Search Results (93)

Background/Objective: This study explores a novel approach for diagnosing common middle ear pathologies using Pressure-Less Acoustic Immittance (PLAI™), a non-invasive alternative to conventional tympanometry. Methods: A total of 516 ear measurements were collected and stratified into three age groups: 0–3, 3–12, and 12+ years, reflecting key developmental stages. PLAI™-derived acoustic parameters, including resonant frequency, peak admittance, canal volume, and resonance peak frequency boundaries, were analyzed using Random Forest classifiers, with SMOTE addressing class imbalance and SHAP values assessing feature importance. Results: Age-specific models demonstrated superior diagnostic accuracy compared to non-stratified approaches, with macro F1-scores of 0.79, 0.84, and 0.78, respectively. Resonant frequency, ear canal volume, and peak admittance consistently emerged as the most informative features. Notably, age-based stratification significantly reduced false negative rates for conditions such as Otitis Media with Effusion and tympanic membrane retractions, enhancing clinical reliability. These results underscore the relevance of age-aware modeling in pediatric audiology and validate PLAI™ as a promising tool for early, pressure-free middle ear diagnostics. Conclusions: While further validation on larger, balanced cohorts is recommended, this study supports the integration of machine learning and acoustic immittance into more accurate, developmentally informed screening frameworks. Full article

Background/Objectives: Obstructive Eustachian tube dysfunction (OETD) is common in adults and may lead to middle-ear conditions such as atelectasis and cholesteatoma. The ETDQ-7 questionnaire is used to assess symptom severity. Balloon dilation of the Eustachian tube (BDET) is a minimally invasive treatment with variable outcomes. This review evaluates the safety and effectiveness of BDET. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Four databases (PubMed, Scopus, Cochrane, Web of Science) were searched using ETD- and BDET-related terms, with the last search on 11 April 2025. Randomized trials were selected based on predefined criteria, and data were extracted by two independent reviewers. Discrepancies were resolved by consensus. Results: This systematic review included 14 studies on BDET published between 2013 and 2025. BDET improved otoscopic findings, Valsalva maneuver (VM) performance, and tympanometry (TMM), particularly within the first 6 weeks. ETDQ-7 scores generally indicated symptom improvement, though pure tone audiometry (PTA) showed no significant changes. Most procedures were performed under general anesthesia, with some studies showing similar outcomes under local anesthesia. Combining BDET with other interventions produced mixed results. Reported complications were rare. Conclusions: BDET is a safe, low-risk procedure that effectively reduces tympanic membrane retraction and improves VM and TMM results. While it relieves ETD symptoms in many patients, evidence for long-term efficacy and impact on PTA is limited. Full article

Emotion recognition by wearable devices is essential for advancing emotion-aware human–computer interaction in real life. Earphones have the potential to naturally capture brain activity and its lateralization, which is associated with emotion. In this study, we newly introduced tympanic membrane temperature (TMT), previously used as an index of lateralized brain activation, for earphone-based emotion recognition. We developed custom earphones to measure bilateral TMT and conducted two experiments consisting of emotion induction by autobiographical recall and scenario imagination. Using features derived from the right–left TMT difference, we trained classifiers for both four-class discrete emotion and valence (positive vs. negative) classification tasks. The classifiers achieved 36.2% and 42.5% accuracy for four-class classification and 72.5% and 68.8% accuracy for binary classification, respectively, in the two experiments, confirmed by leave-one-participant-out cross-validation. Notably, consistent improvement in accuracy was specific to models utilizing right–left TMT and not observed in models utilizing the right–left wrist skin temperature. These findings suggest that lateralization in TMT provides unique information about emotional state, making it valuable for emotion recognition. With the ease of measurement by earphones, TMT has significant potential for real-world application of emotion recognition. Full article

Objectives: This study aimed to investigate the impact of platelet-rich plasma (PRP) and platelet-rich gel (PRG) on tympanic membrane closure rates, hearing improvement, and quality of life following tympanoplasty. Methods: Seventy-two patients with chronic tympanic membrane perforations were enrolled in a double-blinded, randomized controlled trial at a single tertiary referral center. All patients underwent tympanoplasty using a temporalis fascia graft and were randomly assigned to one of two groups: one group received standard tympanoplasty alone, while the other received intraoperative application of autologous PRP and PRG, in addition to the standard procedure. Results: The PRP group demonstrated a significantly higher rate of complete tympanic membrane closure compared to the control group (32/36; 88.9% vs. 24/36; 66.7%; p < 0.05). Bone conduction hearing remained unchanged in both groups, while air conduction hearing improved significantly from pre- to post-treatment in each group. However, the difference in air conduction improvement between the PRP group and the control group was not statistically significant (PRP group: Mdn = −8.25; control group: Mdn = −12.20; U = 618; z = −0.54; p = 0.30). Quality of life improved in both the PRP and control groups; however, the difference between the groups was not statistically significant (PRP group: 10.44 ± 10.46; control group: 10.47 ± 8.22; 95% CI [−4.45; 4.40]; t(66) = −0.01; p = 0.16). Conclusions: Our findings suggest that intraoperative application of autologous PRP and PRG may improve tympanoplasty outcomes, particularly in cases with lower expected success rates or when performing minimally invasive transcanal procedures under local anesthesia. However, variability in PRP preparation, application methods, and graft materials across studies limits direct comparisons. Standardized protocols and further controlled studies are necessary to clarify PRP’s clinical value in tympanoplasty. Full article

Background/Objectives: This study evaluates the anatomical and functional outcomes of type 1 tympanoplasty using an autologous two-piece perichondrium-cartilage (CP) graft in pediatric and adult patients with tympanic membrane (TM) perforations. Methods: A retrospective review of 74 patients (59 children, 15 adults) undergoing type 1 tympanoplasty with CP by a single surgeon (IF) was conducted. Preoperative and postoperative audiological outcomes, perforation size, prognostic factors, and complications were analyzed. Success was defined as an intact TM and an air–bone gap (ABG) < 20 dBHL at 12 months postoperatively. Results: TM closure was achieved in 93.2% of patients, with 93.1% attaining an ABG < 20 dBHL. The combined success rate was 86.3%, with no significant differences between children and adults. Larger perforations (>50%) had significantly lower closure rates (55.6% vs. >97%, p < 0.002). Children who underwent prior adenoidectomy had significantly higher success rates (p = 0.04). Conclusions: Tympanoplasty with a CP graft provides high success rates in both children and adults. The procedure can be performed from age five, considering patient cooperation. In children, simultaneous adenoidectomy is recommended if significant adenoid hypertrophy is present to optimize outcomes. Larger perforations were associated with reduced success, while age had no significant impact. 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

Background: Skull base tumors can extend into the temporal bone and occasionally even be visible through the tympanic membrane (TM) if they grow into the middle ear cavity. The differential diagnosis of a skull base mass is extensive and ranges from non-tumorous lesions like cholesteatoma to benign tumors like schwannoma and to malignant lesions like metastatic cancer. Optical coherence tomography (OCT) is a noninvasive imaging technique that can image tissue with high resolution in three dimensions, including through structures such as the TM and bone. OCT angiography is also able to assess tissue vascularity. We hypothesized that OCT could help shrink the differential diagnosis in clinic on the day of initial presentation. Specifically, we thought that OCT angiography could help distinguish between highly vascular skull base tumors such as glomus jugulare and other less vascular tumors and middle ear pathologies such as cholesteatoma and schwannoma. Objectives: We sought to determine whether OCT can image through the TM in clinic to distinguish a normal ear from an ear with a mass behind the tympanic membrane. Furthermore, we sought to assess whether OCT angiography can detect vascularity in these masses to help inform the diagnosis. Methods: We designed and built a custom handheld OCT system that can be used like an otoscope in clinic. It is based off a 200 kHz swept-source laser with a center wavelength of 1310 nm and a bandwidth of 39 nm. It provides a 33.4 μm axial and 38 μm lateral resolution. Cross-sectional images of the middle ear space, including OCT angiography, were captured in an academic neurotology clinic. Patients with normal ear exams, glomus tumors, cholesteatomas, and facial nerve schwannoma were imaged. Results: OCT images revealed key structures within the middle ear space, including the TM, ossicles (malleus and incudostapedial joint), chorda tympani, and cochlear promontory. OCT also identified middle ear pathology (using pixel intensity ratio in the middle ear normalized to the TM) when compared with patients with normal ear exams (mean 0.082, n = 6), in all patients with a glomus tumor (mean 0.620, n = 6, p < 0.001), cholesteatoma (mean 0.153, n = 4, p < 0.01), and facial nerve schwannoma (0.573, n = 1). OCT angiography revealed significant vascularity within glomus tumors (mean 1.881, n = 3), but minimal vascularity was found in normal ears (mean 0.615, n = 3, p < 0.05) and ears with cholesteatoma (mean 0.709, n = 3, p < 0.01), as expected. Conclusions: OCT is able to image through the TM and detect middle ear masses. OCT angiography correctly assesses the vascularity within these masses. Thus, OCT permits the clinician to have additional point-of-care data that can help make the correct diagnosis. Full article

Background: The aim of this study was to analyse the results of the mastoid obliteration technique with sticky bone (SB) and compare them with those obtained using bioactive glass S53P4 (BAG). Methods: This prospective preliminary study comprised 28 adults who underwent canal wall down (CWD) surgery using two mastoid obliterative techniques: SB (n = 21) or BAG (n = 7). The SB group was treated with the patients’ own bone dust and injectable platelet rich fibrin (IPRF) (n = 13%) or bone dust, IPRF, and additionally allogenic lyophilised demineralised bone (n = 9%). Results: Nine months after the surgery, in the SB group, retroauricular depression was observed in three (14%) patients, temporary retroauricular fistula in one (5%), and a conical and smooth external auditory canal (EAC) was achieved in 15 (71%). Mean EAC capacity was 0.6 mL higher than in the contralateral ear. In the SB group, the tympanic membrane (TM) of nineteen (91%) patients was fully healed, one (5%) had TM perforation, and one (5%) developed a retraction pocket. In the BAG group, retroauricular depression was observed in four (57%) patients, temporary retroauricular fistula was present in one (14%), and a conical and smooth EAC was achieved in five (71%). Mean EAC capacity was 0.3 mL higher than on the opposite side. In the BAG group, we stated six (86%) patients with fully healed TM and one (14%) with a retraction pocket. One cholesteatoma was found in the BAG group and two in SB, (14% vs. 10%). After 9 months, all patients in both groups achieved a dry and self-cleaning cavity. Conclusions: Mastoid obliteration in CWD surgery using SB or BAG allows for reconstruction of the conical shape of the EAC with a volume similar to that of a healthy ear. Both techniques seem to have a minimal risk of complications and result in a dry, self-cleaning cavity. Further studies concerning a larger series of cases are necessary to confirm the findings of this preliminary analysis. Full article

Background/Objectives: The endoscopic repair of the tympanic membrane is an established method for addressing perforations in the tympanic membrane. However, there are limited studies in the literature examining the success rate of this procedure in the pediatric population. Methods: This study retrospectively analyzed data from the tertiary referral center at the University Hospital of Verona, Italy. This medical record contains data from 84 type 1 transcanal endoscopic tympanoplasties performed in pediatric patients between November 2014 and February 2022. Seventy-seven pediatric patients aged 4 to 16 years who underwent type 1 transcanal endoscopic tympanoplasty (seven of whom underwent bilateral surgery at different time points) were included in the study. Our study did not include more extensive procedures than type 1 endoscopic tympanoplasty. Only patients with tympanic membrane perforation due to simple chronic otitis media, trauma or when no apparent cause was found were included. Chronic otitis with cholesteatoma and other pathologies of the external or middle ear were exclusion criteria. Patients with a follow-up of less than 12 months were excluded from this study. The technique was based on the endoscopic placement of an underlay graft of temporal fascia or tragal cartilage to repair a tympanic membrane perforation. Demographic, clinical, audiologic, and surgical data were collected from each patient. In the study, we considered the reduction of the air-bone gap (ABG) as a functional outcome and the integrity of the reconstruction as an anatomic outcome of success. Results: The primary surgery had a closure rate of 92.9% (78 of 84). All patients underwent audiological evaluation 4–6 months post-surgery, with 84 ears tested. The mean preoperative ABG was 17.13 dB HL, reduced to 9.16 dB HL postoperatively, showing a mean reduction of 7.97 dB HL. No significant complications occurred. Conclusions: Transcanal endoscopic type 1 tympanoplasty should be considered a safe procedure with a high success rate for the repair of tympanic membrane perforations, even in pediatric patients. Full article

In the current landscape of hearing rehabilitation, ear mold manufacturing typically involves the injection of silicone into the external ear canal (EEC) of each patient. This invasive procedure poses several risks, including the potential for silicone residue retention and tympanic membrane perforation, which may necessitate surgical intervention. To mitigate these risks, we present the design of a video otoscope that integrates a scanner capable of capturing high-precision, real-time images of the EEC’s geometry. The developed device allows (i) the generation of a 3D CAD model leading to the direct, quick, and low-cost production of customized hearing aids using 3D printing and (ii) the establishment of medical protocols for carrying out diagnoses and monitoring of hearing pathology evolution using methodologies based on Artificial Intelligence. Furthermore, the use of customized hearing aids that allow the application of Rhythmic Auditory Stimulation (RAS) and music therapy enhances audiology as an alternative and innovative way to treat cognitive and degenerative diseases, as well as pathological disorders. Full article

Objectives: Slag injuries in industrial settings pose risks of hearing loss and complications. The aim of this study is to provide specialists with a better understanding of the sequelae, treatment, and long-term outcomes that a patient may have following a slag injury to the tympanic membrane. Data Sources: PubMed, Embase, and Web of Science. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), multiple databases were queried for articles published from inception to 2023 describing Tympanic membrane injuries from welding. The publications were screened by two independent viewers. The Joanna Briggs Institute 2017 Critical Appraisal Checklist was used to assess the quality of studies. Results: A total of 227 articles were identified, and 9 full-text articles were included in this review, comprising a total of 18 patients. The patients’ ages ranged from 18 to 75 years. Most commonly, patients were welding overhead in a tight working space, and none of the patients were wearing protective ear equipment in addition to their welding masks. Patients experienced otalgia (n = 10; 55%), hearing loss (n = 11; 65%), vertigo (n = 6; 35%), chronic otorrhea (n = 5; 29%), and facial paralysis (n = 4; 23%). A total of 12 patients (70.6%) required surgery, most requiring debridement of metallic foreign body multiple times, some undergoing surgery up to four years post-injury. Conclusions: Tympanic membrane injuries from welding are often overlooked. They cause hearing loss and facial nerve damage. Following a period of observation, sturdy reconstruction with cartilage grafting is recommended, given the poor vasculature and inflammation after this injury. Full article

Background: Jugular foramen syndrome (JFS) is a rare condition characterized by the compression or impairment of one or more terminal cranial nerves passing through the jugular foramen. Although malignancies are the primary cause of JFS. Methods: In this report, we present the first documented case of JFS caused by acute otitis media in an adult patient. Results: A 74-year-old woman presented with ear pain, hoarseness, dysphagia, dizziness, tinnitus, and hearing loss. A physical examination revealed a reddish-bulging tympanic membrane, left-sided hearing loss, right uvula deviation, and cranial nerve palsies affecting the ninth and tenth nerves. Imaging studies confirmed temporal bone inflammation, thrombosis of the sigmoid sinus extending into the internal jugular vein, and signs of thrombophlebitis of the jugular vein. The patient underwent a cortical mastoidectomy, sigmoid sinus decompression, and ventilation tube insertion, along with antibiotic, steroid, and anticoagulant therapy. Postoperatively, the patient’s condition improved significantly. Conclusions: This case highlights the importance of considering complicated acute otitis media in the differential diagnosis of neurological abnormalities associated with JFS. A thorough evaluation of the patient’s medical history and radiological imaging can assist in identifying the cause of the symptoms and guide appropriate surgical or conservative treatment. Further research is essential to gain more comprehensive insights into the pathophysiology and therapeutic interventions of JFS affecting the ears. Full article

Objectives: The gold standard for electrocochleography (ECochG) is using dedicated recording devices for auditory evoked potentials. However, these have a very limited time window for recording. The aim of this study is to evaluate EEG amplifiers for ECochG, in particular for recording cochlear microphonics (CMs) without time restriction. Methods: Three high-resolution EEG amplifiers and different types of electrodes were analyzed and compared with a clinical system for recording auditory evoked potentials. For this, CMs were recorded after stimulation with various stimuli in a dummy and in human subjects. In the latter, recordings were made from the tympanic membrane and, during otosurgical procedures, from the promontory. Our evaluation focused on comparing signal amplifiers and electrode types, considering the signal-to-noise ratio, recording characteristics, and measurement reliability. Results: Using a dummy model, we observed significant differences among devices, electrode types, and stimulus frequencies. These findings were subsequently confirmed in human participant measurements. Nevertheless, EEG amplifiers proved to be feasible for ECochG recordings and offered a recording fidelity comparable to proprietary clinical methods. Importantly, with EEG amplifiers, we were able to record cochlear potentials in response to speech stimuli, revealing a strong correlation (r = 0.78) between recorded signals and the input stimulus. Conclusions: Our findings indicate that high resolution EEG amplifiers are suitable for recording cochlear potentials, in particular, CMs. This allows for evaluating cochlear signals in response to extended stimuli, in particular, speech stimuli. Full article

Therapy dogs have been increasingly incorporated into a variety of medical treatment programs to improve patients’ treatment outcomes and wellbeing. However, research investigating the stress level of therapy dogs in this setting is limited. This is the first randomized–controlled and prospective study that investigated the wellbeing of therapy dogs in an inpatient stroke rehabilitation program. In this study, 14 therapy dog–handler pairs were embedded in an inpatient stroke rehabilitation program to provide animal-assisted treatment (AAT). These therapy dog–handler pairs actively participated in stroke rehabilitation by walking with the patient, playing fetch with the patient, and being petted/brushed by the patient, amongst various other AAT activities. To measure canine stress responses during the rehabilitation sessions, salivary cortisol and oxytocin concentrations, heart rate and heart rate variability, tympanic membrane temperature, and a behavioral evaluation were recorded before and after interactions with the patient. The results demonstrated that therapy dogs had significantly decreased heart rate and increased heart rate variability after the AAT session. Right tympanic temperature significantly increased after the session, but there was no significant difference in terms of salivary cortisol or oxytocin levels, nor in stress-related behavioral evaluations after the AAT session. Taken together, the results suggest that incorporating AAT into an inpatient stroke rehabilitation program did not induce stress in the therapy dogs, and that the therapy dogs may have been more relaxed after the session. Full article

The tympanic membrane forms an impenetrable barrier between the ear canal and the air-filled middle ear, protecting it from fluid, pathogens, and foreign material entry. We previously screened a phage display library and discovered peptides that mediate transport across the intact membrane. The route by which transport occurs is not certain, but possibilities include paracellular transport through loosened intercellular junctions and transcellular transport through the cells that comprise the various tympanic membrane layers. We used confocal imaging to resolve the phage’s path through the membrane. Phages were observed in puncta within the cytoplasm of tympanic membrane cells, with no evidence of phages within junctions between epithelial cells. This result indicates that transport across the membrane is transcellular and within vesicles, consistent with the transcytosis process. The trans-tympanic peptide phages display a wide range of transport efficiencies for unknown reasons. This could include variation in tympanic membrane binding, entry into the membrane, crossing the membrane, or exiting into the middle ear. To address this, we titered phages recovered from within the membrane for phages with differing transport rates. We found that differences in the transport rate were inversely related to their presence within the tympanic membrane. This suggests that differences in the transport rate primarily reflect the efficiency of an exocytotic exit from the mucosal epithelium rather than entry into, or passage across, the membrane. Full article