Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery.

BACKGROUND: Cartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures. METHODS: In this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence. RESULTS: The average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma. CONCLUSION: The treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion.

Relevant anatomical details in rats regarding otologic research / Detalles anatómicos relevantes en ratas para la investigación otológica

SUMMARY: The objective of the study was to provide a detailed anatomical description of the rat's ear anatomy that will prove insightful to different experimental otologic surgical procedures regardless of scope. Three male Wistar rats were enrolled in the study. Candidates were screened for systemic and otologic pathology. External ear canal endoscopy was carried out with a 30˚ rigid endoscope through an image capture system. Middle ear anatomical elements were analyzed under stereomicroscopy. 3D computer tomography image reconstruction was realized with a micro-CT to describe the anatomy. Image data from all three rats were analyzed. Anatomical annotations and surgical exposure recommendations were added for key elements. The most relevant images from all three rats were selected for representation. Detailed visualization of the structural elements of the tympanic cavity were clearly visible: promontory, round window, stapedial artery, stapes, incus, and tympanic membrane were all constant findings. We describe a step wise ventral surgical approach of the middle and inner ear for which we found that the clavotrapezius muscle was a reliable landmark. For the transtympanic approach the endoscopic transcanal access was an easy and reliable method for which a detailed anatomical representation was depicted. Further, anatomical similarities to humans were observed by stereomicroscopy and Micro-CT imaging reiterating that the rat model is suitable for otologic research. The endoscopic approach to the tympanic membrane is comfortable and less expensive than a microscope. The tendon of the clavotrapezius muscle can be a reliable landmark for discovering the tympanic bulla when considering a ventral approach. 3D Micro-CT reconstruction allows intact evaluation of the samples, simultaneously being a diagnostic and also a learning tool.

RESUMEN: El objetivo de este trabajo fue proporcionar una descripción anatómica detallada de la anatomía del órgano vestíbulococlear de la rata que resultará útil para diferentes procedimientos quirúrgicos otológicos experimentales, independientemente del alcance. En el estudio se usaron tres ratas Wistar macho. Los ejemplares fueron evaluados por patología sistémica y otológica. La endoscopía del meato acústico externo se realizó con un endoscopio rígido de 30˚ a través de un sistema de captura de imágenes. Los elementos anatómicos del oído medio se analizaron bajo estereomicroscopía. La reconstrucción de la imagen de tomografía computarizada en 3D se realizó con un micro-CT para describir la anatomía. Se analizaron los datos de imagen de las tres ratas. Se agregaron anotaciones anatómicas y recomendaciones de exposición quirúrgica para elementos clave. Las imágenes más relevantes de las tres ratas fueron seleccionadas para su representación. La visualización detallada de los elementos estructurales de la cavidad timpánica era claramente visible: promontorio timpánico, ventana coclear, arteria estapedial, estapedio, yunque y membrana timpánica eran hallazgos constantes. Describimos un abordaje quirúrgico ventral escalonado del oído medio e interno para el cual encontramos que el músculo clavotrapecio era un punto de referencia confiable. Para el abordaje transtimpánico, el acceso transcanal endoscópico fue un método fácil y confiable para el cual se describió una representación anatómica detallada. Además, se observaron similitudes anatómicas con los humanos mediante estereomicroscopía e imágenes Micro-CT, lo que reitera que el modelo de rata es adecuado para la investigación otológica. El abordaje endoscópico de la membrana timpánica es cómodo y menos costoso que un microscopio. El tendón del músculo clavotrapecio puede ser un punto de referencia fiable para descubrir la bulla timpánica cuando se considera un abordaje ventral. La reconstrucción 3D Micro- CT permite la evaluación intacta de las muestras, siendo simultáneamente una herramienta de diagnóstico y también de aprendizaje.

MUSE Stem Cells Can Be Isolated from Stromal Compartment of Mouse Bone Marrow, Adipose Tissue, and Ear Connective Tissue: A Comparative Study of Their In Vitro Properties.

The cells present in the stromal compartment of many tissues are a heterogeneous population containing stem cells, progenitor cells, fibroblasts, and other stromal cells. A SSEA3(+) cell subpopulation isolated from human stromal compartments showed stem cell properties. These cells, known as multilineage-differentiating stress-enduring (MUSE) cells, are capable of resisting stress and possess an excellent ability to repair DNA damage. We isolated MUSE cells from different mouse stromal compartments, such as those present in bone marrow, subcutaneous white adipose tissue, and ear connective tissue. These cells showed overlapping in vitro biological properties. The mouse MUSE cells were positive for stemness markers such as SOX2, OCT3/4, and NANOG. They also expressed TERT, the catalytic telomerase subunit. The mouse MUSE cells showed spontaneous commitment to differentiation in meso/ecto/endodermal derivatives. The demonstration that multilineage stem cells can be isolated from an animal model, such as the mouse, could offer a valid alternative to the use of other stem cells for disease studies and envisage of cellular therapies.

Differentiation of face and auricular shape resulting from diabetes and hypertension in the elderly

The prevalence global of noncommunicable chronic diseases as diabetes and hypertension worldwide has been disregarded until recently by policy makers. In addition, these diseases have growing with the aging of the population. This study sought to identify changes in face shape from the frontal and side views in elderly people diagnosed with diabetes and hypertension. 205 individuals were studied, with 60 years or more, from both sexes, with different ethnicities, and cognition intact. With a digital camera, photos were taken of the front and side and based on these images landmarks for measurement were determined. For statistical analysis, ANOVA, Canonical Variates Analysis, Mahalanobis distance and Thin-Plate Spline were realized. Given sexual dimorphism, the sexes were analyzed separately. From the ANOVA, significant differences (p<0.01) for individuals with diabetes, hypertension, and patients with both or neither of the diseases were observed. The groups were separated by the Canonical Variates and Mahalanobis distance and independent of edentulism, sex or ethnicity. A morphofacial characteristics for the front and side views (especially in the ear region) that identified individuals with these chronic diseases was observed. This methodology can contribute in a specific manner to the identification of at risk populations and help to promote preventative measures for these conditions.

Evaluating the effectiveness of learning ear anatomy using holographic models.

BACKGROUND: Computer-assisted learning has been shown to be an effective means of teaching anatomy, with 3-D visualization technology more successfully improving participants' factual and spatial knowledge in comparison to traditional methods. To date, however, the effectiveness of teaching ear anatomy using 3-D holographic technology has not been studied. The present study aimed to evaluate the feasibility and effectiveness of learning ear anatomy using a holographic (HG) anatomic model in comparison to didactic lecture (DL) and a computer module (CM). METHODS: A 3-D anatomic model of the middle and inner ear was created and displayed using presentation slides in a lecture, computer module, or via the Microsoft HoloLens. Twenty-nine medical students were randomized to one of the three interventions. All participants underwent assessment of baseline knowledge of ear anatomy. Immediately following each intervention, testing was repeated along with completion of a satisfaction survey. RESULTS: Baseline test scores did not differ across intervention groups. All groups showed an improvement in anatomic knowledge post-intervention (p < 0.001); the improvement was equal across all interventions (p = 0.06). Participants rated the interventions equally for delivery of factual content (p = 0.96), but rated the HG higher than the DL and CM for overall effectiveness, ability to convey spatial relationships, and for learner engagement and motivation (p < 0.001). CONCLUSIONS: These results suggest that 3-D holographic technology is an effective method of teaching ear anatomy as compared to DLs and CMs. Furthermore, it is better at engaging and motivating learners compared to traditional methods, meriting its inclusion as a tool in undergraduate medical education curriculum.

A guide to managing disorders of the ear pinna and canal.

This review will help you troubleshoot everything from infections and foreign bodies to trauma and neoplasm.

Evaluation of Morphological Characteristics of the Human Ear in Young Adults.

INTRODUCTION AND OBJECTIVES: Human external ear is a morphologically complex structure and plays a vital role in the collection of sound. The present study would provide the information regarding the shape and size of the various morphological structures of the ear in normal individuals which may help the plastic surgeons to reconstruct the anatomy of the deformed ear and the physical and forensic anthropologists to study variations and establishing its use as a biometrics. The aim of the study was the morphological examination of the ear and its features to investigate the biological variations, sex differences, bilateral variations and further attempt to provide a database of external ears of a normal north Indian population. METHODS: A cross-sectional sample of 71 males and 69 females aged between 18 to 25 years were collected from Nahan city of Sirmaur District in Himachal Pradesh state of North India. Various anthroposcopic parameters were considered and evaluated through personal observation such as ear shape, form of the helix, lobule shape and its attachment to the cheeks, strength of the anti-helix, etc and were sub-divided on the basis of form, shape, elevation, etc. The SPSS statistic (IBM, Armonk, NY) software version 16 was used to evaluate the sexual dimorphism and bilateral differences. RESULTS AND CONCLUSION: The frequencies of various morphological characters of the human external ear were calculated using Crosstabs. The results indicate the oval and round shaped ears were reported in 37.3%; 35.92% males and 23.92%; 38.41% females, respectively. Normally rolled helix was more frequent (73.24% in males and 84.06% in females) and possessed frequently occurring Darwin's tubercle with nodosity form (88.03% in males and 90.58% in females). Hypertrichosis was mostly present on the complete helix in case of males (66.20%). Single knob tragus (40.14% in males and 52.90% in females) and double knob tragus (33.10% in males and 36.23% in females) were found to be with higher frequency in the studied population. Partially free earlobes (53.52% in males and 46.38% in females) were more common than the attached one (38.03% in males and 47.83% in females) in case of males only. The present study provides a database of morphoscopy of the external ears of North Indian population. The database may be useful in the reconstruction of the deformed ears and in the anthropological and forensic research for comparison purposes. The study may also be utilized in the prediction of ear shape and size of the studied population for facial reconstruction in forensic examinations.

2D browsing software and 3D PDF of canine ear based on real color sectioned images / Software de navegación 2D y PDF en 3D del oído canino basado en imágenes seccionadas en color real

Dog ear is very important because of disease vulnerability. Therefore, gross anatomy and sectional anatomy on CT and MRI of the dog ear should be mastered by veterinarian. The purpose of this research was to present the digital atlases which high quality sectioned images and 3D models of detailed structures of dog ear could be displayed freely. In the sectioned images of a female beagle, ear structures were reconstructed by surface modeling to make 3D models. The sectioned images and 3D models were put into the browsing software and PDF file, respectively. Using the browsing software and the PDF file, gross and radiological anatomy of dog ear could be learned easily and accurately. The auditory tube of a dog was placed anterior to the tympanic cavity unlike human. The tensor tympani muscle of a dog was connected to the dorsal wall of the tympanic cavity with the malleus. No remarkable difference in the auditory ossicles, semicircular ducts, facial nerve, and endolymphatic duct was observed between dogs and humans. The software and the PDF file will be provided to other researchers freely to help contribute to veterinary research and education.

La oreja del perro es importante debido a la vulnerabilidad de enfermedad. Por lo tanto, el veterinario debe conocer plenamente la anatomía macroscópica y la anatomía seccional en la TC y la RM del oído del perro. El objetivo de esta investigación fue presentar los atlas digitales que podían mostrar imágenes seccionadas de alta calidad y modelos 3D de estructuras detalladas de orejas de perro. En las imágenes seccionadas de una hembra Beagle, las estructuras de las orejas se reconstruyeron mediante modelado de superficie con el objetivo de crear modelos 3D. Las imágenes seccionadas y los modelos 3D se colocaron en un software de navegación y un archivo PDF. El uso de software de navegación y el archivo PDF permiten un aprendizaje fácil y preciso de la anatomía macroscópica y radiológica de la oreja de perro. El músculo tensor del tímpano de un perro estaba conectado a la pared dorsal de la cavidad timpánica con el martillo. No se observaron diferencias notables en los huesecillos auditivos, los conductos semicirculares, el nervio facial y el conducto endolinfático entre perros y humanos. El software y el archivo PDF estarán disponibles libremente para los investigadores para ayudar en la investigación y educación veterinaria.

Assessment of Ideal Dimensions of the Ears, Nose, and Lip in the Circles of Prominence Theory on Facial Beauty.

IMPORTANCE: A theory on facial beauty might allow clinicians to achieve better results. OBJECTIVES: To find the ideal vertical position of the ears, total lip length, lip pucker length, distance between the irises, and starting point for the nasal radix. DESIGN, SETTING, AND PARTICIPANTS: In this subjective survey, 11 sets of 43 total digitally adjusted pictures (DAPs) and line drawings of actual faces were ranked based on attractiveness by 419 clients at a facial plastic surgery clinic. The data were collected from July 13 to August 29, 2015, and were analyzed from September 17, 2015, to March 21, 2016. MAIN OUTCOMES AND MEASURE: Six groups of line drawings and 5 groups of DAPs of an actual person were used to test the ideal position of the ears to determine whether the face is organized into oblique and parallel relationships and whether the total lip length and the lip pucker length are associated with multiples of an iris width (IW), and to determine the start of the nasal radix and its association with the superior margin of the iris and distance between the irises. RESULTS: Of the 419 survey respondents, the ear aligned with the second oblique was considered the most ideal by the participants. The preferred total lip length was 4.0 IWs in the DAPs and 5.0 IWs in the line drawings. For the lip pucker length, 2.0 and 3.0 IWs were considered the best. The ideal start of the nasal radix was tangential with the superior margin of the iris. The distance of 5.5 IWs from iris to iris and 3.0 IWs from the horizontal level of the iris to the nasal tip was preferred. CONCLUSIONS AND RELEVANCE: The face may be ideally organized into 3 parallel obliques. The IW, horizontal aperture of the eye, and then iris to iris distance may best determine the size and shape of progressively larger objects in the face. The absolute position of the eye was considered important by the participants in the ideal positioning of other objects in the face. LEVEL OF EVIDENCE: NA.

[The effect of EDARV370A on facial and ear morphologies in Uyghur population].

The ectodysplasinA receptor gene (EDAR) plays an important role in the development of ectoderm. The derived G allele of its key missense variant EDARV370A is prevalent in East Asians and Americans, but rare in Africans and Europeans. This leads to distinct ectodermal-derived phenotypes between different continental groups, such as the straighter and thicker hair, more eccrine sweat glands, feminine smaller breasts, shovel incisors characteristic of East Asians. At present, we know little about the association between EDARV370A and facial and ear morphology characteristics. To better understand the effect of EDARV370A on craniofacial phenotypes, we systematically examined the association between EDARV370A and 136 facial quantitative phenotypes, one chin ordinal phenotype and six ear ordinal phenotypes in 715 Uyghurs. The quantitative phenotypes were derived by applying our automated landmark annotation method to facial 3D photos and the ordinal phenotypes were manually graded from facial 2D photos. The analysis identified significant association (P<0.05 after multiple testing correction) between EDARV370A and eight facial phenotypes, one chin phenotype and three ear morphology phenotypes. Our study thus elucidated the pleotropic effect of EDARV370A on craniofacial phenotypes in a European-Asian admixed Uyghur population.

La enseñanza práctica en fonoaudiología a través de modelos tridimensionales: una alternativa prometedora / Theoretical-practical teaching in speech-language pathology through three-dimensional models: a promising alternative

El análisis de cuestionarios respondidos por alumnos de la disciplina Sistemas Sensoriales del curso de Fonoaudiología mostró que había dificultades para entender la histología de las regiones anatómicas del oído. Se estableció que la compresión de la histología demandaba una actividad didáctica complementaria. Por ello, se decidió crear una clase teórico-práctica diferenciada (CTP) usando un modelo tridimensional (3D) del oído humano y preparaciones histológicas de sus regiones. El modelo es una réplica anatómica muy aumentada del oído humano que permite la manipulación exploratoria de modo más eficaz que con piezas anatómicas clásicas. La CTP fue implementada en los dos semestres de 2014. La evaluación de la CTP incluyó un cuestionario de opiniones, más un cuaderno de actividades. Los resultados mostraron medias finales de mejores desempeños en ese año respecto al 2013, donde no fue dada este tipo de clase teórico-práctica. Se concluye que la CTP, asociada al modelo tridimensional y las explicaciones teóricas-prácticas de las preparaciones histológicas, permitió una mejor comprensión del contenido enseñado e introdujo una metodología más eficiente para el proceso de enseñanza-aprendizaje de un tema tan complejo así como importante para la formación académica de los estudiantes de Fonoaudiología. Adicionalmente, a partir de esta experiencia teórico-práctica se ha demostrado, una vez más, la importancia de la relación personal y profesional entre el profesor, preparador estudiantil y los alumnos para la calidad del trabajo académico.

We designed a differentiated theoretical-practical class (CTP) after analyzing questionnaires (Qs) answered by Speech-therapy students that attended the course "Sensory Systems". The Qs showed difficulties related with understanding the practical histology of the sensory systems, as well as problems to correlate it with the learning of the anatomy. We therefore established the to implement an auxiliary didactic activity (CTP). We used a three-dimensional model (3D) AS-001, of the University Extension Project (3D Museum). AS-001, is an enlarged anatomical replica of the human ear which is much more efficient for exploratory manipulation much than anatomical modeling. The assessment of CTP included a questionnaire and a notebook of activities. The CTP was implemented in both semesters during the year 2014. Results showed improvements when compared to 2013's data, when this type of theoretical-practical contents were not implemented. We conclude that the association of the three -dimensional model along with histological analysis of the parts of the ear effectively improved students' understanding of the subject. We therefore consider that CTP is a suitable methodology for the teaching-learning process of a complex, important subject for the academic training of Speech-therapy undergraduate students. Our experience allowed us to determine how important the personal and professional relationship between teachers and students is to improve academic work.

Anatomy and Surgical Approach of the Ear and Temporal Bone.

The temporal bone is one of the more complex structures at the skull base that houses the hearing and vestibular organs, numerous nerves, and vessels. A host of inflammatory and neoplastic processes can occur within the temporal bone that often necessitate permanent and frozen section pathologic examination. A number of simple to complex surgical procedures are used to manage temporal bone pathology. This chapter will provide a brief overview of normal temporal bone anatomy, common surgical approaches, normal histology, and indications for pathologic examination.

Genome-Wide Association Study and Transcriptome Analysis Provide New Insights into the White/Red Earlobe Color Formation in Chicken.

BACKGROUND/AIMS: Earlobe color is a typical external trait in chicken. There are some previous studies showing that the chicken white/red earlobe color is a polygenic and sex-linked trait in some breeds, but its molecular genetic and histological mechanisms still remain unclear. METHODS: We herein utilized histological section, genome-wide association study (GWAS) and RNA-seq, further to investigate the potential histological and molecular genetic mechanisms of white/red earlobe formation in Qiangyuan Partridge chicken (QYP). RESULTS: through histological section analysis, we found the dermal papillary layer of red earlobes had many more blood vessels than that of white earlobes. And we identified a total of 44 SNPs from Chromosome 1, 2, 3, 4, 9, 10, 11, 13, 19, 20, 23 and Z, that was significantly associated with the chicken white/red earlobe color from GWAS, along with 73 significantly associated genes obtained (e.g., PIK3CB, B4GALT1 and TP63), supporting the fact that the white/red earlobe color was also polygenic and sex-linked in QYP. Importantly, PIK3CB and B4GALT1 are both involved in the biological process of angiogenesis, which may directly give rise to the chicken white earlobe formation through regulating blood vessel density in chicken earlobe. Additionally, through contrast of RNA-seq profiles between white earlobe skins and red earlobe skins, we further identified TP63 and CDH1 differentially expressed. Combined with the existing knowledge of TP63 in epithelial development and tumor angiogenesis, we propose that down-regulated TP63 in white earlobes may play roles in thickening the skin and decreasing the vessel numbers in dermal papillary layer, thereby contributing to the white earlobe formation via paling the redness of the skin in QYP, but the specific mechanism remains to be further clarified. CONCLUSION: our findings advance the existing understanding of the white earlobe formation, as well as provide new clues to understand the molecular mechanism of chicken white/red earlobe color formation.

The ideal ear position in Caucasian females.

PURPOSE: Ear position contributes significantly to facial appearance. However, while objective measurements remain the foundation for esthetic evaluations, little is known about how an ear should ideally be positioned regarding its rotational axis. This study aimed to further evaluate whether there exists a universally applicable ideal ear axis, and how sociodemographic factors impact such preferences. MATERIALS AND METHODS: An interactive online survey was designed, enabling participants to change the axis of a female model's ear in terms of its forward and backward rotation. The questionnaire was sent out internationally to plastic surgeons and the general public. Demographic data were collected and analysis of variance was used to investigate respective preferences. RESULTS: A total of 1016 responses from 35 different countries (response rate: 18.5%) were gathered. Overall, 60% of survey takers chose the minus 10 or 5° angles to be most attractive. Significant differences were found regarding sex, ethnicity, country of residence, profession and respective ear axis preferences. CONCLUSION: Across multiple countries and ethnicities, an ear position in slight reclination of minus 5-10° is considered most pleasing in Caucasian females. However, sociodemographic factors significantly impact individual ear axis preferences and should be taken into consideration when performing reconstructive ear surgery.

Comparison of microscopic and endoscopic view of the internal acoustic meatus: A cadaveric study.

The endoscope is thought to provide an improved exposure of the internal acoustic meatus after retrosigmoid craniotomy for microsurgical resection of intrameatal tumors. The aim of this study is to quantify the differences in internal acoustic meatus (IAM) exposure comparing microscopic and endoscopic visualization. A retrosigmoid approach was performed on 5 cadaver heads. A millimeter gauge was introduced into the internal acoustic meatus, and examinations with a surgical microscope and 0°, 30° and 70° rigid endoscopes were performed. The extent of IAM depth visualized with the microscope and the different angled endoscopes were analyzed. The microscopic view allowed an average IAM depth visualization of 2.8 mm. The endoscope allowed an improved exposure of IAM in all cases. The 0°, 30° and 70° endoscopes permitted an exposure that was respectively 96% (5.5 mm), 139% (6.7 mm) and 200% (8.4 mm) more lateral than the microscopic view. Angled optics, however, provided an image distortion, specifically the 70° endoscope. The endoscope provides a superior visualization of the IAM compared to the microscope when using a retrosigmoid approach. The 30° endoscope represented an ideal compromise of superior visualization with marginal image distortion. Additional implementation of the endoscope into microsurgery of intrameatal tumors likely facilitates complete tumor removal and might spare facial and vestibulocochlear function. Clin. Anat. 31:398-403, 2018. © 2017 Wiley Periodicals, Inc.

Three-Dimensional Analysis of the Ear Morphology.

BACKGROUND: For surgical treatment of the face, detailed surgical planning is necessary to avoid later unaesthetic results. Most of the studies in the literature concentrate on the ears' anatomy during childhood and adolescence. Nearly no study evaluates the anatomy of ears of people aged 50 or older. It was our aim to measure and evaluate the ear's anatomy in Caucasians between the ages of 21 and 65. METHODS: Three-dimensional scans of 240 volunteers were taken. The subjects were divided into groups of males and females and each of them into three groups by age (21-35, 36-50, 51-65). Landmarks were placed in these scans. Distances, relations and angles between them were recorded. RESULTS: The distance between the subaurale and superaurale significantly increases (p < 0.001) during the aging process in males and females. Also, the width of the ear, measured between the preaurale and postaurale, significantly increased (p = 0.007) with advancing age. When the length of the ear is divided into four parts by anatomical landmarks, it extended the most in the lower quadrant with increasing subject age. CONCLUSION: The ear of Caucasians does not stop changing its shape during adulthood. Even after the body has stopped growing, the ear still does. With the measured values in this study, it should be possible for the surgeon to plan the operation in advance and achieve satisfactory aesthetic outcomes. 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 www.springer.com/00266 .

Multiethnic GWAS Reveals Polygenic Architecture of Earlobe Attachment.

The genetic basis of earlobe attachment has been a matter of debate since the early 20th century, such that geneticists argue both for and against polygenic inheritance. Recent genetic studies have identified a few loci associated with the trait, but large-scale analyses are still lacking. Here, we performed a genome-wide association study of lobe attachment in a multiethnic sample of 74,660 individuals from four cohorts (three with the trait scored by an expert rater and one with the trait self-reported). Meta-analysis of the three expert-rater-scored cohorts revealed six associated loci harboring numerous candidate genes, including EDAR, SP5, MRPS22, ADGRG6 (GPR126), KIAA1217, and PAX9. The large self-reported 23andMe cohort recapitulated each of these six loci. Moreover, meta-analysis across all four cohorts revealed a total of 49 significant (p < 5 × 10-8) loci. Annotation and enrichment analyses of these 49 loci showed strong evidence of genes involved in ear development and syndromes with auricular phenotypes. RNA sequencing data from both human fetal ear and mouse second branchial arch tissue confirmed that genes located among associated loci showed evidence of expression. These results provide strong evidence for the polygenic nature of earlobe attachment and offer insights into the biological basis of normal and abnormal ear development.

Sport Injuries of the Ear and Temporal Bone.

In cases of head trauma, the ear should be evaluated in all of its components. A good understanding of otologic and skull base anatomy enables a thorough trauma assessment of this complex anatomic region. Auricular laceration, abrasion, avulsion, hematoma, frostbite, otitis externa, exostosis, tympanic membrane perforation, ossicular discontinuity, perilymphatic fistula, labyrinthine concussion, temporal bone fracture, facial nerve paresis, and sensorineural hearing loss are a few of the more common otologic injuries seen in active patients. Prevention of otologic trauma by wearing protective equipment during activity is the best way of maintaining the long-term health of the ear and audiovestibular function.