Attic retraction pockets: Classification system.

INTRODUCTION: Although attic retractions have previously been classified into Grades 0 through IV, it is often not possible to assign attic retraction pockets into a single specific category. The present study describes an improved classification system based on otoscopic and endoscopic visualization of the retraction pocket fundus, the ossicular status in the attic, degree of scutal erosion, and the presence or absence of cholesteatoma. MATERIALS AND METHODS: One hundred and fifty-four patients (200 ears) with different grades of attic retraction pockets who were seen by a tertiary referral otology center between August 2015 and July 2018 were selected for this study. OBSERVATIONS: The new classification system (Grades I, IIa, IIb, IIIa, IIIb, IIIc, IVa, IVb, IVc, and V) was applied to these retraction pockets. Pure tone audiometry was obtained. RESULTS: All attic retraction pockets could be classified precisely using the new classification system. Forty-four of 200 (22%) of ears showed Grade I Attic retraction, 18 ears showed Grade IIa (9%), 14 showed Grade IIb (7%), 28 showed Grade IIIa (14%), 12 showed IIIb (6%), 20 showed Grade IIIc (10%), 16 showed grade IVa (8%), 12 showed grade IVb (6%), 28 showed grade IVc (14%), and eight showed grade V (4%) attic retraction pockets. Grades I, IIa, IIb, IIIa, and IVa had no significant hearing loss. Average hearing loss was 42 dB and 52 dB in Grades IIIb and IIIc, 44 dB and 58 dB in Grades IVb and IVc, and 61 dB in Grade V. LEVEL OF EVIDENCE: 5 Laryngoscope, 130: 2034-2039, 2020.

Targeted molecular investigation in patients within the clinical spectrum of Auriculocondylar syndrome.

Auriculocondylar syndrome, mainly characterized by micrognathia, small mandibular condyle, and question mark ears, is a rare disease segregating in an autosomal dominant pattern in the majority of the families reported in the literature. So far, pathogenic variants in PLCB4, GNAI3, and EDN1 have been associated with this syndrome. It is caused by a developmental abnormality of the first and second pharyngeal arches and it is associated with great inter- and intra-familial clinical variability, with some patients not presenting the typical phenotype of the syndrome. Moreover, only a few patients of each molecular subtype of Auriculocondylar syndrome have been reported and sequenced. Therefore, the spectrum of clinical and genetic variability is still not defined. In order to address these questions, we searched for alterations in PLCB4, GNAI3, and EDN1 in patients with typical Auriculocondylar syndrome (n = 3), Pierre Robin sequence-plus (n = 3), micrognathia with additional craniofacial malformations (n = 4), or non-specific auricular dysplasia (n = 1), which could represent subtypes of Auriculocondylar syndrome. We found novel pathogenic variants in PLCB4 only in two of three index patients with typical Auriculocondylar syndrome. We also performed a detailed comparative analysis of the patients presented in this study with those previously published, which showed that the pattern of auricular abnormality and full cheeks were associated with molecularly characterized individuals with Auriculocondylar syndrome. Finally, our data contribute to a better definition of a set of parameters for clinical classification that may be used as a guidance for geneticists ordering molecular testing for Auriculocondylar syndrome. © 2017 Wiley Periodicals, Inc.

Clasificación de los bolsillos de retracción timpánica del Hospital Barros Luco-Trudeau / Classification of Barros Luco Hospital's tympanic pockets retraction

Introducción: Los bolsillos de retracción póstero-superiores de la pars tensa (BR) pueden progresar con erosión osicular y colesteatoma. Se han descrito una serie de mecanismos fisiopatológicos que explican la mayor ocurrencia de retracciones en esta zona. En el Hospital Barros Luco se utiliza una clasificación, variación a la de Sadé, que representaría mejor la progresión de la enfermedad, junto a una propuesta de tratamiento. Objetivo: Aplicar nuestra clasificación de los BR y describir clínica y audiológica-mente cada grado junto a los tratamientos indicados. Clasificar y describir cada grado según: PTP óseo y aéreo, primera cirugía, progresión de la enfermedad, otorrea, hipoacusia, OME y erosión osicular. Material y método: Estudio retrospectivo y descriptivo de 83 pacientes y 92 oídos presentados al Departamento de Oído del Servicio de Otorrinolaringología del Hospital Barros Luco más la revisión de su ficha clínica y del primer protocolo operatorio entre los años 2005 a 2009. Con seguimiento mínimo de 12 meses. Variables: Edad, sexo, PTP óseo y aéreo en 4 frecuencias, primer procedimiento quirúrgico, progresión de la enfermedad, otorrea, hipoacusia, OME y erosión osicular. Resultados: La hipoacusia y los PTP aéreos y óseos no presentaron diferencias entre los grados. Hubo una gradiente de disminución de OME desde el grado I al V. La presencia de otorrea fue aumentando progresivamente hasta el grado IV, disminuyendo discretamente en el V. Hubo un aumento de la presencia de erosión de la rama larga del yunque desde 0 en el grado I hasta 64,3% en el grado IV. En los tratamientos, la timpanectomía más algún tipo de tubo de ventilación con o sin adenoidectomía, representó el 43,5% en el grado III. En el grado IV el procedimiento más frecuentemente efectuado fue la aticotomía con 40%. Conclusiones: Esta clasificación reflejaría grados de gravedad de los BR en aspectos como: otorrea, erosión osicular y tratamiento propuesto. La presencia de hipoacusia y el PTP aéreo no reflejan el grado de progresión de la enfermedad. Se propone una modificación a nuestra clasificación.

Introduction: Pockets of posterior-superior retraction of the pars tensa (BR) can progress with ossicular erosion and cholesteatoma. Has been described a series of pathophysiological mechanisms that explain the higher occurrence of retraction in this area. In the Barros Luco Hospital we use a classification, a modification of Sadé, that would represent best the progression of the disease together to a treatment proposed. Aim: Applying our classification of BR and describe clinical and audiologically each grade with the indicated treatments. Classify and describe each grade by: PTP bone and air, first surgery, disease progression, otorrhea, hearing loss, ossicular erosion and OME Material and method: Retrospective and descriptive analysis of 83 patients and 92 earssubmitted to the Department of Ear of Otolaryngology Service's Hospital Barros Luco, plus review of the clinical record and the first surgical protocol between the years 2005 to 2009. Minimum follow-up of 12 months. Variables: age, sex, and air bone PTP in 4 frequencies, first surgical procedure, disease progression, otorrhea, hearing loss, ossicular erosion and OME. Conclusion: This classification would reflect degrees of severity of BR in aspects such as otorrhea, ossicular erosion and proposed treatment. The presence of hearing loss and air PTP does not reflect the degree of disease progression. An amendment to our classification is proposed.

Comparison of different computed tomography post-processing modalities in assessment of various middle ear disorders.

Several anatomic structures of the middle ear are not optimally depicted in the standard axial and coronal planes. Several 2D and 3D image-processing modalities are currently available for CT examinations in clinical radiology departments. Till now 3D reconstructions of the temporal bone have not been widely used yet, and attracted only academic interest. The aim of this study was to compare axial (source images), 2D and 3DCT post-processing modalities, and to evaluate the value of 3D reconstructed images/virtual endoscopy (VE) in assessment of various middle ear disorders for identification of the best modality/view for assessment of a particular middle ear structure or pathology. 40 patients with various middle ear disorders, planned for surgical intervention were included in prospective study. Multi-slice CT was performed for all patients. Scans were acquired in the axial plane. The axial source datasets were utilized for generation of 2D reformations and 3D reconstructed images. All studied images were divided into three categories: axial (source images), 2D reformations (MPR and sliding-thin-slab MIP) and 3D reconstruction (virtual endoscopy). The visibility of middle ear structures and pathologies with each modality were scored qualitatively using three-point scoring system in reference to operative findings. Stapes superstructure and footplate, incudostapedial joint, oval and round windows, tympanic segment of the facial nerve and tegmen were not optimally depicted in the axial plane. Sinus tympani and facial recess were best visualized with axial images or VE. 3D reconstruction/VE allowed good visualization of all parts of ossicular chain except stapes superstructure. Regarding pathologic changes, 2D reformations and 3D reconstructed images allowed better visualization of erosion of ossicles and tegmen. 3D reconstruction/VE did not allow detection of foci of otospongiosis. 2D reformations can be considered the mainstay in assessment of most middle ear structures and pathologies. 3D reconstruction/VE seems to provide a useful method for a preoperative general overview of the middle ear anatomy, particularly for the ossicular chain, round window and retrotympanum.

HEAR MAPS a classification for congenital microtia/atresia based on the evaluation of 742 patients.

OBJECTIVE: Describe anatomical and radiological findings in 742 patients evaluated for congenital aural atresia and microtia by a multidisciplinary team. Develop a new classification method to enhance multidisciplinary communication regarding patients with congenital aural atresia and microtia. METHODS: Retrospective chart review with descriptive analysis of findings arising from the evaluation of patients with congenital atresia and microtia between January 2008 and January 2012 at a multidisciplinary tertiary referral center. RESULTS: We developed a classification method based on the acronym HEAR MAPS (Hearing, Ear [microtia], Atresia grade, Remnant earlobe, Mandible development, Asymmetry of soft tissue, Paralysis of the facial nerve and Syndromes). We used this method to evaluate 742 consecutive congenital atresia and microtia patients between 2008 and January of 2012. Grade 3 microtia was the most common external ear malformation (76%). Pre-operative Jahrsdoerfer scale was 9 (19%), 8 (39%), 7 (19%), and 6 or less (22%). Twenty three percent of patients had varying degrees of hypoplasia of the mandible. Less than 10% of patients had an identified associated syndrome. CONCLUSION: Patients with congenital aural atresia and microtia often require the intervention of audiology, otology, plastic surgery, craniofacial surgery and speech and language professionals to achieve optimal functional and esthetic reconstruction. Good communication between these disciplines is essential for coordination of care. We describe our use of a new classification method that efficiently describes the physical and radiologic findings in microtia/atresia patients to improve communication amongst care providers.

Manejo actual de la microtia: redefinición anátomo-quirúrgica / Management of microtia based on a redefinition of its anatomical-surgical classification

Background: Incomplete development and growth of the pinna can lead to a small or deformed pinna, called microtia. Aim: To report and evaluate the effectiveness of a surgical technique previously described for the treatment of microtia, based on a new anatomical-surgical classification. Materials and Methods: Retrospective study of patients treated at two plastic surgery departments from January 2008 to December 2010. We recruited a total of 15 patients aged 9 to 25 years. Thirteen (87 percent) had unilateral and 2 (13 percent) bilateral microtia. All patients underwent the surgical reconstructive technique described by Firmin. Results: Among patients with unilateral microtia, seven belonged to Firmin type I, five to type II and one to type IIIa. Both patients with bilateral microtia, were classified as type IIIb. In all cases with unilateral microtia, a good initial projection of the cartilage frame was achieved during the first surgical procedure. Six patients were subjected to a second operation. During 18 months follow up, four patients (16 percent) had complications. Conclusions: This surgical technique that is based on an anatomical surgical classification, achieves favorable and satisfactory results.

Objetivos: Reportar y evaluar la efectividad de una técnica quirúrgica, previamente descrita para el tratamiento de microtias, basado en un nuevo concepto de clasificación anátomo-quirúrgica. Material y Método: Estudio retrospectivo de pacientes tratados en el Hospital Militar y Clínica Alemana de Santiago en el Servicio de Cirugía Plástica desde enero de 2008 hasta diciembre de 2010. Se reclutaron a un total de 15 pacientes, 13 (87 por ciento) de los cuales eran unilaterales y 2 (13 por ciento) bilaterales. A todos los pacientes se les realizó la reconstrucción mediante técnica quirúrgica de Firmin. Resultados: Se operó a 15 pacientes de rango de edad entre 9 y 25 años, con una mediana de 11 años. De los casos unilaterales; 7 correspondían a tipo I de Firmin, 5 casos a tipo II Firmin y un caso tipo IIIa. De los casos bilaterales, ambos tenían microtia tipo IIIb. Se logró en la totalidad de los casos unilaterales una buena proyección inicial del marco cartilaginoso durante el primer tiempo quirúrgico. Seis casos fueron sometidos a un segundo tiempo quirúrgico. Durante el seguimiento mínimo de 18 meses, se observaron complicaciones en 4 (16 por ciento) pacientes. Conclusiones: Se comprueba que mediante una técnica basada en la clasificación anátomo-quirúrgica, los resultados a corto plazo fueron favorables y satisfactorios.

Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment.

PURPOSE OF REVIEW: We present an update on clinical evaluation, staging, classification and treatment of canal cholesteatoma, including a meta-analysis of clinical data of the last 30 years. RECENT FINDINGS: Ear canal cholesteatoma is frequently associated secondarily to other canal pathologies. The cause for the rare idiopathic form of the disease remains enigmatic. Epidemiologic and experimental studies of its pathogenesis have increased; however, the main explanatory theory of a deficient migratory capacity of the canal epithelium affected has been falsified only recently. Therefore, the debate on the pathogenesis has gained additional impetus and more data is needed. SUMMARY: Canal cholesteatoma is a rarity in otologic pathology, often leading to misdiagnosis as external otitis or otomycosis by physicians unfamiliar with the disease. It presents typically with otorrhea, focal erosion and keratin accumulation in the osseous ear canal and has to be distinguished from keratosis obturans, which leads to otalgia and bilateral conductive hearing loss by ceruminal plugs, with circumferential distention of the ear canal. Treatment by canaloplasty is curative and highly successful. Alternative conservative treatment is feasible, however, requiring long-term follow up, with often painful cleaning of the lesion.

Classification of otoneurological cases according to Bayesian probabilistic models.

We show that Bayesian methods can be efficiently applied to the classification of otoneurological diseases and to assess attribute dependencies. A set of 38 otoneurological attributes was employed in order to use a naive Bayesian probabilistic model and Bayesian networks with different scoring functions for the classification of cases from six otoneurological diseases. Tests were executed on the basis of tenfold crossvalidation. We obtained average sensitivities of 90%, positive predictive values of 92% and accuracies as high as 97%, which is better than our earlier tests with neural networks. Our assessments indicated that Bayesian methods have good power and potential to classify otoneurological patient cases correctly even if this is often a complicated task for the best specialists. Bayesian methods classified the current medical data and knowledge well.

Atresia aural congênita unilateral / Unilateral congenital aural atresia

A atresia do canal auditivo externo (ACAE) é uma disordem congênita rara. A ACAE unilateral é de 3 a 6 vezes mais comum que a atresia bilateral. Tradicionalmente, não se acreditava que a ACAE unilateral fosse limitante ao desenvolvimento da linguagem da criança. No entanto, terapias recentes para perda auditiva têm demonstrado a importância da audição bilateral para um ótimo desenvolvimento da fala e da linguagem. Além disso, a audição bilateral é importante na localização de ruídos. Por isso exige diagnóstico rápido, aconselhamento genético e avaliação precoce da audição. Deve-se aconselhar adequadamente e encaminhar essas crianças e suas famílias para que possam ser avaliadas as opções de tratamento e indicações para intervenção. Avaliação clínica, audiológica e com estudo tomográfico de alta resolução do osso temporal é essencial para obter resultados satisfatórios e prevenir complicações na seleção de candidatos adequados para a cirurgia ou para avaliação do paciente, opções de tratamento, época de tratamento cirúrgico, critérios de seleção cirúrgica, técnicas cirúrgicas, complicações, prognóstico e controvérsias atuais relacionadas à atresia aural congênita serão discutidos.

Basic techniques in autogenous microtia repair.

Although several techniques can be used for microtia repair, some standard procedures have been developed over the past few decades. In specialized centers, these techniques are performed most frequently. They include two to four operative steps using autogenous rib cartilage for the framework and local skin for its tegument. We have been using this technique presented here in more than 800 cases over the past two decades with good and mostly stable results.

The learning curve in microtia surgery.

Reconstruction of the auricle is known to be complex. Our objective was to evaluate the improvement of the outcome of the lobulus-type microtia reconstruction. Patient satisfaction was also evaluated. There are no previous reports of the learning process in this field. Postoperative photographs of 51 microtia reconstructions were assessed and rated by a panel made up of six surgeons. The ratings were gathered to generate learning curves. Twenty-two patients assessed the outlook of their reconstructed ears, and the results were analyzed as a self-assessment group. The reliability of the rating by a panel was tested by intraclass correlations. There is a highly significant increasing trend in learning ( P = 0.000001). This trend is not constantly upward, and the steady state was not reached during the study. In the self-assessment group, females were significantly more critical than males ( P = 0.014). Intraclass correlation for six panel members was 0.90, and the rating was considered reliable. Thus, a long and gentle learning curve does exist in microtia reconstruction. To secure good quality and continuity, centralization of the operations and trainee arrangements are highly advisable. Outcomes of plastic surgery can reliably be rated by an evaluation panel.

Histopathological classification of tympanosclerotic plaques.

Tympanosclerotic plaques seen in the middle ear and tympanic membrane as a sequelae of otitis media have different characteristics. Tympanosclerotic plaque consistency shows a wide range from soft to hard during surgical excision and can be classified histologically. The aim of this study is to classify surgically excised tympanosclerotic plaques macroscopically and histologically. Seventeen surgically excised tympanosclerotic tissues were examined otomicroscopically and light microscopically. Otomicroscopically, plaques were classified as type I: soft (four cases), type II: moderately hard (six cases) and type III: very hard (seven cases), according to their consistency and surgical detachment feature. Sections prepared from tympanosclerotic tissues were stained with hematoxylin-eosin, Mallory-Azan and von Kossa stains for light microscopic evaluation. In type I tympanosclerotic tissue, fibroblasts and collagen fibers were equally abundant in typical loose connective tissue. A few small calcium crystals were seen. In type II tympanosclerotic tissue, large bundles of collagen fibers, proliferation of fibroblasts and focal calcification points were seen. In type III tympanosclerotic tissue, round shaped condroblast-like cells located in lacunae and intense calcification points were evident. Tympanosclerotic tissues can be classified in respect of their morphological and histological aspects. Histological classification of tympanosclerotic tissue may inform us about the maturation of the tissue, and therefore the grade of the disease. In type I tympanosclerotic disease, even if complete resection of sclerotic tissue is performed, the underlying process may go on and new sclerotic tissue formation can be expected. Type III sclerotic tissue is associated with limited, inactive disease. Progress of the disease and the patient's benefit from surgery can be interpreted according to this classification. However, these results will need to be verified by long-term patient follow-up and comparison of histological classification and clinical audiological symptoms.

The Erasmus atelectasis classification: proposal of a new classification for atelectasis of the middle ear in children.

OBJECTIVES: Atelectasis presents a challenging, often progressive, problem in children. Because of the lack of a clinically practical classification, we introduce a new classification, which in our opinion is more useful in the pediatric age group. This alternative classification enables a more clinically relevant correlation between stage of disease and clinical sequelae and technical difficulty at surgery. STUDY DESIGN: Observational study of patients seen and operated at the Sophia Children's Hospital in Rotterdam, The Netherlands between 1989 and 2005. METHODS: Based on clinical appearance, each ear was placed into one of the five groups of the proposed classification and into one of the four stages of Sadé's classification. Preoperative air and bone conduction thresholds and air-bone gaps (ABG) were calculated using the four-tone pure-tone (500, 1,000, 2,000, and 4,000 Hz) averages for bone and air conduction. RESULTS: : Of the 248 ears in the study group, 72 were in stage I, with an ABG of 18.2 +/- 12.3 dB. Twenty-two were in stage II, with an ABG of 12.9 +/- 9.5 dB. In stage III, there were 32 ears, with an ABG of 11.6 +/- 10.0 dB. Thirty-one ears were in stage IV, with an ABG of 16.1 +/- 11.5 dB. Eighty-five ears were in stage V, with an ABG of 26.1 +/- 13.3 dB. When grouped according to Sadé's classification, 92 ears could not be classified. CONCLUSIONS: We found the currently proposed classification more useful in that it follows the natural progression of the disease and is more practical in determining operative procedures at each stage.

Medial canal fibrosis: surgical technique, results, and a proposed grading system.

OBJECTIVE: To report the hearing and surgical results in patients with medial canal fibrosis. To describe the surgical technique for removal of medial canal fibrosis and to propose a classification for grading postoperative surgical outcome and to correlate this with hearing results. SETTING: Tertiary university referral center. STUDY DESIGN: Retrospective case review. METHODS: Twenty-one patients with mature medial canal fibrosis underwent a total of 26 operations at our institution from February 1994 to June 2003. Four patients underwent surgery for bilateral disease and another had a second operation for recurrence. RESULTS: According to the proposed grading system, 10 (38.5%) of the 29 ears operated on achieved a Grade I result (normal self-cleaning ears) and three (11.5%) had recurrence (Grade III). One patient was found to have external ear canal cholesteatoma. Postoperatively, 15 ears demonstrated closure of the air-bone gap to within 10 dB or improvement on four-frequency average pure-tone audiogram to better than 25 dB. The mean preoperative air-bone gap was 28.7 dB compared with 12.5 dB postoperatively (p < 0.001). When hearing results were correlated with postoperative grade, 90.0% of the ears with a Grade I result had significant hearing improvement, 46.2% in patients with Grade II and 33.3% in patients with Grade III results. Four patients complained of temporomandibular joint pain postoperatively. CONCLUSION: Surgery remains the treatment of choice for mature medial canal fibrosis. With proper surgical technique and meticulous postoperative care, a patent and functioning external ear canal can be achieved in a majority of patients. Absence of recurrence does not equate with improved hearing thresholds.

Evaluation of attic retraction pockets by microendoscopy.

OBJECTIVE: Attic retraction pockets (RPs) are one of the important sequelae of otitis media with effusion and are classified on the basis of the findings of otoscopy or otomicroscopy. It is unclear when and how RPs turn into cholesteatomas. We compared the findings of RPs obtained with the use of a microendoscope with those from an otomicroscope to determine the extension of RPs. STUDY DESIGN: Comparative study. PATIENTS: Twenty-seven attic RPs (Tos type III or IV) and 10 precholesteatomas previously classified under an otomicroscope were reexamined. MAIN OUTCOME MEASURES: A high-resolution, fine, rigid microendoscope with an outer diameter of 1.0 mm was used to observe the extension of a retraction. In addition, to confirm the extent of the RP, computed tomography (CT) scans using water as the contrast media were performed in representative cases. RESULTS: Endoscopy with the microendoscope revealed that in 59%, the RP was deeper than indicated by the initial otomicroscopic estimation, suggesting that the extension of the RP was underestimated. The findings of water-enhanced CT scans were comparable with the endoscopic findings. The bottom was observable with the microendoscope and the otomicroscope in 20 (74%) and 11 (41%) of 27 RPs, respectively. Seven ears had a deeper RP, which extended beyond the incudomallear joint. Of the 10 precholesteatoma cases, in which the bottoms were not visible with an otomicroscope or conventional endoscopes, the microendoscope revealed the bottom in 5 (50%). CONCLUSION: On the basis of the observations of our study, we suggest that reexamination of cases of RP classified as Tos type III or IV, preferably with a microendoscope, if available, and assessment of the depth of the RP using water-enhanced CT, would be useful and that careful follow-up is necessary for deep RPs because of a potential risk of development into cholesteatoma.

Classification of the external auditory canal cholesteatoma.

OBJECTIVES/HYPOTHESIS: The external auditory canal cholesteatoma (EACC) is a rare disease in the field of otolaryngology. Only 1 in 1,000 new otologic patients present with this entity, which was first described by Toynbee. The aim of this article is to classify EACC by different histopathologic and clinical findings of patients presenting to the Department of Otolaryngology at the University of Mannheim, Germany. METHODS: From 2000 to 2004, 17 patients presented to our clinic with EACC. The cholesteatoma were treated surgically, and the specimens were investigated histologically. Clinical findings were also recorded. We classified four stages: stage I with hyperplasia of the canal epithelium, stage II including periosteitis, Stage III including a defective bony canal, and stage IV showing an erosion of adjacent anatomic structure. RESULTS: Eight patients presented with stage II, five patients with stage III, three with stage I, and only one patient presented with erosion of the mastoid cells, which was determined as stage IV. CONCLUSION: In summary, our classification serves to describe the different histopathologic and clinical stages of EACC.

Clinical and experimental investigations of spontaneous impedance changes of the middle ear.

The major symptoms of glomus tympanicum tumors are pulsatile tinnitus and spontaneous impedance changes (SICs) of the middle ear. On the other hand, SICs often occur even in the absence of pathological findings. The aim of this study was to analyze the occurrence of SICs in patients and healthy volunteers. We retrospectively evaluated 184 patients with SICs and/or complaints of periodic tinnitus. Most of them (n = 134) showed pulse-synchronous SICs. Pathological findings were recorded in only 66 patients. Binaural SICs were registered significantly (p = .03) more frequently in patients with arterial hypertension (63% versus 18%). Because of the positive correlation between arterial hypertension and the occurrence of SICs, the influence of increasing blood pressure (systolic blood pressure > 160 mm Hg after physical activity) on the occurrence of SICs was investigated in a prospective trial in healthy test subjects (n = 42). In 17 of them, pulse-synchronous SICs occurred for the first time or were registered at a lower sensitivity level after an increase in blood pressure. In summary, only half of the patients with pulse-synchronous SICs showed pathological findings. A significant correlation between high blood pressure and binaural pulse-synchronous SICs was demonstrated in patients with arterial hypertension and healthy volunteers after physical activity.

Diseases of the ear pinna.

In conclusion, there are a wide variety of dermatologic diseases that can affect the ear pinnae. Most of these disorders are manifestations of a generalized dermatosis. Therefore, when pinnal lesions are present, a thorough diagnostic workup is indicated.