8%). Considering the antibiotic susceptibility, Pseudomonas aeruginosa was susceptible to piperacillin/tazobactam and meropenem while least sensitive to levofloxacin and ciprofloxacin. Staphylococcus aureus was susceptible to linezolid, daptomycin, and vancomycin. The maximum resistance of Staphylococcus aureus was observed to ciprofloxacin and levofloxacin. CONCLUSION:  The study of changing clinico-bacteriological profile and antibiotic susceptibility pattern in cases of COM due to variations in the geography and environment of the study population can help to guide appropriate antibiotic treatment and thus prevent the development of multidrug-resistant bacteria.

Dexmedetomidine leads to the amelioration of stress response to surgery.

Objectives: To determine the impact of intravenous Dexmedetomidine (Dex) administered perioperatively on stress response markers in patients undergoing ENT surgeries. Methods: This randomized interventional study was conducted at POFs Hospital and NUMS affiliated WMC, Wah Cantt, in collaboration with IIMC Rawalpindi, Pakistan, from October 2021 to April 2022. One hundred patients aged between 15-60 years, after satisfying the inclusion standards were randomly divided into two groups C and D. Group-C (n=50) received normal saline in addition to the standard anesthesia protocol. The intervention Group-D (n=50) was administered 1µg/kg dexmedetomidine hydrochloride intravenously over 10 minutes just before the induction followed 0.5µg/kg/hr as maintenance dose till the end of surgery. Serum inflammatory biomarkers (interleukins-6, TNF-α and cortisol) were measured in blood samples in both groups, taken at 0 (T0), 30 minutes(T1), and two hours (T2) time intervals and analyzed by using Enzyme-linked immunosorbent assay (ELISA). Data was statistically analyzed using SPSS 23. Results: The patients receiving Dex showed marked decrease in serum levels of cortisol, TNF- α and interleukins-6, from 139.73 to10.18, 99.51 to 0.96 and 85.09 to 0.96 respectively. Comparison between C and D groups revealed significant differences (p≤0.05) in these serum biomarkers. Conclusions: In the present study, intravenous Dex suppressed the intraoperative rise in levels of cytokine secretion and enhanced smooth recovery with no incidence of nausea and vomiting. These effects could be attributed to the anti-inflammatory effects of dexmedetomidine.

Hearing loss during chemotherapy: prevalence, mechanisms, and protection.

Ototoxicity is an often-underestimated sequela for cancer patients undergoing chemotherapy, with an incidence rate exceeding 50%, affecting approximately 4 million individuals worldwide each year. Despite the nearly 2,000 publications on chemotherapy-related ototoxicity in the past decade, the understanding of its prevalence, mechanisms, and preventative or therapeutic measures remains ambiguous and subject to debate. To date, only one drug, sodium thiosulfate, has gained FDA approval for treating ototoxicity in chemotherapy. However, its utilization is restricted. This review aims to offer clinicians and researchers a comprehensive perspective by thoroughly and carefully reviewing available data and current evidence. Chemotherapy-induced ototoxicity is characterized by four primary symptoms: hearing loss, tinnitus, vertigo, and dizziness, originating from both auditory and vestibular systems. Hearing loss is the predominant symptom. Amongst over 700 chemotherapeutic agents documented in various databases, only seven are reported to induce hearing loss. While the molecular mechanisms of the hearing loss caused by the two platinum-based drugs are extensively explored, the pathways behind the action of the other five drugs are primarily speculative, rooted in their therapeutic properties and side effects. Cisplatin attracts the majority of attention among these drugs, encompassing around two-thirds of the literature regarding ototoxicity in chemotherapy. Cisplatin ototoxicity chiefly manifests through the loss of outer hair cells, possibly resulting from damages directly by cisplatin uptake or secondary effects on the stria vascularis. Both direct and indirect influences contribute to cisplatin ototoxicity, while it is still debated which path is dominant or where the primary target of cisplatin is located. Candidates for hearing protection against cisplatin ototoxicity are also discussed, with novel strategies and methods showing promise on the horizon.

Quantifying skin permeation of a novel metformin lotion using modified hydrophilic interaction liquid chromatography.

Aim: This study aimed to quantify the permeation of metformin (Met) lotion through pig ear skin using high-performance liquid chromatography, specifically hydrophilic interaction liquid chromatography (HILIC), to separate Met from biological contaminants and effectively measure its permeation through skin similar to human skin.Materials & methods: A Franz cell permeation assay was used to assess the permeation kinetics of 6% Met lotion through pig ear skin. Samples were collected at various time points and prepared for high-performance liquid chromatography analysis by removing large biological contaminants. The permeated Met was quantified by monitoring its retention time (RT) at 9 min using HILIC, with an acidic, polar mobile phase and a normal-phase column.Results: A distinct Met peak with a RT of approximately 9 min was observed in the 6% Met lotion, which was absent in the permeation samples from the 0% Met lotion. This peak (RT 9 min) was distinct from the 'biological-contaminants' peaks at RT 2-3 min and increased linearly over time, reaching 36.8% of the total applied Met at 24 h.Conclusion: These findings demonstrate that the HILIC method effectively separates Met from biological components in pig ear skin, allowing accurate quantification of Met despite the presence of skin lipids and proteins.

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Systematic contribution of the auditory region to the knowledge of the oldest European Bovidae (Mammalia, Ruminantia).

The ear region has a strong potential for evolutionary studies. While the petrosal bone suffers from ontogeny and allometry, the bony labyrinth provides crucial information for phylogeny. The study of the bony labyrinth itself allowed for argumentation of the early bovid species Eotragus artenensis and Eotragus clavatus being closely related, while a newly described species and genus of early Bovidae from Montréal-du-Gers (France), formerly attributed to Eotragus, clearly belong to another lineage. The morphology of the bony labyrinth of these oldest bovids confirms that Eotragus is a stem Bovidae, while the new Bovidae is more derived. Since the bony labyrinth is a structure that is little affected by ontogeny, allometry, and sexual dimorphism, we propose this structure and its surrounding petrosal bone as the holotype for this new species. This study shows the importance of the ear region in the context of micro- and macro-evolution.

Mobile Spatiotemporal Gait Segmentation Using an Ear-Worn Motion Sensor and Deep Learning.

Mobile health technologies enable continuous, quantitative assessment of mobility and gait in real-world environments, facilitating early diagnoses of gait disorders, disease progression monitoring, and prediction of adverse events like falls. Traditionally, mobile gait assessment predominantly relied on body-fixed sensors positioned at the feet or lower trunk. Here, we investigate the potential of an algorithm utilizing an ear-worn motion sensor for spatiotemporal segmentation of gait patterns. We collected 3D acceleration profiles from the ear-worn sensor during varied walking speeds in 53 healthy adults. Temporal convolutional networks were trained to detect stepping sequences and predict spatial relations between steps. The resulting algorithm, mEar, accurately detects initial and final ground contacts (F1 score of 99% and 91%, respectively). It enables the determination of temporal and spatial gait cycle characteristics (among others, stride time and stride length) with good to excellent validity at a precision sufficient to monitor clinically relevant changes in walking speed, stride-to-stride variability, and side asymmetry. This study highlights the ear as a viable site for monitoring gait and proposes its potential integration with in-ear vital-sign monitoring. Such integration offers a practical approach to comprehensive health monitoring and telemedical applications, by integrating multiple sensors in a single anatomical location.

Analysis of Meis2 knockout mice reveals Sonic hedgehog-mediated patterning of the cochlear duct.

BACKGROUND: The mechanisms underlying the formation of complex structures such as during the outgrowth of the cochlear duct are still poorly understood. RESULTS: We have analyzed the morphological and molecular changes associated with cochlear development in mouse mutants for the transcription factor Meis2, which show defective coiling of the cochlea. These morphological abnormalities were accompanied by the formation of ectopic and extra rows of sensory hair cells. Gene profiling of otic vesicles from Meis2 mutants revealed a dysregulation of genes that are potentially involved in Sonic hedgehog (Shh)-mediated patterning of the cochlear duct. Like in Shh mutants, Meis2 defective mice showed a loss of genes that are expressed in the apical part of the cochlear duct. CONCLUSIONS: Taken together, these data reveal that the loss of Meis2 leads to a phenotype that resembles Shh mutants, suggesting that Meis2 is instrumental for cochlear Shh signaling. The modulation of the same subset of genes provides an interesting insight into which Shh responsive genes are essential for outgrowth and patterning of the cochlear duct.

The therapeutic effect of dressing of exposed reconstructed auricle on patients after reconstruction of auricle.

The dressing of the reconstructed auricle after total auricle reconstruction surgery is an important measure of postoperative nursing. However, a uniform dressing of the reconstructed auricle after total auricle reconstruction surgery has not been formed. We carried out this clinical study to provide a new idea and method for the postoperative dressing of reconstructed auricle by comparing the therapeutic effect of the completely covered dressing method and the dressing method of exposed reconstructed auricle. Clinical data and postoperative data of patients with microtia treated by total auricle reconstruction in Plastic Surgery Hospital from January 2023 to January 2024 were retrospectively collected. Patients treated with the completely covered dressing method after surgery were included in the control group, and patients treated with the dressing method of exposed reconstructed auricles after surgery were included in the experimental group. A total of 45 patients were in the experimental group and 48 patients in the control group. In terms of postoperative complications, the incidence of complications was 8.89% in the experimental group and 37.5% in the control group (P < 0.05). In terms of the satisfaction rate of patients and their families, the satisfaction rate of the experimental group was 97.78%, and that of the control group was 83.3% (P < 0.05). Compared with the traditional method of the completely covered dressing method after total auricle reconstruction surgery, the dressing method of exposed reconstructed auricle has a lower complication rate, a higher satisfaction rate of patients and their families, and a better therapeutic effect for patients after total auricle reconstruction surgery.

Destructive foreign body granuloma: A case report.

External auditory canal polyps are predominantly inflammatory processes but occasionally indicate more severe pathology. Prolonged conservative management may postpone accurate diagnosis and appropriate therapeutic intervention. This case report presents a 37-year-old woman, previously healthy with a normal ear, who underwent a right myringotomy with the insertion of a pressure-equalizing tube in one hospital after an upper respiratory tract infection. However, due to the pandemic era, she lost follow-up for 2 years and subsequently presented to another hospital with worsening hearing and persistent otorrhea. The attending physician found a large polypoid lesion occupying her right external ear canal. A computerized tomography scan revealed an irregular enhancement mass involving the right ear canal, the middle ear cavity, and mastoid air cells with multiple destruction of the skull base and intracranial involvement in the right middle cranial fossa. The possibility of malignancy was raised, prompting the patient to seek evaluation in a third hospital. A right tympanomastoidectomy was performed, and during a posterior tympanotomy, a pressure-equalizing tube was discovered in her middle ear. The pathological results confirmed the presence of foreign body granuloma. Following surgery, the patient's otorrhea improved.

Feasibility of Easy to Use and Inexpensive Three-Dimensional Printed Educational Model of Temporal Bone: Practiced Without Drilling.

OBJECTIVE: Three-dimensional (3D) printed temporal bone model draws great attention as a promising alternative for conventional cadaveric model in education of otologic surgery. However, its high price and requirement for specialized tools hinder widespread use. We devised a simple educational model based on lattice structure to overcome these problems and compared it with a commercial model. METHODS: We converted high-resolution temporal bone computed tomography images into stereolithography format, and printed it using the G005 3D printing system from CUBICON©. In this process, the part to be drilled out was made of lattice structure. We evaluated the model by a questionnaire prepared in advance, and compared the results with those of a commercial model. RESULTS: We created an educational 3D printed temporal bone lattice model one-tenth the cost of commercial temporal bone. Our model reproduced the important structures of the temporal bone, produced less dust, and had similar strength and grinding sensation compared to the commercial model. The surface texture and reproducibility were comparable to the commercial model. Although most of structures were remodeled more elaborately in the commercial model than our model, our model demonstrated significant potential as a cost-effective educational tool for medical students and residents. CONCLUSION: 3D printed temporal bone lattice model has potential for widespread use due to low cost and easy accessibility. Further improvements in the fine structures of the temporal bone are necessary to enhance its utility as an educational model.

From Silence to Sound: Graeme Clark's Cochlear Implant.

Graeme Clark is an exceptional Australian professor and otolaryngologist who spent most of his life researching a way to help his deaf father and others suffering from profound hearing loss gain a better connection to those around them. His invention, the cochlear implant, has changed the lives of over 300,000 people around the world, with more than half of those individuals being children. Clark successfully created the first sensory connection linking the external world with human consciousness. He subsequently established the Bionic Ear Institute, now known as the Bionics Institute, to further improve his invention through research. He served as the full-time director until he retired at age 70 in 2005. Graeme Clark has been recognized worldwide for restoring hearing to the deaf and greatly improving their everyday lives.

Lentigo Maligna and Lentigo Maligna Melanoma of the External Ear: Clinical and Dermoscopic Features of 19 Patients.

External ear lentigo maligna/lentigo melanoma (LM/LMM) represents approximately 1%-4% of all primary cutaneous melanomas. Over the past 20 years, dermoscopy has proven highly effective in early detection of LM/LMM, with recent studies identifying perifollicular linear projections (PLP) as a specific diagnostic criterion for early LM. However, in clinical practice, LM and LMM turn out to be very difficult to distinguish based on dermoscopic findings. Therefore, our retrospective monocentric study aimed to investigate dermoscopic characteristics, as well as the epidemiological and clinical data of 19 patients diagnosed with the external ear (EE) LM/LMM at the Oncologic Dermatology Unit in Bologna. Dermoscopic images were obtained using the FotoFinder Medicam 800HD, and specific criteria validated by the International Dermoscopy Society (IDS) for atypical pigmented facial lesions were assessed. Fisher's exact test was primarily used for statistical comparisons. As results, most of the patients were male (74%) with an average age (± SD) at diagnosis of 69.8 (± 15.1) years old. LMM appeared more commonly observed in elderly patients as compared to LM (mean 71.6 vs. 66.7, p = 0.514), presenting as pigmented macule (89.5%) of the ear lobule (23.9%). A statistically significant difference (p = 0.01) of tumour' diameter between LMM and LM was reported with the first resulting more than twice the size of the latter. Concerning dermoscopic findings, asymmetric pigmented follicles, obliteration of the follicular openings and grey circles were more frequently observed in LMM compared to LM (63.2% vs. 31.6%; 63.2% vs. 26.3%; 47.4% vs. 15.8%, respectively).

Our Experience in Endoscopic Button Tympanoplasty Providing High Success Rate in Varying Sizes of Perforation : A Case Series.

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

Endoscopic Rosette Cartilage Inlay-Onlay Myringoplasty: A 1-Year Prospective Study.

Since 1952, myringoplasty has evolved with various surgical techniques, including overlay, underlay, sandwich, pegging, rosette, and plugging. Overlay and underlay methods are most commonly used. In 1998, Eavey introduced the cartilage and perichondrium butterfly inlay myringoplasty, designed for small to medium-sized perforation closure, offering practical advantages such as reduced surgical time and improved hearing outcomes. A one-year prospective study (September 2022 to September 2023) in a tertiary care hospital in India involved 30 patients aged 9-52 years with inactive small central perforations. Pre-operative pure tone audiometry (PTA) results were required to be no higher than 35 dB conductive hearing loss. General or local anesthesia was used based on the patient's age. The surgical technique involved visualizing the perforation, graft preparation, and transcanal insertion. Among the 30 patients, the graft uptake rate was 100% at 3 months and 93.33% at 6 months. Pre-operative mean PTA was 29.76 dB, which decreased to 25.03 dB post-operatively, with a statistically significant air-bone gap closure of 4.73 dB. Cartilage rosette inlay-onlay myringoplasty offers an effective solution for small to medium-sized perforations, achieving high success rates (93.33%). This technique is associated with reduced surgical time, suitability for day care surgery, and minimal scarring, making it a valuable addition to routine clinical practice. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04831-4.

Unveiling a Rare Phenomenon: Sudden Sensorineural Hearing Loss Following Skin Prick Testing.

Introduction: The skin prick test (SPT) is a standard method for diagnosing allergic diseases, while sudden sensorineural hearing loss (SSNHL) remains a perplexing condition often of unknown etiology. We present a unique case of SSNHL emerging shortly after an SPT, suggesting a potential link between allergic reactions and inner ear disorders. Case Report: A 27-year-old male presented with unilateral hearing loss following an SPT for allergic rhinitis. Audiometric findings revealed SSNHL in the affected ear. Treatment with corticosteroids led to a full recovery of hearing function. Conclusion: This case highlights the rare occurrence of SSNHL possibly triggered by a type 1 allergic reaction to an SPT. Prompt corticosteroid therapy proved effective in restoring hearing. Further research is needed to understand the relationship between allergies and SSNHL and explore alternative treatment options.

Impact of Otoendoscopy in Cholesteatoma Surgery.

To study the Impact of Otoendoscopy at the end of apparent microscopic clearance of disease during primary Cholesteatoma surgery in detecting the residual cholesteatoma. A prospective, interventional, non randomized and non comparative study was conducted at the ESIC Medical College and PGIMSR. All patients of chronic otitis media of squamosal type undergoing modified radical mastoidectomy were included in the study. Otoendoscopy was performed after apparent clearance of cholesteatoma under microscope. If any residual cholesteatoma detected during otoendocsopy was recorded. Total of 63 cases were included in the study. Residual cholesteatoma was seen in 14% of the cases. Commonest site of residual cholesteatoma was sinus tympani. Otoendoscopy helps in visualizing the deep recesses of the middle ear cleft for residual cholesteatoma after apparent clearance under the operating microscope. It also helps in clearing the cholesteatoma from these deep recesses there by it helps in reducing the recurrence rate of cholesteatoma.

Bat Ear Correction Steps and Outcomes for Better Life Support.

An unusually projecting human ear is known as a prominent ear, otapostasis, or bat ear. It might be both bilateral and unilateral. The scapha and antihelix of the big concha are not well formed. It is the outcome of cartilage deformity that occurred during early ear development in utero. After the child reaches five years old, the abnormality can be corrected at any time. In order to prevent psychological suffering, the procedure should ideally be performed as soon as possible. Otoplasty correction is reshaping the ear cartilage to bring the ear closer to the side of the head. The cartilage is reshaped, but the skin is left in place. Hearing remains unaffected by the operation. It is mainly done for aesthetic reasons. Although they are uncommon, the post-operative consequences from the operation include hematoma development, keloid formation, infection, and asymmetry in the ears. Otoplasty is a cosmetic operation that involves permanent sutures to alter the size, shape, or location of the ear. The main purpose of otoplasty is to treat promin auris, or bulging ears. Promin auris, the principal indication for otoplasty, is the subject of this review. The indications, contraindications, and method utilized in otoplasty are reviewed in this exercise, which also emphasizes the need of pre- and post-operative care for patients having this surgery. Otoplasty results are generally lifelong and will improve the self-confidence. The goals of otoplasties are to make the ears appear more natural in comparison to the head and help with the overall contour of the ears. Final ear surgery results will be visible after a two week recovery period, with small improvements appearing for up to 12 months post-procedure. A proper understanding of the diagnosis, indications, and surgical techniques will lead to positive outcomes in otoplasty.