Ear Abnormalities Research Articles

Otoplasty and Ear Reconstruction Complications.

Prominauris, often known as prominent ears, is one of the most frequent congenital deformities of the head and neck. Therefore, otoplasty has gained significant popularity and is now one of the most performed procedures in the field of facial plastic surgery.Reconstructing and correcting ear abnormalities remains a challenging procedure in facial plastic and reconstructive surgery. These deformities, whether congenital or acquired, have a substantial influence on patients' lives and inflict psychological harm. Addressing the deformity and tissue loss will improve the overall quality of life.Throughout history, various surgical techniques have been reported for treating external ear abnormalities. While most of these surgeries are considered safe, a comprehensive preoperative evaluation and understanding of the different techniques and risks can minimize potential complications.

Middle Ear Malformations

Middle ear malformations (MEMs) represent a diverse group of congenital anomalies with significant implications for auditory function. These malformations, which occur in approximately 0.5 to 3% of conductive hearing loss cases, can arise from various genetic and environmental factors. They often manifest unilaterally and may occur in isolation or as part of a syndromic condition. MEMs are closely associated with abnormalities of the external ear and less frequently with inner ear anomalies.Embryologically, the middle ear develops from the first and second pharyngeal arches, with interactions between the ectoderm and endoderm contributing to the formation of essential structures such as the tympanic membrane, ossicles and Eustachian tube. Disruptions in these developmental processes can lead to a spectrum of MEMs, ranging from minor defects to severe malformations affecting multiple middle ear components.Clinical management of MEMs requires a multidisciplinary approach, involving otolaryngologists, pediatricians, and audiologists. Early intervention with appropriate hearing aids, including conventional hearing aids and bone conduction devices, is essential to mitigate the impact of conductive hearing loss on speech and language development, particularly in children.Surgical planning involves comprehensive preoperative assessment, including high-resolution computed tomography imaging to evaluate middle ear anatomy, the facial nerve course, and vascular anomalies. Traditional surgical approaches such as stapesplasty and tympanoplasty remain mainstays for correcting specific middle ear defects, while advances in technology have expanded the role of active middle ear implants in treating special cases.In conclusion, MEMs represent a heterogeneous group of congenital anomalies with diverse etiologies and clinical implications. A thorough understanding of their embryological basis, genetic underpinnings, and surgical management strategies is crucial for optimizing outcomes in affected individuals.

Drug-induced congenital abnormalities of the outer ear

Drug-induced congenital abnormalities of the outer ear

Naa80 is required for actin N-terminal acetylation and normal hearing in zebrafish.

Actin is a critical component of the eukaryotic cytoskeleton. In animals, actins undergo unique N-terminal processing by dedicated enzymes resulting in mature acidic and acetylated forms. The final step, N-terminal acetylation, is catalyzed by NAA80 in humans. N-terminal acetylation of actin is crucial for maintaining normal cytoskeletal dynamics and cell motility in human cell lines. However, the physiological impact of actin N-terminal acetylation remains to be fully understood. We developed a zebrafish naa80 knockout model and demonstrated that Naa80 acetylates both muscle and non-muscle actins in vivo. Assays with purified Naa80 revealed a preference for acetylating actin N-termini. Zebrafish lacking actin N-terminal acetylation exhibited normal development, morphology, and behavior. In contrast, humans with pathogenic actin variants can present with hypotonia and hearing impairment. Whereas zebrafish lacking naa80 showed no obvious muscle defects or abnormalities, we observed abnormal inner ear development, small otoliths, and impaired response to sound. In conclusion, we have established that zebrafish Naa80 N-terminally acetylates actins in vitro and in vivo, and that actin N-terminal acetylation is essential for normal hearing.

The disease burden of untreated chronic otitis media in Indigenous children from remote communities does not improve over time. A longitudinal study.

In Australia, middle ear disease disproportionately affects Indigenous children, leading to poor hearing outcomes. This study aimed to determine the natural history of untreated chronic otitis media in Indigenous children in remote South Australia. Baseline and 3 year follow-up data was collected from Indigenous children aged 5-18 years living on the Anangu Pitjantjatjara Yankunytjatjara Lands. 4-frequency pure-tone audiometry was used to determine hearing levels. Middle ear pathology was determined by video-otoscopy with tympanometry and classified at baseline as group 1 (normal), group 2 (abnormal with intact tympanic membrane), or group 3 (perforated tympanic membrane). A total of 253 children were included in this study. Children in group 1 (20.6 ± 1.5 dBHL; Mean ± SD) had significantly better hearing outcomes at 3 year follow-up than children with abnormal ears (groups 2 and 3) (23.8 ± 7.0 dBHL), P < 0.001. The difference was greatest for group 1 versus 3 (27.6 ± 8.4 dBHL), P < 0.001, followed by 1 versus 2 (22.4 ± 5.8 dBHL), P = 0.009, and between 2 (22.4 ± 5.8 dBHL) and 3 (27.6 ± 8.4 dBHL), P < 0.001. Hearing in Indigenous children with untreated middle ear pathology remains poor at follow-up compared to those without pathology. Intervention is therefore critical to prevent persisting poor hearing outcomes.

12466 Dual Bone Defect In Patients With Charge Syndrome

Abstract Disclosure: N. Reyes: None. R.J. Santen: None. S.M. Jan De Beur: None. R. Balasubramanian: None. Chromodomain Helicase DNA-binding protein 7 (Chd7) is an ATP-dependent chromatin modifier that mediates nucleosome remodeling. Chd7 mutations result in CHARGE syndrome characterized by coloboma, heart defects, choanal atresia, growth/developmental delay, ear abnormalities, and hypogonadotropic hypogonadism/Kallmann syndrome (IHH/KS). Testosterone has direct and indirect effects (through estrogen), to increase bone formation and decrease bone resorption. Untreated hypogonadism is associated with decreased bone density and fractures. Reports of fractures and low bone density in CHARGE syndrome patients have been attributed to sex hormone deficiency associated with hypogonadism. However, recent data from a Chd7 mouse knockout model suggests an intrinsic Chd7-related bone defect. In wild-type mice, Chd7 promotes osteogenic differentiation of mesenchymal stem cells. Chd7 deficient mice show markedly reduced osteoblasts. Thus, we propose, a dual bone defect in CHARGE syndrome resulting from impaired osteogenesis from CHD7 and sex steroid deficiency; and increased bone resorption due to lack of sex steroids. Here we present two individuals with CHARGE syndrome with markedly low bone density and literature review supporting the dual bone defect concept. Case 1 is a 30 yo male with a pathogenic CHD7 mutation, multiple congenital anomalies of CHARGE syndrome and hypogonadotropic hypogonadism. He had multiple fractures in his teen age years and a bone density Z score of -5.2 at the lumbar spine and -3.3 at the left femoral neck. Because he did not tolerate androgen therapy, a single infusion of zoledronic acid was administered with no further fractures for eight years following infusion. Case 2 is a male evaluated for IHH/KS and ultimately diagnosed with CHARGE Syndrome based on a pathogenic CHD7 mutation. Despite 7 years of testosterone therapy with full virilization, his bone density remained low at Z-score of -1.9 at the spine and -2.6 at the total hip. Results: Both patients had low bone density, one while untreated and the other after full virilization with exogenous androgens. This raises the question whether the bone defects were related to the CHD7 mutation, to androgen deficiency or both. To answer this question, a literature search examined bone density data in untreated patients with CHARGE syndrome versus IHH/KS. We found substantially lower bone density in untreated CHARGE patients Z score -3.46±0.36 (SEM) (n=13) versus IHH/KS -2.16 ±1.0 (n=4). Furthermore, the bone density was also lower in treated CHARGE patients -2.46±0.28 (n=6) versus IHH/KS -0.94±0.26 (n=140). Conclusion: These data, taken together, provide direct human evidence to support the concept that the CHD7-related CHARGE syndrome patients have a defect in both osteogenesis as well as an effect of sex steroid deficiency on bone. Presentation: 6/3/2024

A Systematic Review and Meta-analysis Examining Outcomes of Cochlear Implantation in Children With Bilateral Cochlear Nerve Deficiency.

To assess hearing and speech outcomes in pediatric patients with bilateral cochlear nerve deficiency (CND) who underwent cochlear implantation (CI) and to identify factors associated with improved outcomes. PubMed, Embase, Web of Science, and Cochran databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that reported hearing and speech outcomes of pediatric patients with bilateral CND who underwent CI were included. Demographics, comorbidities, inner ear abnormalities, CND classification (aplasia or hypoplasia), details of diagnostic workup, and outcomes data were extracted. Outcomes were assessed using the four-level auditory performance level (APL) scale. Meta-analysis, using Cochran-Armitage tests, was performed on patients with individual data to assess factors associated with performance. A total of 314 papers were screened, and 40 papers with 378 total patients met inclusion criteria. A total of 339 patients had patient-level data and were included in the meta-analysis. Of the 339 patients, 19% (n = 63) of patients had no measurable stimulation, 28% (n = 95) had improved detection, 22% (n = 76) achieved closed-set speech perception, and 31% (n = 105) achieved open-set speech perception. Patients with cochlear nerve aplasia (p = 0.016) and syndromes (p < 0.001) had significantly worse APL scores relative to patients with cochlear nerve hypoplasia and patients without syndromes, respectively. While most patients with bilateral CND benefit from CI and almost one-third of patients achieved open-set speech perception, outcomes were heterogenous and one-fifth of patients did not experience measurable benefit from CI.

Abnormal ear development in corn: Does hybrid, environment, and planting date matter?

AbstractCorn (Zea mays L.) yields have increased historically, but production concerns still exist. For decades, abnormal corn ear development symptoms have been reported. Most of these reports have not been addressed through research, perhaps due to low occurrence and challenges in replicating them. In 2016, widespread abnormal ear development (multiple ears per node, barbell‐ears, and short‐husk ears) issues were reported in several cornfields in the Texas Panhandle, Eastern Colorado, Nebraska, and other US Midwest states. Fields with a high frequency of abnormalities resulted in lower yields. To investigate causal factors, a field trial was established to study the effect of hybrids, environments, and planting dates on abnormal ears. The project was conducted at two Nebraska sites during the 2018, 2019, and 2020 growing seasons. Six hybrids, six environments, and four planting dates were studied. Approximately 59,200 plants were individually assessed at the dent stage (R5). Abnormal ear percentages ranged from 0% to 45% per plot, with a mean of 6.66% across all conditions. Interactions among hybrids, environments, and planting dates were documented despite the overall low incidence of abnormal ears. Grain yields ranged from 5.2 to 22.5 Mg ha−1; hybrids with higher abnormal ear percentages were associated with lower yields. The main documented symptom was short‐husk ears. Abnormal ears were often placed at lower heights in the plant relative to normal ears. The results presented here demonstrate the importance of studying abnormal ears and understanding the impact of planting dates and hybrid selection as potential strategies to mitigate abnormal ears.

Classification of Microtia With Unusable Remnant Ear and Techniques in the First Stage of Two-Stage Auricular Reconstruction.

The remnant ear is a very important material in auricular reconstruction surgery; its dimension, position, and shape determine how it is used. However, the local conditions of microtia patients are complex and variable. Situations may be encountered where a series of abnormal remnant ears cannot be utilized in clinical practice. Currently, there are no literature that elaborates on this type of microtia and provides systematic treatment methods. The purpose of this article is to systematically classify them and optimize the two-stage method auricular reconstruction, to provide an effective surgical method for these patients. Based on the size, shape, and relative position of the residual ears, the unusable remnant ears were classified into three types: tiny size, abnormal shape, and relative position anomaly (over 1-cm higher than the contralateral earlobe). Fifty-three microtia patients with unusable remnant ear (54 ears) who underwent two-stage auricular reconstruction from August 2020 to August 2023 were reviewed. All patients had experienced earlobe reconstruction by using autologous rib cartilage during the first stage of surgery. Aesthetic assessments were evaluated from the naturalness of the earlobe reconstructed with autologous rib cartilage and the connection with the overall framework. The data on any complications that occurred during the follow-up period and patient satisfaction were collected. Among all patients, 31 had tiny size, 14 had abnormal shape, and 8 had excessively high positions. Patients were followed up for an average period of 9.2 months (6 to 12 months). No complex complications such as infection, skin necrosis, or cartilage exposure occurred. Fifty patients (94.3%) achieved excellent or good aesthetic outcomes. Fifty-one patients (96.2%) were satisfied with the reconstruction outcomes. An accurate assessment of the residual ear preoperatively is essential. Reconstructing and splicing the earlobe with autologous rib cartilage in cases where the residual ear cannot be utilized compensate for the defect that the soft tissue cannot provide the earlobe flap. This is an effective surgical method for the ear reconstruction in such patients.

Pharyngeal Arches, Chapter 2: Ear and Neck Abnormalities.

The pharyngeal arches are the foundation of face and neck development. Impaired development of these embryologic structures can result in craniofacial abnormalities. Surgeons who manage head and neck pathology will invariably encounter conditions associated with aberrant pharyngeal arch anatomy, and a thorough understanding of the normal development of these structures is paramount to accurate diagnosis and treatment. This manuscript is the second of a four-part series written for plastic surgeons, focusing on the abnormal development of pharyngeal arches leading to pathologic ear and neck anomalies seen in clinical practice.

Digital Otoscopy With Computer-Aided Composite Image Generation: Impact on the Correct Diagnosis, Confidence, and Time.

This study investigated the comparative performance of ear, nose, and throat (ENT) physicians in correctly detecting ear abnormalities when reviewing digital otoscopy imaging using 3 different visualization methods, including computer-assisted composite images called "SelectStitch," single video frame "Still" images, and video clips. The study also explored clinicians' diagnostic confidence levels and the time to make a diagnosis. Clinician diagnostic reader study. Online diagnostic survey of ENT physicians. Nine ENT physicians reviewed digital otoscopy examinations from 86 ears with various diagnoses (normal, perforation, retraction, middle ear effusion, tympanosclerosis). Otoscopy examinations used artificial-intelligence (AI)-based computer-aided composite image generation from a video clip (SelectStitch), manually selected best still frame from a video clip (Still), or the entire video clip. Statistical analyses included comparisons of ability to detect correct diagnosis, confidence levels, and diagnosis times. The ENT physicians' ability to detect ear abnormalities (33.2%-68.7%) varied depending on the pathologies. SelectStitch and Still images were not statistically different in detecting abnormalities (P > .50), but both were different from Video (P < .01). However, the performance improvement observed with Videos came at the cost of significantly longer time to determining the diagnosis. The level of confidence in the diagnosis was positively associated with correct diagnoses, but varied by particular pathology. This study explores the potential of computer-assisted techniques like SelectStitch in enhancing otoscopic diagnoses and time-saving, which could benefit telemedicine settings. Comparable performance between computer-generated and manually selected images suggests the potential of AI algorithms for otoscopy applications.

Barriers to auditory brainstem response testing under anesthesia

ObjectiveAuditory brainstem response (ABR) testing is the gold standard for diagnosis of hearing loss in children who cannot complete behavioral audiometry. Testing under general anesthesia is often recommended when natural sleep ABR and/or behavioral audiometry are unsuccessful. This study aims to determine which demographic and patient factors serve as barriers to receiving this diagnostic testing. MethodsA retrospective chart review from an internal database of patients who underwent ABR testing under anesthesia from 2017 to 2023 was completed. Patient demographics, clinical diagnoses, dates of initial recommendation, and dates of testing were recorded. ResultsA total of 395 patients met inclusion criteria, with a median time from initial evaluation to successful ABR under anesthesia of 5.1 months (range 0.1–209 months). This time was significantly higher in patients with public insurance compared to private insurance and in patients with the following medical complexities: cardiac disease, developmental delay, neurologic disease, eye disease, and genetic syndromes not associated with hearing loss. The interval was significantly shorter in patients with abnormal ear anatomy. ConclusionPatient factors, such as insurance type and certain medical diagnoses, may lead to delayed ABR testing under anesthesia and thus delayed diagnosis and management of hearing loss. This has implications for the timely care and treatment of children with hearing loss.

Challenges to Contraceptive Counseling With Isotretinoin Treatment and Future Directions for Dermatologists

Accutane, also known as isotretinoin, is an oral systemic retinoid utilized in the treatment of severe, treatment-resistant acne. Isotretinoin is a pregnancy category X drug, meaning that studies have documented congenital defects in pregnant patients on isotretinoin. Known abnormalities include ear abnormalities, facial dysmorphia, cleft palate, CNS abnormalities, thymus gland abnormalities, and parathyroid hormone deficiencies. With teratogenicity well-documented with isotretinoin use, the iPLEDGE system was created to educate prescribers, pharmacists, and patients about the risks of isotretinoin use. Utilizing iPLEDGE, individuals of child bearing potential (ICBP) are required to document two negative pregnancy tests before the initiation of isotretinoin therapy with two documented forms of birth control. We conducted a literature review utilizing the terms: accutane, isotretinoin, contraception, and birth control. We found that amongst multiple articles, the most popular primary contraceptive methods in iPLEDGE were abstinence (47% of users) and combined oral contraceptives (31% of users). Individuals have attributed their lack of contraceptive use to fear of birth control health impacts and belief in the equivalent effectiveness of non-accepted methods (e.g. withdrawal and natural family planning. Despite the establishment of iPLEDGE to systematically reinforce counseling requirements, the incidence of isotretinoin-exposed pregnancies continues to persist with approximately 100-200 pregnancies annually. Given these findings, it is clear that counseling is tantamount to dispelling misconceptions regarding contraception and optimizing rates of patient compliance. Despite this importance, counseling remains a large issue for dermatologists. Only half of board-certified dermatology residents surveyed in 2023 felt comfortable providing counseling on adverse effects of combined oral contraceptives (COCs), and only 38.8% felt comfortable providing counseling directions for COCs. Solutions for this include quickly accessing a referral to primary care or OB/GYN and potentially new avenues that are more easily accessible such as the progestin-only oral contraceptive pill that was recently approved for over the counter use by the United States Food and Drug Administration.

Risk factors for imaging abnormalities in patients with dizziness complaints: an algorithm for ordering brain imaging

The diagnostic detection of abnormal findings with head imaging is low for dizziness. This study aimed to investigate the risk factors associated with abnormal computed tomography (CT) or magnetic resonance imaging (MRI) findings for patients with dizziness. Medical records of patients who had CT or MRI examinations for dizziness complaints between January 1, 2019, and December 31, 2020, were retrospectively reviewed. Imaging outcomes were grouped as normal or abnormal findings. Risk factors, including demographics, dizziness pattern, symptoms, comorbidities, and medical history were assessed. A Chi-square automatic interaction detection decision tree model was used to classify abnormal imaging findings based on risk factors identified through multivariable analyses. A total of 2,342 scans were examined. Detection of abnormal findings was 4.8% (n = 96), including acute cerebral infarction (n = 33), acute cranial hemorrhage (n = 15), cancer/tumor-like lesions (n = 27), and inner ear abnormalities (n = 21). The risk factor most indicative of abnormal findings were loss of consciousness and neurologic deficit (Odds Ratio 55.57, p < 0.001). The likelihood of abnormality indicating acute brain lesions was 44.4% for patients with loss of consciousness and neurologic deficits. Loss of consciousness and neurologic deficits, hearing loss, nausea/vomiting, and comorbid malignancy distinguished abnormal findings from negative imaging findings (AUC 0.729; 95%CI 0.672-0.785; p < 0.001). Patients with unspecific dizziness complaints were less likely to have abnormal imaging findings. These findings highlighted the significance of specific risk factors in recognizing individuals with dizziness complaints who may have abnormal imaging findings indicative of serious diseases. Further studies are warranted to verify the findings.

Whole Exome Sequencing Revealing a Novel PBX1 Gene Variant in a Chinese Family Causing Recurrent Neonatal Death.

Causative mutations of PBX1 are associated with congenital abnormalities of the kidney and urinary tract (CAKUT), often accompanied by hearing loss, abnormal ear morphology, or developmental delay. The aim of the present investigation was to introduce a novel variant in the PBX1 gene identified in a Chinese family, leading to recurrent neonatal mortality. A pregnant woman (gravida 5, para 0), who had experienced recurrent neonatal deaths, sought genetic etiology diagnosis. Whole exome sequencing (WES) was conducted to identify sequence variants and copy number variants in the fetus presenting with posterior nuchal cystic hygroma and fetal hydrops. A novel NM_002585.4:c.694G>C(p.D232H) in PBX1 was identified in the fetus through trio whole exome sequencing (WES), revealing a paternal mosaic PBX1 variant in blood at 11.54% (6/52 variants reads). Subsequent parental Sanger sequencing confirmed the variant detected by WES. Ultimately, the variant was classified as likely pathogenic, leading the family to elect pregnancy termination at 17 weeks gestation. The novel variant in the PBX1 gene appears to be a significant factor contributing to recurrent neonatal deaths in the Chinese family. Such findings expand the spectrum of PBX1 gene variants and provide valuable perinatal guidance for diagnosing fetuses with PBX1 mutations.

Classic ear moulding technique for a lop ear deformity: case report

Introduction and importance: Lop ear is a congenital auricular deformity (CAD) detected at birth. It can negatively impact aesthetic appearance and the mental health of both the parents and the infant. Therefore, a treatment initiated at an early age is imperative. Case presentation: A male newborn patient on his 11th week of his life presented with his mother to the Maxillofacial Prosthodontic Unit. The extraoral examination showed a pendulous upper part of the auricle covering the antihelix with no deficiencies. The newborn’s hearing function was normal and no associated syndrome was identified. The patient was diagnosed with congenital unilateral lop ear (Tanzer grade II constricted ear). A non-surgical correction with a classic ear moulding device was attempted at the 11th week after birth to reshape the abnormal ear. Clinical discussion: Congenital auricular deformities (CADs) are traditionally managed by an otoplasty at age 6. Unfortunately, this option can cause many unpredictable complications, such as anaesthesia risks and under-correction. Therefore, the classic non-surgical correction of congenital auricular deformities is a non-surgical and earlier alternative to otoplasty. Moreover, many patient present at an older age; an auricular moulding device can still be a successful treatment option for these older patients. Conclusion: Classic ear moulding is an early non-surgical alternative to otoplasty for managing congenital ear abnormalities. It can be initiated as early as 6 weeks after birth. Including an ear examination as a routine in every child’s immediate post-birth physical examination is crucial for early diagnosis and better outcomes.

The Value of Endoscopic Exposure of Round Window in Cochlear Implant via Facial Recess

Abstract Background Cochlear implantation (CI) has been considered as the best treatment in patients with severe to profound hearing loss unaidable with hearing aids. The main value of endoscope-assisted cochlear implantation is improved visibility of the RW and reduced risk of complications, especially in patients with congenital malformations. Aim of the Work The aim of the present study was to assess the value of endoscopic assisted CI surgery via facial recess approach without elevating tympanic anulus. Methods This Prospective case series study non-randomized sample was performed on a total of 50 patients with severe to profound hearing loss unaidable with hearing aids undergoing unilateral endoscopic assisted cochlear implant surgery with round window electrode insertion at Ain Shams University hospitals from April 2020 till March 2022 and approved 94/2020MD by an ethical committee before the start of the recruitment. Results 50 CI operations with endoscopic assistance were prospectively evaluated. There were 23 male (46%) and 27 female (54%) patients. The majority of the cases were children (41 cases, 82%). Of those 50 patients, 39 (78%) were prelingually hearing impaired. Four cases (8%) had various inner ear abnormalities. The standard mastoidectomy and Posterior Tympanotomy (PT) approach were used for all cases. Med-El (FLEX28TM; FLEX24TM Med-El, Innsbruck, Australia), Advanced Bionics (AB)Mid-Scala Electrode and CochlearTM (NUCLEUS® CI422 WITH SLIM STRAIGHT, NUCLEUS® CI24RE CONTOUR ADVANCETM, Sydney, Australia) implants were used. Endoscope-assisted visualization of the RW region through the PT was performed in all cases Rigid endoscopes with 0o and 30o (1.9, 2.7 and 4 mm in width, 11 and 6 cm in length) and an HD (high-definition) camera system (Karl Storz, Tuttlingen, Germany) were used for the endoscopic evaluation. The RW region was visualized and identified by inserting the endoscope through the PT without elevating the tympanic annulus. Then we switched to the microscope and drilled the RW niche (tegmen) using both hands until a circumferential view of the RW membrane is obtained. After proper exposure, the electrode was inserted through an opening in the RW membrane mostly under microscopical vision. Endoscopic identification of the RW through the PT enabled us to perform regular surgery in all cases. The current study concludes the difference between microscopic exposure and endoscopic exposure represented by Saint Tomas classification regarding round window exposure found that endoscopic exposure of round window classification is better represented by downgrading in the classification of round window exposure as type I 29(58%), type IIa 18(36%) type IIb 3 (6%) Non were type III by endoscopic exposure compared to microscopic exposure of round window is a type I 7(14%), type II 14(28%), type IIb 22(44%) and type III 7 (14%). Conclusion As evident from the current study, Endoscopy proved a great value in exposure and identification of RW in CI surgery through posterior tympanotomy approach, especially in difficult cases. Endoscopic-assisted CI through facial recess could be easily done using 1.9mm 0-degree endoscopy even in cases e narrow PT or rotated cochlea

Visualization of Reissner's membrane in the mouse inner ear using highly sensitive magnetic resonance imaging analysis

Although research on hearing loss, including the identification of causative genes, has become increasingly active, the pathogenic mechanism of hearing loss remains unclear. One of the reasons for this is that the structure of the inner ear of mice, which is commonly used as a genetically modified animal model, is too small and complex, making it difficult to accurately capture abnormalities and dynamic changes in vivo. Especially, Reissner's membrane is a very important structure that separates the perilymph and endolymph of the inner ear. This malformation or damage induces abnormalities in hearing and balance. Until now, imaging analyses, such as magnetic resonance imaging (MRI) and computed tomography, are performed to investigate the inner ear structure in vivo; however, it has been difficult to analyze the small inner ear structure of mice owing to resolution. Therefore, there is an urgent need to develop an image analysis method that can accurately capture the structure of the inner ear of mice including Reissner's membrane, both dynamically and statically.This study aimed to investigate whether it is possible to accurately capture the structure (e.g., Reissner's membrane) and abnormalities of the inner ear of mice using an 11.7 T MRI. By combining two types of MRI methods, in vivo and ex vivo, we succeeded for the first time in capturing the fine structure of the normal mouse inner ear, such as the Reissner's membrane, and inflammatory lesions of otitis media mouse models in detail and accurately. In the future, we believe that understanding the state of Reissner's membrane during living conditions will greatly contribute to the development of research on inner ear issues, such as hearing loss.

Clinical Portrait of Cochlear Implantation in Patients With CHARGE Syndrome.

To examine the clinical characteristics and auditory performance of patients with CHARGE syndrome following cochlear implantation (CI), as well as the prognostic factors affecting auditory outcomes. Retrospective cohort. Tertiary academic center. A retrospective chart review was performed in patients with CHARGE syndrome who underwent CI from 2007 to 2022. The category of auditory performance (CAP) score was used to assess the CI outcomes, and factors that may affect the speech outcomes were also evaluated. In 14 children with CHARGE syndrome, 22 CIs were performed, 6 unilaterally and 8 bilaterally. The mean age at CI was 25.9 months (range: 10-62). All patients had ear abnormalities and developmental delays, and cochlear nerve deficiency (CND) was present in all ears. At the last follow-up (mean: 49.6 months), the mean CAP score improved significantly compared to the preoperative measure (from 0.36 ± 0.81 to 3.21 ± 1.70, P = .001), with 6 patients (42.9%) achieving a CAP score of 4 points or higher. However, between the unilateral and bilateral CI groups, the final CAP score or change in CAP score was similar. Factors including age, coloboma, and CND did not significantly affect speech outcomes (all P > .05). Even though CHARGE syndrome features challenging anomalies, CI can be conducted safely and can offer effective contribution to significant speech improvement. Patients with CHARGE syndrome should be given the opportunity to undergo CI to maximize their audiological progress.

Boron Impact on Maize Growth and Yield: A Review

Maize (Zea mays L.) is a vital crop, contributing significantly—at least 30%—to global dietary energy intake and biofuels and ethanol production. This review article delves into the dynamic interplay between boron (B) and maize growth, yield, and agricultural sustainability. Boron, a crucial micronutrient, is pivotal in essential physiological processes such as root development, leaf expansion, and cob formation. These processes are fundamental for ensuring the vigour and productivity of maize crops. Conversely, boron deficiency manifests as thinner leaves with reduced chlorophyll content, compromising plant health, and hindering yield potential. Maintaining adequate boron levels, particularly during reproductive stages, is critical for mitigating the risk of abnormal ears and maximizing the quantity and quality of maize production. Emerging research underscores the significance of foliar boron application at various growth stages of maize, which stimulates growth, facilitates cell wall development, and increases leaf area. This translates to improved light interception and photosynthetic efficiency, ultimately contributing to increased plant vigour and biomass accumulation. Furthermore, exploring innovative approaches for sustainable boron management is crucial. This includes precision fertilization techniques and biofortification strategies to ensure optimal maize production while minimizing environmental impacts. By gaining a deeper understanding of the complex relationship between boron and maize, farmers can develop customized fertilization plans that utilize strategic foliar boron application. This approach unlocks maize's full yield potential and contributes to sustainable agricultural practices, supporting global food security.