Otologic Research Articles

Endoscopic annular chondroperichondrial tympanoplasty, technical description.

Tympanoplasty is a surgical procedure performed to cure middle ear infections and restore normal middle ear function. It is one of the most common procedures in otological surgery. Since Wullstein described tympanoplasty, the microscope has been a widely used surgical tool in otological surgery. Transcanal endoscopic ear surgery (TEES) has come to the forefront as an alternative option due to the various limitations of microscopic surgery and the development of otological surgical techniques. When reviewing the types and tecniques of grafts used in tympanoplasty in the current literature, it is clear that the ideal graft material and tecnique to meet all needs has not yet been found. The objective of this study is to describe a novel graft technique, a modification of the cartilage-perichondrium graft obtained from tragal cartilage, which is believed to represent an optimal solution for the desired graft technique at the highest level. The study included 40 patients who underwent endoscopic annular chondroperichondrial tympanoplasty at Hatay Mustafa Kemal University Hospital between 2015 and 2022. All patients underwent clinical otological examination and pure tone audiometry before and after surgery. Hearing results were expressed as pure tone mean air-bone gap (ABG) at 4 frequencies (500,1000,2000,4000Hz). For all operations, the primary surgeon was the second author. Patients with inadequate follow-up, revision surgery, inflammatory middle ear mucosa, perforation etiology other than chronic otitis media were not included in the study. No complications were observed in the patients included in the study. Accordingly, the graft was intact at the end of the 6th month in 38 of the 40 patients operated on. The graft success rate was 95%. The mean preoperative PTA-ABG was 22.1. The mean post-operative PTA-ABG was 5.7. Mean closed PTA-ABG was 16.4. In parallel with the development of otological surgical technologies, endoscopy is becoming increasingly important in tympanoplasty. We believe that our technique, endoscopic annular chondroperichondrial tympanoplasty, will be an important step in the search for the ideal grafting technique.

Utilizing deep learning for automatic segmentation of the cochleae in temporal bone computed tomography.

Segmentation of the cochlea in temporal bone computed tomography (CT) is the basis for image-guided otologic surgery. Manual segmentation is time-consuming and laborious. To assess the utility of deep learning analysis in automatic segmentation of the cochleae in temporal bone CT to differentiate abnormal images from normal images. Three models (3D U-Net, UNETR, and SegResNet) were trained to segment the cochlea on two CT datasets (two CT types: GE 64 and GE 256). One dataset included 77 normal samples, and the other included 154 samples (77 normal and 77 abnormal). A total of 20 samples that contained normal and abnormal cochleae in three CT types (GE 64, GE 256, and SE-DS) were tested on the three models. The Dice similarity coefficient (DSC) and Hausdorff distance (HD) were used to assess the models. The segmentation performances of the three models improved after adding abnormal cochlear images for training. SegResNet achieved the best performance. The average DSC on the test set was 0.94, and the HD was 0.16 mm; the performance was higher than those obtained by the 3D U-Net and UNETR models. The DSCs obtained using the GE 256 CT, SE-DS CT, and GE 64 CT models were 0.95, 0.94, and 0.93, respectively, and the HDs were 0.15, 0.18, and 0.12 mm, respectively. The SegResNet model is feasible and accurate for automated cochlear segmentation of temporal bone CT images.

Association between the ABCC11 gene polymorphism-determined earwax properties and external auditory canal microbiota in healthy adults.

The ABCC11 gene polymorphism, which determines earwax characteristics, regulates the composition of the ear canal microbiota and its metabolic pathways. We determined the presence of genome-microbiome interactions in the resident microbiota of the ear canal. Future studies should focus on ABCC11 gene polymorphisms to elucidate the pathogenesis of ear diseases and develop therapeutic methods.

Comparing Otolaryngology Subspecialties' Changes in Medicare Reimbursement From 2013 to 2024.

Identify differences in Medicare reimbursement changes for general otolaryngology, pediatric otolaryngology, head and neck oncology, laryngology, rhinology, otology, facial plastic and reconstructive surgery, and sleep surgery subspecialties from 2013 to 2024. Subspecialty-based procedures' facility prices and relative value units (RVUs) were sourced from the Centers for Medicare & Medicaid Services' Physician Fee Schedule. Prices were adjusted for inflation, and the average percent change in facility price and RVUs for each subspecialty was calculated. Each subspecialty's average inflation-adjusted, facility price change was compared to general otolaryngology using t-tests, and differences between subspecialties were assessed using Dunn's test. From 2013 to 2024, general otolaryngology's average percent change was -29.9% and significantly differed from facial plastic and reconstructive surgery (-26.4% [-5.5 to -0.7%]; p = 0.011) and sleep surgery (-23.7% [-19.2 to -2.2%]; p = 0.016). Rhinology (-32.5% [-1.3 to 6.1%]), otology (-30.2% [-6.5 to 7.6%]), laryngology (-29.3 [-4.2 to 2.1%]), head and neck (-27.4% [-5.7 to 0.2%]), and pediatric otolaryngology (-25.8% [-14.6 to 3.8%]) also decreased drastically but were not significantly different from general otolaryngology. For the multiple comparisons test, rhinology was statistically different from sleep surgery and facial plastic and reconstructive surgery. General otolaryngology and rhinology were more negatively affected due to changes in work and practice expense RVUs. Universal decreases were due to inflation and legislative reductions to the conversion factor. Medicare's budget constraints, potential effects on access to otolaryngology services, and continuing inflation warrant lobbying efforts to address these changes to maintain financial viability. NA Laryngoscope, 2025.

Circadian rhythm disruptions exacerbate inner ear damage in a murine endolymphatic hydrops model.

Meniere's disease (MD) is an inner ear disease characterized by endolymphatic hydrops (EH). Maintaining a regular daily routine is crucial for MD patients. However, the relationship between circadian rhythms and MD remains unclear. Therefore, we investigated the effect of circadian rhythm on endolymphatic hydrops and its underlying mechanisms. Mice with endolymphatic hydrops were subjected to chronic jet lag (CJL) conditions to simulate the MD patients under circadian rhythm disruptions. We assessed whether this disruption would exacerbate inner ear damage with endolymphatic hydrops. RNA-seq of the inner ear and bioinformatic analysis were performed. Then, the expression of PER2, AQP2, AQP4, AQP5, and BDNF were assessed, and the morphological changes were evaluated in the inner ear. Our findings showed circadian rhythm disruption affected the cochlear internal clock genes in the inner ear, particularly in mice with EH. EH mice under CJL conditions exhibited exacerbated hearing impairment and an increased severity of EH. GO enrichment analysis revealed that the regulation of fluid homeostasis and neurotransmitter release at synapses were significantly enriched. Disruption of circadian rhythms disturbed the expression pattern of PER2, reduced BDNF levels, and affected the expression of aquaporins in the cochlea. Moreover, the disruption of circadian rhythm compromised inner hair cell synapses and auditory nerve fibers. This study indicated that disruption of circadian rhythms may exacerbate inner ear damage in endolymphatic hydrops mice by affecting the aquaporins and compromising synapses and auditory nerves in the inner ear. BDNF and PER2 may play a central role in these pathophysiological processes.

The influence of aging of the hearing system on the variability of the Carhart effect in middle ear diseases.

<b>Introduction:</b> In the course of middle ear diseases, a disturbed influence of the system transmitting sound through the middle ear on the function of the inner ear is observed. The audiometric consequence of the disease process taking place in the middle ear is the shift in bone conduction (BC) thresholds, which is called pseudoperceptive hearing loss (the so-called Carhart effect). The natural process of aging of the hearing system (age-related hearing loss) means that the manifestation of the Carhart effect varies in different age groups.<b>Aim:</b> The aim of the study is to assess the influence of the sound transmitting system in the middle ear and the aging of the hearing system on the variability of the Carhart effect in middle ear diseases.<b>Methods:</b> The study included 532 patients with audiometrically confirmed Carhart effect, diagnosed and treated for middle ear diseases in 2010-2020. Three groups of patients were distinguished: otosclerosis, otitis media with effusion treated surgically with myringotomy and subsequent drainage of secretions from the middle ear, chronic otitis media. The behavior of the Carhart effect was assessed by pure tone audiometry performed before and after the therapeutic process.<b>Results:</b> The restoration of physiological amplification of the sound transmitted through the ossicular chain led to a statistically significant change in the Carhart effect and a strong positive correlation between the change in the Carhart effect and the change in average BC thresholds. Canal wall down tympanoplasty coexisting with significant damage to the ossicular chain weakened the influence of middle ear mechanics on the inner ear, being a factor that adversely affected the change in the Carhart effect and the change in average BC threshold values.<b>Conclusions:</b> 1. Restoring the physiological amplification of sound transmitted through the ossicular chain leads to a statistically significant change in the Carhart effect and a change in the average BC threshold values; 2. The role of the impact of aging of the hearing system on the behavior of pseudoperceptive hearing loss is best visible in the case of a properly preserved system transmitting sound through the middle ear; 3. As the damage to the ossicular chain progressed, the type of reconstruction of the ossicular chain played a major role in the audiometrically observed change in the Carhart effect; 4. Canal wall down tympanoplasty coexisting with significant damage to the ossicular chain weakened the influence of middle ear mechanics on the inner ear, being a factor that adversely affected the change in the Carhart effect and the change in average BC threshold values.

Deep learning multi-classification of middle ear diseases using synthetic tympanic images

Background Recent advances in artificial intelligence have facilitated the automatic diagnosis of middle ear diseases using endoscopic tympanic membrane imaging. Aim We aimed to develop an automated diagnostic system for middle ear diseases by applying deep learning techniques to tympanic membrane images obtained during routine clinical practice. Material and methods To augment the training dataset, we explored the use of generative adversarial networks (GANs) to produce high-quality synthetic tympanic images that were subsequently added to the training data. Between 2016 and 2021, we collected 472 endoscopic images representing four tympanic membrane conditions: normal, acute otitis media, otitis media with effusion, and chronic suppurative otitis media. These images were utilized for machine learning based on the InceptionV3 model, which was pretrained on ImageNet. Additionally, 200 synthetic images generated using StyleGAN3 and considered appropriate for each disease category were incorporated for retraining. Results The inclusion of synthetic images alongside real endoscopic images did not significantly improve the diagnostic accuracy compared to training solely with real images. However, when trained solely on synthetic images, the model achieved a diagnostic accuracy of approximately 70%. Conclusions and significance Synthetic images generated by GANs have potential utility in the development of machine-learning models for medical diagnosis.

Quantifying capacity of otolaryngology-head and neck surgery in Zimbabwe.

To evaluate the otolaryngology surgical capacity in Harare, Zimbabwe by analyzing procedural volumes across four hospitals, one private and three public, from 2019 to 2022. A retrospective review of hand-written surgical case logs was conducted at Harare Eye, Ear, Nose, and Throat Institute (HEENT), Parirenyatwa Group of Hospitals (PGH), Sally Mugabe Children's Hospital (SMCH), and Sally Mugabe Adult's Hospital (SMAH). Patient age and surgical intervention for all otolaryngology surgeries performed in the operating room from 2019 to 2022 were recorded. Procedures were categorized into six groups: head and neck malignancy, laryngeal surgery, oropharyngeal surgery, otologic surgery, rhinology/sinus surgery, and other. Data were analyzed using descriptive statistics to identify trends in surgical volume and types of procedures across hospitals. A total of 2626 procedures were recorded: 1470 at HEENT, 377 at PGH, 625 at SMCH, and 154 at SMAH. Of these, 39.5% were performed on pediatric patients and 60.5% on adult patients. The most common procedures were adenotonsillectomy/adenoidectomy/tonsillectomy (38.9%), diagnostic endoscopies (10.4%), and endoscopic sinus surgery (8.3%). HEENT performed the highest volume and widest range of procedures. HEENT had higher surgical volumes across all groups of procedure, except for laryngeal surgery. This study found disparities in otolaryngology surgical capacity between a private hospital, HEENT, and three public tertiary hospitals-SMCH, SMAH, and PGH, the largest hospital in the country-in Harare, Zimbabwe. Additionally, it highlights areas for targeted interventions in capacity building. This study establishes a foundation for understanding otolaryngologic surgical capacity in the country, supporting international collaboration, guiding future research, and serving as a model for similar assessments in other LMICs. Level VI.

Novel Use of Drug-eluting Stent in Otologic Surgery to Prevent Restenosis

Objectives: The primary objective of this case series is to assess the effectiveness of the off-label use of the PROPEL drug-eluting stent, traditionally FDA-approved for sinus surgery, in preventing restenosis following canalplasty in patients with chronic otologic conditions or congenital anomalies. The stent provides both mechanical support to maintain canal patency and localized steroid delivery to reduce inflammation and scarring. Methods: Four patients with various otologic conditions underwent canalplasty, followed by the placement of drug-eluting stents into the external auditory canal. The stents were inserted to address postoperative stenosis. Clinical outcomes, including ear canal patency, hearing improvement, and the rate of restenosis, were evaluated through regular follow-ups. Results: All patients showed improved ear canal patency, with minimal restenosis observed during follow-up. Hearing improvement was reported in 3 out of 4 patients. The pediatric case exhibited mild medial canal stenosis despite stent placement, but overall improvement was noted. No adverse effects were associated with the stent usage. Conclusions: The off-label use of a drug-eluting stent in canalplasty appears to reduce restenosis rates and maintain canal patency in adults effectively. Further research is warranted to standardize protocols and expand its indications for otologic surgery, particularly in pediatric cases where outcomes may vary.

Prevalence of Ear, Nose, and Throat Problems in Saudi Arabia: A Cross-Sectional Study.

Background Ear, nose, and throat (ENT) disorders are common and significantly impact the quality of life. This study aimed to assess the prevalence of ENT problems among the Saudi population and to explore its association with sociodemographic factors, knowledge, and healthcare utilization. Methodology A cross-sectional study was conducted among 405 participants aged 18-80 years across Saudi Arabia. Data were collected using a self-administered, anonymous electronic questionnaire distributed through social platforms. Data was cleaned on Excel (Microsoft® Corp., Redmond, WA, USA) and analyzed using IBMSPSSStatistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, NY, USA). Results The study revealed that 38.5% of participants were diagnosed with a chronic ENT condition, with sinusitis being the most common (n = 90, or 22.2%). Chronic nasal congestion (n = 187, or 46.2%), tinnitus (n = 182, or 44.9%), and hoarseness (n = 176, or 43.5%) were the most frequently reported symptoms. Significant differences in total ENT problem scores were observed based on gender, with females having higher median scores than males (p = 0.038). Knowledge of ENT problems was rated as average by 213 (52.6%) participants, with 376 (92.8%) supporting the need for public awareness campaigns. Healthcare utilization showed that 164 (40.5%) sought medical care over the past year, while 178 (44.0%) visited an otolaryngologist for ENT symptoms. Conclusion The study highlights a high prevalence of ENT problems in Saudi Arabia, particularly among the female population. There is a need for targeted public health interventions and educational campaigns to improve the awareness of the population, and to reduce the burden of ENT disorders. Future research should focus on longitudinal studies to explore causal relationships between risk factors and ENT conditions.

Temporal Bone Gunshot Wounds: A Multi-institutional Retrospective Study.

To investigate management practices and outcomes in a retrospective cohort of patients who have sustained temporal bone gunshot wounds (TBGSW). Retrospective chart review. Five participating hospitals. Twenty-two patients met inclusion criteria: experienced a TBGSW, survived ≥30 days following the injury, and were evaluated and managed by a neurotologist between 2019 and 2023. No specific interventions were performed for the purposes of this study. Characteristics, evaluation, management, and outcomes of TBGSW survivors. Patients were found to have a mean age of 33 ± 18 years and were predominantly male (18/22, 81.8%). Majority of patients (17/22, 77.3%) had mastoid injury. Most patients (14/22, 63.6%) had some evidence for vascular injury, most frequently the internal carotid artery (9/22, 40.9%). Almost three-quarters (17/22, 77.3%) of patients had clinical exam findings of facial nerve injury, which was the most common indication for surgery. Otologic surgery was performed in 72.7% (16/22), with delayed adverse events most commonly including cholesteatoma and external auditory canal stenosis. Though evidence for hearing impairment was clinically present in at least 15 of 22 patients (68.2%), hearing rehabilitation was pursued in only two patients. With increasing numbers of TBGSW survivors, there is a growing need for practicing neurotologists to be familiar with the wide spectrum of injury patterns and possible complications to inform clinical management in these patients. Early neurotologic assessment and follow-up beyond the acute period is crucial to minimize morbidity in this high-risk cohort.

Investigating the Process of Autoimmune Inner Ear Disease: Unveiling the Intricacies of Pathogenesis and Therapeutic Strategies.

Autoimmune inner ear disease (AIED) is a rare condition characterized by immune-mediated damage to the inner ear, leading to progressive sensorineural hearing loss (SNHL) and vestibular symptoms such as vertigo and tinnitus. This study investigates the pathogenesis and therapeutic strategies for AIED through the analysis of three cases with different underlying autoimmune disorders: rheumatoid arthritis, relapsing polychondritis, and IgG4-related disease. The etiology of AIED involves complex immunopathological mechanisms, including molecular mimicry and the "bystander effect," with specific autoantibodies, such as those against heat shock protein 70 (HSP70), playing a potential role in cochlear damage. Diagnosis remains challenging due to nonspecific symptoms and the lack of distinct biomarkers, emphasizing the need for comprehensive clinical evaluation and exclusion of other hearing loss causes. Treatment primarily involves immunosuppressive therapies, with glucocorticoids as the first line, effective in 70% of cases. However, resistance or partial response necessitates the use of additional agents like methotrexate and biologics such as anti-TNF and IL-6 receptor antagonists. Early intervention is crucial for favorable outcomes, as demonstrated in the studied cases, where timely corticosteroid and immunosuppressive treatments led to significant hearing improvement. The study underscores the importance of personalized treatment strategies based on individual immunologic profiles and comorbidities. Our findings highlight the heterogeneity of AIED and the potential for biologic therapies in refractory cases.

Application of data mining for diagnosis of ENT diseases using the Naïve Bayes method with genetic algorithm feature selection

Ear, nose, and throat (ENT) disease is a disorder that occurs in the eustachian tube in one of the organs, be it the ear, nose, or throat. Early signs of ENT disease include sore throat, painful swallowing, swollen and red tonsils, runny nose, nosebleeds, blocked nose, discharge from the ears, and others. To determine the diagnosis, it is necessary to carry out a physical examination of the ears, nose, and throat as recommended by an expert, namely an ENT doctor. The research carried out was implementing data mining for the diagnosis of ENT diseases using the Naïve Bayes (NB) method. This method was chosen because it can increase the accuracy, efficiency, and accessibility of health services and is also easy to understand and apply to classify ENT disease symptom data. The NB method was used to build an ENT diagnosis classification model and the model performance was evaluated using accuracy, precision, and recall metrics. To increase the accuracy of the NB algorithm predictions, feature selection using a genetic algorithm can be used. Genetic algorithms can help select the most relevant and significant features, improving the accuracy of NB models by eliminating irrelevant or noisy features. By applying this method, predictions for ENT diseases can be produced with an accuracy of 95.67%.

WAR IN THE MIDDLE EAR: MICROBIOLOGY OF CHRONIC SUPPURATIVE OTITIS MEDIA WITH SPECIAL REFERENCE TO ANAEROBES AND ITS ANTIMICROBIAL SUSCEPTIBILITY PATTERN: OPTIMIZING ANTIMICROBIAL THERAPY IN A TERTIARY CARE HOSPITAL OF RURAL INDIA

Objective: To isolate etiological organisms of Chronic Suppurative Otitis Media (CSOM), study the antimicrobial susceptibility pattern, study the risk factors and associated co-morbid conditions with CSOM, and detect biofilm production in isolated bacteria. Methods: An ear discharge specimen was obtained from the diseased ear of the patient, using three separate sterilized swabs. One of the swabs was used for Gram staining and Aerobic culture. Antibiotic susceptibility testing was done by the Kirby-Bauer standard disc diffusion method all the g-negative isolates were screened for Extended-Spectrum Beta-Lactamase (ESBL) production and Amp C ß-lactamase production. Methicillin-Resistant Staphylococcus Aureus (MRSA) screening was done using a Cefoxitin disc. Biofilm production was done using the Tube method and Microtiter plate method. Anaerobic culture was inoculated into Robertson’s Cooked Meat (RCM) broth. Potassium hydroxide (KOH) mount was done using 10% KOH for the presence of budding yeast cells, fungal hyphae, and spores. Tubes showing positive cultures were examined by LactoPhenol Cotton Blue (LPCB) mount. Final Candida speciation and Antifungal susceptibility testing was done using VITEK-2. Results: A total of 500 patients were included in the study, with 62.8% being males. The most common organism isolated was Pseudomonas aeruginosa. Fungi accounted for 30 isolates (5%) and anaerobes were 5 isolates (1%). Gram-negative bacteria were found to be most sensitive to Piperacillin-tazobactam (96%) while the highest resistance was noted to Amoxicillin-clavulanate (65%). 100% of Staphylococcus aureus isolates were sensitive to Vancomycin, Linezolid, and Teichoplanin.13% of S. aureus were found to be Cefoxitin resistant (MRSA). The highest resistance in S. aureus isolates was noted to Ciprofloxacin (65%).13% of isolates of Gram-negative bacteria had ESBL production while Amp C β-Lactamase production was noted in 9% of isolates. Out of 186 isolates tested for biofilm production, 149 isolates (80%) showed biofilm production. A total of 30 fungal isolates were obtained in culture. Aspergillus spp. Accounted for 66.6% of fungal isolates while Candida spp. accounted for 33.3% of fungal isolates. The sensitivity of Candida isolates was tested to Fluconazole, Itraconazole, Voriconazole, and Flucytosine and they were found to be 100% sensitive to all the antifungals tested. Conclusion: CSOM often has polymicrobial pathology and creates a war in the middle ear environment, augmented by mixed aerobic and anaerobic organisms and synergism between aerobic and anaerobic organisms. A high rate of Clindamycin resistance was seen in anaerobe which is noteworthy because this is a frequently utilized antimicrobial for treating anaerobic infections.

BA inhibits LPS-stimulated inflammatory response and apoptosis in human middle ear epithelial cells by regulating the Nf-Kb/Iκbα axis.

Otitis media (OM) is a prevalent childhood ear disease characterized by inflammation of the middle ear cavity, which can lead to ear pain, fever, and hearing loss. The pathogenesis of OM is multifaceted, encompassing a variety of factors including bacterial or viral infections, host immune responses, and the function of middle ear epithelial cells. Boswellic acid (BA), a natural triterpene compound extracted from frankincense resin, has been proven to possess significant anti-inflammatory and immunomodulatory effects. This study aims to investigate the effects of BA on lipopolysaccharide (LPS)-stimulated inflammatory responses and apoptosis in human middle ear epithelial cells (HMEECs) and its potential mechanisms. Our findings demonstrated that BA enhances the proliferation of LPS-stimulated HMEECs and concurrently inhibits their apoptosis. In addition, BA blocked LPS-stimulated HMEEC inflammation. Mechanistically, BA suppressed the NF-κB/IκBα axis in LPS-stimulated HMEECs. In conclusion, BA effectively inhibits LPS-stimulated inflammation and apoptosis by mediating the NF-κB/IκBα axis, highlighting its potential as a therapeutic agent for OM.

Organization of otolaryngological care in Ukraine: current challenges and directions of response

Annotation. Diseases of the ear, throat, and nose remain an urgent public health problem. The aim of the study was to conduct a theoretical study of the organization of otolaryngological care for the population of Ukraine; identify current problems and areas of response. Content analysis of legislative and regulatory acts, analysis of reference materials, industry statistical data and generalization of results was carried out. It was established that until 2023, otolaryngological care to the population was traditionally provided in primary care institutions by general practitioners-family doctors, as well as in multidisciplinary inpatient and outpatient healthcare institutions. In order to ensure the ability of the network of health care facilities to function not only in peacetime, but also in wartime conditions, from 2023 specialized medical care will be provided in designated facilities of hospital districts, in particular, otolaryngological care is available to the population in primary care facilities, cluster and supracluster health care institutions. From 2012 to 2022, the number of otolaryngologists in Ukraine decreased from 4.033 to 2.580 (0.63 per 10 000 population), and the supply of general practitioners-family doctors remained insufficient (3.44 per 10 000 population). As a result, the volumes of primary medical care are low (40.0-60.0% of the total number of outpatient visits), which increases the burden on specialized care facilities, including those where otolaryngological care is provided. One of the problematic issues in primary care institutions is the lack of medical equipment to help patients with ear, throat, and nose diseases. The professional level of medical workers in specialized offices of outpatient facilities needs to be increased, and it is necessary to ensure strict adherence by doctors to the standards of otolaryngological care. Thus the identified shortcomings require justification for improving the organization of otolaryngological care for the population of the hospital district in order to ensure its availability and quality, which are the prospects for further research.

Design Framework of Expert System Program in Otolaryngology Disease Diagnosis use Extreme Programming (XP)Method(Case Study in THB Bekasi Hospital)

The prevalence of Ear, Nose, and Throat (ENT) diseases presents diagnostic challenges, especially in resource-limited settings. At THB Bekasi Hospital, constrained specialist availability and long consultation queues highlight the need for an accessible diagnostic solution. This study aims to develop an expert system for diagnosing ENT diseases using the Extreme Programming (XP) methodology, incorporating the forward chaining technique for inference. The research includes assessment, knowledge acquisition through expert consultations, system design, and rigorous testing. The system was developed as a mobile application using Android Studio, enabling users to input symptoms and receive real-time diagnostic insights. The knowledge base integrates data from medical experts, synthesizing 11 diseases and 35 symptoms into a robust decision-making framework. The diagnostic process applies predefined rules to ensure accuracy in identifying conditions such as sinusitis, laryngitis, and otitis. Evaluation results demonstrate a 100% match accuracy during testing with 15 test cases, confirming the system’s reliability. The application offers users rapid diagnostic assistance, promoting timely treatment for ENT issues, although it does not substitute medical professionals. By leveraging ubiquitous smartphone access, this system addresses gaps in healthcare accessibility and enhances patient autonomy. This research contributes a scalable framework for deploying expert systems in other medical domains. Future improvements include integrating geolocation services for nearby specialist referrals and adopting backward chaining for more complex diagnoses, thereby broadening its applicability and utility

Effects of Controlled Hypotension on Cerebral Oxygenation in Tympanoplasty and Tympanomastoidectomy Surgery

Background: Controlled hypotension can reduce bleeding and improve visualization of the surgical field. We aimed to evaluate the effects of deliberate controlled hypotension by using esmolol and nicardipine on cerebral oxygenation, hemodynamics, bleeding, surgical satisfaction and quality of recovery. Methods: Sixty patients between the ages of 18 and 65 who were scheduled tympanomastoidectomy surgery were included. Anesthesia induction was performed with propofol, rocuronium and general anesthesia was maintained with sevoflurane and remifentanil infusion. The mean arterial blood pressure was aimed to be <30% from baseline for controlled hypotension. Nicardipine infusion (1-5 µg/kg/min) was used in group N and Esmolol infusion (30-300 µg/kg/min) was used in group E. Surgical bleeding and surgical satisfaction, extubation and recovery time, postoperative side effects, antiemetic and additional analgesic medications were recorded. Results: There was no difference between the groups in demographic data, duration of anaesthesia, extubation time, recovery time, Aldrette recovery scores, and the use of antiemetic and additional analgesics. The NIRS values in N group were observed higher than E group at the 20th and 40th minutes on the left, and at the 25th, 30th, 35th, 40th, 45th and 60th minutes on the right (p<0.05). Mean arterial blood pressure at the 70th and 80th minutes, and heart rate at the 15th, 25th, 30th, 35th and 40th minutes were observed higher in N group when compared to the E group. In the esmolol group, it was observed mild bleeding in 23 patients, moderate bleeding in 7 patients. In the nicardipine group, it was observed mild bleeding in 11 patients, moderate bleeding in 18 patients, severe bleeding in 1 patient. Surgeon’s satisfaction was higher in the Esmolol group (p<0.05). Conclusion: It was concluded that both Nicardipine and Esmolol could be applied for controlled hypotension during the otologic surgery, cerebral oxygenation was maintained with at doses administered Nicardipine and Esmolol in sevoflurane-remifentanil anesthesia. Surgical bleeding was lesser and surgeon’s satisfaction was higher with the Esmolol group than the Nicardipine group.

Morphological studies of labyrinthine tissue in patients affected with Meniere's disease and vestibular schwannoma following labyrinthectomy.

Meniere's disease (MD) is a disabling disease of the inner ear, having a substantial effect on a patient's quality of life. While various postulations regarding its aetiology exists, due to the difficulty with accessing inner ear tissue, there have been limited histological studies in patients with active MD. Tissue was collected during labyrinthectomy from 8 patients with intractable MD who had failed medical therapy (22 samples), and 9 patients undergoing translabyrinthine resection of vestibular schwannoma (19 samples). 20 additional samples were obtained from 2 cadavers without a history of inner ear disease. Samples were assessed with routine histology and a panel of immunohistochemical markers to assess any differences between the groups. No MD samples demonstrated significant inflammatory infiltrate, evidence of denervation of the sensory epithelium, fibrosis, or thickening of blood vessel wall stroma. Novel findings included confirmation that no lymphatic channels of usual type were present and that the subepithelial stromal cells are strongly positive for S100, suggesting possible perineurial origin. There were no consistent differences in expression of Claudin or Aquaporin between the MD and VS patient samples. This is one of the largest comparative histological study utilising operative samples from inner ear of living donors with active intractable MD and control patients with VS. There were no significant morphological differences between the two groups, suggesting that the aetiology lies elsewhere within the vestibular system. Examination of endolymphatic sac tissue is therefore a priority for future work.

Comparison of Temporalis Fascia Graft Uptake in Patients with Large Tympanic Membrane Perforation Undergoing Type 1 Tympanoplasty

Background: Managing a large tympanic membrane perforation without middle ear disease involves reconstruction of tympanic membrane through tympanoplasty. Graft uptake may be highly influenced by the choice of either an endoscopic or microscopic modality. Objective: This study aimed at comparing graft uptake rates and hearing results for patients with large tympanic membrane perforations who received Type 1 tympanoplasty using temporalis fascia grafts via endoscopic and microscopic modalities. Methods: Sixty patients presenting with large-sized tympanic membrane perforations were divided into two different groups, Group A consisting of patients who underwent endoscopic tympanoplasty and Group B consisting of patients who underwent microscopic tympanoplasty. Intraoperative damage to chorda tympani nerve was monitored and post-operative pain was measuered by neumeric pain scale on 1st and 7th post-operative days. The graft uptake after 42 days of operation was analyzed and the hearing improvement was noted by using audiometric tests. The research took place at Sir Salimullah Medical College, Dhaka, Bangladesh, between July 2022 to June 2023. Results: Graft uptake in Group B was 90% while in Group A it was 83.33%. The average postoperative hearing gain in Group A and in Group B was 9.29 dB and 10 dB respectively. There has been no statistical significance found between the two techniques regarding graft uptake and hearing outcome but significant pain score was seen on 1st POD. Conclusion: Both the endoscopic and microscopic tympanoplasty techniques yielded similar graft uptake rates and hearing improvements in patients with large tympanic membrane perforations, thus the choice of technique should depend on surgeon preference rather than the expected outcome. More studies are needed in larger cohorts for the validation of these results.