Primary Repair of Ear Avulsion with Adjuvant Hyperbaric Therapy and Nitroglycerin Ointment.

Traumatic auricular avulsion is a rare and deforming injury. Classically, repair has required microvascular anastomosis. In this publication, we report two separate cases of pediatric auricular avulsion from dog bites. In both cases, the ear was cleaned and surgically reattached. Adjunctive therapies included hyperbaric oxygen and nitroglycerin ointment. There was complete graft take for one patient and 90% graft take for the second, both achieving satisfactory aesthetic outcome. These unique cases highlight the benefits of surgical reattachment of the avulsed portion of the ear followed by hyperbaric oxygen therapy and nitroglycerin ointment.

Prevalence of cauliflower ear in high level judoka.

Judo is an Olympic sport, and the way of its performing can lead to repetitive blunt injuries on head and ears. The chronic consequences of such traumata on the auricle are the formation of so-called cauliflower ear. This condition is painful, can lead to interruptions in the training process and long-term consequences for the athlete's health. There is limited knowledge of epidemiological data about cauliflower ear deformities in judo. Evaluation of the prevalence of cauliflower ear among judokas based on their profile pictures on the international judo federation was performed. A large cohort of judo athletes from around the world was studied. Two different classifications for the severity of ear deformities were used. Statistical calculations of the collected data and correlations to different parameters were performed. Images of 1632 top athletes were evaluated in the study. Ear deformities were found in 55.5% of the judokas. There was gender-specific differences. Male athletes were affected much more often than female athletes. In addition, ear deformities were more pronounced in male athletes. A correlation was found between the age of the athletes and the presence of an ear deformity. It has also been shown that judokas with a high world ranking are more likely to have an ear deformity. Ear deformities are a common consequence of injury among leading judo athletes. The current study represents the largest and high heterogeny cohort ever conducted on the prevalence of cauliflower ear in judoka. Knowledge of the prevalence of cauliflower ear in judoka based on reliable data from this study, may be important prerequisites for further studies on the impact of this traumatic consequence on training preparation and judoka health.

Office-Based Pediatric Otoplasty Under Local Anesthesia.

BACKGROUND: Many parents seek otoplasty for their school age children but fear having to undergo general anesthesia (GA). In our experience, otoplasty can safely be performed in an office-based setting under local anesthesia (LA). There is a gap in the literature regarding pediatric otoplasty under LA. METHODS: All children aged 5 to 10 who underwent otoplasty between 2017 and 2021 were included in a retrospective review. Demographics, operative techniques, complications, recurrences, and reoperation rates were collected. Surveys were provided 3 months after treatment to assess parental satisfaction and anxiety. Results were compared between patients who received otoplasty under GA and LA. RESULTS: A total of 13 patients (6 male, 7 female), with a mean age of 7 years (ranging 5-10) underwent otoplasty under LA. Tweleve children (6 male, 6 female), with a mean age of 5 years (ranging 4-7) underwent otoplasty under GA. The only complications seen were 3 minor conchal bowl hematomas that were aspirated, each retrieving <1 mL of blood; no revisions were necessary. The LA subgroup was more likely to repeat otoplasty under identical conditions ( P =0.025). Postoperatively, mean parental anxiety scores between the LA and GA subgroups were significantly different (1.4±1.1 versus 4.8±2.7, P =0.0005). Lastly, the mean satisfaction scores between the LA and GA subgroups were marginally different (3.83±0.58 versus 3.17±1.03, P =0.063). CONCLUSION: Pediatric otoplasty under LA is a safe and feasible operation for patients between 5 and 10 years of age.

Near-Total Ear Avulsion Repaired With Primary Closure and Hyperbaric Oxygen: A Case Series and Review of the Literature.

INTRODUCTION: Near-total ear avulsion is a rare and challenging problem to repair with many techniques described; primary repair is an attractive option but is not always successful. Healing may be augmented with postoperative hyperbaric oxygen therapy (HBOT), but this technique is under-reported, and an ideal regimen is not known. The study objective is to discuss the role of HBOT in the management of ear avulsion by reviewing 2 unique cases. METHODS: Case report and review of the literature. A Pubmed search using the terms ear avulsion and postoperative hyperbaric oxygen was performed. RESULTS: Two pediatric patients presented with near-total avulsion of the auricle after suffering a dog bite. Various management options were discussed including observation, primary repair, post-auricular cartilage banking, graft reconstruction with periauricular tissue or rib cartilage, or microsurgical replantation. The decision was made to perform primary reattachment, followed by adjuvant hyperbaric oxygen therapy (HBOT). The patients achieved favorable esthetic results and continue to maintain the function of the reattached ear. Photo documentation was obtained throughout the process. DISCUSSION: There is no consensus on the management of near-total ear avulsion. Primary repair is ideal from a cosmetic and ease-of-operation standpoint but does not always yield viable tissue. The use of postoperative HBOT is an attractive option that may boost success rates, but the ideal HBOT regimen is unknown. These cases represent a successful application of this innovative technique in a pediatric patient.

A 10-Year Retrospective Review of the Nonsurgical Treatment of Infant Ear Anomalies.

BACKGROUND: A review of a single surgeon's 10-year experience treating congenital ear anomalies using nonsurgical ear molding is presented. This study assesses the efficacy of treating a variety of anomalies in infants with age ranging from younger than 1 week to 22 weeks and identifies potential barriers to care. METHODS: A retrospective chart and photographic review of 246 consecutive infants treated with ear molding between 2010 and 2019 was undertaken. Data regarding patient demographics, anomaly classification, device selection, treatment duration, adverse events, and satisfaction with outcomes were collected. RESULTS: This study included 385 infant ear anomalies in 246 patients. Median age at initiation of treatment was 16 days and median treatment duration was 29.5 days. A median number of three devices was needed to complete bilateral treatment. Treated anomalies included mixed deformity, helical rim, prominent, lidding/lop, Stahl ear, conchal crus, cupping, and cryptotia. Complications occurred in 47 patients, with skin breakdown being the most common [26 patients (55.3 percent)]. Satisfaction rate was 92 percent in 137 surveyed parents. Median patient household income was approximately $112,911, and treatment was covered by insurance for 244 of 246 patients. CONCLUSIONS: The study outcomes demonstrate that ear molding can be effective in patients as old as 22 weeks without compromising treatment duration or complexity. In addition, in the authors' experience, molding is an effective treatment for the majority of infant ear deformities. Despite a steady increase in patient volume over the past 10 years and consistent coverage of treatment by insurance, the authors' catchment area continues to be largely limited to affluent households. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Evolution of Anomaly-Specific Techniques in Infant Ear Molding: A 10-Year Retrospective Study.

BACKGROUND: Congenital ear anomalies occur in at least one-third of the population, and less than one-third of cases self-correct. Ear molding is an alternative to surgery that spares operative morbidity and allows for significantly earlier intervention. In this retrospective study, the senior author (S.B.B.) developed a tailored approach to each specific type of ear deformity. The use of modifications to adapt standard ear molding techniques for each unique ear are described. METHODS: The authors conducted a retrospective, institutional review board-approved study of 246 patients who underwent ear molding performed by a single surgeon. The procedure reports for each case were reviewed to develop stepwise customization protocols for existing EarWell and InfantEar systems. RESULTS: This review included 385 ears in 246 patients. Patient age at presentation ranged from less than 1 week to 22 weeks. Presenting ear deformities were subclassified into mixed (37.4 percent), helical rim (28.5 percent), prominent (10.6 percent), lidding/lop (9.3 percent), Stahl ear (3.6 percent), conchal crus (3.3 percent), and cupping (2.8 percent). Two patients (0.8 percent) had cryptotia. Deformity subclass could not be obtained for 11 patients (4.5 percent). Recommended modifications to existing ear correction systems are deformity-specific: cotton-tip applicator/setting material (Stahl ear), custom dental compound mold (lidding/lop and cupping), scaphal wire (helical rim), cotton-tip applicator/protrusion excision (prominent), and custom dental compound stent (conchal crus). CONCLUSIONS: Presentation of ear anomalies is heterogenous. This 10-year experience demonstrates that the approach to ear molding should be dynamic and customized, using techniques beyond those listed in system manuals to complement each ear and to improve outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Lop Ear to Conchal Microtia: An Algorithmic Surgical Approach.

BACKGROUND: The lop ear deformity is defined by a deficient helix and scapha, underdeveloped anthelix, and downfolding of the helix. The terminology used is still confusing, and the treatment is not entirely structured. The aim of this study was to provide a new systematic surgical approach of this deformity based on our center's experience. MATERIALS AND METHODS: All patients undergoing surgical correction of lop ears between 2007 and 2019 at Great Ormond Street Hospital were included. Patients' data, surgical techniques, and postoperative complications were recorded. RESULTS: Based on our records, we identified 3 surgical techniques for the correction of lop ears, based on the degree of deformity encountered. In a mild lop ear, correction was achieved with a modified otoplasty technique by improving the definition of the antihelix and superior crus. In a moderate deformity, additional remodeling of the lidded helix was performed (extended otoplasty), whereas for the severe lop ear, the amount of cupping and the deficient cartilage required formal reconstruction using a carved rib cartilage framework. There were a total of 109 patients and 146 lop ears: 58 mild, 27 moderate, and 61 severe lop ears. CONCLUSION: We feel that there is a point in the spectrum of congenital ear deformity when a severe lop ear becomes a conchal microtia and recommend this approach to simplify the management of these cases. This is intended to bring greater clarity to how to deal with lop ears, based on the severity of the deformity and the surgical techniques used.

High-resolution computational modeling of the current flow in the outer ear during transcutaneous auricular Vagus Nerve Stimulation (taVNS).

BACKGROUND: Transcutaneous auricular Vagus Nerve Stimulation (taVNS) applies low-intensity electrical current to the ear with the intention of activating the auricular branch of the Vagus nerve. The sensitivity and selectivity of stimulation applied to the ear depends on current flow pattern produced by a given electrode montage (size and placement). OBJECTIVE: We compare different electrodes designs for taVNS considering both the predicted peak electric fields (sensitivity) and their spatial distribution (selectivity). METHODS: Based on optimized high-resolution (0.47 mm) T1 and T2 weighted MRI, we developed an anatomical model of the left ear and the surrounding head tissues including brain, CSF/meninges, skull, muscle, blood vessels, fat, cartilage, and skin. The ear was further segmented into 6 regions of interest (ROI) based on various nerve densities: cavum concha, cymba concha, crus of helix, tragus, antitragus, and earlobe. A range of taVNS electrode montages were reproduced spanning varied electrodes sizes and placements over the tragus, cymba concha, earlobe, cavum concha, and crus of helix. Electric field across the ear (from superficial skin to cartilage) for each montage at 1 mA or 2 mA taVNS, assuming an activation threshold of 6.15 V/m, 12.3 V/m or 24.6 V/m was predicted using a Finite element method (FEM). Finally, considering every ROI, we calculated the sensitivity and selectivity of each montage. RESULTS: Current flow patterns through the ear were highly specific to the electrode montage. Electric field was maximal at the ear regions directly under the electrodes, and for a given total current, increases with decreasing electrode size. Depending on the applied current and nerves threshold, activation may also occur in the regions between multiple anterior surface electrodes. Each considered montage was selective for one or two regions of interest. For example, electrodes across the tragus restricted significant electric field to the tragus. Stimulation across the earlobe restricted significant electric field to the earlobe and the antitragus. Because of this relative selectivity, use of control ear montages in experimental studies, support testing of targeting. Relative targeting was robust across assumptions of activation threshold and tissue properties. DISCUSSION: Computational models provide additional insight on how details in electrode shape and placement impact sensitivity (how much current is needed) and selectivity (spatial distribution), thereby supporting analysis of existing approaches and optimization of new devices. Our result suggest taVNS current patterns and relative target are robust across individuals, though (variance in) axon morphology was not represented.

Electrical stimulation of the external ear acutely activates noradrenergic mechanisms in humans.

BACKGROUND: Transcutaneous stimulation of the external ear is thought to recruit afferents of the auricular vagus nerve, providing a means to activate noradrenergic pathways in the central nervous system. Findings from human studies examining the effects of auricular stimulation on noradrenergic biomarkers have been mixed, possibly relating to the limited and variable parameter space explored to date. OBJECTIVE: We tested the extent to which brief pulse trains applied to locations of auricular innervation (canal and concha) elicit acute pupillary responses (PRs) compared to a sham location (lobe). Pulse amplitude and frequency were varied systematically to examine effects on PR features. METHODS: Participants (n = 19) underwent testing in three separate experiments, each with stimulation applied to a different external ear location. Perceptual threshold (PT) was measured at the beginning of each experiment. Pulse trains (∼600 ms) consisting of different amplitude (0.0xPT, 0.8xPT, 1.0xPT, 1.5xPT, 2.0xPT) and frequency (25 Hz, 300 Hz) combinations were administered during eye tracking procedures. RESULTS: Stimulation to all locations elicited PRs which began approximately halfway through the pulse train and peaked shortly after the final pulse (≤1 s). PR size and incidence increased with pulse amplitude and tended to be greatest with canal stimulation. Higher pulse frequency shortened the latency of PR onset and peak dilation. Changes in pupil diameter elicited by pulse trains were weakly associated with baseline pupil diameter. CONCLUSION: (s): Auricular stimulation elicits acute PRs, providing a basis to synchronize neuromodulator release with task-related neural spiking which preclinical studies show is a critical determinant of therapeutic effects. Further work is needed to dissociate contributions from vagal and non-vagal afferents mediating activation of the biomarker.

TGF-ß loaded exosome enhances ischemic wound healing in vitro and in vivo.

Rationale: With over seven million infections and $25 billion treatment cost, chronic ischemic wounds are one of the most serious complications in the United States. The controlled release of bioactive factor enriched exosome from finbrin gel was a promising strategy to promote wound healing. Methods: To address this unsolved problem, we developed clinical-grade platelets exosome product (PEP), which was incorporate with injectable surgical fibrin sealant (TISSEEL), to promote chronic wound healing and complete skin regeneration. The PEP characterization stimulated cellular activities and in vivo rabbit ischemic wound healing capacity of TISSEEL-PEP were performed and analyzed. Results: PEP, enriched with transforming growth factor beta (TGF-ß), possessed exosomal characteristics including exosome size, morphology, and typical markers including CD63, CD9, and ALG-2-interacting protein X (Alix). In vitro, PEP significantly promoted cell proliferation, migration, tube formation, as well as skin organoid formation. Topical treatment of ischemic wounds with TISSEEL-PEP promoted full-thickness healing with the reacquisition of hair follicles and sebaceous glands. Superior to untreated and TISSEEL-only treated controls, TISSEEL-PEP drove cutaneous healing associated with collagen synthesis and restoration of dermal architecture. Furthermore, PEP promoted epithelial and vascular cell activity enhancing angiogenesis to restore blood flow and mature skin function. Transcriptome deconvolution of TISSEEL-PEP versus TISSEEL-only treated wounds prioritized regenerative pathways encompassing neovascularization, matrix remodeling and tissue growth. Conclusion: This room-temperature stable, lyophilized exosome product is thus capable of delivering a bioactive transforming growth factor beta to drive regenerative events.

The effects of transcutaneous auricular vagal nerve stimulation on cognition in healthy individuals: A meta-analysis.

OBJECTIVE: Transcutaneous auricular vagal nerve stimulation (taVNS) may benefit cognition in healthy adults but may differentially affect specific domains of cognitive function. Currently, optimal stimulation parameters of taVNS have yet to be identified and the overall effectiveness of this approach remains unclear. METHOD: A literature review and random effects meta-analysis evaluated the effects of taVNS on cognitive performance outcomes across domains of function and outcome metrics (accuracy and response times). Subgroup meta-analyses and meta-regression models explored the moderating effects of stimulation parameters on performance outcomes. RESULTS: Meta-analyses on 19 eligible studies indicated a weighted effect size of 0.21 for the effect of taVNS on overall cognitive performance, with significant effects on measures of executive function and measures of accuracy. Parameter meta-analyses indicated that stimulation site was most associated with improvements in executive function (gtragus = 2.39, gcymba concha = 0.48; Q = 39.84, p < .0001; ß = -2.33, p = .03). CONCLUSIONS: taVNS may improve cognition, particularly executive function, and stimulation parameters may differentially influence outcomes. Continued research into the effects of taVNS as well as optimal stimulation parameters will be beneficial. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Arterial only anastomosis associated with modified Baudet technique in ear replantation: Case reports and literature review.

BACKGROUND: Total ear amputation is a relatively rare trauma with an absolute indication for surgical treatment. Numerous techniques for auricular reconstruction have been described. When local and general conditions allow microsurgical replantation, this must be the first choice. We propose the association of microsurgical techniques with some modification (modified Baudet technique) to obtain higher survival rate of the reimplanted stump. METHODS: This study included cases of 3 male patients with total ear amputation, the injuries and their mechanism (workplace accident) being identical. Chief complaints were pain, bleeding, important emotional impact due by an unaesthetic appearance. The established diagnosis was traumatic complete ear amputation (grade IV auricular injury according to Weerda classification). Microsurgical replantation was performed only with arteriorraphy, and no vein anastomosis. Cartilage incisions and skin excisions were made to enlarge the cartilage-recipient site contact area. Medicinal leeches were used to treat venous congestion, to which systemic anticoagulant therapy was added. RESULTS: The results showed the survival of the entire replanted segment in all cases, with good function and esthetical appearance. Patients were fully satisfied with the final outcome. CONCLUSION: Microsurgical replantation is the gold standard, for the surgical treatment of total ear amputation. We believe that cartilage incisions and the increased surface of contact between cartilage and recipient site has an adjuvant role in revascularization of the amputated stump (with only arterial anastomosis) and the use of hirudotherapy helps to relieve early venous congestion.

Outpatient Posttraumatic Auricle Reconstruction Under Local Anesthesia.

ABSTRACT: We described an outpatient auricle reconstruction in an elderly patient after an accidental facial trauma. The procedure was carried out under local anesthesia given patient's comorbidities and acetylsalicylic acid (ASA) therapy. The patient subsequently underwent to regular follow-up. An excellent healing of the auricle injury was achieved.

Transcutaneous Vagus Nerve Stimulation in Humans Induces Pupil Dilation and Attenuates Alpha Oscillations.

Vagus nerve stimulation (VNS) is widely used to treat drug-resistant epilepsy and depression. While the precise mechanisms mediating its long-term therapeutic effects are not fully resolved, they likely involve locus coeruleus (LC) stimulation via the nucleus of the solitary tract, which receives afferent vagal inputs. In rats, VNS elevates LC firing and forebrain noradrenaline levels, whereas LC lesions suppress VNS therapeutic efficacy. Noninvasive transcutaneous VNS (tVNS) uses electrical stimulation that targets the auricular branch of the vagus nerve at the cymba conchae of the ear. However, the extent to which tVNS mimics VNS remains unclear. Here, we investigated the short-term effects of tVNS in healthy human male volunteers (n = 24), using high-density EEG and pupillometry during visual fixation at rest. We compared short (3.4 s) trials of tVNS to sham electrical stimulation at the earlobe (far from the vagus nerve branch) to control for somatosensory stimulation. Although tVNS and sham stimulation did not differ in subjective intensity ratings, tVNS led to robust pupil dilation (peaking 4-5 s after trial onset) that was significantly higher than following sham stimulation. We further quantified, using parallel factor analysis, how tVNS modulates idle occipital alpha (8-13Hz) activity identified in each participant. We found greater attenuation of alpha oscillations by tVNS than by sham stimulation. This demonstrates that tVNS reliably induces pupillary and EEG markers of arousal beyond the effects of somatosensory stimulation, thus supporting the hypothesis that tVNS elevates noradrenaline and other arousal-promoting neuromodulatory signaling, and mimics invasive VNS.SIGNIFICANCE STATEMENT Current noninvasive brain stimulation techniques are mostly confined to modulating cortical activity, as is typical with transcranial magnetic or transcranial direct/alternating current electrical stimulation. Transcutaneous vagus nerve stimulation (tVNS) has been proposed to stimulate subcortical arousal-promoting nuclei, though previous studies yielded inconsistent results. Here we show that short (3.4 s) tVNS pulses in naive healthy male volunteers induced transient pupil dilation and attenuation of occipital alpha oscillations. These markers of brain arousal are in line with the established effects of invasive VNS on locus coeruleus-noradrenaline signaling, and support that tVNS mimics VNS. Therefore, tVNS can be used as a tool for studying how endogenous subcortical neuromodulatory signaling affects human cognition, including perception, attention, memory, and decision-making; and also for developing novel clinical applications.

Development and validation of an evidence-based auricular acupressure intervention for managing chemotherapy-induced nausea and vomiting in breast cancer patients.

BACKGROUND: Auricular therapy (AT) has been utilized as a promising complementary health approach to alleviating chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients. However, current evidence on AT for CINV management has been inconclusive, and relevant AT treatment protocols have varied considerably in the intervention dosage and acupoint formula without an evidence-informed intervention protocol tailored to CINV symptoms. This study aimed to develop an evidence-based AT intervention protocol for CINV management in breast cancer patients receiving chemotherapy. METHODS: This study adopted the Medical Research Council Framework for Developing and Evaluating Complex Interventions (the MRC framework) to guide the AT intervention development process. The process consists of four steps: identification of the evidence base, identification of theories and practice standards, identification of cancer symptom characteristics, and modelling and validation. The preliminary AT intervention was then evaluated through a content validity study to identify its theoretical and practical appropriateness. The content validity index (CVI) was used to determine the consensus level of the panel. RESULTS: A preliminary AT intervention protocol, including a true AT intervention and a sham AT intervention, was developed based on research evidence identified from five systematic reviews, the homuncular reflex theory, the zang-fu organs and meridian theory, relevant AT practice standards, and the natural symptom progress of CINV. The true AT was designed as a daily manual acupressure for five consecutive days. While the sham AT was designed with the same intervention duration and acupoint formula as the true AT without manual acupressure. The content validity study demonstrated excellent consensus among the expert panel to support the AT intervention as a theoretically and practically feasible program with the item-level CVI ranging from 0.83 to 1.0 and the scale-level CVI reaching 1.0. CONCLUSION: This study followed the MRC framework to develop an evidence-based AT intervention for CINV management which is well supported by systematic review research evidence, AT theories and practice standards, CINV symptom characteristics, and expert panel consensus. The AT intervention would be further evaluated in a pilot randomised controlled trial to confirm its utility, feasibility and acceptability in clinical settings.

Ethyl Alcohol Versus Botulinum Toxin A: A Comparative Study of the Visual and Histopathological Outcomes in the Rabbit Anterior Auricular Muscle Model.

BACKGROUND: Botulinum toxin has long been known for its paralytic effects at the neuromuscular junction. Although it has been widely used for vascular and nervous tissues, there has been no study of the aesthetic effects of the application of ethanol to muscle tissues to date. OBJECTIVE: The authors aimed to demonstrate the effects of the application of ethanol to muscle tissues after an intramuscular injection and to compare the effects of botulinum toxin A (BTA) and ethanol. METHODS AND MATERIALS: A total of 28 rabbits were divided into 4 groups (n = 7 each). Botulinum toxin A (5 units) and different concentrations of ethanol (5 cc) were injected into the left and right anterior auricular muscles of all rabbits, respectively. Ear ptosis was assessed, and histopathological examination was performed after all rabbits were euthanized in the eighth week. RESULTS: Muscle function was affected earlier in ethanol-treated ears than in botulinum-treated ears; however, the ptotic effect lasted for a significantly shorter duration in ethanol-injected ears than in BTA-applied ears. CONCLUSION: Ethanol can block muscle function reversibly and can serve as an alternative to BTA, particularly when rapid results are desirable.

Case for diagnosis. Pruritic erythematosquamous lesion in the auricle

Abstract Chromoblastomycosis is a subcutaneous mycosis with chronic evolution that mainly affects the lower limbs and, less frequently, the auricles. Clinically, it presents with papillary verrucous, nodular, and/or tumoral lesions, whether isolated or infiltrated, forming plaques and, sometimes, atrophic in some areas. Histopathologically, it is characterized by a dermal granulomatous inflammatory infiltrate, and the diagnosis can be confirmed by the presence of fumagoid bodies in anatomopathological or direct mycological exams. The treatment to be indicated will depend on the extent and location of the lesions, using systemic antifungals, surgical removal, cryotherapy, thermotherapy, and immunoadjuvants. The present study reports an atypical presentation of chromoblastomycosis on the auricle.

Case for diagnosis. Pruritic erythematosquamous lesion in the auricle.

Chromoblastomycosis is a subcutaneous mycosis with chronic evolution that mainly affects the lower limbs and, less frequently, the auricles. Clinically, it presents with papillary verrucous, nodular, and/or tumoral lesions, whether isolated or infiltrated, forming plaques and, sometimes, atrophic in some areas. Histopathologically, it is characterized by a dermal granulomatous inflammatory infiltrate, and the diagnosis can be confirmed by the presence of fumagoid bodies in anatomopathological or direct mycological exams. The treatment to be indicated will depend on the extent and location of the lesions, using systemic antifungals, surgical removal, cryotherapy, thermotherapy, and immunoadjuvants. The present study reports an atypical presentation of chromoblastomycosis on the auricle.

Anesthetic and Analgesic Efficient of Regional Nerve Blockade in Otoplasty.

AIM: The prominent ear is the most common congenital deformity of the external ear. Otoplasty is performed to correct the appearance of the prominent ear. This study was planned to compare the analgesic and anesthetic effects of local nerve blockade and local infiltration anesthesia in the otoplasties. METHOD: Thirty-two patients who underwent otoplasty in both ears between February 2018 and March 2019 were included in the study. Three patients were excluded because they refused regional anesthesia. In the patients included in the study, only local infiltration anesthesia was applied to 1 ear and regional nerve blockade was applied to the other ear. Regional nerve blockade was applied to the study group; local infiltration anesthesia was applied to the control group. Surgical and anesthetic complications were recorded. The onset time, duration and severity of pain were followed. Numerical evaluation scale scores were used to evaluate pain levels. RESULTS: It was observed that the first pain of the patients On the side where regional nerve block (RNB) anesthesia was applied after an average of 10.5 hours. On the other hand on the side where local infiltration anesthesia was applied; the pain was observed to start after an average of 3.5 hours. At the 6th and 12th hours postoperatively, the scores of the numerical evaluation scale were significantly lower in the study group than the control group (P < 0.05). At the 24th-hour pain score, the values were lower in the study group, but the difference was not significant between the groups (P > 0.05). In the regional anesthesia group, can develop such as difficulty in swallowing, weakness in the neck, weakness in the upper extremity, nausea, Horner syndrome; but all side effects resolve spontaneously within 6 to 12 hours. CONCLUSION: The application of regional anesthesia in prominent ear surgical procedures can be considered as an alternative method to provide better quality preoperative anesthesia and better quality postoperative analgesia in patients.

The effects of low-and high-frequency non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) on gastric slow waves evaluated using in vivo high-resolution mapping in porcine.

BACKGROUNDS: Gastric motility is regulated by an electrophysiological activity called slow-wave and neuronal innervations by the vagus nerve. Transcutaneous auricular vagal nerve stimulation (taVNS) has been demonstrated to have therapeutic potential for a wide range of medical conditions, including the management of gastric dysfunctions. The main objective of this study was to gain a better understanding of how non-invasive neuromodulation influences gastric slow wave under in vivo conditions. METHODS: TaVNS protocols were applied in conjunction with 192-channel gastric bioelectrical mapping in porcine subjects under general anesthesia. The spatiotemporal profiles of gastric slow wave were assessed under two different taVNS protocols at 10 and 80 Hz. KEY RESULTS: The taVNS protocols effectively altered the interval and amplitude of gastric slow waves, but not the velocity or the percentage of spatial dysrhythmias. In the subjects that responded to the protocols, the 10 Hz protocol was shown to normalize slow-wave propagation pattern in 90% of the subjects, whereas the 80 Hz protocol was shown to inhibit slow waves in 60% of the subjects. CONCLUSIONS AND INFERENCES: Chronic responses of gastric motility and slow waves in response to taVNS should be investigated using non-invasive means in conscious subjects in future.