Flat Ears Research Articles

Auricular deformity correction with simultaneous reconstruction of the conchal bowl using autologous ear cartilage for “flat ear”: A novel surgical technique

Backgrounds"Flat ear" is a subtype of Grade II conchal-type microtia characterized by severely underdeveloped conchal bowl. Traditional surgical techniques often rely on autologous costal cartilage, which poses several risks and complications. This study aimed to introduce a novel surgical technique using autologous ear cartilage in auricular deformity correction surgery with simultaneous conchal bowl reconstruction for “flat ear”. MethodsA total of 19 patients were involved in this single-center, retrospective cohort study. All patients underwent the described surgical technique. The data before the surgery, immediately after the surgery, and at the last follow-up were collected, including length, width, perimeter of auricle and depth of conchal bowl. Patient satisfaction was assessed via the Visual Analog Scale (VAS). ResultsThe study included 12 males and 7 females, with an average age of 10.67 ± 3.86 years. Postoperative results showed significant improvements in auricular measurements, with the affected ear achieving near symmetry with the normal ear. The mean conchal bowl depth was restored from a preoperative 4.33±1.78mm to 17.32±1.28mm postoperatively. VAS scores for patient satisfaction increased significantly from 1.44±0.92 preoperatively to 7.72±1.49 postoperatively, with stability observed at the last follow-up. ConclusionThe novel technique offers a promising alternative to traditional costal cartilage-based auricular deformity correction surgery, providing excellent aesthetic outcomes and high patient satisfaction. This approach may expand treatment options for patients with "flat ear" and related auricular deformities, with reduced invasiveness and potential for future auditory rehabilitation.

Analysis of genotypes on 850 newborns with SLC26A4 single-allele mutation and the phenotypes of those with second variant

Objective: To clarify the phenotypes of the newborns with SLC26A4 single-allele mutation in deafness genetic screening and second variant; to analyze the SLC26A4 genotype and hearing phenotype. Methods: 850 newborns born in Beijing from April 2015 to December 2019 were included and there were 468 males and 382 females. They received genetic deafness screening for 9 or 15 variants, with the result of SLC26A4 single-allele mutation. Firstly, three step deafness gene sequencing was adopted in this work, i.e., the first step was "SLC26A4 gene whole exons and splice sites" sequencing; the second step was "SLC26A4 gene promoter, FOXI1 gene and KCNJ10 gene whole exons" sequencing; and the third step was detection for "SLC26A4 gene copy number variation". Secondly, we collected the results of newborn hearing screening for all patients with the second mutation found in the three step test, and conducted audiological examinations, such as acoustic immittance, auditory brainstem response and auditory steady state response. Thirdly, for novel/VUS mutations, we searched the international deafness gene database or software, such as DVD, ClinVar and Mutation Taster, to predict the pathogenicity of mutations according to the ACMG guideline. Lastly, we analyzed the relationship between genotype and phenotype of newborns with SLC26A4 single allele mutation. Results: Among 850 cases, the median age of diagnosis was 4 months. In the first step, 850 cases were sequenced. A total of 32 cases (3.76%, 32/850) of a second variants were detected, including 18 cases (2.12%, 18/850) with identified pathogenic variants; 832 cases were sequenced and 8 cases of KCNJ10 gene missense variants were detected among the second step. No missense mutations in the FOXI1 gene and abnormal SLC26A4 gene promoter were detected; the third step sequencing results were all negative. Genotypes and hearing phenotypes included 18 cases combined with the second clear pathogenic variant, 16 cases (16/18) referred newborn hearing screening and 2 cases (2/18) passed in both ears; degree of hearing loss consisted of 18 profound ears (18/36), 13 severe ears (13/36) and 5 moderate ears (5/36); audiogram patterns comprised 17 high frequency drop ears (17/36), 14 flat ears (14/36), 3 undistinguished ears (3/36), and 2 U shaped ears (2/36); 11 cases underwent imaging examination, all of which were bilateral enlarged vestibular aqueduct. As for 22 cases of other genotypes, all passed neonatal hearing screening and the hearing diagnosis was normal, including 9 cases with VUS or possibly novel benign variants, 8 cases with KCNJ10 double gene heterozygous variants, and 5 cases with double heterozygous variants. Conclusions: The probability of individuals with SLC26A4 single-allele variant who merge with a second pathogenic variant is 2.12%, all of which are SNV, which can provide scientific basis for the genetic diagnosis and genetic counseling of SLC26A4 variants. Those who have merged with second pathogenic variant are all diagnosed with sensorineural hearing loss. Patients with KCNJ10 gene mutations do not manifest hearing loss during the infancy, suggesting the need for further follow-up.

Estimating Cured Fractions of Uveal Melanoma

The extent to which uveal melanoma is cured by ocular therapy is not known. To estimate cured fractions (CF) of uveal melanoma using combination of institutional and Surveillance, Epidemiology, and End Results (SEER) data. Integrative analysis of 42 years of SEER data (1975-2016) with 25 years (1993-2018) of complementary institutional data. The analysis included SEER US patients and molecularly prognosticated patients in the United States and Europe. Three SEER databases (SEER-9, SEER-13, and SEER-18) were merged. A total of 10 678 SEER cases of uveal melanoma diagnosed from 1975 to 2016 using International Classification of Disease for Oncology morphology codes 8720-8790 (for melanoma) and site codes C69.2-4 (for choroid, ciliary body, and iris) were downloaded April 16, 2019. The institutional data included 5 institutional cohorts of 788 molecularly prognosticated patients (diagnosed prior to July 2019) with 3115 person-years at risk of death and 262 observed deaths. Excess absolute risks of death (EAR) and cured fraction (CF) indicates lifetime area under the EAR curve. These are applied to populations and subpopulations. The SEER EAR, with sexes and races pooled, can be modeled as a sum of 2 waves. The first wave peaks at approximately 3 years and is negligible by 15 years, at which time the second wave peaks. Institutional data suggest that the first wave is owing to BAP1 mutant cases (204 of 355 [57.5%]; 95% CI, 52%-63%) and that the second wave is owing to BAP1 wild-type SF3B1 mutant cases (60 of 355 [17%]; 95% CI, 13%-21%). There is also a third group with a low flat EAR time course (91 of 355 [25.5%]; 95% CI, 21%-30%). The overall statistical CF of 60% is reached by approximately 25 years. These findings suggest that the benefits of ocular therapy for curing uveal melanoma may be questionable because statistical cures reflect deaths of poor prognosis cases and survival of good prognosis cases. Changes in uveal melanoma patient management may be needed to improve survival.

"Yo Soy La Malinche": Chicana Writers and the Poetics of Ethnonationalism

It was toward the end of the year 13-Rabbit in Tenochtitlan when Moctezuma, ruler of the Aztec empire, first received news of the strange-looking foreigners arriving on the coast of his domain. (In Christian terms, the time was August of 1519, and Tenochtitlan was the biggest city in the world.) strangers' bodies are completely covered, reported Moctezuma's messengers, that only their faces can be seen. Their skin is white as if it were made of lime... .Their deer (for so the Aztecs saw the Spaniards' horses) carry them on their backs wherever they wish to go. These deer, our lord, are as tall as the roof of house.... Their dogs are enormous, with flat ears and long, dangling tongues. The color of their eyes is burning yellow; their eyes flash fire and shoot off sparks. So reported the Aztec chronicles twenty years after Mexico had fallen to the invaders (Leon-Portillo 13). Were these peaceable visitors, Moctezuma wondered, invad- ers? the god Quetzalcoatl whose return had been prophesied by the ancients? Messengers upon messengers were sent to report on the newcomers' activities as they made their way into Aztec territory, and their news left Moctezuma distraught and bewildered. At first, so the chroniclers report, it was hoped Moctezuma would be encouraged by news of the Aztec woman traveling with the strangers, a woman from this land, who speaks our Nahuatl tongue. She is called La Malinche, and she is from Teticpac. They found her there on the coast(Leon-Portillo 13). One of Moctezuma's own subjects, young Aztec woman of noble birth, was acting as translator and mediator for the bearded newcomers, and was their leader's lover. As the party made its way inexorably toward Tenochtitlan, the reports multiplied, and so did the questions. Who was she? Why was she serving these pale visitors with their metal clothes and deadly, inexplicable weapons? Why was she helping them forge an army of Moctezuma's own conquered peoples? Why did she save them from ambushes, attacks, misunderstandings likely to prove their undoing? Was her presence, and her role as Cortes's lover, proof of his divinity? Or was she simply traitor? Exploration, imperial invasion, and plunder are endeavors overwhelmingly associ- ated with men. Yet this young Aztec woman, known variously as Malintzin, La Malinche, and Dofia Marina, became key participant in the struggle between the Aztec and Spanish empires, as it played itself out in Mesoamerica over the two and half years between Cortes's arrival and the fall of Aztec rule. Like many key historical agents, Malinche/Marina has acquired importance as mythic figure. From the time those first messengers reached Moctezuma down to the very present, she has remained site for the ongoing negotiation of meaning and self understanding in Mexican America. As Sandra Messinger Cypess has documented, her race, her gender, and her historical role as supporter of the Spanish challenge to Aztec rule make her one of the most complex

Surgery of the protruding ear.

In most instances the protruding ear is a congenital and/or hereditary deformity caused by maldevelopment of the anthelix. The angle between the concha and scapha is formed by the anthelix, and an absence or lack of development of the angle formed by the anthelix will result in a protrusion of the auricle away from the head. Since the angle of the anthelix determines the degree of protrusion of the ear, the pathology would resolve itself into the type and development of the anthelix, i.e., the more obtuse the angle, the more the ear projects. Other pathological factors are encountered less frequently. A heavy concave concha will protrude the lower portion of the ear and is often accompanied by a thickened antitragus. Congenital deformities of the helical rim are usually associated with a thin flat ear which may or may not be protruding but is frequently lopped forward at the upper

ACOUSTIC SOUND FILTRATION AND HEARING AIDS

The purpose of this paper is to discuss the acoustic properties of the external canal of the ear and of the middle ear with special reference to the fitting of hearing aids and the design of individual ear molds. If the receiver of a hearing aid is connected with an individual ear mold and inserted into the ear canal, it can be observed that the high frequency partial tones of the speech sound seem rather weak. This results in greater difficulty in distinguishing consonants like s, th, f and similar sounds. When the hearing aid is connected with a flat ear piece, the mentioned tones are perceived more clearly than with the first arrangement. It is also observed that patients suffering from perceptive hearing loss hear better with a flat ear piece than with a so-called midget receiver connected to an individual ear mold. The final choice is the latter