Middle-ear osteolytic transthyretin amyloidosis: A CARE case report.

INTRODUCTION: Wild-type transthyretin amyloidosis (ATTRwt) is a rare but serious disease that is underestimated due to asymptomatic progression. Cardiac deposits worsen prognosis, highlighting the importance of early detection for preventive treatment. CASE REPORT: An elderly patient presented with an osteolytic lesion of the middle ear. Pathology diagnosed amyloid transthyretin deposits associated with cholesteatoma. DISCUSSION: Identifying reliable markers to screen for risk of cardiac amyloidosis is important, due to poor prognosis. Recent studies found higher prevalence of hearing loss in ATTRwt than in the general population. The present case identified the middle ear as a target of ATTR, which could improve our understanding of the pathophysiology.

Effect of electromagnetic middle-ear implant simulating sites on the stapes spatial motion: A finite element analysis.

The electromagnetic middle-ear implant (MEI) is a new type of hearing device for addressing sensorineural and mixed hearing loss. The hearing compensation effect of the MEI varies depending on the transducer stimulation sites. This paper investigates the impact of transducer stimulation sites on MEI performance by analyzing stapes spatial motion. Firstly, we constructed a human-ear finite element model based on micro-CT scanning and inverse molding techniques. This model was validated by comparing its predictions of stapes spatial motion and cochlear response with experimental data. Then, stimulation force was applied at four common sites: umbo, incus body, incus long process and stapes to simulate the electromagnetic transducer. Results show that at low and middle frequencies, stapes-stimulating and incus-long-process-stimulating produce similar spatial motion to normal hearing; at high frequencies, incus-body-stimulating produces similar results to normal hearing. The equivalent sound pressure level generated by the stapes piston motion is less sensitive to the stimulation direction than that deduced by the stapes rocking motion.

Otolith reliability is context-dependent for estimating warming and CO2 acidification impacts on fish growth.

Otoliths are frequently used as proxies to examine the impacts of climate change on fish growth in marine and freshwater ecosystems worldwide. However, the large sensitivity differences in otolith growth responses to typical changing environmental factors (i.e., temperature and CO2 concentration), coupled with unclear drivers and potential inconsistencies with fish body growth, fundamentally challenge the reliability of such otolith applications. Here, we performed a global meta-analysis of experiments investigating the direct effects of warming (297 cases) and CO2 acidification (293 cases) on fish otolith growth and compared them with fish body growth responses. Hierarchical models were used to assess the overall effect and quantify the influence of nine explanatory factors (e.g., fish feeding habit, life history stage, habitat type, and experimental amplitude and duration). The overall effects of warming and acidification on otolith growth were positive and significant, and the effect size of warming (effect size = 0.4003, otolith size of the treatment group increased by 49.23% compared to that of the control group) was larger than that of acidification (0.0724, 7.51%). All factors examined contributed to the heterogeneity of effect sizes, with larger responses commonly observed in carnivorous fish, marine species, and young individuals. Warming amplitudes and durations and acidification amplitudes increased the effect sizes, while acidification durations decreased the effect sizes. Otolith growth responses were consistent with, but greater than, fish body growth responses under warming. In contrast, fish body growth responses were not significant under acidification (effect size = -0.0051, p = .6185) and thus cannot be estimated using otoliths. Therefore, our study highlights that the reliability of applying otoliths to examine climate change impacts is likely varied, as the sensitivity of otolith growth responses and the consistency between the growth responses of otoliths and fish bodies are context-dependent.

Evaluating diagnostic and management agreement between physiotherapists and ear, nose and throat specialist in a primary contact physiotherapy-led vestibular clinic: A prospective blinded inter-rater agreement pilot study.

BACKGROUND: Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. Primary contact physiotherapy-led vestibular clinics are recognized as improving access to care. This pilot study investigated agreement between physiotherapists and an ENT medical practitioner for diagnostic and management decisions in patients attending a primary contact physiotherapy-led vestibular clinic. METHODS: Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants were adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included agreement of diagnoses and management decisions made by an ENT medical practitioner and Physiotherapist based on a vestibular physiotherapy assessment. Adverse events were reviewed 11 months post data collection. Gwet's first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT. RESULTS: Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a substantial agreement (AC1 0.613) on diagnosis. AC1 between physiotherapy and ENT for recommending Magnetic resonance imaging (0.810) and computerized tomography (0.935) both indicated near perfect agreement. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. Substantial agreement (AC1 0.720) was found for recommendations for ENT input, near perfect agreement (AC1 0.933) for neurology input and moderate agreement (AC1 0.574) for physiotherapy input. There were no adverse events from physiotherapist's management decision, based on final recommendations undertaken 11-months post data collection. CONCLUSIONS: Physiotherapists and ENT medical practitioner made comparable diagnostic and management decisions, based on physiotherapy and audiology hearing assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This study provides support for this type of Physiotherapy-led service in managing patients referred to an ENT service with vestibular dysfunction.

Signal quality evaluation of an in-ear EEG device in comparison to a conventional cap system.

Introduction: Wearable in-ear electroencephalographic (EEG) devices hold significant promise for integrating brain monitoring technologies into real-life applications. However, despite the introduction of various in-ear EEG systems, there remains a necessity for validating these technologies against gold-standard, clinical-grade devices. This study aims to evaluate the signal quality of a newly developed mobile in-ear EEG device compared to a standard scalp EEG system among healthy volunteers during wakefulness and sleep. Methods: The study evaluated an in-ear EEG device equipped with dry electrodes in a laboratory setting, recording a single bipolar EEG channel using a cross-ear electrode configuration. Thirty healthy participants were recorded simultaneously using the in-ear EEG device and a conventional EEG cap system with 64 wet electrodes. Based on two recording protocols, one during a resting state condition involving alternating eye opening and closure with a low degree of artifact contamination and another consisting of a daytime nap, several quality measures were used for a quantitative comparison including root mean square (RMS) analysis, artifact quantification, similarities of relative spectral power (RSP), signal-to-noise ratio (SNR) based on alpha peak criteria, and cross-signal correlations of alpha activity during eyes-closed conditions and sleep activities. The statistical significance of our results was assessed through nonparametric permutation tests with False Discovery Rate (FDR) control. Results: During the resting state, in-ear and scalp EEG signals exhibited similar fluctuations, characterized by comparable RMS values. However, intermittent signal alterations were noticed in the in-ear recordings during nap sessions, attributed to movements of the head and facial muscles. Spectral analysis indicated similar patterns between in-ear and scalp EEG, showing prominent peaks in the alpha range (8-12 Hz) during rest and in the low-frequency range during naps (particularly in the theta range of 4-7 Hz). Analysis of alpha wave characteristics during eye closures revealed smaller alpha wave amplitudes and slightly lower signal-to-noise ratio (SNR) values in the in-ear EEG compared to scalp EEG. In around 80% of cases, cross-correlation analysis between in-ear and scalp signals, using a contralateral bipolar montage of 64 scalp electrodes, revealed significant correlations with scalp EEG (p < 0.01), particularly evident in the FT11-FT12 and T7-T8 electrode derivations. Conclusion: Our findings support the feasibility of using in-ear EEG devices with dry-contact electrodes for brain activity monitoring, compared to a standard scalp EEG, notably for wakefulness and sleep uses. Although marginal signal degradation is associated with head and facial muscle contractions, the in-ear device offers promising applications for long-term EEG recordings, particularly in scenarios requiring enhanced comfort and user-friendliness.

Outcomes with Management of Cholesteatoma.

This article provides an expert summary of the immense amount of outcomes research in cholesteatoma surgery. Specific topics discussed include canal wall-up versus canal wall-down surgery, ossicular chain reconstruction, endoscopic ear surgery, disease-specific quality-of-life outcomes, and congenital cholesteatoma.

Skeletal labyrinth morphology of four species of living elasmobranchs.

Despite detailed descriptions of cranial anatomy in representatives of most major chondrichthyan groups, the inner ear has been described infrequently and most often from the soft tissue of the membranous labyrinth. However, skeletal labyrinth morphology has been linked with ecology in several groups of vertebrates, and shark skeletal labyrinths bear several specializations for detecting low frequency sounds. Without description of these structures across a broad sample of taxa, future exploration of the ecomorphology of ear shape is not possible. We used high-resolution CT scanning to generate three-dimensional models of the endocranial anatomy in four elasmobranchs: the Nurse Shark (Ginglymostoma cirratum), the Japanese Tope Shark (Hemitriakis japanica), the Horn Shark (Heterodontus francisci), and the Zebra Shark (Stegostoma tigrinum). Major differences are apparent between the skeletal labyrinths of these taxa, which might be ascribed to either phylogenetic history or lifestyle. In particular, the size of the skeletal labyrinth relative to the cranium dramatically differs among these chondrichthyans, as does the diameter and angle of the semicircular canals and the size of the canals relative to the vestibule. Based on the separation of the anterior and posterior semicircular canals, and the lack thereof in S. tigrinum, the degree of specialization for low frequency sound detection may also vary.

Sudden Hearing Loss Waves: The Effect of COVID-19 Infection and Vaccination on the Inner Ear.

Sudden sensorineural hearing loss (SSNHL) has emerged as a potential complication of COVID-19 infection and vaccination. Various mechanisms by which the SARS-CoV-2 virus can cause hearing loss have been reported, including direct viral invasion, neuroinflammation, blood flow disturbances, and immune-mediated response. However, the temporal relationship between COVID-19 infection and SSNHL remains unclear, with mixed findings and conflicting results reported in different studies. Similarly, while anecdotal reports have linked COVID-19 vaccination to SSNHL, evidence remains scarce. Establishing a correlation between COVID-19 vaccines and SSNHL implies a complex and multifactorial pathogenesis involving interactions between the immune system and the body's stress response. Nevertheless, it is important to consider the overwhelming evidence of the vaccines' safety and efficacy in limiting the spread of the disease and remains the primordial tool in reducing death.

Aetiologies of Ear Infections Among Patients Who Visited King Fahad Hospital in Al-Baha, Saudi Arabia.

Background Ear infections encompass otitis media (OM) which is a significant cause of hearing loss and otitis externa (OE) which may affect the surrounding tissues leading to serious complications. This study reports the common pathogens causing ear infections. Methods Microbiological, clinical, and demographic data of ear-infected patients who visited King Fahad Hospital in Al-Baha, Saudi Arabia, during the period from January 2019 to June 2023 were enrolled in this study. Result  This study enrolled 307 patients aged 1-94 years, with a median age of 40 years (IQR=22-57). Overall, the detectable infection rate was 81.1% (n=249), while 18.9% (n=58) had no identified aetiology. Of all isolates, 178 (58%) were bacterial, while 71 (23.1%) were fungal. Staphylococcus aureus (S. aureus) followed by Pseudomonas aeruginosa (P. aeruginosa), Enterobacteriaceae, andcoagulase-negative Staphylococcus (CoNS) were the main bacterial isolates. Of the total 63 S. aureus isolates, 21 (33%) were methicillin-resistant (MRSA). A cohort of 227 subjects were diagnosed with either OM (n=178; 79.5%), OE (n=46; 20.5%), or both OM and OE (n=3; 1%). Of those with OM, children constituted 89.1% (41/46) as compared to 75.3% (134/178) of adults (p=0.041). The main isolates from OM patients were S. aureus followed by P. aeruginosa and fungi. Of 49 OE patients, 16 (32.7%) had no identified pathogen, while 15 (30.6%) had fungi, and 13 (29.5%) had P. aeruginosa. Conclusions Ear infections in general were mainly bacterial followed by fungal with a considerable proportion of unidentified aetiology. A significant proportion of S. aureus isolates were MRSA. S. aureus followed by P. aeruginosa and fungi were the main causes of OM, while fungi followed by P. aeruginosa were the main causes of OE.

Exclusive endoscopic tympanoplasty efficacy in the treatment of cholesteatoma without mastoid involvement.

PURPOSE: The purpose of this study is to determine the recurrence rate of cholesteatoma in patients who have undergone exclusive endoscopic tympanoplasty at our tertiary referral institution. A secondary objective is to analyze different clinical aspects that could be considered risk factors for recurrence to establish if it is possible to determine when a second-look procedure is indicated instead of a clinical follow-up. METHODS: A retrospective study was performed on patients who had undergone exclusive endoscopic tympanoplasty for cholesteatoma in the last eight years and who were followed up for at least one year. The efficacy of the treatment performed only with the exclusive endoscopic technique was analyzed. Then, the anamnestic and intraoperative data were studied to identify possible factors that could increase the risk of recurrence. RESULTS: The recurrence rate (14.5%) in patients (164) who underwent primary surgery with the exclusive endoscopic technique between January 2014 and January 2022 was similar to that in patients who underwent the microscopic technique with mastoidectomy in literature. In addition, we analyzed several clinical factors such as age, ossicular chain erosion, extension and localization of the cholesteatoma finding that only the last one could potentially be a risk factor for recurrence in this selected population. CONCLUSION: Exclusive endoscopic tympanoplasty has been shown to be effective in removing cholesteatoma in patients without evidence of mastoid involvement, with recurrence rates comparable to traditional microscopic technique and a minimally invasive approach, even considering the patient's age, ossicular chain erosion and extension of the disease.

Management of a Pott puffy tumor: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Frontal bone osteomyelitis associated with a subperiosteal abscess is known as Pott's puffy tumor. Pott puffy tumor (PPT) is a rare entity that mainly affects children and adolescents. It is less common in adults, accounting for 30 % of cases, and predominates in men. The therapeutic management of Pott's puffy tumor is an emergency and is based on a combination of antibiotic therapy and surgical treatment to prevent the emergence of intracranial complications and reduce morbidity and mortality. CASE PRESENTATION: We report the case of a 29-year-old female patient, who consulted our ENT (ear, nose, and throat) department for a post-traumatic periorbital swelling. CT scan confirmed osteomyelitis of the frontal bone and subperiosteal abscess. The patient underwent a combined surgical drainage with antibiotics. The aim is to describe an effective management of this clinical case. CLINICAL DISCUSSION: This condition presents as a subperiosteal/subgaleal abscess creating a frontal swelling, with osteomyelitis of the frontal bone most often secondary to frontal sinusitis. The most feared complications are intracranial, which can be life-threatening. Imaging is the key to positive diagnosis, as the evolution and prognosis of TPP depend on rapid management. A CT scan of the head is the examination of choice to confirm the diagnosis. Antibiotic therapy should be started as soon as possible, it is usually administered by intravenous injection. Surgical management may be limited to percutaneous drainage by needle or transnasal endoscopy or trephination, sometimes including trimming of the subperiosteal/subgaleal abscess. In the case of intracranial complications, a craniotomy may be necessary. CONCLUSION: The Pott's puffy tumor is little-known complication, usually secondary to untreated or poorly treated sinusitis. As a result of this poor understanding, the condition can lead to complications, especially intracranial ones, which increase morbidity and mortality.

A Nanoparticle-Based Artificial Ear for Personalized Classification of Emotions in the Human Voice Using Deep Learning.

Artificial intelligence and human-computer interaction advances demand bioinspired sensing modalities capable of comprehending human affective states and speech. However, endowing skin-like interfaces with such intricate perception abilities remains challenging. Here, we have developed a flexible piezoresistive artificial ear (AE) sensor based on gold nanoparticles, which can convert sound signals into electrical signals through changes in resistance. By testing the sensor's performance at both frequency and sound pressure level (SPL), the AE has a frequency response range of 20 Hz to 12 kHz and can sense sound signals from up to 5 m away at a frequency of 1 kHz and an SPL of 126 dB. Furthermore, through deep learning, the device achieves up to 96.9% and 95.0% accuracy in classification and recognition applications for seven emotional and eight urban environmental noises, respectively. Hence, on one hand, our device can monitor the patient's emotional state by their speech, such as sudden yelling and screaming, which can help healthcare workers understand patients' condition in time. On the other hand, the device could also be used for real-time monitoring of noise levels in aircraft, ships, factories, and other high-decibel equipment and environments.

Efficacy and innocuity of lotilaner in the treatment of otodectic mange in ferrets.

Otodectes cynotis is a contagious ear mite generally responsible of a parasitic otitis. This prospective study evaluates the efficacy, safety and impact on quality of life (QoL) of oral lotilaner for the treatment of Otodectes infestation in ferrets. Ferrets of weight greater than 500 g, with Otodectes mites confirmed on ear swabs examination and that did not receive an acaricidal treatment in the previous two weeks were included. Oral lotilaner (Credelio 12 mg, ELANCO FRANCE, Sèvres, France) was administered at inclusion day (D0) and 28 days later (D28). Parasitic counts and clinical examination were performed at D0, D28 and D56. A QoL and owner satisfaction questionnaire was given at D0 and D56. Statistical analysis was performed with Shapiro-Wilk test for normality and Wilcoxon test for mean comparison (significance: p<0.05). Eleven ferrets were included, two were asymptomatic. Mean weight was 1.2 kg (0.68-2.66). Mean lotilaner dose was 12.3 mg/kg (9-17.6). Mean eggs, adults or nymphs, larvae, and fragments counts were 30.4 (3-104), 11.2 (1-61), 5.4 (0-36), 3.5 (1-7) respectively at D0; 0, 0, 0.1 (0-1), 0.5 (0-3) respectively at D28; 0, 0, 0, 0.14 (0-1) respectively at D56. Differences were statistically significant from baseline in all cases (p<0.05). Pruritus was absent in all cases at D56. No adverse effects were reported. All owners were "completely satisfied" with the treatment. Mean impact of the disease on QoL was 4.5/18 (SD=4.15) at D0 and 0 at D56 (significant difference, p<0.05). Oral lotilaner appears as a safe, efficient, easy to use and satisfactory treatment of Otodectes cynotis infestation in ferrets.

EVL is not essential for cuticular plate and stereocilia development in mouse auditory hair cells.

In inner ear hair cells, the stereocilia are inserted into a dense F-actin-enriched meshwork named the cuticular plate, which provides support to the stereocilia. Enah/Vasp-like (EVL) was shown to localize at the cuticular plate, and evl knockdown leads to disrupted cuticular plate and disorganized stereocilia in Xenopus hair cells. In the present work, we show that Evl transcripts are specifically expressed in mouse hair cells, and EVL is localized to the cuticular plate. However, the cuticular plate and stereocilia are unaffected by Evl knockout, and auditory function is largely normal in Evl knockout mice. In conclusion, our present data suggest that EVL is not essential for cuticular plate and stereocilia development in mouse auditory hair cells.

Identification of rare missense variants in the BSN gene co-segregating with chronic otitis media in a consanguineous Pakistani family.

BACKGROUND: Otitis media (OM) is the most frequent and complex middle ear condition with multifactorial etiology including genetic predisposition. OM depicts a variable clinical spectrum, leading to speech, developmental delay, and hearing loss. Here, we report the clinical and genetic findings of chronic suppurative otitis media (CSOM) segregating in a six-generation consanguineous Pakistani family PKOM08. METHODS: Clinical evaluations, including audio and tympanometry, were conducted to assess OM manifestation and their impact on hearing function. Exome sequencing was performed to identify potential genetic variants underlying CSOM in the study participants. RESULTS: Clinical evaluation of participating individuals revealed varying degrees of disease severity, with mild to moderate hearing loss. All the affected individuals had CSOM with no other apparent comorbidity. Whole exome followed by Sanger sequencing revealed two rare heterozygous variants [c.1867C>T, p.(Pro623Ser) and c.11015G>A, p.(Arg3672Gln)] of BSN gene in most of the affected individuals of family PKOM08. BSN encodes a scaffold bassoon protein involved in synaptic vesicle trafficking. The identified variants replaced evolutionary conserved amino acid residues in the encoded protein and are predicted to impact the ionic interactions in the secondary structure. CONCLUSION: A deep intronic variant of BSN has been previously implicated in the etiology of childhood ear infections. Our study further supports a link between BSN-impaired function and ear infection and CSOM in children.

Exploring the application of stem cell technology in treating sensorineural hearing loss.

Sensorineural deafness mainly occurs due to damage to hair cells, and advances in stem cell technology, especially the application of induced pluripotent stem cells (iPSCs) and adult stem cells, provides new possibilities for hair cell regeneration. This review describes the basic knowledge of stem cells and their important applications in regenerative medicine, as well as recent progress in stem cell research in the field of hair cell regeneration, especially the induced differentiation of hair-like cells. At the same time, we also point out the challenges facing current research, including differentiation efficiency, cell stability issues, and treatment safety and long-term efficacy considerations. Finally, we look forward to the direction of future research, and emphasize the importance of the cell differentiation mechanism, simulation of the inner ear microenvironment, safety assessment, and personalized treatment strategies. In conclusion, despite many challenges, stem cell technology has shown great potential in the field of hearing research and is expected to bring revolutionary treatment options for patients with sensorineural hearing loss in the future.

Characteristics of ear fullness and synaptic loss in ear fullness revealed by SV2A positron emission tomographycortical.

Objective: Studies on feeling of ear fullness (FEF) related to sudden sensorineural hearing loss(SSNHL) are limited. The mechanisms of FEF are unclear. This study aimed to explore the characteristics and related brain activation of SSNHL with FEF. Methods: A total of 269 SSNHL patients were prospectively observed and divided into two groups, with FEF and without FEF. Fifteen SSNHL patients with FEF and 20 healthy controls (HCs) were recruited and underwent 18F-SynVesT-1 static PET. Standardized uptake values ratios (SUVr) of 18F-SynVesT-1 were computed between regions of interest. Results: The occurrence of FEF was not related to the audiogram type or severity of hearing loss. There was a positive correlation between the degree of FEF and the degree of hearing loss. Recovery from FEF was not related to the audiogram shape, the degree of hearing loss or recovery. Fifteen SSNHL patients with FEF had relatively low 18F-SynVesT-1 uptake in the right middle frontal gyrus, right inferior frontal gyrus, right middle temporal gyrus, bilateral parietal lobe sub-gyral and left medial frontal gyrus, as compared with HCs. There was no relatively high 18F-SynVesT-1 uptake in the cerebral cortex. Conclusion: The occurrence and recovery of FEF in SSNHL patients are not related to the classification, degree and recovery of hearing loss. The 18F-SynVesT-1 uptake in the cerebral cortex of patients experiencing SSNHL and FEF has shown alterations. This indicates that FEF may be related to cortical reorganization after the sudden impairment of unilateral auditory input.

Enhancing Vagal Tone, Modulating Heart Rate Variability with Auricular Acupressure at Point Zero: A Randomized Controlled Trial.

Introduction: Point Zero located within the vagus nerve's auricular branch shows promise in addressing imbalances. This study aims to explore its effects on vagal activity using auricular acupressure (AA), measured through heart rate variability (HRV). Methods: This single-blinded randomized controlled trial involved 114 healthy volunteers randomly assigned to receive AA (AA group, n = 57) or sham-AA (SA group, n = 57) at Point Zero. The 30-minute procedure comprised six stages: T1 and T2 (pre-intervention), T3 to T5 (intervention), and T6 (post-intervention). Interventions involving 30-s acupoint pressure stimulations at T3 and T5. The HRV-measured outcomes included heart rate (HR), standard deviation of R-R intervals (SDNN), root mean square of successive RR interval differences (RMSSD), natural logarithm of low-frequency power (LnLF), and natural logarithm of high-frequency power (LnHF). In addition, respiratory rate (RR) was monitored for its stability. Results: The AA group demonstrated a significant decrease in HR and increases in SDNN, RMSSD, and LnHF from stages T3 to T6 compared with T1 (baseline), notably prominent at T3 (median changes [25th; 75th percentiles]: -2 [-5; -1], 17.85 [9.65; 31.72], 4.9 [1.08; 10.65], 0.26 [0.00; 0.62], respectively) and T5 (-3 [-6; -1], 19.45 [10.6; 32.89], 6.17 [-0.17; 16.34], 0.40 [-0.14; 0.83], respectively), while the SA group did not. LnLF showed nonsignificant alterations, and RR remained stable in both groups. Despite minor HRV fluctuations, the AA group consistently displayed significantly higher changes in SDNN and RMSSD compared with the SA group from T3 onwards. HR remained unchanged at T6, and LnHF significantly differed only at T5. Conclusion: AA at Point Zero may promptly enhance vagal activity, evident in the modulation of HRV, notably pronounced with pressure stimulation, and can be sustained for at least 5 min. Further studies are needed to assess its long-term effectiveness and efficacy in preventing or treating patients.(Clinical Trial Registration: NCT05586698).

Issues Concerning the Mechanisms of Bone Conduction.

Air and bone conduction thresholds are used to differentiate between conductive and sensori-neural hearing losses because bone conduction is thought to bypass the conductive apparatus, directly activating the inner ear. However, the suggested bone conduction mechanisms involve the outer and middle ears. Also, normal bone conduction thresholds have been reported in cases of lesions to the conduction pathway. Therefore, further investigation of bone conduction mechanisms is required.