Auditory Canal Research Articles

Morphology and anatomical variability of the external auditory canal: A population-based MRI study

BackgroundThe external auditory canal (EAC) exhibits a complex morphology and strong inter-individual variations. However, these have not yet been comprehensively described in the literature. PurposeThis study aims to determine the width, height and cross-sectional area of the cartilaginous portion of the EAC and to describe the three-dimensional morphology and variability of different EACs. MethodsMagnetic resonance imaging was performed on 870 subjects (401 male, 469 female, resulting in 1740 EACs) who participated in the longitudinal, population-based cohort study ‘Study of Health in Pomerania–START-3’. The height and width were measured in the cartilaginous part of the EAC, between the first and second bend. The variability of the EAC morphology was visualized in three-dimensional models. ResultsThe mean height (vertical length) of the EAC was 8.62 mm (SD = 2.42) on the right, 8.47 mm (SD = 2.36) on the left. The width (horizontal length) was 4.08 mm (SD = 1.6) on the right, 3.93 mm (SD = 1.64) on the left. The EAC cross-section was 28.6 mm2 (SD = 15.19) on the right, 27.15 mm2 (SD = 14.33) on the left. The average cross-sectional area of the EAC in men was higher than in women. Subjects with larger body size had larger cross-sectional areas. Subjects with higher body mass index tended to have smaller cross-sections. Although the average EAC had an oval shape, a three-dimensional comparison of different EACs revealed strong individual variation in morphology. ConclusionThis study enhances the understanding of otolaryngologists and anatomists regarding the complex morphology and variability of the cartilaginous portion of the EAC.

Bilateral Internal Auditory Canal Metastasis From Lung Cancer on FDG PET/CT.

The occurrence of metastatic tumor in the internal auditory canal is very rare. Thus, we report FDG PET/CT findings of bilateral Internal auditory canal metastasis from lung cancer in a 67-year-old man. FDG PET/CT and MRI showed nodules in the bilateral internal auditory canal with an SUVmax of 5.2. This case hints us that bilateral metastasis should be considered as differential diagnosis when we encounter bilateral nodule in the internal auditory.

Prevalence of the Huschke Foramen in Colombian Population: An Important Anatomic Alteration for the Planning of TMJ Arthroscopy

Abstract Background Ignoring this anatomic structure would have implications for iatrogenic perforation with the trocar toward the FH during the initial blind drilling or due to the diffusion of the infusion liquid toward the middle ear. Purpose To analyze the prevalence of the FH in an institutional population with a high incidence of TMD to provide further guidelines in diagnosing this anomaly and the planification of TMJ arthroscopy. Materials and Methods A retrospective tomographic study was conducted at the ENT—Oral and Maxillofacial and Radiology Department of the Hospital Universitario la Samaritana in Bogotá, Colombia. Inclusion criteria were patients over 18 years of age who had complementary exams such as ear, face, paranasal sinus, and/or TMJ tomography. Exclusion criteria were history of direct trauma to the external auditory canal in the medical history, patients with craniofacial syndromes, congenital anomalies, and/or history of cranial, mandibular, or temporal fractures. Two radiologists were part of the evaluators of the CT images who conducted the measures in the axial tomographic section and established the presence of the tympanic defect. Results A sample size of 139 medical records of patients, where females represent n: 101 (72.6%) and males represent n: 38 (27.4%). The average age was 43 years ± 18 years. Among the studied population, a total of five FH were detected, corresponding to a prevalence of 3.6% (95% CI 1.5–8.1%). The average size of the defect was 3.52 mm ± 1.1 mm. All the patients had TMJ-related symptoms, but none of them reported otalgia. Conclusion The initial evaluation of each patient must be addressed to assess the integrity of the tympanic bone. In this study, the defects size was smaller than others previously reported. However, diffusion through the tympanic defect could spread the lavage substance into the middle ear during TMJ arthroscopic surgery.

Otomycosis: Epidemio-Clinical and Therapeutic Profile at the Fousseyni DAOU Hospital in Kayes, Mali

Introduction: Otomycosis is a relatively common pathology of the external ear canal, its prevalence is estimated to be 5 to 10% of all otitis externa [1,2, 3]. There are no data on otomycosis at the Kayes Hospital, hence the interest of this study. Methodology: This was a descriptive study with retrospective data collection that spanned the period from January 1, 2021 to December 31, 2023. All patients with clinically suspected otomycosis on otoscopy, otoendoscopy and/or confirmed on mycological examination and with usable medical records were included. Results: We recorded 1156 cases of otitis externa, including 384 cases of otomycosis, i.e. a frequency of 33.2%. Females were the most represented at 51.6% (n=198) with a sex ratio of 0.93. The mean age was 37 years with extremes of 7 and 77 years. The reasons for consultation were: otalgia 44.8% (n=172), pruritus 35.2% (n=135), otorrhea 20% (n=77). The main contributing factors were cleaning the ear with cotton swab, 57.8% (n=221), wearing a turban 26.3% (n=101), and using antibiotic and corticosteroid drops 9.6% (n=37). The otologic examination revealed whitish or blackish deposits, purulent otorrhea and inflammation of the external auditory canal. Mycological examination found yeasts 42.3% (n=122) and molds 57.2% (n=163). Treatment was based on topical antifungals and antibiotics in 69% (n=265) and the combination of antifungal and antihistamine in 31% (n=119). Conclusion: Otomycoses are benign, chronic infectious pathologies. Their occurrence is multifactorial. Cleaning with the cotton swab and wearing the turban were the main causes. Keywords: Otomycosis, Fousseyni DAOU Hospital in Kayes.

Ectoparasites of the European wildcat (Felis silvestris) in Germany

Understanding the impact of parasites on wildlife populations is an important aspect of conservation management. However, research on ectoparasites in wildlife can be difficult, as examinations of live animals which are not habituated to human handling are often impossible. The European wildcat (Felis silvestris) is a strictly protected wildlife species whose population has been recovering in Germany in recent decades. Several studies from different European countries have investigated the parasitological status of European wildcat populations. However, most of these studies assessed endoparasite infections, whereas ectoparasite infestations have often been neglected. To fill this knowledge gap for wildcats in Germany, 131 dead found specimens were examined for ectoparasites by macroscopic and microscopic examination of the fur and the ear canals. Infestation with ectoparasites was present in 84.0% (110/131) of the wildcats. Ticks showed the highest prevalence with 72.5% (95/131) of wildcats infested, with 49.6% (65/131) infested with Ixodes ricinus and 36.6% (48/131) with Ixodes hexagonus/canisuga. A total of 27.5% (36/131) of the wildcats were positive for at least one flea species. Of the nine different flea species identified by morphology and/or molecular analyses, Ceratophyllidae were most common (16.8% [22/131]), with Ceratophyllus sciurorum confirmed on 12.2% (16/131) and Nosopsyllus fasciatus on 1.5% (2/131) animals, followed by Pulex irritans (5.3% [7/131]), Spilopsyllus cuniculi (3.8% [5/131]), Chaetopsylla spp. (3.1% [4/131]) (2/131 Chaetopsylla trichosa and 1/131 Chaetopsylla globiceps), Ctenocephalides felis (1.5% [2/131]), Archaeopsylla erinacei (1.5% [2/131]) and Ctenophthalmus baeticus (0.8% [1/131]). Further, 23.7% (31/131) of the wildcats harboured mites, identified as Trombicula autumnalis in 12.2% (16/131) and Otodectes cynotis in 4.8% (6/124) of cases. The only louse species detected was Felicola hercynianus with a prevalence of 2.3% (3/131). Infestation intensities ranged from 1 to 86 ticks, 1–49 fleas, 1–1896 mites, and 1–92 F. hercynianus per wildcat. This study demonstrates that a variety of ectoparasites infests wildcats in Germany, but they do not seem to have a serious impact on the general health of wildcats, as judged by the hosts' mostly good or very good nutritional condition. In addition, the potential risk to domestic cats (Felis catus) and humans posed by the wildcats’ ectoparasites, appears to be low but present.

Surgical Outcomes in Patients with Endolymphatic Sac Tumors: A Single-Center Experience of 29 Patients.

To analyze the clinical features and surgical outcomes of patients with endolymphatic sac tumors (ELSTs). Single institution retrospective cohort study. The clinical data of 29 patients with 30 ELSTs who underwent surgery were retrospectively reviewed. Information on patient demographics, tumor size and grade, intraoperative blood loss volume, hearing and facial nerve outcomes, and follow-up data was collected and analyzed. The main symptoms were hearing loss in 26 ELSTs (86.7%) and tinnitus in 17 (56.7%). Twenty-four (80%) ELSTs were in advanced stages (Grade III). The median tumor volume was 6.35 cm3. The median intraoperative blood loss volume was 300 mL. Facial nerve function was well preserved in 21 patients. Among all patients with Grade III tumors, 12 patients underwent tension-free anterior facial nerve rerouting, and 11 patients (91.7%) maintained good facial nerve function postoperatively (HB I and HB II). Only one patient exhibited permanent vocal cord paralysis, and no patients experienced cerebrospinal fluid (CSF) leakage postoperatively. Gross total resection was achieved in 22 patients (73.3%), 5 patients (16.7%) experienced tumor recurrence, and 3 (10%) had residual tumors. Most ELSTs tend to be diagnosed in the advanced stage. Tension-free anterior facial nerve rerouting could maximally preserve facial nerve function. The intraoperative blood loss volume was associated with tumor size and stage. Tumor recurrence tends to occur at the posterior edge of the petrosal bone, internal auditory canal, and surface of the posterior fossa. Given the relatively high recurrence rate of ELSTs, long-term follow-up is recommended. 4 Laryngoscope, 2024.

External auditory canal metastasis leading to peripheral facial paralysis as first manifestation of de novo stage IV invasive lobular carcinoma of the breast: a rare case report

Facial nerve (FN) palsy, as a solitary symptom resulting from a metastatic tumor, is uncommon, and metastases to the external auditory canal (EAC) are even more infrequent. In this article, we report a unique case of the de novo stage IV invasive lobular breast carcinoma (LBC) presenting as an EAC metastasis and leading to FN palsy as the first symptom, highlighting the importance of considering a broad differential diagnosis.

Extra-cochlear insertion in the internal auditory canal during cochlear implantation: Is reimplantation possible?

Cochlear Implant (CI) auditory rehabilitation is indicated for patients with severe to profound sensorineural hearing loss who do not benefit from conventional hearing aids. In the vast majority of cases, cochlear implantation is performed effectively and safely, without significant complications. However, in approximately 0.5% of patients, surgical revision is necessary to correct malpositioned electrodes [1]. Inner ear anomalies and malformations are commonly associated with electrode malpositioning during CI surgery.

Vital parameter monitoring in harsh environment by the MedSENS in-ear multisensor device

Accurate assessment of vital parameters is essential for diagnosis and triage of critically ill patients, but not always feasible in out-of-hospital settings due to the lack of suitable devices. We performed an extensive validation of a novel prototype in-ear device, which was proposed for the non-invasive, combined measurement of core body temperature (Tc), oxygen saturation (SpO2), and heart rate (HR) in harsh environments. A pilot study with randomized controlled design was conducted in the terraXcube environmental chamber. Participants were subsequently exposed to three 15 min test sessions at the controlled ambient temperatures of 20 °C, 5 °C, and − 10 °C, in randomized order. Vital parameters measured by the prototype were compared with Tc measurements from commercial esophageal (reference) and tympanic (comparator) probes and SpO2 and HR measurements from a finger pulse-oximeter (reference). Performance was assessed in terms of bias and Lin’s correlation coefficient (CCC) with respect to the reference measurements and analyzed with linear mixed models. Twenty-three participants (12 men, mean (SD) age, 35 (9) years) completed the experimental protocol. The mean Tc bias of the prototype ranged between − 0.39 and − 0.80 °C at ambient temperatures of 20 °C and 5 °C, and it reached − 1.38 °C only after 15 min of exposure to − 10 °C. CCC values ranged between 0.07 and 0.25. SpO2 and HR monitoring was feasible, although malfunctioning was observed in one third of the tests. SpO2 and HR bias did not show any significant dependence on environmental conditions, with values ranging from − 1.71 to − 0.52% for SpO2 and 1.12 bpm to 5.30 bpm for HR. High CCC values between 0.81 and 0.97 were observed for HR in all environmental conditions. This novel prototype device for measuring vital parameters in cold environments demonstrated reliability of Tc measurements and feasibility of SpO2 and HR monitoring. Through non-invasive and accurate monitoring of vital parameters from the ear canal our prototype may offer support in triage and treatment of critically ill patients in harsh out-of-hospital conditions.

MRI findings of preauricular sinus: a case report

BackgroundThe preauricular sinus (PS) is a benign congenital abnormality affecting the soft tissues in the preauricular region. Diagnosis is typically clinical and routine imaging is usually unnecessary in symptomatic cases, but individuals with recurrent sinuses or previous unsuccessful surgeries may benefit from pre-operative imaging. Furthermore, PS may be detected incidentally during head and neck magnetic resonance imaging (MRI), emphasizing the need for radiologists and ear, nose, and throat specialists to be familiar with its characteristics. Notably, there is a gap in the existing literature regarding the MRI description of PS.Case presentationWe present the case of a 19 year-old man complaining of pain in the right external auditory canal. During the physical examination, a small depression was observed at the front edge of the ascending limb of the helix with the discharge of particulate material. Suspecting a PS, further investigation through an MRI examination was requested. The contrast-enhanced MRI documented a PS characterized by a small superficial subcutaneous cyst located in front of the right external auditory canal at the front edge of the ascending limb of the helix, behind the superficial temporal artery, and behind and above the parotid gland. The cyst showed restricted diffusivity (due to purulent content) and was surrounded by inhomogeneous adipose tissue with contrast-enhancement (due to inflammatory phenomena).ConclusionsTo the best of our knowledge, there is a lack of clear description of MRI semeiotics of PS in the literature and this case helps to fill that gap. MRI could play a role in the pre-surgical planning of complex PS cases. Additionally, a comprehensive understanding of the MRI appearance is essential for distinguishing PS from other diseases, such as branchial fistulas, epidermal inclusion cysts, and trichilemmal cysts.

External auditory canal cholesteatoma in children: clinical manifestations.

The purpose of this study was to explore the characteristics of external auditory canal cholesteatoma (EACC) among children and to describe its radiological findings on high-resolution computed tomography (CT) of the temporal bone in order to improve the diagnostic accuracy of primary EACC. The clinical records and CT imaging features of 44 patients who were diagnosed with EACC between January 2017 and May 2022 at Shenzhen Children's Hospital were retrospectively reviewed. Clinical features, including external auditory canal wall findings, hearing damage, symptoms and physical examination findings, were analysed against the level of lesion involvement. The correlation between different types of EACC and the incidence of different clinical symptoms was analysed, and the degree of hearing impairment and the rate of bone wall destruction were examined using CT. The mean age at EACC onset was 9.02 ± 3.15 years, and the mean age at onset for EACC involving the right ear was older than that of EACC involving the left ear (P < 0.05). There were 44 patients (46 ears), including 10 ears with type I EACC, 23 ears with type II EACC, and 13 ears with type III EACC. Conductive hearing loss was the main type of hearing impairment observed among EACC patients. There were differences in types I, II and III EACC in terms of hearing impairment; specifically, there was a significant difference in moderate hearing impairment between type II and type III EACC patients (P < 0.05). The four most common symptoms were otorrhea, otalgia, itching and bleeding. The incidence of itching symptoms was greater in type I EACC than the incidence of otorrhea, and the incidence of otorrhea symptoms in type II and type III EACC was significantly greater than that in type I EACC(P < 0.05). There were no significant differences in the fracture rates of the anterior, posterior, superior or inferior walls of the external auditory canal within or between type II and type III EACC patients (P > 0.05). The failure rate of scute damage was significantly higher in type III EACC patients than in type II EACC patients (P < 0.05). The presence of otorrhea and hearing loss as well as the identification of granulation tissue during otoscopy suggest the need for a temporal bone CT scan. This imaging modality can aid in the early detection and accurate classification of EACC, thereby guiding the selection of appropriate surgical interventions and greatly assisting in preventing further progression of hearing impairment.

Unveiling the Giants: A Descriptive Study of Giant External Auditory Canal Osteomas – An Uncommon Clinical Odyssey

Abstract Background: External auditory canal (EAC) osteoma, an uncommon manifestation within the mastoid bone, emerges as a particularly intriguing subject of study. Despite its low prevalence, the emergence of giant variants of these osteomas presents unique clinical and therapeutic challenges. Aim and Objectives: The study focuses on five patients presenting with giant bony osteomas, aiming to elucidate the prevalence, clinical features, radiological aspects, and optimal management strategies of these lesions. Material and Methods: Patients were selected from those presenting to the ear, nose, and throat outpatient department at a tertiary hospital between June 2022 and June 2023. Diagnosis was established through clinical examination and high-resolution computed tomography scans of the temporal bone. The diagnostic process underscored the importance of imaging studies in confirming osteoma characteristics, differentiating them from other conditions like exostosis. Management primarily involved surgical excision using a novel “eggshell thinning” technique to ensure minimal damage to the EAC skin and preserve natural canal contours. Results: The patients, predominantly young males, presented with symptoms ranging from hearing loss to ear pain and aural fullness. The outcomes across the cases were optimal, with surgical interventions resulting in symptom resolution. Notably, the innovative eggshell thinning technique facilitated complete removal while preserving skin flap integrity in 80% of cases. The contour of canal was well maintained. Conclusion: This research highlights the importance of recognizing and addressing the distinctive features of giant osteomas in the EAC. The findings emphasize the effectiveness of the surgical approach utilized, characterized by minimal trauma and successful preservation of skin flap integrity. The study calls for continued research and documentation to refine strategies for managing such rare entities, underscoring the necessity for a patient-centered, multidisciplinary approach in otologic surgery.

External Auditory Canal Exostosis and the California Surfer Population: A Cross-Sectional Study.

California has the most surfers in the United States and a high prevalence of external auditory canal exostoses (EACEs) among them. We aimed to characterize their EACE knowledge, use of earplugs, and barriers toward earplug use. A RedCap survey was distributed to online surfing forums and surfers at California beaches. Descriptive statistics and regression analyses were used to characterize responses. Our cohort included 334 primarily male (n = 269, 81.52%), college-educated (n = 237, 71.17%) surfers who were on average 30.79 years old (SD = 11.07). Two hundred and ninety-seven (90.00%) heard of EACE and 317 (96.06%) believed earplugs prevent EACE. However, 214 (64.85%) had never used earplugs. Multivariable logistic regression found increased age (OR = 1.04, 95% CI = [1.00-1.08], p = 0.03), higher EACE knowledge quiz scores (OR = 1.47, 95% CI = [1.19-1.80], p < 0.001), and primarily surfing in Southern California (OR = 2.19, 95% CI = [1.15-4.16], p = 0.02) increased the likelihood of earplug use. Common reasons against earplug use included reduced hearing, discomfort, and social hindrance. Two hundred and eighty-seven (86.45%) would wear earplugs following more EACE knowledge. They preferred learning from surf community members, doctors, and surf events. Low earplug use despite awareness of EACE preventability suggests a need for EACE education among California surfers and more accessible, user-friendly earplugs. Younger, less-skilled surfers who were more commonly unaware of EACE may represent a key intervention group. Education could be promoted through partnerships between health professionals and renowned surf organizations, as most participants indicated a willingness to use earplugs post-education. N/A Laryngoscope, 2024.

The imaging appearances of stapical footplate fistula related to inner ear malformation

Objective: To summarize the HRCT and MRI appearances of stapical footplate fistula related to inner ear malformation (SFF-Re-IEM). Methods: The HRCT and MRI materials of 48 cases (53 ears) SFF-Re-IEM were retrospectively analyzed. Among them, 25 SFF-Re-IEM ears were confirmed by surgery. Their CT and MRI findings including associated IEM type, internal auditory canal (IAC) malformation, tympanic fluid, its density and signal features, and accompanied labyrinthitis were recorded. Results: Among 48 cases (53 ears) with SFF-Re-IEM, 17 ears with incomplete partition type Ⅰ, accounting for 32.1%, 13 ears with common cavity for 24.5%, 13 ears with cochlear aplasia for 24.5%, 7 ears with cochlear dysplasia Ⅱ for 13.2%, and 3 ears with Mondini for 5.7%,were found respectively. 94.3% of them were associated with a defect or dysplasia in the found of the IAC. They were divided into 4 types according to the intact of the stapical footplate and accompanied CSF otorrhea: 22 ears were diagnosed as the stapical footplate leaking, of them, 2 ears might come from the stapical footplate bony defect, 6 ears were from the stapical footplate hernia. 1 ear belonged to the peristapical footplate leaking. 30 ears with the isolated the stapical footplate hernia were another found. The bony defect in 2 ears with the stapical footplate bony defect were not presented on CT and MRI.The focal bony defect of the affected stapical footplate of 36 ears with the stapical footplate hernia were demonstrated, which presented the hemispherical protruding into the tympana, the soft-tissue density on CT, and CSF-like signal on the MR heaved-T2WI images. Among 22 ears with the stapical footplate leaking, their imaging appearances varied from the different amount of the leaking CSF. Besides the focal bony defects of the affected stapical footplates, there were much more CSF-like density or signal in the ipsilateral tympanic cavity in 17 affected ears connecting with the vestibule through the defect area. In the CSF leaking ears with less CSF leaking in 5 ears, the CSF-like cysts like SFH were shown on the stapical footplate defect area, but their outer edges were irregular, and the CSF-like signal scattering in the tympanic cavity did not connect with the protruding cysts at the stapical area. Conclusion: The variable appearances of the SFF-Re-IEM ears based on the different subtypes are its characteristic HRCT and MRI appearances. This is helpful for the SFF-Re-IEM diagnosing to grasp its imaging features.

Objective evaluation, using computed tomography, of round window access for cochlear implantation.

The aim of this study was to determine optimal radiological parameters for assessment of the round window approach in cochlear implantation surgery. Patients undergoing cochlear implantation at the Department of Otolaryngology in Szczecin, between 2015 and 2022 inclusive, were eligible for the study. Radiological assessments were performed according to eight parameters (seven proposed in the literature) and visibility clinical assessments were made intra-operatively on a scale of 1 to 5 (1 - not visible, 5 - fully visible). Visibility assessments of the round window niche (RWN) and round window membrane (RWM) allowed the difference (RWN minus RWM) to be used as a clinical assessment of the size of the overhang over the round window. Computed tomography images of 57 ears from 52 patients were analyzed in terms of round window access. The study group included 26 females and 26 males, ranging in age from 1 year to 80 years, with a median age of 41 years. In clinical assessment, round window visibility was rated as 5, after removal of the bone overhang, in 69% of patients. Cochlear access through the round window was achieved in 39 (68%) cases, extended access through the round window in 13 (23%) cases and cochleostomy was performed in 5 (9%) cases. Statistically significant ordinal correlations with round-window access were found using one parameter from the literature (Chen_Angle) and from our proposal (RWM_prediction). From parameters describing the bone overhang of the round window, positive correlations (using Kendall rank tests) were found using parameters from the literature (Sarafraz_OH and Mehanna_OH). Radiological measurements describing access to the round window which determine the angle based on the anatomy of the posterior wall of the auditory canal and the position of the facial nerve were found to be of the highest value. In the future, the use of algorithms for computed tomography evaluation and robot-assisted surgery will require parameters for assessing round window access, for surgery planning and choice of electrode. The parameters proposed by various authors are summarized, allowing researchers to assess their usefulness in further clinical practice.

CLINICAL COMPLICATIONS OF MALIGNANT OTITIS EXTERNA AND SURGICAL TREATMENT

For clinical complications of malignant otitis externa and its surgical treatment, the introduction addresses a rare and serious condition, characterized by necrotizing infection of the external auditory canal, often associated with comorbidities such as decompensated diabetes mellitus. This condition requires rapid intervention due to the potential for spread to adjacent structures such as the skull and skull base, resulting in serious complications such as facial paralysis, osteomyelitis, and meningitis. Management includes broad-spectrum intravenous antibiotic therapy and, in many cases, surgical intervention to debride necrotic tissue and control infection. Objective: to synthesize recent evidence on the effectiveness of surgical treatments in malignant otitis externa, highlighting clinical outcomes and associated mortality. Methodology: it was structured according to the PRISMA checklist, using PubMed, Scielo and Web of Science databases to search for articles published in the last 10 years. Descriptors included "malignant otitis externa", "surgical treatment", "complications", "mortality" and "intervention". Inclusion criteria were clinical studies and systematic reviews that addressed surgical treatment and clinical outcomes. Exclusion criteria were studies focusing exclusively on non-surgical treatments, isolated case reports and studies with fewer than 10 participants. Results: highlighted the effectiveness of early surgical debridement in reducing mortality and serious neurological complications. The analysis revealed that adjuvant antibiotic therapy and intensive surveillance are crucial for successful management. Conclusion: the importance of a multidisciplinary approach and timely surgical intervention is emphasized to improve outcomes in patients with malignant otitis externa, highlighting the need for further studies to elucidate ideal therapeutic protocols and prevention strategies

Temporomandibular joint alloplastic replacement failure

Temporomandibular joint disorders are common, with alloplastic temporomandibular joint replacement (TMJR) being one method of addressing chronic pain and movement limitations that cannot otherwise be managed. Despite this, TMJR has known complications that can lead to failure. We present our experience of managing these cases and review the current evidence on the management and outcomes of alloplastic TMJR failures. Until 2015 our unit regularly used Dundee full metal prostheses, and encountered multiple issues such as infection, heterotopic bone formation, and progression of osteoarthritis beneath the condylar element. We also present our experience with other standard TMJR implants. One common cause of failure we observed is improper placement of a prosthesis due to poor technique, for instance, placement of the fossa implant too close to the ear canal can cause unresolved postoperative pain. There is no consensus on the management of TMJR, but non-surgical measures are preferred initially and surgical intervention is reserved for later stages. Recently our unit has managed numerous failure cases, employing a multidisciplinary approach combined with thorough preoperative planning and postoperative care, which has proven effective in reducing complications and improving outcomes. Based on our experience, we do not recommend the use of Dundee full metal prostheses for TMJR. Appropriate training in the placement of contemporary implants remains crucial. Suboptimal alignment of the implant in some cases does not need surgical intervention, but surgical management is justifiable in cases of persistent symptoms and functional limitations. When placing stock implants or designing a custom-made implant for an adult, we recommend that the posterior edge of the fossa component is at least 3 mm away from the bone of the ear canal.

The posterolateral neck dissection: indications, planning, and techniques

The posterolateral neck dissection removes the occipital and retroauricular lymph nodes in addition to nodal groups two through five. This procedure is performed for the removal of metastatic or at-risk lymph nodes in the posterolateral neck, which most commonly originate from the cutaneous surfaces of the scalp and neck posterior to a coronal plane connecting the external auditory canals. The major surgical consideration is the identification and preservation of the spinal accessory nerve.

Simultaneous cochlear implantation with early endoscopic surgery in small acoustic neuroma.

The exclusive endoscopic transcanal transpromontorial approach (EETTA) has recently been developed for the removal of small-sized acoustic neuromas in the labyrinth (intralabyrinthine schwannoma [ILS]) or internal auditory canal (IAC). Although small tumors that meet the indications for EETTA are also good candidates for cochlear implantation (CI), there are few reports on CI after schwannoma removal using EETTA. Here we present an outcome of patients who underwent simultaneous EETTA and CI. Five patients (two with IAC fundus tumors and three with ILS) who underwent simultaneous EETTA and CI between 2020 and 2022 were retrospectively enrolled. Their medical charts and test results were reviewed. After at least 12 months of follow-up, there were no severe surgical complications such as meningitis, infection, or skin necrosis. Four of the five patients responded to auditory stimulation. Three out of four auditory-responsive patients scored >80% on sentence recognition. Simultaneous EETTA and CI are feasible for the treatment of ILS and IAC fundus tumors. Preservation of the cochlear nerve and modiolus is important for favorable CI outcomes. Therefore, ILS and IAC fundus tumors in patients with nonserviceable hearing should be surgically removed as early as possible to enable proper hearing rehabilitation with CI. Level 4.

Speakers-Used as sensors for detecting acoustic loads with artificial intelligence.

Previous research demonstrated the potential of using speakers as sensors to detect ear canal conditions. This study continues that effort by using a single speaker to measure electrical impedance across various acoustic loads. Electrical impedance data were collected and preprocessed for machine learning model training. Different image forms were tested, including magnitude only and combined magnitude phase. Using 2100 data samples with convolutional neural network-based models (AlexNet, ResNet, and DenseNet), binary and multiclass classifications achieved average accuracies of 0.9716 and 0.907, respectively. This innovative approach is set to revolutionize acoustic sensing through artificial intelligence.