Search Results (33)

Vagus nerve stimulation (VNS) may improve cognition and promote underlying brain health through various mechanisms including the noradrenaline and cholinergic pathways. Whilst early human studies used invasive devices (iVNS), recent decades have seen the emergence of non-invasive devices that stimulate the vagus nerve transcutaneously (tVNS) via either the cervical branches in the neck (tcVNS) or the auricular branch in the ear (taVNS). With this increase in more accessible devices, tVNS is gaining interest as a novel therapy in mild cognitive impairment (MCI) and Alzheimer’s disease (AD). This targeted review aims to understand the current evidence in human trials in this specific population. PubMed, Cochrane, EMBASE, MEDLINE, and Google Scholar were searched. Six human interventional studies were found (one iVNS; five taVNS). VNS is well tolerated and study designs demonstrate feasibility within this population for future blinded and appropriately powered long-term studies with participants applying tVNS at home. However, protocols and tVNS settings remain variable. Working memory domains such as verbal fluency and 3D processing show the most promise but global cognitive scores were also sensitive in some cases. The role of biomarkers of tVNS activity and its effect on AD markers and neuroinflammation should be considered in the design of future studies. Full article

Blastomycosis-like pyoderma (BLP) is a rare chronic inflammatory dermatosis characterized by exuberant vegetative and verrucous plaques, most frequently associated with bacterial colonization, particularly Staphylococcus aureus. Owing to its striking clinical and histopathological resemblance to squamous cell carcinoma (SCC) and other granulomatous or hyperplastic dermatoses, BLP represents a well-recognized diagnostic pitfall, often leading to delayed diagnosis or unnecessary surgical management. We report an unusual case of bilateral auricular BLP in a 58-year-old apparently immunocompetent woman, initially misdiagnosed as SCC. Comprehensive clinicopathological reassessment revealed pseudoepitheliomatous hyperplasia, intraepidermal neutrophilic microabscesses, and a dense mixed inflammatory infiltrate, findings consistent with a reactive rather than neoplastic process. Microbiological cultures confirmed Staphylococcus aureus, supporting the final diagnosis of BLP and guiding effective antimicrobial therapy. To better contextualize this rare presentation, we reviewed all previously reported cases of BLP, summarizing available clinical, histopathological, microbiological, and therapeutic data. This case further raises the possibility of an association between BLP and systemic inflammatory conditions, as the patient subsequently developed severe colitis, highlighting the potential role of immune dysregulation and the gut–skin axis in disease pathogenesis or a possible temporal association, without allowing causal inference. Beyond inflammatory bowel disease, blastomycosis-like pyoderma has been reported in association with a variety of systemic and immune-mediated conditions, including diabetes mellitus, hematologic malignancies, HIV infection, chronic renal failure, autoimmune disorders, and prolonged immunosuppressive therapies. These associations support the concept that BLP represents a hyperinflammatory reaction pattern occurring in the setting of altered immune surveillance rather than a purely infectious disease. Accurate recognition and management of BLP require careful integration of clinical features, histological findings, and microbiological results. Increased awareness of its diverse presentations is essential to avoid misdiagnosis and to ensure appropriate, conservative treatment. Full article

Background: Auricular keloids and ear helix deformities are undesirable and aesthetically unpleasing deformities that can cause significant patient psychologic and self-esteem problems. Pressure therapy for keloids is well documented to be an effective non-invasive treatment modality. However, current devices lack comfort and aesthetic appeal to deliver the pressure forces required effectively and uniformly. This work aims to highlight some different pressure therapy approaches for the management of keloids and irregularities in the ear helix morphology. Methods: A case series of four patients presenting with auricle keloids of various sizes and at different locations secondary to ear piercing and one case of congenital helix deformity were treated successfully with pressure therapy devices. The device designs varied based on the keloids’ characteristics and patients’ preferences and involved wire-based spring-activated appliances resembling ear rings for moderate keloid lesions, modified double-spring systems for large or elongated lesions, and magnet-based devices. A pair of inert magnetic discs of different diameters was positioned on the anterior and posterior aspects of the keloid lesion. The magnets were then encapsulated in acrylic resin to improve retention and adaptation, and the external surface was masked with gold glitter to enhance aesthetics and patient acceptance. The helix-deformity case was treated following a complete digital workflow integration where the sound contralateral ear was digitally scanned, mirror-imaged and then 3D-printed in resin to produce an ear model based on which an anatomically symmetrical pressure device was constructed. Results: All devices were successfully fitted and well tolerated, with no reported discomfort or adverse reactions. The wire spring devices were effective in reducing a large keloids volume; however, frequent reactivation every two weeks was required to ensure continuous pressure application. Incorporating magnets in the customised design allowed controlled and uniform pressure application to small keloid-lesion morphology, with enhanced aesthetics and improved patient acceptance and compliance. The digitally assisted case achieved near-perfect anatomical symmetry with the contralateral ear, reducing operator dependency and fabrication guesswork. Conclusions: Customised pressure therapy devices, of magnetic and spring-based systems, alongside utilising digital technologies, offer effective, non-invasive management for auricular keloids and irregular ear helices as long as the patient is committed to wearing the device. Full article

Relapsing polychondritis (RP) is a rare immune-mediated inflammatory disorder characterized by recurrent inflammation of cartilaginous structures. Although RP frequently coexists with other autoimmune disorders, its association with inflammatory bowel disease (IBD), particularly Crohn’s disease, has been rarely described. We report the case of a 53-year-old man who presented with bilateral auricular inflammation sparing the earlobes and was diagnosed with RP based on clinical and histopathological findings. During treatment with systemic corticosteroids and methotrexate, he developed severe abdominal pain accompanied by inflammatory arthritis. These symptoms were initially considered related to treatment; however, subsequent endoscopic and histologic evaluation revealed Crohn’s disease involving the terminal ileum. Therapeutic adjustment, including discontinuation of nonsteroidal anti-inflammatory drugs and optimization of immunosuppressive therapy, resulted in resolution of both gastrointestinal and musculoskeletal symptoms. This case emphasizes the importance of considering concomitant IBD in patients with RP who develop unexplained gastrointestinal manifestations. Recognizing this rare coexistence may facilitate earlier diagnosis and more appropriate therapeutic decision-making in patients with multisystem inflammatory disease. Full article

Background/Objectives: Surgical site infection (SSI) after autologous rib cartilage microtia reconstruction is an uncommon but potentially devastating complication, as infection of the avascular cartilage framework can rapidly lead to partial or complete framework loss. Traditional management often favored aggressive debridement or framework removal, resulting in significant deformity. This study aimed to evaluate salvage-oriented management strategies and to propose a structured treatment algorithm for SSI following microtia reconstruction. Methods: A retrospective case series was conducted of patients who developed SSI after autologous rib cartilage microtia reconstruction between March 2021 and November 2025. SSI was defined by clinical and surveillance criteria requiring intervention beyond routine postoperative care. Nine patients were included. Management strategies were analyzed with respect to infection control, framework preservation, and wound healing outcomes. Results: SSI occurred at variable time points, ranging from early postoperative infection to delayed and late-onset presentations. Identified pathogens included Gram-positive cocci and multidrug-resistant Gram-negative organisms. Negative-pressure wound therapy (NPWT) was applied in all cases with wound dehiscence, persistent drainage, or cartilage exposure. Conservative staged debridement was performed only after clear demarcation of nonviable tissue. Overall auricular framework preservation was achieved in 100% of patients, with no cases requiring complete framework removal, although limited cartilage loss occurred in select cases. These outcomes demonstrate the clinical feasibility and effectiveness of salvage-oriented management across heterogeneous infection scenarios. Conclusions: SSI following autologous microtia reconstruction can be effectively salvaged without routine framework removal through a structured, timing-based algorithm emphasizing early culture-guided antimicrobial therapy, NPWT, and conservative staged intervention. This salvage-oriented approach provides a clinically relevant and reproducible framework for preserving auricular structure while minimizing morbidity, even in infections involving multidrug-resistant organisms. Full article

Staphylococcal scalded skin syndrome (SSSS) is a rare, toxin-mediated dermatosis caused by exfoliative toxin–producing Staphylococcus aureus strains, with neonates and preterm infants being particularly vulnerable due to immature immunity and reduced toxin clearance. We report the case of a male preterm infant, born at 24 weeks of gestation, who presented at the age of one month with fever and later developed widespread erythema, flaccid bullae, and periorificial desquamation. Methicillin-sensitive S. aureus (MSSA) was isolated from blood, catheter, and auricular swabs. Whole-genome sequencing revealed sequence type ST121 carrying both eta and etb genes, confirming the dual-toxin profile associated with severe disease. The infant improved with targeted intravenous oxacillin following catheter removal. A subsequent nasal swab identified a methicillin-resistant S. aureus (MRSA) ST30 strain lacking exfoliative toxins, consistent with asymptomatic colonization. This case underscores the importance of integrating advanced molecular diagnostics such as next-generation sequencing into the management of neonatal SSSS, enabling precise identification of virulence factors and resistance genes. Literature also highlights the global epidemiology of SSSS, diversity of S. aureus toxin genes, and value of genomic surveillance in neonatal care; our case aligns with reports of ST121 strains carrying both ETA and ETB, where the dual-toxin profile drives rapid onset, extensive skin disease, and good outcomes with prompt therapy. Full article

Background: Adrenal insufficiency has been recognized as a condition linked to petrified ear. To further explore this issue, we conducted a review of the literature. Methods: The study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines after pre-registration. Excerpta Medica, the National Library of Medicine, and Web of Science databases without language restrictions were used. Inclusion criteria comprised adrenal insufficiency and the presence of petrified ear. Data extraction included demographics, clinical and laboratory features, and outcome. Results: Thirty-six reports were identified, encompassing 40 cases: 38 males and 2 females, aged between 22 and 79 years. All cases exhibited bilateral petrified ears, with 18 cases of primary adrenal insufficiency and 20 cases of central insufficiency. The type of adrenal insufficiency was not specified in two cases. Sixteen patients had concurrent endocrine disorders. In primary adrenal insufficiency, petrified ear was typically (N = 13; 72%) detected two or more years after the endocrine diagnosis. In central adrenal insufficiency, auricular calcification was identified either prior to or at the time (N = 17; 85%) of the endocrine diagnosis. Petrified ear was never associated with hearing impairment and never improved with therapy. Conclusions: In adrenal insufficiency, petrified ear is always bilateral, affects adult males, occurs in both primary and central forms of the disease and does not improve on therapy. In primary insufficiency, this feature is mostly observed two years after the endocrine diagnosis, whereas in central cases, it is identified before or concurrently with the endocrine diagnosis. Full article

Auricular avulsion injuries are rare, and microvascular reimplantation is considered the preferred treatment according to current literature. However, when a small skin pedicle is preserved, non-microvascular reattachment techniques may offer comparable outcomes. This systematic review aims to assess whether these techniques could represent a viable alternative. We analyzed 32 cases of pedicled auricular avulsion reported in 16 articles, focusing on patient demographics, injury mechanisms, pedicle characteristics, venous congestion, and postoperative management. Venous congestion occurred in 11 patients, with a significantly higher risk in narrower pedicles (mean width 9.82 mm; 95% CI: 4.75–14.89; p = 0.025). Prophylactic heparin significantly reduced this risk (p = 0.007). Other interventions—leech therapy and hyperbaric oxygen—lacked sufficient data for firm conclusions. Most cases achieved graft survival; necrosis occurred in some, and only two patients required additional surgery. Non-microvascular techniques appear to be a viable alternative to microvascular reimplantation, with similar results and potentially fewer complications. Venous congestion remains the main challenge, requiring active management and hospitalization for monitoring. Limited case series and publication bias still hinder the development of standardized guidelines. Full article

Background: Cervicogenic headache (CGH) is a prevalent secondary headache disorder associated with upper cervical spine dysfunction, often involving nociceptive convergence at the trigeminocervical complex. While manual therapy and exercise have demonstrated benefit, autonomic dysregulation may contribute to persistent symptoms. This case report explores the integration of external vagus nerve stimulation (eVNS) into a multimodal physical therapy approach targeting both mechanical and neurophysiological contributors to CGH. Case Description: A 63-year-old female presented with chronic CGH characterized by right-sided suboccipital and supraorbital pain, impaired sleep, and postural dysfunction. Examination revealed a right rotational atlas positional fault, restricted left atlantoaxial (AA) mobility, suboccipital hypertonicity, and reduced deep neck flexor endurance. Initial treatment emphasized manual therapy to restore AA mobility and atlas symmetry, combined with postural correction and neuromuscular training. Intervention: After initial symptom improvement plateaued, eVNS targeting the auricular branch of the vagus nerve was introduced to modulate autonomic tone. The patient used a handheld eVNS device nightly over three weeks. Outcomes: Substantial improvements were observed in the Neck Disability Index (↓77%), Headache Disability Inventory (↓72%), and pain scores (↓100%). Cervical mobility, atlas symmetry, and deep neck flexor endurance improved markedly. The patient reported reduced anxiety, improved sleep, and sustained headache relief at one-month follow-up. Conclusions: This case highlights the potential synergistic benefits of integrating eVNS within a physiotherapy-led CGH management plan. Further research is warranted to explore its role in targeting autonomic imbalance and enhancing conservative treatment outcomes. Full article

Background: Assisted reproductive technologies (ARTs) are essential in treating infertility but often face limited success due to low implantation and live birth rates. East Asian traditional medicine (EATM), including acupuncture and herbal medicine (HM), may enhance physiological responses during ART cycles. This study evaluated the effectiveness and safety of EATM in improving clinical pregnancy and live birth outcomes in women undergoing ART. Methods: This review, registered in PROSPERO (CRD42023411712), systematically searched 11 databases up to 31 March 2023. We included randomized controlled trials (RCTs) comparing EATM interventions to control groups. Data extraction and quality assessment were performed independently by two authors. Meta-analysis used the inverse-variance method in Stata 12.0. A total of 37 RCTs involving 10,776 women (aged 29–38) were analyzed. Studies addressed infertility causes including polycystic ovary syndrome, tubal blockage, diminished ovarian reserve, and unexplained infertility. Acupuncture therapies included body, electro-, laser, and auricular acupuncture. Herbal treatments were administered as powders, pills, granules, decoctions, and ointments based on traditional Chinese formulas. Results: EATM interventions were associated with significant improvements in clinical pregnancy and live birth rates. Acupuncture increased clinical pregnancy rates (CPR: RR 1.316, 95% CI 1.171–1.480) and live birth rates (LBR: RR 1.287, 95% CI 1.081–1.533). HM also enhanced CPRs (RR 1.184) and LBRs (RR 1.147). Subgroup analysis showed true acupuncture and HM were more effective than sham or placebo. No significant differences in adverse events were found. Conclusions: EATM, particularly acupuncture and HM, appears to be a safe and effective complementary therapy that can be used to improve ART outcomes. Future research should focus on developing standardized acupuncture and herbal protocols to optimize integration with ART. Full article

Background: Microtia is a congenital outer ear deformity that causes the auricle to be absent or underdeveloped. It is frequently associated with external auditory canal atresia and causes hearing and psychosocial problems. Objectives: We thoroughly investigate the aspects of microtia and explore both current and innovative therapies. Methods: A systematic literature review was conducted following PRISMA guidelines, focusing on microtia and reconstruction methodologies. This review utilized three databases: PubMed, Scopus, and Web of Science. Results: The etiology involves both genetic and environmental factors and can occur as part of a syndrome or as an isolated condition. Clinically, it has esthetic and functional implications, potentially leading to conductive hearing loss. A multidisciplinary approach is essential for treatment, which includes surgical reconstruction using autologous cartilage or synthetic prostheses. Advances in bioengineering and 3D printing offer new, less invasive solutions. Conclusions: This review aims to synthesize current knowledge on microtia, focusing on tissue engineering for auricular reconstruction, identifying research gaps, evaluating techniques, and providing a resource for clinicians to improve decision-making and foster further research. Full article

Introduction: Antimicrobial resistance (AMR) has surfaced as a critical challenge to public health on a global scale. The precise and swift identification of resistance to antimicrobial agents, along with timely and suitable antimicrobial therapy paired with effective stewardship practices, is crucial for managing the rise and dissemination of antimicrobial resistance. The objective of our investigation was to outline the antimicrobial resistance profile of Staphylococcus spp., a significant contributor to canine otitis, a prevalent condition in dogs, isolated in Western Romania. Methods and Materials: All data were collected from clinical cases of canine otitis externa which presented at the University Clinic of the Faculty of Veterinary Medicine in Timișoara/Romania. A clinical evaluation was conducted, from which era swabs are usually collected and sent for analysis at the laboratory. Laboratory analysis included the microbiological examination for identifying Staphylococcus spp. and determining antibiotic susceptibility phenotypes. Statistical analysis was implemented on all data that were collected. The ear swabs were processed with standard procedures for cultivating and identifying bacteria. The resulting subcultures were processed to determine the staphylococcal species on the GP ID Cards of the Vitek^® 2 automatic system. The antimicrobial susceptibility profiles were detected by the Vitek^® 2 system using an AST-GP80 card. These isolated Staphylococcus spp. strains were further processed by real-time PCR and PCR-RFLP. Results: Of all the auricular exudate samples analyzed, 76 were positive for Staphylococcus spp. (59.38%). Within these, in 82% of auricular samples, six distinct Staphylococcus spp. were identified (Staphylococcus (S.) pseudintermedius, S. intermedius, S. hyicus, S. delphiny, S. shleiferi, and S. aureus). Our data indicate that the PCR-RFLP assay is a practical approach to S. pseudintermedius identification, allowing for discrimination from the other Staphylococcus Intermedius Group (SIG) species and important staphylococcal pathogens of dogs. The highest frequency of resistant S. pseudintermedius isolates was detected against tetracycline (21/34; 61.76%; p-value 0.003), gentamicin (20/34; 58.82%), and kanamycin (20/34; 58.82%). Conclusions: These results are essential to guide the prudent use of antibiotics in veterinary medicine. They will also help design efficient control strategies and measure their effectiveness. Full article

A new therapeutic approach, known as neuromodulation therapy—which encompasses a variety of interventional techniques meant to alter the nervous system in order to achieve therapeutic effects—has emerged in recent years as a result of advancements in neuroscience. Currently used methods for neuromodulation include direct and indirect approaches, as well as invasive and non-invasive interventions. For instance, the two primary methods of stimulating the vagus nerve (VN) are invasive VN stimulation (iVNS) and transcutaneous VN stimulation (tVNS). Since the latter is non-invasive, basic, clinical, and translational studies have focused on transcutaneous auricular VN stimulation (taVNS), the primary tVNS therapy, because of its advantages over iVNS, including ease of use, greater accessibility, and a lower side effect profile. taVNS is currently used as a novel neuromodulatory application to treat cardiovascular, mental, and autoimmune diseases. Future applications of this non-invasive neuromodulation technology to conditions like atrial fibrillation (AF) or ischemic stroke are highly likely due to its advancement. Full article

Vitiligo is a complex skin disorder that involves oxidative stress and inflammatory responses and currently lacks a definitive cure. Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive method for targeting the auricular branch of the vagus nerve and has gained widespread attention for potential intervention in the autonomic nervous system. Although previous research has suggested that vagus nerve stimulation can potentially inhibit inflammatory responses, its specific role and mechanisms in vitiligo treatment remain unknown. This study aimed to explore the therapeutic effects of taVNS in a mouse model of vitiligo induced by monobenzone. Initially, a quantitative assessment of the treatment effects on vitiligo mice was conducted using a scoring system, revealing that taVNS significantly alleviated symptoms, particularly by reducing the depigmented areas. Subsequent immunohistochemical analysis revealed the impact of taVNS treatment on melanocyte granules, mitigating pigment loss in the skin of monobenzone-induced vitiligo mice. Further analysis indicated that taVNS exerted its therapeutic effects through multiple mechanisms, including the regulation of oxidative stress, enhancement of antioxidant capacity, promotion of tyrosine synthesis, and suppression of inflammatory responses. The conclusions of this study not only emphasize the potential value of taVNS in vitiligo therapy, but also lay a foundation for future research into the mechanisms and clinical applications of taVNS. Full article

Tissue engineering (TE) techniques offer solutions for tissue regeneration but require large quantities of cells. For microtia patients, TE methods represent a unique opportunity for therapies with low donor-site morbidity and reliance on the surgeon’s individual expertise. Microtia-derived chondrocytes and perichondrocytes are considered a valuable cell source for autologous reconstruction of the pinna. The aim of this study was to investigate the suitability of perichondrocytes from microtia patients for autologous reconstruction in comparison to healthy perichondrocytes and microtia chondrocytes. Perichondrocytes were isolated via two different methods: explant culture and enzymatic digestion. The isolated cells were analyzed in vitro for their chondrogenic cell properties. We examined migration activity, colony-forming ability, expression of mesenchymal stem cell markers, and gene expression profile. We found that microtic perichondrocytes exhibit similar chondrogenic properties compared to chondrocytes in vitro. We investigated the behavior in three-dimensional cell cultures (spheroids and scaffold-based 3D cell cultures) and assessed the expression of cartilage-specific proteins via immunohistochemistry, e.g., collagen II, which was detected in all samples. Our results show that perichondrocytes from microtia patients are comparable to healthy perichondrocytes and chondrocytes in terms of chondrogenic cell properties and could therefore be a promising cell source for auricular reconstruction. Full article