Search Results (467)

Background and Objectives: Chronic adenoiditis is a major contributor to persistent middle ear dysfunction (PMED) in children; however, clinical evolution varies considerably despite similar anatomical obstruction. This study aimed to identify inflammatory endotypes of chronic adenoiditis using unsupervised clustering and to evaluate their association with PMED through mechanistic and predictive modeling. Materials and Methods: A retrospective cohort of 236 children (3–12 years) with chronic adenoiditis and otitis media with effusion was analyzed. Clinical, endoscopic, audiological, and hematologic inflammatory parameters (eosinophils, NLR, ELR, CRP, IgE) were included. K-means clustering identified inflammatory endotypes. Associations with PMED at six months were evaluated using multivariate logistic regression and mediation analysis. Predictive performance was compared using logistic regression, random forest, and gradient boosting models, with SHAP-based interpretability and decision curve analysis. Results: Three distinct endotypes were identified: eosinophilic (28%), neutrophilic (41%), and fibrotic–obstructive (31%). PMED occurred in 44% of the fibrotic endotype compared with 22% in the eosinophilic group (p < 0.001). In multivariate analysis, the fibrotic endotype independently predicted PMED (OR = 3.48, 95% CI 1.92–6.31), alongside PTA > 30 dB (OR = 2.91) and NLR > 3.5 (OR = 2.36). Mediation analysis showed that hearing impairment accounted for 34% of the effect of anatomical obstruction on persistence. Gradient boosting achieved superior discrimination (AUC = 0.90) and demonstrated the highest net clinical benefit. Conclusions: Chronic adenoiditis comprises biologically distinct inflammatory endotypes with differential risk of persistent middle ear dysfunction. Integrating inflammatory profiling with machine learning enhances mechanistic understanding and risk stratification, supporting precision-based management in pediatric otorhinolaryngology. Full article

Background: The adenoid surface serves as a potential bacterial reservoir for upper respiratory tract pathologies, including Adenoid Hypertrophy (AH) and Otitis Media with Effusion (OME). While dysbiosis is implicated in the pathogenesis of these conditions, it remains unclear whether the microbiome of children with otitis media differs significantly from those with simple hypertrophy when compared against a healthy baseline. This study aimed to characterize the adenoid microbiome in children with adenoid hypertrophy with and without middle ear effusion, contrasting them with a healthy control group. Methods: We conducted a cross-sectional case–control study involving 58 pediatric participants divided into three groups: adenoid hypertrophy, adenoid hypertrophy and otitis media with effusion and healthy controls. Nasopharyngeal swabs were collected, and bacterial community composition was analyzed using 16S rRNA gene V4 sequencing. Alpha and beta diversity metrics, taxonomic composition, and differential abundance were evaluated. Results: Alpha diversity was significantly reduced in both disease groups compared to healthy controls (p < 0.001), indicating a collapse of microbial richness and evenness. Beta diversity analysis revealed a distinct separation between healthy and diseased cohorts; however, the microbial profiles of the AH and AH with OME groups were nearly identical. Taxonomic analysis demonstrated that disease was characterized by the depletion of health-associated commensals, specifically Veillonella, Actinomyces, and Gemella, and a concomitant expansion of Fusobacterium, Haemophilus, and Streptococcus. Conclusions: Adenoid hypertrophy is associated with a profound dysbiotic shift characterized by the loss of protective commensal flora and the dominance of pathobionts. The lack of significant microbial differentiation between the AH and AH with OME groups suggests that the adenoid surface acts as a centralized reservoir of dysbiosis, the composition of which is conserved regardless of the presence of middle ear effusion. These findings highlight the importance of restoring the commensal microbiome in the management of chronic adenoid disease. Full article

The article presents a clinical case involving a patient with presumptive coexistence of two hereditary disorders, confirmed by molecular genetic analyses. Clinical evaluation of the proband, a 9-year-old girl, revealed features characteristic of Kabuki syndrome, including a typical “Kabuki makeup” facial phenotype, short stature, intracranial hypertension, and diffuse muscular hypotonia. Additional clinical findings included chronic right-sided otitis media, conjunctivitis, recurrent pneumonia, bilateral conductive hearing loss, astigmatism, and primary adenitis. Clinical assessment and molecular genetic testing were performed. High-throughput sequencing identified a previously reported pathogenic heterozygous variant in the KMT2D gene, NM_003482.4:c.15142C>T p.Arg5048Cys, and two known heterozygous variants in the CFTR gene: NM_000492.4:c.1521_1523delCTT p.Phe508del and c.3454G>C p.Asp1152His, classified as pathogenic and of variable clinical significance, respectively. Segregation analysis demonstrated that the KMT2D variant most likely arose in the proband de novo, whereas the CFTR variants were inherited from each of the parents. Notably, the proband’s clinically unaffected elder sister carried the same CFTR genotype. Based on the clinical presentation and molecular genetic findings, the diagnosis of Kabuki syndrome type 1 was conclusively established in the patient. Functional assessment of CFTR demonstrated its preserved function, which did not support a diagnosis of CF or CFTR-related disorders. Full article

The canine ear microbiota plays an important role in ear health, and dysbiosis is associated with otitis externa (OE) and antimicrobial resistance (AMR). This study aims to investigate the ear microbiota of dogs with healthy ears and OE using bacterial culture-based methods and shotgun metagenomic sequencing, and to screen for AMR and virulence-associated genetic signatures. Ear swab specimens from 100 healthy and 100 OE-affected dogs were analyzed. The isolates obtained via bacterial culture were identified by MALDI-TOF MS and 16S rRNA sequencing. Metagenomic analysis was performed via Illumina shotgun sequencing. The most commonly defined species in healthy dogs in culture were Staphylococcus pseudintermedius (24.5%) and Staphylococcus epidermidis (5.7%); in dogs with OE, the most commonly defined species were S. pseudintermedius (30.5%), and Clostridium perfringens (4.5%). In healthy samples, metagenomic analysis revealed higher relative abundances of Bacteroides fragilis (15.8%) and Ezakiella coagulans (8.2%), while S. pseudintermedius (38.7%) dominated in OE. AMR profiling demonstrated diverse resistance determinants, including efflux pump systems and methicillin resistance-associated genes. In conclusion, the present study shows that S. pseudintermedius is a predominant member of canine ear microbiota, with higher presence in OE highlighting microbial shifts, and demonstrates that combining culture and metagenomic analyses provides a concise view of microbial communities and clinical relevance. Full article

Background/Objectives: Skull base osteomyelitis and necrotising otitis externa require prolonged antibiotic therapy, yet determining optimal treatment cessation timing remains challenging. Conventional imaging modalities demonstrate persistent abnormalities beyond infection resolution, confounding treatment decisions. This systematic review evaluated the diagnostic test accuracy of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) for treatment response monitoring in skull base osteomyelitis and necrotising otitis externa. Methods: We conducted a systematic review following PRISMA-DTA guidelines, searching MEDLINE, Embase, CENTRAL, CINAHL, Scopus, and Web of Science from inception to November 2025. Studies evaluating ¹⁸F-FDG PET diagnostic accuracy for treatment response assessment in confirmed skull base osteomyelitis or necrotising otitis externa were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using QUADAS-2. Bivariate random-effects meta-analysis was performed using MetaBayesDTA to obtain pooled sensitivity and specificity. Results: Eight studies comprising 154 lesions contributed to the primary analysis. Pooled sensitivity was 95.2% (95% credible interval 85.6–99.0%) and pooled specificity was 89.1% (95% credible interval 70.7–96.7%). The positive likelihood ratio was 8.7 (95% credible interval 3.2–28.4) and negative likelihood ratio was 0.05 (95% credible interval 0.01–0.17), with a diagnostic odds ratio of 172.0. Seven studies evaluating detection rate at initial presentation yielded a pooled rate of 96.1% (95% confidence interval 91.3–98.3%). SUVmax was the most frequently used metabolic parameter. Conclusions: ¹⁸F-FDG PET, specifically using SUVmax, demonstrates high sensitivity and good specificity for treatment response monitoring, with excellent capacity to rule out persistent infection. However, evidence quality is limited by retrospective designs and substantial heterogeneity. Prospective studies with standardised thresholds are needed to validate clinical utility. Full article

Background: Vietnam is one of few remaining countries without a pediatric pneumococcal National Immunization Program (NIP). However, four pneumococcal conjugate vaccines (PCVs) are available in Vietnam: 10-, 13-, 15-, and 20-valent PCVs (PCV10, PCV13, PCV15 and PCV20). Given the availability of multiple PCVs, selecting an optimal vaccination strategy is challenging. This paper aims to estimate the vaccination impact of these PCVs, with and without the implementation of a pediatric NIP, to inform decision-makers and healthcare providers. Methods: A Markov model was adapted to evaluate the impact of all vaccines administered under a 3 + 1 schedule (50% vaccine uptake with direct protection assumed only) and a hypothetical scenario including PCVs 2 + 1 in Vietnam’s pediatric NIP (90% uptake with both direct and indirect protection) from a payer’s perspective. For each scenario, we performed stepwise comparisons of each vaccine with the next higher-valent option: PCV13 versus PCV10, PCV15 versus PCV13, and PCV20 versus PCV15. Results: Under the 3 + 1 schedule, PCV13 and PCV20 were cost-effective versus PCV10 and PCV15, respectively. PCV15, however, was not cost-effective versus PCV13, though offering greater health benefit but at a higher total cost. Under the 2 + 1 schedule, PCV13 remained cost-effective over PCV10, while PCV15 was not cost-effective relative to PCV13. PCV20 was dominant over PCV15. Sensitivity analyses demonstrated results consistent with both reference cases. Conclusions: Vaccinating infants in Vietnam through the private market or an NIP with PCV13 or PCV20 was estimated to be more cost-effective or cost saving than strategies based on PCV10 or PCV15, respectively. These findings provide valuable evidence to inform policy decisions. Full article

Although increasingly studied feline otitis externa (OE) prevalence is not yet well defined. The aim of this study was to assess the prevalence of OE in a population of privately owned cats in Northern Italy. Cats were clinically, otoscopically and cytologically evaluated. Diagnosis of OE was based on clinical findings along with abnormal ear cytology. The influence of the main demographic variables was examined. The prevalence of OE was 17% with a positive correlation to being European, and having short hair, a dermatological history, pruritus and multiple clinical signs. Ear cytology was abnormal in 19% of cats. Mites were found in 6% of the cats, about half of which were exclusively indoor cats and completely asymptomatic. Pathological numbers of bacteria and/or yeasts were found on cytology in 15% of cats and, of these, 29% had only Malassezia spp., 65% only cocci, and 6% a mixed population of these microorganisms. The prevalence of OE in owned cats in Northern Italy is relatively high. The identification of parasitic OE in asymptomatic and exclusively indoor cats, and a correlation between OE and dermatological history highlights the importance of systematic ear evaluation as part of routine feline health assessments. Full article

Background: Cholesteatoma is a destructive middle ear lesion that compromises hearing and quality of life, for which endoscopic ear surgery (EES) has emerged as a minimally invasive alternative to microscopic approaches. While recurrence and audiological outcomes are frequently reported, patient-centered evaluations using validated patient-reported outcome measures (PROMs) remain limited. Objective: This study aimed to assess postoperative quality of life in patients undergoing exclusive endoscopic cholesteatoma surgery, using validated patient-reported outcome measures. Methods: We conducted a prospective observational cohort study in a tertiary referral center, enrolling 41 patients who underwent exclusive endoscopic cholesteatoma surgery over 20 months. Pre- and postoperative QoL was assessed using the Chronic Otitis Media Questionnaire-12 (COMQ-12) and the Glasgow Benefit Inventory (GBI). Results: COMQ-12 scores improved significantly from baseline (54.0 ± 4.2) to 12 months (10.2 ± 3.3; mean difference −43.8, 95% CI: −46.1 to −41.5; p < 0.001). GBI scores were consistently high, increasing from 82.6 ± 4.8 at 6 months to 84.1 ± 4.9 at 12 months (p < 0.001). Audiometric evaluation demonstrated a significant postoperative improvement, with the mean air–bone gap (ABG) decreasing from 52.1 ± 5.3 dB preoperatively to 26.4 ± 4.7 dB postoperatively (p < 0.001), indicating substantial closure of the conductive gap. Conclusions: Exclusive endoscopic cholesteatoma surgery yields robust QoL improvement, favourable hearing outcome, and recurrence rates similar to classic techniques at short-term evaluation. Full article

Congenital external auditory canal atresia (EACA) is a rare developmental anomaly in dogs with limited information to guide management. This report describes the clinical presentation, diagnostic work-up, surgical technique, and long-term outcome in two young dogs with unilateral congenital EACA. An 8-month-old Caucasian Shepherd and a 9-month-old Maltese presented with left-sided otalgia and absence of the external canal opening. Computed tomography identified segmental atresia of the vertical canal with intraluminal soft-tissue attenuating material and mild otitis externa and media in both dogs. Cytology and culture of canal contents were unremarkable, supporting a congenital, non-infectious origin. Both dogs underwent a canal-preserving vertical canal-to-external acoustic meatus anastomosis using a pull-through approach. Minor postoperative complications (partial wound dehiscence, mild canal stenosis) were successfully managed. At the 5-year and 1.5-year follow-up, respectively, both dogs remained free of clinical signs, with preserved hearing, supporting this procedure as a functional, cosmetically acceptable option in carefully selected dogs. Full article

Pseudomonas aeruginosa is a clinically important opportunistic pathogen in dogs and cats, frequently associated with chronic infections and increasing antimicrobial resistance. In 2024, 111 P. aeruginosa isolates from 77 dogs and 34 cats were analyzed. Isolates originated from the external ear canal of animals with chronic otitis externa (66/111, 59.5%) and the nasal cavity of animals with chronic rhinitis (29/111, 26.1%), wounds (7/111, 6.3%), the conjunctival sac (5/111, 4.5%), and the skin (4/111, 3.6%). MICs for ciprofloxacin, meropenem, ceftazidime, aztreonam, piperacillin, piperacillin/tazobactam, and colistin were determined using a commercial microdilution panel and interpreted with CLSI M100 breakpoints for P. aeruginosa. Susceptibility was highest to piperacillin and piperacillin/tazobactam (both 90.1% susceptible and 7.2% resistant). Resistance was more frequent to ciprofloxacin (26.1%), meropenem (17.1%), and ceftazidime (16.2%). Colistin resistance (MIC ≥ 4 µg/mL) was detected in 6.3% of isolates. MDR (Magiorakos definition; non-susceptibility to ≥1 agent in ≥3 antimicrobial categories) was identified in 17/111 (15.3%) isolates. Meropenem non-susceptibility was strongly associated with ceftazidime non-susceptibility (25/111, 22.5%; OR 11.21; 95% CI 4.29–29.30; phi 0.51; p = 2.4 × 10⁻⁷). These findings provide baseline phenotypic surveillance data for P. aeruginosa from companion animals in Poland and highlight clinically relevant co-non-susceptibility patterns involving meropenem and ceftazidime. Full article

Background/Objectives: The variable accuracy of middle ear disease diagnosis based on oto-endoscopy underscores the need for improved decision support. Although convolutional Neural Networks (CNNs) are currently a mainstay of computer-aided diagnosis (CAD), their constraints in global feature integration persist. We therefore systematically benchmarked state-of-the-art CNNs and Transformers to establish a performance baseline. Beyond this benchmark, our primary contribution is the development of a probability-guided Top-K clinical decision framework that balances high accuracy with complete case coverage for practical deployment. Methods: Using a multicenter dataset of 6361 images (five categories), we implemented a two-stage validation strategy (fixed-split followed by 5-fold cross-validation). A comprehensive comparison was performed among leading CNNs and Transformer variants assessed by accuracy and Macro-F1 score. Results: The Swin Transformer model demonstrated superior performance, achieving an accuracy of 95.53% and a Macro-F1 score of 93.37%. It exhibited exceptional stability (95.61% ± 0.38% in cross-validation) and inherent robustness to class imbalance. A probability-guided Top-2 decision framework was developed, achieving 93.25% accuracy with 100% case coverage. Conclusions: This rigorous benchmark established Swin Transformer as the most effective architecture. Consequently, this study delivers not only a performance benchmark but also a clinically actionable decision-support framework, thereby facilitating the deployment of AI-assisted diagnosis for chronic middle ear conditions in specialist otology. Full article

Background: The majority of cleft palate patients have been reported to suffer from otitis media with effusion (OME). The improvement of velopharyngeal function (VPF) after palatoplasty might be evidence for the improvement of the function of the Eustachian tube. The improvement of the function of Eustachian tube by palatoplasty has been reported to be effective for the treatment of OME simultaneously with the insertion of a ventilation tube into the tympanic membrane. There are only a few reports that clearly show the association between improvement of VPF and improvement of OME after palatoplasty. In this study, we discussed whether the improvement of VPF after palatoplasty in cleft palate patients with OME improved OME. Methods: Twenty-six patients with cleft palate were included in the study. We retrospectively extracted the information of cleft type, gender, surgical technique, and presence of OME risk factors from electronic medical records. We also investigated the recurrence of OME and the improvement level of VPF at 36 months postoperatively. OME was assessed based on the otolaryngologist’s findings in electronic medical records, with a good prognosis group with no symptom of OME, or a recurrence group with prolonged or recurrent OME. Results: At 36 months after palatoplasty, 19 of 23 patients (82.6%) were in the OME good prognosis group and four (17.4%) were in the OME recurrence group. The rate of patients with recurrent OME did not differ significantly by the degree of improvement of VPF. This study indicated that clear association between other risk factors for OME and OME recurrence could not be shown. Conclusion: We observed that most patients with cleft palate who underwent palatoplasty showed a good prognosis for OME at 36 months after surgery. However, further studies are needed to investigate the impact of different surgical techniques on the improvement of OME and the degree to which VPF improves, as well as the effect of each OME risk factor. Full article

Background/Objectives: Otitis media (OM), including acute otitis media (AOM) and chronic otitis media (COM), is a common middle ear disease that can lead to significant morbidity if not accurately diagnosed. Otoscopic interpretation remains subjective and operator-dependent, underscoring the need for objective and reproducible diagnostic support. Recent advances in artificial intelligence (AI) offer promising solutions for automated otoscopic image analysis. Methods: We developed an AI-based diagnostic framework consisting of three sequential steps: (1) semi-supervised learning for automatic recognition and semantic segmentation of tympanic membrane structures, (2) region-based feature extraction, and (3) disease classification. A total of 607 clinical otoscopic images were retrospectively collected, including normal ears (n = 220), AOM (n = 157), and COM with tympanic membrane perforation (n = 230). Among these, 485 images were used for training and 122 for independent testing. Semantic segmentation of five anatomically relevant regions was performed using multiple convolutional neural network architectures, including U-Net, PSPNet, HRNet, and DeepLabV3+. Following segmentation, color and texture features were extracted from each region and used to train a neural network-based classifier to differentiate disease states. Results: Among the evaluated segmentation models, U-Net demonstrated superior performance, achieving an overall pixel accuracy of 96.76% and a mean Dice similarity coefficient of 71.68%. The segmented regions enabled reliable extraction of discriminative chromatic and texture features. In the final classification stage, the proposed framework achieved diagnostic accuracies of 100% for normal ears, 100% for AOM, and 91.3% for COM on the independent test set, with an overall accuracy of 96.72%. Conclusions: This study demonstrates that a semi-supervised, segmentation-driven AI pipeline integrating feature extraction and classification can achieve high diagnostic accuracy for otitis media. The proposed framework offers a clinically interpretable and fully automated approach that may enhance diagnostic consistency, support clinical decision-making, and facilitate scalable otoscopic assessment in diverse healthcare screening settings for disease prevention and health education. Full article

Background/Objectives: Canine otitis externa (OE) is frequently complicated by Pseudomonas aeruginosa (P. aeruginosa) infections, which are often associated with treatment failure due to intrinsic and acquired antimicrobial resistance. This study aimed to assess the prevalence and antimicrobial susceptibility of P. aeruginosa isolates from dogs with OE in Timiș County, Romania, with a focus on aminoglycosides and fluoroquinolones, to provide region-specific, clinically relevant data and address potential public health implications. Methods: Exudate samples were collected from 435 dogs diagnosed with OE across multiple veterinary clinics between 2022 and 2025. P. aeruginosa isolates were identified using standard culture methods, and antimicrobial susceptibility was determined using the VITEK^® 2 Compact system according to CLSI VET01, Fifth Edition (2018) guidelines. Tested antibiotics included amikacin, gentamicin, enrofloxacin, marbofloxacin, and pradofloxacin. Resistance profiles were analyzed at both the individual antibiotic and class levels. Results:P. aeruginosa was isolated in 14.0% (61/435) of dogs. All isolates were susceptible to amikacin and gentamicin, whereas resistance to enrofloxacin and marbofloxacin was 27.9%, and pradofloxacin resistance reached 63.9%. A total of 24.6% of isolates were susceptible to all tested antibiotics. The most frequent multidrug-resistant combination among fluoroquinolones was ENR (R) + MAR (R) + PRA (R), observed in 23.0% of isolates. Conclusions: This study provides recent, region-specific data on P. aeruginosa prevalence and antimicrobial susceptibility in canine OE, offering clinically relevant insights into aminoglycoside and fluoroquinolone resistance. The findings highlight the potential public health significance of resistant P. aeruginosa strains at the human–animal interface and underscore the importance of antimicrobial stewardship in veterinary practice. Full article

Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disorder of motile cilia that leads to impaired mucociliary clearance and recurrent airway infections. Children with PCD often present with ear and sinus disease resembling common pediatric conditions, yet the true burden and management remain incompletely defined. To address this gap, a systematic search for pediatric cohort studies published between 2020 and 2025 reporting otologic and sinonasal features of PCD was performed. Searches of PubMed, Embase, Scopus, and Web of Science identified 12 eligible studies, encompassing 524 children with confirmed PCD. Data extracted focused on demographics, otologic and sinonasal manifestations, vestibular findings, radiographic imaging, and interventions. Across studies, 60.3% had a history of otitis media and 39.1% had hearing loss, predominantly conductive. Tympanostomy tubes were utilized in more than half of patients, with many requiring multiple sets over time due to recurrent effusions or tube occlusion. Sinonasal disease was nearly universal, with 78.5% demonstrating chronic rhinosinusitis and most reporting nasal congestion and rhinorrhea; nasal polyps were uncommonly noted. Vestibular symptoms were also infrequently assessed but present in some patient cohorts. In conclusion, otologic and sinonasal disease are highly co-prevalent in pediatric PCD, highlighting the need for early recognition, regular surveillance, and standardized outcome reporting to guide long-term management of this complex chronic disease. Full article