Search Results (413)

Eosinophils are tissue-adapted granulocytes with important roles in host defense, immune regulation, barrier responses, and inflammatory disease. Beyond classical degranulation, activated eosinophils can release eosinophil extracellular traps (EETs), extracellular DNA and protein structures that arise through cytolytic nuclear EETosis or rapid mitochondrial DNA (mtDNA) release. These traps may contribute to host protection by immobilizing pathogens and concentrating eosinophil granule proteins at sites of mucosal or tissue inflammation. However, when EET formation is excessive, persistent, or insufficiently cleared, the same structures may promote epithelial injury, mucus viscosity, thromboinflammation, tissue remodeling, fibrosis, and chronic eosinophilic inflammation. This review summarizes the cellular mechanisms, structural organization, inducing stimuli, and disease relevance of EETs. Particular attention is given to infectious settings, eosinophilic airway and middle-ear disease, systemic vasculitic and hypereosinophilic disorders, inflammatory skin and ocular diseases, eosinophilic gastrointestinal disease, and cancer. Current evidence indicates that EETs should be interpreted as context-dependent eosinophil effector structures with dual biological potential. Although their mechanistic relevance is increasingly recognized, further histological, functional, and clinical validation is needed before EETs can be established as reliable biomarkers or therapeutic targets. Full article

Background: Adolescents in low- and middle-income countries face a disproportionate burden of dietary inadequacy, yet evidence on the determinants of overall diet quality remains scarce. This study assessed the prevalence of macro- and micronutrient inadequate intake and identified factors associated with dietary adequacy among adolescents in rural Pakistan. Methods: A cross-sectional survey was conducted among adolescents using multistage cluster sampling. Dietary intake was assessed through a single 24-h dietary recall; nutrient adequacy was determined using age-and sex-specific Dietary Reference Intake (DRI) standards, including Estimated Average Requirements (EARs), Adequate Intakes (AIs), Estimated Energy Requirements (EERs), and Acceptable Macronutrient Distribution Ranges (AMDRs), as appropriate. Overall dietary adequacy was quantified using the Mean Adequacy Ratio (MAR), calculated as the unweighted mean of nutrient adequacy ratios for fourteen nutrients, including protein, fiber, calcium, iron, zinc, thiamin, riboflavin, niacin, vitamins A, B6, C, D, E, and folate, scaled from 0 to 100. Multivariable linear regression incorporating survey weights and clustering was used to identify independent predictors of MAR using STATA. Results: A total of 1132 adolescents were included. Most of the energy was derived from carbohydrates, and a high proportion of adolescents had energy intakes below age- and sex-specific Estimated Energy Requirement (EER) values, while very high levels of inadequacies were observed for protein, fiber, calcium, vitamin D, and vitamin A. The mean MAR score was 54.04 ± 16.51, indicating overall poor dietary adequacy. In multivariable analysis, male sex (β = 3.26; 95% CI: 1.76, 4.75), belonging to the richest wealth quintile (β = 5.81; 95% CI: 1.76, 9.86), always eating between meals (β = 6.70; 95% CI: 3.93, 9.47), and use of bar soap for handwashing (β = 4.97; 95% CI: 2.00, 7.94) were significantly associated with higher dietary adequacy. Adolescents who were underweight (β = −2.40; 95% CI: −4.81, −0.11) and those with moderate physical activity levels (β = −3.96; 95% CI: −7.62, −0.29) had significantly lower dietary adequacy scores. Conclusions: Dietary inadequacy among rural adolescents in Pakistan was highly prevalent and was associated with socioeconomic, behavioral, and nutritional factors. These findings highlight the need for interventions that address food insecurity, promote equitable food distribution, and strengthen nutrition education to support adolescent health and nutrition. However, these findings should be interpreted in light of the cross-sectional design and the use of a single 24-h dietary recall, which may not reflect habitual dietary intake. Full article

Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann–Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia. Full article

Background and Objectives: Ventilation tube insertion (VTI) is the most commonly performed surgical procedure for otitis media with effusion (OME) in children. While the factors associated with tube extrusion have been investigated, their quantitative impact on the timing of extrusion remains insufficiently characterized. This study aimed to identify independent factors associated with ventilation tube extrusion time and to quantify the magnitude and direction of their effect using survival analysis methodology. Materials and Methods: This retrospective cohort study included 150 patients (262 ears) who underwent VTI with Shepard-type tubes for OME at a tertiary referral center between February 2019 and July 2025. Patient-level variables (age, sex, laterality, allergic rhinitis, secondhand smoke exposure, adenoidectomy, and tonsillectomy) were analyzed per patient (n = 150), while ear-specific variables (effusion type, history of previous VTI, and tube obstruction) were analyzed per ear (n = 262). Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent factors associated with extrusion time. Kaplan–Meier survival curves with log-rank tests were used to compare median extrusion times between groups. Results: The mean ventilation tube extrusion time was 280.38 ± 99.24 days (9.35 ± 3.30 months). Three independent factors significantly associated with shorter extrusion time were identified in multivariate analysis: tube obstruction during follow-up (HR = 2.629, 95% CI: 1.731–3.993, p < 0.001), history of previous VTI (HR = 2.292, 95% CI: 1.678–3.131, p < 0.001), and serous effusion type compared to glue (HR = 1.914, 95% CI: 1.455–2.517, p < 0.001). Age, sex, laterality, allergic rhinitis, secondhand smoke exposure, adenoidectomy, and tonsillectomy were not significantly associated with extrusion time. Conclusions: History of previous VTI, serous effusion type, and tube obstruction during follow-up were independently associated with shorter ventilation tube extrusion time. Notably, tube obstruction during follow-up, which has not been previously evaluated as a factor associated with extrusion time in survival analyses of tube retention, demonstrated the strongest independent effect on extrusion timing. These findings may assist clinicians in anticipating tube behavior and individualizing postoperative follow-up schedules. Full article

Background/Objectives: The anatomical relationship between the oval window (OW) and the facial nerve (FN) is of significant importance in the context of stapes and middle ear surgery. However, the influence of mastoid pneumatization on OW morphology and FN proximity remains to be elucidated. Methods: This retrospective study included 220 radiologically normal temporal bones from 110 adults. OW width, OW height, OW niche width, FNt–OW distance, FNm–OW distance, OW–mastoid cell distance, and OW–FNm–FNt corridor area were measured on HRCT images. Mastoid pneumatization was classified using a sigmoid sinus-based grading system. RASCI was developed by integrating OW morphology, OW niche width, and mastoid pneumatization. Results: The mean width of the OW, the height of the OW, and the width of the OW niche were 2.41 ± 0.92 mm, 1.38 ± 0.36 mm, and 1.03 ± 0.38 mm, respectively. The mean FNt–OW and FNm–OW distances were recorded as 0.93 ± 0.33 mm and 2.78 ± 0.94 mm, respectively. It was established that larger OW dimensions and FN-OW distances were associated with higher levels of mastoid pneumatization. The radiological–anatomical constraint was categorised as low in 21.4% of cases, moderate in 69.5%, and high in 9.1% of the temporal bones (RASCI). Conclusions: Mastoid pneumatization appears to be associated with OW morphology and FN–OW spatial relationships. The RASCI could provide an initial HRCT-based framework for grading the constraints of the OW-FN corridor; however, prospective surgical validation is required. Full article

Background and Objectives: Patency of the aditus ad antrum is essential for middle ear and mastoid ventilation and may influence surgical outcomes in chronic otitis media (COM). Although preoperative computed tomography (CT) is commonly used to assess patency, its reliability remains uncertain. This study compared preoperative CT findings with intraoperative saline and suction testing and evaluated the impact of intraoperative assessment on surgical planning. Materials and Methods: This observational study included 55 patients with mucosal COM who underwent middle ear surgery with preoperative CT assessment of the aditus. After limited antrostomy, aditus patency was assessed intraoperatively using saline and suction tests, which served as the reference standard. CT and intraoperative findings were cross-tabulated, diagnostic accuracy for CT-detected obstruction was calculated, and changes in surgical planning were recorded. Associations were tested using the chi-square test, with significance set at p < 0.05. Analysis was performed using SPSS version 22.0. Results: Intraoperative testing showed a patent aditus in 31 patients (56.4%), while CT indicated patency in 19 (34.5%). CT and intraoperative findings were concordant in 23 cases (41.8%) and discordant in 32 (58.2%), with a Cohen kappa of −0.12. CT detected obstruction with 58.3% sensitivity, 29.0% specificity, 38.9% positive predictive value, 47.4% negative predictive value, and 41.8% accuracy. Intraoperative findings changed the surgical plan in 26 patients (47.3%). Intraoperative patency was significantly associated with antral mucosal appearance (p < 0.001). Conclusions: Preoperative CT alone may not reliably assess aditus ad antrum patency. Intraoperative saline and suction testing provides a simple, practical method to confirm patency and guide mastoid surgery. Full article

Background: Inappropriate antibiotic use contributes significantly to antibiotic resistance (ABR), particularly in low- and middle-income countries. Understanding community-level knowledge, attitudes, and practices is essential for designing effective interventions. This study assessed Knowledge, Attitudes and Practices (KAP) related to antibiotic use, with consideration of awareness of antibiotic resistance, in Montserrado County, Liberia. Methods: A community-based cross-sectional survey was conducted among 1160 adults in Montserrado County, Liberia, using a structured questionnaire to assess knowledge, attitudes, and practices (KAP) related to antibiotic use and antibiotic resistance. Composite KAP scores were calculated from Likert-scale items and subsequently categorized into ordered levels (poor, moderate, and good) based on percentile thresholds. Ordinal logistic regression was used to examine associations between sociodemographic characteristics and KAP outcomes. Results are presented as crude and adjusted odds ratios (COR, AOR) with 95% confidence intervals (CI), and statistical significance was set at p < 0.05. Results: Participants demonstrated moderate knowledge, with correct identification of antibiotic use for bacterial infections (skin infections: 78.8%; ear infections: 76.8%), but widespread misconceptions were observed, including use for colds and flu (73.6%) and diarrhea (80.7%). Attitudes were mixed, with many recognizing inappropriate use, yet expectation-driven demand remained common (62.7% dissatisfied when antibiotics were not prescribed; 80.9% willing to suggest antibiotics to clinicians). Practices were inconsistent, with both appropriate and inappropriate behaviors reported. While 46.2% of participants always completed antibiotic courses, inappropriate practices were frequent, including antibiotic use for common symptoms (38.6%), preventive use (37.2%), and self-medication without prescription (20.1% always). In multivariable analysis, older age was associated with higher knowledge (AOR = 3.82, 95% CI: 1.26–11.1), while lower education predicted poorer knowledge and practices (e.g., AOR = 0.25, 95% CI: 0.07–1.00). Urban residence was associated with poorer practices (AOR = 0.42, 95% CI: 0.29–0.61). Conclusions: While overall knowledge of antibiotic use in Montserrado County is moderate, critical misconceptions remain, and appropriate practices are inconsistent. Weak relationships between knowledge, attitudes, and practices highlight the limitations of knowledge-based interventions alone. Efforts to improve antibiotic use should address structural drivers, including access to antibiotics, healthcare-seeking behavior, and regulatory enforcement, through targeted and context-specific strategies. Full article

Background and Objective: Non-alcoholic fatty liver disease (NAFLD) induces systemic low-grade inflammation and lipotoxicity. While its microvascular effects on the inner ear are recognized, its impact on the middle ear remains unexplored. This study aimed to investigate subclinical biomechanical alterations in the middle ear of normal-hearing NAFLD patients using Wideband Tympanometry (WBT). Materials and Methods: This prospective observational study included 28 patients with ultrasonographically confirmed NAFLD and 30 healthy, sex-matched controls. All included participants had normal pure-tone hearing thresholds and Type A tympanograms. WBT was performed to measure Resonance Frequency (RF) and frequency-specific absorbance (226–8000 Hz). A subgroup analysis compared early-stage (Grade 1) and advanced-stage (Grades 2–3) hepatosteatosis. Results: The mean RF was significantly lower in the NAFLD group compared to the controls for both the right (781.6 ± 218.7 vs. 1010.6 ± 529.0 Hz; p = 0.035) and left ears (740.3 ± 212.7 vs. 1221.6 ± 754.2 Hz; p = 0.002). Furthermore, wideband absorbance was significantly elevated at lower frequencies (250 Hz and 500 Hz) in the study group (p < 0.001 for both ears). Middle ear resting pressures were similar between the groups. Subgroup analysis revealed no significant differences in WBT parameters between Grade 1 and advanced stages (p > 0.05). Conclusions: Normal-hearing NAFLD patients exhibit a mass-dominated biomechanical shift in the middle ear, characterized by a decreased RF and increased low-frequency absorbance. These subclinical alterations, observable even in early-stage hepatosteatosis, likely reflect mucosal micro-edema driven by systemic inflammation. WBT serves as a sensitive, non-invasive tool for detecting early metabolic-related otologic changes. Full article

Acute otitis media is an inflammatory disease affecting all compartments of the middle ear, characterized by localized pain, fever, hearing impairment, and, occasionally, purulent exudate. It represents a significant clinical concern in both pediatric and adult populations, with approximately 709 million cases reported annually worldwide, 51% of which occur in children. However, currently available topical otic formulations are limited by their inability to achieve predictable therapeutic concentrations at the site of inflammation, resulting in reduced efficacy. In addition, the selection of appropriate active pharmaceutical ingredients (APIs) for drug products remains challenging; as a result, existing therapies do not comprehensively address all stages of pathogenesis. This study aimed to analyze existing locally acting formulations for middle ear drug delivery, evaluate their advantages and limitations, and assess modern approaches to the development of novel drug delivery systems and API combinations. A critical review of 69 publications (2010–2026) was conducted, supplemented by a strengths and limitations analysis of dosage forms and an evaluation of APIs based on clinical data. The findings highlight a lack of targeted drug delivery systems, limited efficacy of existing API combinations against bacterial biofilms, and their risk of ototoxicity. Emerging innovative drug delivery approaches, including microemulsions, vesicular systems, stimuli-responsive systems, and hydrogels, have demonstrated promising results in preclinical studies; however, their efficacy and safety remain to be confirmed in clinical settings before their full therapeutic potential in otitis media treatment can be realized. Full article

Background and Objectives: Eustachian tube (ET) dysfunction links adenoidal disease to persistent middle ear dysfunction in children, yet the independent contribution of ET orifice obstruction grade to audiological outcomes and health-related quality of life remains unquantified after adjustment for anatomical and inflammatory confounders. Because conventional anatomical grading (e.g., the Cassano classification) does not directly characterize the degree of ET orifice compromise, it may underestimate the functional threat to middle ear ventilation; this study is the first to quantify the independent predictive value of endoscopic ET obstruction grade. This study aimed to evaluate ET obstruction grade as an independent determinant of hearing thresholds, middle ear pressure, and quality-of-life impairment in children with chronic adenoiditis and otitis media with effusion. Materials and Methods: A retrospective cohort of 236 children (aged 3–12 years) was analyzed. ET orifice obstruction was graded endoscopically as none, partial, or complete. Primary outcomes included pure tone average (PTA), middle ear pressure (MEP), and OSA-18 total score. Multivariate linear and logistic regression models were fitted, adjusting for age, sex, Cassano grade, neutrophil-to-lymphocyte ratio (NLR), allergic status, and acute otitis media frequency. The modifying role of mucosal appearance (edematous versus fibrotic/remodeling) on quality-of-life outcomes was also assessed. Results: ET obstruction was absent in 42 (17.8%), partial in 114 (48.3%), and complete in 80 (33.9%) children. PTA increased progressively across groups (22.2 ± 5.5 to 36.2 ± 6.7 dB; p < 0.001), as did OSA-18 scores (44.9 ± 7.9 to 80.4 ± 10.3; p < 0.001). In adjusted analysis, each obstruction increment independently predicted a 5.57 dB PTA increase (95% CI 4.37–6.77; p < 0.001), a 14.89-point OSA-18 increase (95% CI 12.87–16.92; p < 0.001), and 5.12-fold higher odds of PTA > 30 dB (95% CI 2.84–9.24; p < 0.001). Persistent middle ear dysfunction at six months occurred in 7.1%, 26.3%, and 61.3% across obstruction grades. Among children with complete obstruction, fibrotic mucosa was associated with higher OSA-18 scores than edematous mucosa (82.3 vs. 76.8; p = 0.02). Conclusions: ET obstruction grade independently determines audiological and quality-of-life outcomes in pediatric chronic adenoiditis. Mucosal remodeling further amplifies quality-of-life burden in complete obstruction. These findings support routine ET endoscopic grading in pediatric otorhinolaryngology risk stratification. Full article

Background and Clinical Significance: To report an unusual case of a bilateral low-frequency air–bone gap consistent with an apparent conductive audiometric pattern following spinal anesthesia and discuss a possible underlying mechanism; Case Presentation: A 56-year-old man underwent elective inguinal hernia repair under spinal anesthesia. On the second postoperative day, he developed a severe postural headache followed by bilateral hearing loss. Otoscopic examination was normal. Tuning fork tests and pure-tone audiometry demonstrated a bilateral low-frequency air–bone gap consistent with an apparent conductive audiometric pattern. Laboratory findings were unremarkable. The patient was managed conservatively with bed rest, hydration and systemic corticosteroids, resulting in gradual clinical improvement; Conclusions: Hearing loss after spinal anesthesia is typically sensorineural and attributed to cerebrospinal fluid pressure alterations. This case highlights a rare apparent conductive audiometric pattern in the absence of clinically evident middle-ear pathology. A possible mechanism may involve altered inner-ear pressure dynamics leading to transient mechanical restriction of stapes mobility. Awareness of this atypical presentation may facilitate prompt recognition and appropriate management. Full article

Objective fitting measures offer a means to circumvent the subjectivity of cochlear implant programming, with the stapedius reflex representing one robust predictor of the maximum comfortable loudness level. With the present study, it was investigated whether long-term electromyographic measurements of the stapedius muscle using implanted electrodes are feasible. In nine sheep, myoelectrical activities were recorded intraoperatively and synchronized with middle ear admittance as a reference signal. For acoustic stimulation pure tones with different frequencies were used. The electrodes were placed at the stapedius muscle surface after exposing it via the retrofacial approach. EMG-based detection of the stapedius reflex was achievable over six months when electrode integrity and placement were preserved. The treated muscles were subsequently excised, cut and examined histologically. No signs of atrophy were found in the muscles examined. However, the histological section series showed a clear division of the muscle from proximal to distal, the ratio between tendon and muscle fibers being most pronounced in favor of the muscle fibers in the proximal section. The integration of an electromyography-based measurement method for the objective determination of the stapedius reflex threshold and thus, for the long-term adjustment of cochlear implants, appears possible and could potentially enable autonomous fitting of implants. Full article

Background: Otitis media with effusion (OME) is a common pediatric middle-ear disorder with multifactorial pathogenesis. Allergic rhinitis and allergic sensitization have been proposed as contributing factors, but previous evidence remains heterogeneous. This systematic review and meta-analysis aimed to clarify the association between allergic rhinitis, allergic sensitization, and pediatric OME, while separately considering Eustachian tube dysfunction (ETD) and middle-ear dysfunction. Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus, and the Cochrane Library. Observational studies evaluating allergic rhinitis, rhinitis, atopy, IgE sensitization, or allergy-related symptoms in relation to OME, ETD, abnormal tympanometry, or middle-ear dysfunction were considered eligible. Random-effects meta-analyses were performed separately for allergic rhinitis/rhinitis–OME and atopy/IgE sensitization–OME. ETD and middle-ear dysfunction outcomes were synthesized narratively because of methodological heterogeneity. Results: After removal of duplicates, 956 records were screened, 46 reports were assessed for eligibility, and 21 studies were included in the qualitative or narrative synthesis. Nine studies contributed to at least one pooled quantitative synthesis, while one additional birth-cohort study contributed adjusted estimates to the narrative sensitivity interpretation. Allergic rhinitis/rhinitis was significantly associated with OME in the primary meta-analysis (OR = 3.73, 95% CI 1.79–7.74, p < 0.001; I² = 69.7%). The association remained significant in an expanded sensitivity analysis including one additional community-based study (OR = 3.46, 95% CI 1.92–6.23, p < 0.001; I² = 63.7%). Atopy/IgE sensitization was also associated with OME (OR = 5.45, 95% CI 1.33–22.35, p = 0.018; I² = 86.0%), although this analysis included only two studies. Most pooled estimates were derived from crude data and should therefore be interpreted as associations rather than causal effects. Conclusions: Allergic rhinitis/rhinitis and allergic sensitization are associated with increased odds of pediatric OME. However, the available evidence is mainly observational and heterogeneous. Allergic disease should be considered a potential contributing factor in selected pediatric OME phenotypes, rather than a universal or isolated cause. A phenotype-based approach involving both otolaryngology and allergy/immunology may be clinically useful. Full article

Introduction: Otorrhagia is an uncommon finding in forensic practice and is classically associated with skull base fractures, temporal bone trauma, or barotraumatic events. However, the literature suggests that ear bleeding may also rarely occur in deaths due to neck compression, including strangulation and hanging. Case Presentation: We report the case of a man died by hanging. External examination revealed an oblique ligature mark on the neck, conjunctival petechiae, and bilateral otorrhagia. At autopsy, no fractures of the skull vault or skull base were identified. Otoscopic examination showed bilateral tympanic membrane laceration. Internal examination of the neck disclosed small hemorrhagic infiltrates in the perithyroid muscles and prevertebral soft tissues, as well as bilateral carotid intimal tears consistent with Amussat’s sign. Moreover, a unilateral lesion involving the petrous portion of the temporal bone was observed. The distinctive feature of this case is the association of bilateral otorrhagia, bilateral tympanic membrane laceration, and unilateral petrous bone erosion in the absence of skull base fracture. Histology showed visceral congestion, pulmonary overdistension with rupture of interalveolar septa, cerebral edema, myocardial fiber fragmentation and trabecular remodeling and areas of necrosis of the bone fragment sampled from the right petrous temporal bone. Death was attributed to mechanical asphyxia due to hanging. Conclusions: This case suggests that bilateral otorrhagia in hanging may result from the combined effects of impaired cervico-cephalic venous drainage and pressure changes transmitted to the middle ear during forceful respiratory efforts. The pre-existing unilateral petrous bone lesion may have acted as a local predisposing factor, although its etiology and actual contribution cannot be established with certainty. Otoscopic examination should therefore be regarded as a potentially useful adjunct in selected cases, particularly for documenting auricular findings and supporting differential diagnosis. Full article

Background/Objectives: This study evaluated the intra-session repeatability, reliability, and clinical consistency of resonance frequency derived from pressure-less acoustic immittance (PLAI), and compared the results with those obtained using conventional multifrequency tympanometry under identical clinical conditions. Methods: In this pilot methodological comparison study, resonance frequency (RF) measurements were obtained in 15 subjects (30 ears) using multifrequency tympanometry (MFT) and pressure-less acoustic immittance (PLAI). Three consecutive measurements were performed for each ear using both methods. Agreement between methods was evaluated using Bland–Altman analysis. Within-method repeatability was assessed using range, coefficient of variation, repeatability coefficient, and intraclass correlation coefficients. Results: PLAI demonstrated lower intra-session variability than MFT. The mean within-series SD was 96.6 Hz for MFT and 10.5 Hz for PLAI. The coefficient of variation was 9.3% for MFT and 3.2% for PLAI, while intraclass correlation coefficients were 0.60 and 0.83, respectively. The repeatability coefficient was ±367 Hz for MFT and ±47 Hz for PLAI. Bland–Altman analysis revealed a systematic difference between the two methods, with a mean bias of 580.7 Hz and 95% limits of agreement between 247.5 Hz and 913.9 Hz, indicating that the two methods are not interchangeable. Conclusions: PLAI demonstrated higher repeatability than MFT. Its lower variability may support a more consistent clinical interpretation; PLAI-derived RF may therefore represent a stable method-specific parameter for middle ear assessment. However, RF values should be interpreted within method-specific frameworks. Full article