Search Results (175)

Background/Objectives: An aberrant internal carotid artery (aICA) in the middle ear is a rare vascular anomaly with potentially catastrophic consequences if injured during otologic procedures. Given its rarity, standardized treatment recommendations are lacking. This study aims to present four cases of aICA bleeding, systematically review the literature, and evaluate the outcomes of conservative and interventional management. Methods: A retrospective review of four patients treated for intraoperative aICA hemorrhage at two tertiary referral centers was performed. A systematic review was conducted following PRISMA guidelines. Neurologic and otologic outcomes, hemostasis, and complications were analyzed. Results: Two patients were treated conservatively with external auditory canal packing, while two required endovascular coil embolization due to pseudoaneurysm formation or persistent bleeding. One patient suffered a stroke due to traumatic ICA occlusion. The systematic review identified 20 additional cases. Conservative treatment alone sufficed in 37.5% of cases, whereas 62.5% required vessel occlusion via coiling, balloon occlusion, or stenting. Neurologic complications occurred in 25% of patients, while otologic outcomes varied widely and were inconsistently reported. Conclusions: Initial external auditory canal packing and a CT angiogram should be recommended for all patients. Initial conservative management may be appropriate for cases with early hemostasis if close monitoring is ensured. Endovascular treatment is often necessary, particularly in cases of pseudoaneurysm or rebleeding. Full article

Introduction: The important factor in applying substances for inner ear therapy is the atraumatic execution, as well as effective concentration uniformly distributed in all regions of the cochlea within a reasonable time frame. This study investigates whether an additional cochlear opening (“second-hole technique”) can improve fluid distribution and reduce intracochlear pressure during dye delivery into the cochlear models and human petrous bone. Material and Methods: Three experimental setups were used: an uncoiled scala tympani model, a full-scale 3D-printed cochlear model, and a human petrous bone. In all cases, 1% methylene blue-stained saline was infused using a cochlear catheter (MED-EL, Innsbruck, Austria) through the round window. Intracochlear pressure was measured via fiberoptic pressure sensors inserted through a burr hole (artificial cochlear models) or at the lateral semicircular canal (human petrous bone). A second hole was made on the helicotrema in the inner ear models or at the oval window of the human petrous bone to examine the effect of a second hole on intracochlear pressure and fluid distribution. Dye distribution and intracochlear pressure were measured in 3D artificial models at two flow rates (0.2 and 0.4 mL/h). The intracochlear pressure were measured in the human petrous bone at a fixed rate (0.4 mL/h). Results: The use of a second hole significantly improved dye distribution in 3D models at both flow rates (p < 0.05) and led to earlier saturation-level distribution. Intracochlear pressure remained significantly lower and more stable in models with a second hole (p < 0.05). In human petrous bones, pressure fluctuation was reduced by the second hole, though pressure still increased over time. Conclusions: Using a second-hole technique leads to a faster, uniform level of dye distribution throughout the cochlear models, as well as a lower intracochlear pressure, which can be assumed to be an essential factor for hearing preservation during dye application. Full article

This study aimed to perform ultrasonography of the tympanic bulla in healthy, non-sedated camelids for the first time. In the first step, dissection and sonography in cadaver specimens allowed the essential identification of the anatomical structures of the region of interest. Ultrasonography of the tympanic bulla was then performed on 71 healthy llamas and alpacas, and the length of the visible lateral bulla wall was measured sonographically. The reproducibility of measuring was determined between two examiners. Differences in length and the influences of gender, age, and body condition scores were monitored. A 10 MHz linear probe was positioned in the rostrocaudal and dorsoventral directions caudal to the mandibular ramus and ventral to the base of the ear using a lateral approach. The equipment used proved to be appropriate to visualize the tympanic bulla, the zygomatic bone, the paracondylar process, the external ear canal, and the parotid gland in the cadaver specimens and all live animals. Llamas revealed a significantly longer visible lateral bulla wall than alpacas, but its length was not influenced by gender, body condition score, or age. In alpacas, older females showed a significantly shorter tympanic bulla wall. The intra- and inter-observer reliability yielded a significant agreement. Based on this study’s results, ultrasonography may serve as a non-invasive diagnostic tool for detecting osseous and soft-tissue changes in camelids with otitis media. Full article

Exercise metrics are critical for assessing health, but real-time heart rate and respiration measurements remain challenging. We propose a physiological monitoring system that uses an in-ear microphone to extract heart rate and respiration from faint ear canal signals. An improved non-negative matrix factorization (NMF) algorithm combines with a short-time Fourier transform (STFT) to separate physiological components, while an inverse Fourier transform (IFT) reconstructs the signal. The earplug effect enhances the low-frequency components, thereby improving the signal quality and noise immunity. Heart rate is derived from short-term energy and zero-crossing rate, while a BiLSTM-based model can refine the breathing phases and calculate indicators such as respiratory rate. Experiments have shown that the average accuracy can reach 91% under various conditions, exceeding 90% in different environments and under different weights, thus ensuring the system’s robustness. Full article

Background: Trismus, or restricted mouth opening, can present significant challenges in oral and maxillofacial surgery and trigger substantial functional and psychosocial disabilities. Intra-articular causes, such as temporomandibular joint ankylosis and arthritis, are thoroughly described; however, extra-articular pathologies like neoplastic, traumatic, infectious, and fibrotic conditions of adjacent soft and hard tissues are less frequently reported and present distinct diagnostic complexities and therapeutic hurdles. This retrospective study aims to investigate the difficulties encountered in diagnosis and surgical interventions associated with rare extra-articular causes of trismus. Material and Methods: This article describes five rare causes of extra-articular trismus. The cases range from benign pathologies like coronoid hyperplasia and osteomas to more complex diagnoses of myositis ossificans, external auditory canal abscess, and chronic osteomyelitis. A thorough diagnostic workup was performed for each patient, and specific surgical interventions were administered based on their pathology. Results: All five patients showed significant improvements in mouth opening after surgery. Diagnostic accuracy was ensured with advanced imaging modalities and innovative surgical techniques, and adequate postoperative care translated the favorable outcome. Conclusions: Although based on individual case descriptions, this study emphasizes the potential importance of early diagnosis, a multidisciplinary approach, and individualized treatment planning in managing rare extra-articular causes of trismus. These cases suggest a basis for a more organized system for the timely identification and treatment of such conditions. Additional research is needed to improve diagnostic accuracy, optimize surgical management, and develop evidence-based aftercare treatment to improve patient care and quality of life. Full article

Electroencephalography (EEG) remains an essential method for monitoring brain activity, but the limitations of conventional systems due to the complexity of installation and lack of portability have led to the introduction and development of in-ear EEG technology. In-ear EEG is an emerging method of recording electrical activity in the brain and is an innovative concept that offers multiple advantages both from the point of view of the device itself, which is easily portable, and from the user’s point of view, who is more comfortable with it, even in long-term use. One of the fundamental components of this type of device is the electrodes used to capture the EEG signal. This innovative method allows bioelectrical signals to be captured through electrodes integrated into an earpiece, offering significant advantages in terms of comfort, portability, and accessibility. Recent studies have demonstrated that in-ear EEG can record signals qualitatively comparable to scalp EEG, with an optimized signal-to-noise ratio and improved electrode stability. Furthermore, this review provides a comparative synthesis of performance parameters such as signal-to-noise ratio (SNR), common-mode rejection ratio (CMRR), signal amplitude, and comfort, highlighting the strengths and limitations of in-ear EEG systems relative to conventional scalp EEG. This study also introduces a visual model outlining the stages of technological development for in-ear EEG, from initial research to clinical and commercial deployment. Particular attention is given to current innovations in electrode materials and design strategies aimed at balancing biocompatibility, signal fidelity, and anatomical adaptability. This article analyzes the evolution of EEG in the ear, briefly presents the comparative aspects of EEG—EEG in the ear from the perspective of the electrodes used, highlighting the advantages and challenges of using this new technology. It also discusses aspects related to the electrodes used in EEG in the ear: types of electrodes used in EEG in the ear, improvement of contact impedance, and adaptability to the anatomical variability of the ear canal. A comparative analysis of electrode performance in terms of signal quality, long-term stability, and compatibility with use in daily life was also performed. The integration of intra-auricular EEG in wearable devices opens new perspectives for clinical applications, including sleep monitoring, epilepsy diagnosis, and brain–computer interfaces. This study highlights the challenges and prospects in the development of in-ear EEG electrodes, with a focus on integration into wearable devices and the use of biocompatible materials to improve durability and enhance user comfort. Despite its considerable potential, the widespread deployment of in-ear EEG faces challenges such as anatomical variability of the ear canal, optimization of ergonomics, and reduction in motion artifacts. Future research aims to improve device design for long-term monitoring, integrate advanced signal processing algorithms, and explore applications in neurorehabilitation and early diagnosis of neurodegenerative diseases. Full article

Vestibular atelectasis (VA) is a rare clinical entity characterized by a collapse of the endolymphatic space resulting in vestibular loss with the possible onset of positional and/or sound/pressure-induced vertigo. It could be idiopathic or secondary to other inner-ear diseases including Meniere’s disease (MD). A collapse of the membranous labyrinth involving the semicircular canals (SCs) and the utricle represents its distinctive histopathological feature. While specific radiological patterns consistent with VA have been described on contrast-enhanced MRI with delayed acquisitions, an impairment of the blood–labyrinthine barrier (BLB) could be detected in several disorders leading to vestibular loss. We conducted a narrative review of the literature on VA focusing on the putative pathomechanisms accounting for positional and sound/pressure-induced nystagmus despite unilateral vestibular loss (UVL) in this condition, providing two novel cases of VA. Both patients presented with a clinical picture consistent with unilateral MD that rapidly turned into progressive UVL and positional and/or sound/pressure-induced vertigo. In both cases, the posterior SC was initially impaired at the video-head impulse test (vHIT) and both cervical and ocular VEMPs were initially reduced. Progressively, they developed unsteadiness with paretic spontaneous nystagmus, an impairment also for the lateral and anterior SCs, caloric hypo/areflexia and VEMPs areflexia. They both exhibited ipsilesional nystagmus to sound/pressure stimuli and in one case a persistent geotropic direction-changing positional nystagmus consistent with a “light cupula” mechanism involving the lateral SC of the affected side. A collapse of the membranous labyrinthine walls resulting in contact between the vestibular sensors and the stapes footplate could explain the onset of nystagmus to loud sounds and/or pressure changes despite no responses to high- and low-frequency inputs as detected by caloric irrigations, vHIT and VEMPs. On the other hand, the onset of positional nystagmus despite UVL could be explained with the theory of the “floating labyrinth”. Both patients received contrast-enhanced brain MRI with delayed acquisition exhibiting increased contrast uptake in the pars superior of the labyrinth, suggesting an impairment of the BLB likely resulting in secondary VA. A small intralabyrinthine schwannoma was detected in one case. VA should always be considered in case of positional and/or sound/pressure-induced vertigo despite UVL. Full article

Canine otitis, a prevalent and often recurrent condition in small animal veterinary medicine, can lead to severe and chronic ear disease, necessitating surgical intervention when medical management fails. In advanced cases, Total Ear Canal Ablation with Bulla Osteotomy (TECA-BO) is frequently considered the most effective treatment option to alleviate pain, resolve infection, and improve the overall quality of life of affected dogs. However, as with any major surgical procedure, TECA-BO carries inherent risks, particularly those related to anaesthesia. This single-centre retrospective study aims to evaluate and characterise anaesthesia-related complications in dogs undergoing TECA-BO surgery. The study analyses data from canine patients that underwent the procedure at a specialised veterinary referral centre over a 14-year period spanning from 2007 to 2021. The primary objective is to determine the incidence of anaesthesia-related complications and to identify any potential risk factors that may contribute to their occurrence. A statistical analysis was performed to compare the incidence of complications, with Fisher’s Exact Test being used to assess the significance of observed differences. The significance level was set at p = 0.05 to determine whether specific variables had a meaningful impact on anaesthesia-related complications. The findings of this study may help inform clinical decision-making, optimise anaesthetic management strategies, and ultimately improve the safety and success of TECA-BO procedures in veterinary practice. Full article

External otitis is one of the most common conditions in dogs to be presented to the veterinarian. Moreover, the disorder is often challenging to manage. The range and role of microorganisms involved in the pathogenesis are currently not fully understood. Therefore, the condition has been studied using third-generation sequencing (Oxford Nanopore Technology) to gain a more complete picture of the pathogens involved. Throughout the metagenome assembly of a sample from the ear canal of an 11-year-old female Yorkshire terrier suffering from chronic external otitis, a genome of Lawsonella clevelandensis was compiled. To our knowledge, this result is the first of its type of animal origin. The outcome of the assembly is a single circular chromosome with a length of 1,909,339 bp and 1727 predicted genes. One open reading frame associated with antimicrobial resistance could have been identified. Comparing all available genomes, the species can be associated with three main genome clusters. The finding contributes to the extending knowledge bank about this often-overlooked pathogen and raises attention to the role of nanopore sequencing by the identification and characterization of microorganisms that are difficult to culture. Full article

A soft tissue-filled external ear canal, sometimes also referred to as otitis externa in the veterinary literature, is a prevalent disease in pet rabbits, especially in lop-eared pet rabbits. The authors describe the clinical findings, diagnostic workup, therapy, and outcome of pet rabbits treated surgically for a lateral ear canal ablation (LECA). For the time period between 2015 and 2023, the medical records of two veterinary clinics were evaluated retrospectively. A total of 25 pet rabbits, diagnosed via computed tomography (CT) scans with a soft tissue-filled external ear canal and (if present) middle ear, were identified. All the pet rabbits were evaluated as lop-eared pet rabbits and all were treated surgically using the same surgical technique, LECA. In accordance with Richardson et al., we categorized the different ear filling levels by using the grading system that was established in 2019. The mean follow-up period was 19 days, and in one case complete wound healing was not reached within 131 days after surgery. A total of 7/25 of the pet rabbits were evaluated with wound healing issues. Of the cases, 18/25 did not develop any recurrent ear diseases. Loss to follow-up was observed in 5/25 of the cases and recurrent ear diseases were identified in 2/25 of the pet rabbits. Progression of the ear disease was detected in four cases. CT post-operative images were acquired for 14/25 of the pet rabbits. Based on this study, LECA can be considered a safe surgical method to treat soft tissue-filled external ear canals, especially in lop-eared pet rabbits. Nonetheless, thorough post-surgical management including wound control is critical for therapy success. Full article

Ceruminous glands are specialized apocrine sweat glands. Neoplastic transformation of these glands is often seen in the external ear canal. Tumors arising from these glands can present a diagnostic dilemma because of their varied clinical and histological manifestations. This study was conducted as little information is currently available on these neoplasms. The present study undertakes a scoping review of research on canine and feline CGTs according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for scoping reviews on three databases (NCBI-PubMed, Scopus and ScienceDirect) from 1980 to 2023 (43 years) to determine the extent of the existing literature on its clinicopathological characteristics, overall prognosis, survival rates, and biomarker studies. Seventeen canine and nineteen feline publications that met the inclusion criteria were analyzed. Eleven canine and twelve feline unpublished cases of CGTs managed in Malaysia were also reviewed. Our study concluded surgical excision as part of the treatment for this neoplasia may lengthen animals’ survival period and produce a satisfactory quality of life; however, a substantial risk of complications, especially after aggressive surgical excision, exists. Full article

Background: Vestibular function implements head position regulation and body spatial navigation. It matures during childhood and adolescence and integrates with the completion of an individual’s motor development. Nevertheless, vestibular impairment is associated with profound paediatric hearing loss and has a negative impact on the child’s motor proficiency. Cochlear implantation (CI) is the treatment of choice for severe hearing loss, where conservative treatment plans are not appropriate or fail. The Teenager and Young Adults Cochlear Implant (TAYACI) study investigates the long-term outcomes of early implantation with respect to the hearing, speech, psychological, and balance development among CI users. Methods: This study focuses on the vestibular function and the appropriate methods for vestibular assessment. The results of two established vestibular test methods are explored: the video head impulse test (vHIT) and cervical/ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP) with air and bone conduction vibration stimulation. The results of vHIT, cVEMP, and oVEMP, per implanted ear and the relation to the aetiology of hearing loss are reported. An additional dynamic visual acuity (DVA) test was included to assess clinical oscillopsia. Results: Overall abnormal lateral canal testing was detected in 35/76 (46.1%) of the implanted ears. Bone-conducted cVEMP (BC cVEMP) was pathological in 33/76 (43.3%) and BC oVEMP in 42/76 (55.3%). Lateral canal impairment was associated with the background diagnosis of the hearing loss. Oscillopsia was related to bilateral canal impairment (sensitivity 73% specificity 100%). Conclusions: Lateral canal testing together with BC VEMPs were the most reproducible modules for vestibular testing The above tests were related to each other and complemented the overall vestibular assessment. DVA is a helpful tool to screen dynamic oscillopsia in patients with bilateral vestibular impairment. Full article

The inner ear and/or lateral line are responsible for hearing and balance of vertebrate. The otic sensory hair cells (HCs) employ cilium organelles, namely stereocilia and/or kinocilia, to mediate mechanical stimuli to electrical signal transition. Tektins (Tekts) are known as the cilium microtubule stabilizer and inner-space filler, and four Tekt(1-4)-encoding genes are identified in zebrafish HCs, but the subcellular location of Tekts in HCs remains unknown. In the present study, we first found that tekt3 is expressed in the inner ear and lateral line neuromast. Antibody staining revealed that Tekt3 is present in neuromast and utricular HCs. It is absent in the saccule, the authentic hearing end-organ of zebrafish and the crista of semi-circular canals. Furthermore, Tekt3 were enriched at the apical side of neuromast and utricular HCs, mainly in the cytosol. Similar subcellular distribution of Tekt3 was also evident in the outer HCs of mature mouse cochlea, which are not directly linked to the hearing sense. However, only neuromast HCs exerted morphological defect of kinocilia in tekt3 mutant. The disrupted or distorted HC kinocilia of mutant neuromast ultimately resulted in slower vital dye intake, delayed HC regeneration after neomycin treatment, and reduced startle response to vibration stimulation. All functional defects of tekt3 mutant were largely rescued by wild-type tekt3 mRNA. Our study thus suggests that zebrafish Tekt3 maintains the integrity and function of neuromast kinocilia to against surrounding and persistent low-frequency noises, perhaps via the intracellular distribution of Tekt3. Nevertheless, TEKT3/Tekt3 could be used to clarify HC sub-types in both zebrafish and mice, to highlight the non-hearing HCs. 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

Background/Objectives: Aural toilet using microsuction is a common procedure in ENT clinics, and vertigo is a frequent complaint during this procedure. This study aimed to investigate the characteristics and incidence of microsuction-induced nystagmus and vertigo based on the appearance of the tympanic membrane (TM). Methods: In 85 patients with various TM appearances, microsuction-induced vertigo and nystagmus were assessed. Results: Microsuction elicited nystagmus in 95% (81 of 85) of patients and vertigo in 36% (31 of 85). The nystagmus direction was towards the ipsilateral ear in a bowing position and towards the contralateral ear in a leaning position. The proportion of patients who complained of rotatory vertigo was significantly higher in those with TM perforation, open cavity mastoidectomy, and adhesive otitis media (74%, 26 of 35) compared to those without TM perforation (10%, 5 of 50) (p < 0.001, X² test). Conclusions: Aural toilet using microsuction commonly induces vertigo due to convection in the lateral semicircular canal endolymph caused by the cooling effect. While microsuction-induced nystagmus was observed in most patients, the incidence of vertigo varied depending on the TM condition. Clinicians should closely monitor patients for vertigo during the procedure, and methods to prevent microsuction-induced vertigo should be explored. Full article