Middle Ear Pathology Research Articles

Air–Bone Gap in Meniere’s Disease: A Case Series and Literature Review

Background/Objectives: An air–bone gap (ABG) on audiometry is usually secondary to a conductive hearing loss. However, persistent and repeatable ABGs on audiometry in the absence of external or middle ear pathology is thought to arise from inner ear disorders including Meniere’s Disease (MD). In this paper, we aim to showcase this interesting finding occurring in MD with an associated literature review. Methods: Using retrospective review and analysis of case notes, we describe eight cases of persistent ABG on audiometry in MD. All other causes for the ABG were explored and excluded with the aid of objective audiological testing. Results: ABG can occur in a small sub-set of the MD population. In our case series, the ABG was typically found to affect the low frequencies. Higher frequencies appear to be spared. However, a detailed history, examination and battery of objective tests are required to ensure that all other causes of the ABG are reliably considered and excluded prior to attributing it to the inner ear. The finding of an ABG in MD may be dependent on the stage of the disease. Further research is required to determine the underlying cause of the ABG and its potential applications to help guide treatment.

Diagnosis of Enlarged Vestibular Aqueduct Using Wideband Tympanometry.

Background: Wideband tympanometry (WBT) has the potential to distinguish various mechanical middle ear and inner ear pathologies noninvasively. This study investigated the diagnostic value of WBT in the diagnosis of enlarged vestibular aqueduct (EVA). Methods: The absorbance and resonance frequency (RF) of patients with EVA (40 ears, 25 patients) and matched population controls (39 ears, 28 subjects) were compared, alongside receiver operating characteristic (ROC) analysis. Correlations between VA width and RF were also examined. Results: Patients with EVA had higher absorbance at low frequencies (226-917 Hz) and lower absorbance at high frequencies (2520-4896 Hz) compared to controls. The RF of the EVA group was significantly lower versus controls (751 [391-1165] vs. 933 [628-1346] Hz). The ROC analysis revealed area under the curve values of 0.771 and 0.801, respectively, for absorbance and RF. RF had a sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 82.5%, 76.7%, and 80.6%, respectively, for diagnosing EVA. In the EVA group, the VA midpoint width (r = -0.334) and VA petrous width (r = -0.402) both significantly correlated with RF. Conclusions: Our findings support the utility of WBT for diagnosing EVA, with RF as the optimal index used.

Outcomes of Concurrent Balloon Eustachian Tuboplasty and Tympanostomy Tube Placement in Children.

Balloon dilation eustachian tuboplasty (BDET) has been proven to be a safe treatment option for children with eustachian tube dysfunction (ETD). This study aims to analyze the long-term outcomes of children who underwent concurrent BDET and tympanostomy tube (TT) placement. We hypothesize that patients who underwent simultaneous therapy have experienced a low overall rate of middle ear pathology and have consistent hearing quality at subsequent office visits. Retrospective chart review of 19 pediatric patients (36 ears) who previously underwent concurrent BDET and TT placement. Patient charts within the extended postoperative period were reviewed. Specific data points included need for reoperation, rates of middle ear pathology, audiological outcomes, and number of previous TT placements. Pediatric patients who underwent concurrent BDET and TT placement had long-term success in 34/36 ears (94.4%). All postoperative tympanograms and audiograms (100%) were normal when performed within 12 months after the procedure. Notably, 34/36 ears (94.4%) had history of tube placement in the past. Patients had an average of three sets of tympanostomy tubes prior to undergoing concurrent BDET and TT. Concurrent BDET and TT placement may be an effective treatment option for pediatric patients with persistent eustachian tube dysfunction. Specifically, BDET may be a useful adjunct tool in pediatric patients with refractory ETD despite having multiple sets of tympanostomy tubes. This study aims to strengthen the argument of performing multimodal therapy in pediatric patients with recurrent middle ear disease. 4 Laryngoscope, 134:4799-4802, 2024.

Characterization of middle ear microbiome in otitis media with effusion in Hungarian children: Alloiococcus otitidis may potentially hamper the microbial diversity

IntroductionAlthough otitis media with effusion (OME) is a common cause of hearing impairment in children, little is known about its microbiological background. We aimed to analyse the microbiome of the middle ear fluid (MEF) in OME to identify microbiological, demographic and environmental factors that may potentially influence the middle ear microbiome. In addition, we aimed to compare the results of conventional culture techniques and PCR-based methods. Methods39 samples from children with OME were investigated using conventional culture and 16S rRNA sequencing. Bioinformatic analyses were carried out to assess the microbial communities and their association with clinical data. ResultsBy conventional culture technique bacteria could be cultured in 33 % of the MEF samples; the most frequent bacterium was Haemophilus influenzae, followed by Staphylococcus species, Cutibacterium acne, and Streptococcus species. The 16S rRNA analysis showed that Alloiococcus was the most abundant bacterium, followed by Haemophilus, Streptococcus. and Sphingobium.A “High Alloiococcus group” with significantly lower and a “Low Alloiococcus group” with significantly higher alpha and beta diversity could be defined. Children born by Caesarean sections had lower beta and Shannon diversity than patients born by natural birth. Breastfeeding for at least six months showed a negative correlation with alpha diversity. Age, previous antibiotic treatment, parental smoking, duration of symptoms, existence of siblings, did not alter the significantly bacterial composition of MEF samples and there were no significant differences in regard to alpha or beta diversity. ConclusionThe conventional culture technique and 16S rRNA results were not congruent. Remarkably, Alloiococcus could not be cultured at all, even by 16S rRNA analysis the presence of Alloiococcus seems to be important. Based on our results, A. otitidis possibly impacts the diversity of middle ear microbiome in children with OME. However, further studies are required to determine the role of A. otidis in middle ear pathologies.

Unveiling the Aggressiveness of Cholesteatoma: Associating MERI with miRNA-21 & IL-6 Expression.

Cholesteatoma, a destructive middle ear condition, poses challenges due to its variable clinical presentation and propensity for recurrence. Understanding its molecular underpinnings could enhance prognostication and guide therapeutic interventions. This study investigates the association between cholesteatoma aggressiveness, as assessed by the Middle Ear Risk Index (MERI), and the expression of miRNA-21 and IL-6 genes. A cross-sectional observational study involving 30 patients with cholesteatoma undergoing tympanomastoid exploration was conducted. MERI scores were calculated preoperatively, and cholesteatoma tissue was analyzed for miRNA-21 and IL-6 gene expression using RT-PCR. Statistical analysis was performed to correlate MERI scores with gene expression levels. The majority (80%) of patients exhibited severe MERI scores, correlating with extensive middle ear pathology and necessitating canal wall-down (CWD) mastoidectomy. Higher miRNA-21 and IL-6 gene expression levels were observed in cholesteatoma tissues, indicating local aggressiveness and inflammatory activity. Significant moderate correlations were found between MERI scores and miRNA-21 (Pearson correlation = 0.579, p = 0.001) and IL-6 gene expression (Pearson correlation = 0.388, p = 0.034). Patients with severe MERI scores had elevated miRNA-21 and IL-6 levels, suggesting a more aggressive disease phenotype. MERI scores demonstrated utility in predicting cholesteatoma aggressiveness, with higher scores correlating with elevated miRNA-21 and IL-6 expression. These findings suggest a potential role for MERI in guiding surgical decision-making and prognostication. Future research on targeted therapies based on molecular mechanisms holds promise for improving cholesteatoma management. 3 Laryngoscope, 2024.

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.

Evaluation High-Resolution Computed Tomography (HRCT) Of Temporal Bone In Cholesteatoma Of Middle Ear In Comparison With Histopathological Findings: A Prospective Study

Background: Cholesteatoma is relatively common and potentially dangerous disease of the ear. It is characterised by local destruction and osseous erosion leading to complications. Pre-operative assessment of middle ear cholesteatoma is a must for assessing the disease's location, extent, and complication. High resolution computed tomography (HRCT) is the imaging modality of choice for evaluation of middle ear structures and pathology. Therefore, in the present study we aimed to evaluate HRCT of temporal bone in cholesteatoma of middle ear cleft in comparison with histopathological results. Materials and Methods: This is a prospective study carried out on total of 30 patients who were undergoing HRCT of temporal bone for middle ear cleft pathology and found to have imaging evidence of chronic otomastoiditis on HRCT, subsequently undergoing surgery and histopathological validation. Results: The mean age of study subjects was found to be 23.97 ± 11.30 years. Majority of the study subjects were belonged to age group of 11-40 years (40%) with female predominance (53.3%) as compared to male (46.7%). Majority of the patients i.e., 60% showed signs of loss of aeration and sclerosis of mastoid air cells followed by soft tissue density lesions (43.3%), bony erosions (26.7%), and bony expansions (6.7%). Surgical findings and histopathological reports were correlated with pre-operative HRCT scans analyses with 95.88% accuracy. Conclusion: Compared to histopathological findings, HRCT offers a diagnostic capacity that is remarkably sensitive and specific in identifying cholesteatoma and the condition of the bone structures in the temporal bone

Awareness of middle ear pathologies in South Africa: Towards a primordial preventive audiology

Background: Public awareness of auditory pathologies, has been explored in the literature. However, there is limited evidence regarding public awareness of middle ear pathologies and their risk factors in South African communities.Objectives: The aim of this study was to describe public awareness regarding middle ear pathologies and their associated risk factors in the community of Giyani, Limpopo province, South Africa.Method: A quantitative cross-sectional survey design was conducted among 94 adults aged 18 years and older living in Giyani, Limpopo province. A questionnaire was used to collect data. Descriptive statistics was used to summarise the data, while a Chi-squared test was used to determine if there is any association between awareness and independent variables with categorised outcomes.Results: Adults aged between 18 and 65 years participated in this study. Most participants were aware of aural itchiness (71.3%) and pain (35%) as symptoms related to middle ear pathologies. The use of cotton buds (51.1%) and other illnesses (35.5%) were primarily reported as risk factors for middle ear pathologies. There were varied responses with regard to awareness of which professionals manage middle ear pathologies, indicating a general lack of awareness. No statistically significant association was found between the dependent and independent variables (p 0.005).Conclusion: The study indicated a general lack of public awareness regarding middle ear pathologies and their associated risk factors among Giyani community.Contribution: The study raises implications for public awareness campaign that educates communities about middle ear pathologies, risk factors and social determinants of health associated with these pathologies.

The role of gastroesophageal reflux disease in the middle ear pathology formation

The extraesophageal reflux effect investigation on the middle ear structures in adults is of considerable interest. The gastroesophageal reflux disease associated otitis media formation mechanism is closely related to such concepts as nasopharyngeal reflux and laryngopharyngeal reflux. It has been established that the pathophysiological mechanism originates in the nasopharynx and further spread to the middle ear structures. The tympanic cavity mucous membrane under the gastric enzymes influence is prone to remodeling, which results in the various chronic inflammation types gradual formation. The study purpose was to analyze medical literature from 1990 to 2024, aimed at studying the middle ear cavity inflammation causes and mechanisms formed by the gastric contents influence. As materials and methods, this article uses publications in such scientific databases as PubMed, eLIBRARY, Science Direct, Research Gate. The analyzed scientific materials provide insight into the relationship between the tympanic cavity inflammation formation and extraesophageal manifestations of GERD, as well as the potential negative H. Pylori impact on the middle ear structures. Conclusions. A detailed understanding of the middle ear cavity inflammation formation by pathophysiological mechanisms of the extraesophageal reflux influence, consisted of various gastrointestinal tract components had been obtained. The potential H. Pylori role in the tympanic cavity mucous membrane alteration remains controversial. This is due to the large number of scientific publications conflicting results in this research field. Major scientific studies confirm that gastroesophageal reflux disease acts as a risk factor for the different types middle ear cavity inflammation formation

Masseteric-facial anastomosis and hypoglossal-facial anastomosis after lateral skull base and middle ear surgery.

Lateral skull base (LSB) and middle ear pathologies often involve the facial nerve (FN), and their treatment may require FN sacrifice. Cases with unidentifiable proximal stump or intact FN with complete FN palsy, necessitate FN anastomosis with another motor nerve in order to restore innervation to the mimicking musculature. The results of hypoglossal-to-facial nerve anastomosis (HFA) and masseteric-facial nerve anastomosis in patients with facial paralysis after middle ear and LSB surgeries, are presented and compared. Adult patients with total definitive facial paralysis after middle ear or LSB surgery undergoing facial nerve reanimation through hypoglossal or masseteric transfer anastomosis were enrolled. The facial nerve function was graded according to the House Brackmann grading system (HB). The facial function results at 3months, 6months, 12months, 18months and at the last follow up (more than 18months) are compared. 153 cases of LSB and middle ear surgery presented postoperative facial palsy and underwent facial nerve reanimation surgery with HF in 85 patients (55.5%) and MF in 68 patients (44.5%). The duration of the FN palsy before reconstructive surgery was inversely associated to better FN results, in particular with having a grade III HB (p = 0.003). Both techniques had significantly lower HB scores when an interval between palsy onset and reanimation surgery was 6months or less (MF p = 0.0401; HF p = 0.0022). Patients who underwent a MF presented significant improvement of the FN function at 3months from surgery (p = 0.0078). At the last follow-up, 63.6% recovered to a grade III HB and 22.7% to a grade IV. On the other hand, the first significant results obtained in the HF group were at 6months from surgery (p < 0.0001). 67.8% of patients had a grade III HB after a HF at the last follow-up, 28.8% a grade IV. FN grading at 6months from surgery was significantly lower in the MF group compared to the HF (p = 0.0351). The two techniques had statistically similar results at later follow-up evaluations. MF was associated to initial superior results, presenting significant facial recovery at 3months, and significantly better functional outcomes at 6months from surgery compared to HF. Although later results were not significantly different in this study, earlier results have an important role in order to limit the duration of risk of corneal exposure.

Optical coherence tomography otoscope for imaging of tympanic membrane and middle ear pathology.

Pathologies within the tympanic membrane (TM) and middle ear (ME) can lead to hearing loss. Imaging tools available in the hearing clinic for diagnosis and management are limited to visual inspection using the classic otoscope. The otoscopic view is limited to the surface of the TM, especially in diseased ears where the TM is opaque. An integrated optical coherence tomography (OCT) otoscope can provide images of the interior of the TM and ME space as well as an otoscope image. This enables the clinicians to correlate the standard otoscopic view with OCT and then use the new information to improve the diagnostic accuracy and management. We aim to develop an OCT otoscope that can easily be used in the hearing clinic and demonstrate the system in the hearing clinic, identifying relevant image features of various pathologies not apparent in the standard otoscopic view. We developed a portable OCT otoscope device featuring an improved field of view and form-factor that can be operated solely by the clinician using an integrated foot pedal to control image acquisition. The device was used to image patients at a hearing clinic. The field of view of the imaging system was improved to a 7.4mm diameter, with lateral and axial resolutions of and , respectively. We developed algorithms to resample the images in Cartesian coordinates after collection in spherical polar coordinates and correct the image aberration. We imaged over 100 patients in the hearing clinic at USC Keck Hospital. Here, we identify some of the pathological features evident in the OCT images and highlight cases in which the OCT image provided clinically relevant information that was not available from traditional otoscopic imaging. The developed OCT otoscope can readily fit into the hearing clinic workflow and provide new relevant information for diagnosing and managing TM and ME disease.

Clinical and Audiological Outcome of Surgical Treatment in Patients with Adenoid Hypertrophy

Background: Adenoid hypertrophy is a common condition in childhood, which may be associated with recurring acute otitis media, otitis media with effusion (OME), and obstructive sleep apnoea syndrome. There is close relationship between adenoids and possible middle ear pathology leading to conductive deafness. Objective: To find out the outcome of surgery regarding clinical features and hearing status in children with adenoids. Methods: This hospital based prospective study was conducted at the Department of Otolaryngology&amp; Head-Neck Surgery, Shaheed Suhrawardy Medical College &amp; Hospital, for a period of 6 months following approval from IRB. Patients having enlarged adenoids with or without OME of 3-12 years and both sex group were approached for inclusion of the study. Informed written consent was taken from the guardian. Proper surgical intervention was chosen according to condition of the child. Before and after intervention, data were collected by the researcher himself. Data were recorded into the case record form. Following collection, data were analyzed by the SPSS 26 (SPSS Inc, Chicago, IL, USA). Results: Among 100 patients, 66% were males and 34% were females. Mean age was 7.2±2.34 SD (years). Of all, 60% underwent adenoidectomy (AT), 20% underwent adenoidectomy with myringotomy (AM), and remaining 20% underwent adenoidectomy with myringotomy with grommet insertion (AMG). The PTA findings (baseline) of adenoidectomy, adenoidectomy with myringotomy, and adenoidectomy with myringotomy with grommet insertion group were 15.466±1.395, 37.8±3.349 and 38.2±3.548 db, respectively. Similarly, significant improvement was noticed in all of the three groups as evidenced by PTA value in three groups were 11.91±1.12, 18.65±.933 and 17.45±1.31 db, respectively (p&lt;0.05). Improvements in PTA among different groups also showed significant changes following operation (p&lt;0.05). Conclusion: Clinical improvement are noticed following surgical intervention in both ............

Preliminary results of classifying otosclerosis and disarticulation using a convolutional neural network trained with simulated wideband acoustic immittance data

Current noninvasive methods of clinical practice often do not identify the causes of conductive hearing loss due to pathologic changes in the middle ear with sufficient certainty. Wideband acoustic immittance (WAI) measurement is noninvasive, inexpensive and objective. It is very sensitive to pathologic changes in the middle ear and therefore promising for diagnosis. However, evaluation of the data is difficult because of large interindividual variations. Machine learning methods like Convolutional neural networks (CNN) which might be able to deal with this overlaying pattern require a large amount of labeled measurement data for training and validation. This is difficult to provide given the low prevalence of many middle-ear pathologies. Therefore, this study proposes an approach in which the WAI training data of the CNN are simulated with a finite-element ear model and the Monte-Carlo method. With this approach, virtual populations of normal, otosclerotic, and disarticulated ears were generated, consistent with the averaged data of measured populations and well representing the qualitative characteristics of individuals. The CNN trained with the virtual data achieved for otosclerosis an AUC of 91.1 %, a sensitivity of 85.7 %, and a specificity of 85.2 %. For disarticulation, an AUC of 99.5 %, sensitivity of 100 %, and specificity of 93.1 % was achieved. Furthermore, it was estimated that specificity could potentially be increased to about 99 % in both pathological cases if stapes reflex threshold measurements were used to confirm the diagnosis. Thus, the procedures’ performance is comparable to classifiers from other studies trained with real measurement data, and therefore the procedure offers great potential for the diagnosis of rare pathologies or early-stages pathologies. The clinical potential of these preliminary results remains to be evaluated on more measurement data and additional pathologies.

Assessment of Outer and Middle Ear Pathologies in Lilongwe, Malawi.

Outer and middle ear pathologies are known to disproportionately affect low-income countries but data is limited. We aim to quantify the prevalence rate of patients presenting with middle/outer ear pathologies at ABC Hearing Clinic and Training Centre in Lilongwe, Malawi. Audiological consultations (adult and paediatric) from 2018-2020 were reviewed for outer and middle ear pathologies. Secondary outcomes included patient type (private vs. community) compared to otoscopy findings, tympanometry findings, need for follow up, and follow up compliance. Out of 1576 patients reviewed, the proportion of abnormal cases' was 98.2%, with 41.4% being unilateral and 57.4% bilateral. Eighty-three percent presented with outer/middle ear pathologies. 68% of those presented with a pathology often associated with some degree of conductive hearing loss (occluding wax, perforation, discharge, Type B/Type C tympanogram). Average age was 29 + 0.527 years; 41.6% private and 58.2% community patients. Cerumen impaction was most common finding (51%). Higher rates of otoscopic abnormalities and type B tympanograms were noted in community vs. private patient (~40% vs. ~30%; ~70% vs. ~30%). Adherence to follow up was higher for community vs. private patients (29% vs. 17%); ~70% reported subjective improvement upon follow up. The majority required multiple interventions on follow up. Secondary follow up was recommended in 64.8%. A significant disease burden of outer and middle ear pathologies was identified. Further research is required to understand the disease burden and promote health policy.

Myringoplasty - A Rewiev of 438 Cases.

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.

Making Recommendations for an Evaluation and Treatment Algorithm for Patients with Ear Fullness and No Objective Abnormalities.

To make recommendations for evaluation, approach to counseling and treatment for patients who present with ear fullness without abnormalities on otomicroscopic examination, standard audiometric studies, or imaging results. Retrospective chart review of adult patients in a tertiary referral center presenting with ear fullness and/or otalgia without external, middle, and/or inner ear pathologies. Data collected include demographics (age and gender), laterality and duration of symptoms, co-morbid conditions and final diagnoses of temporomandibular joint (TMJ) dysfunction, intermittent Eustachian tube dysfunction (iETD), migraine disorder, and anxiety. In the span of 8 years of a single neurotologist's practice, 964 patients presented with ear fullness. After excluding all instances where external, middle, and inner ear disorders were identified and where audiometric and radiologic findings were abnormal, 263 patients had ear fullness and no objective causes. Women were more likely than men to complain of ear fullness and/or otalgia and were also more likely to present with no objective abnormalities ( p < 0.05). Patients who reported isolated ear fullness were more likely to be diagnosed with iETD, whereas patients who reported pain were more likely to be diagnosed with TMJ dysfunction (TMJD). Fourteen patients (5.3%) had completely unexplained sensation of ear fullness. There were 94.7% of the patients presenting with unexplained ear fullness were diagnosed as having a possible contribution of TMJ dysfunction, IETD, migraine disorder, anxiety, or a combination of these conditions to their symptomatology. Directing treatments toward these diagnoses may alleviate symptoms of ear fullness or, if unsuccessful, provide an avenue for counseling in the framework of functional neurologic disorders.

ВТОРИЧНЫЕ ГНОЙНЫЕ ОТОГЕННЫЕ МЕНИНГИТЫ У ВЗРОСЛЫХ: ОСОБЕННОСТИ ПРОТИВОМИКРОБНОЙ ТЕРАПИИ

Secondary purulent otogenic meningitis (SPOM) in adult patients is less common than in children, but among all intracranial complications of middle ear pathology it occupies the leading position. In the absolute majority of cases, a patient with SPOM on admission to the emergency room is supervised by a neurologist with a suspicion of acute cerebral circulation disorder, and an otorhinolaryngologist, along with other subspecialists, is initially an invited consultant. All this is associated with the risks of untimely diagnosis of SPOM and inadequate tactics of medical care, including the rationality of prescribing the choice of systemic antimicrobial therapy (SPMT), which increases the likelihood of unfavorable outcomes. As a result of retrospective analysis of medical records of 33 completed cases of SPOM for the period from 2017 to October 2023, the features of the course of SPOM microbial landscape in this pathology and the nature of SPMT were studied. It was revealed that in the structure of secondary meningitis of otogenic and rhinosinusogenic etiology VHOM took the leading positions (81.1%). In 62.5% of cases, patients had comorbid pathology, which negatively affected the course of the underlying disease and worsened the prognosis of the disease. Such manifestations as headache, vomiting, disorders of consciousness were observed in 62.5%, 57.6%, 62.1% of cases, respectively. Clearly expressed signs of inflammatory process on the part of general blood analysis and cerebrospinal fluid were revealed. The structure of etiologic factors in adult SPOM was dominated by coccal microflora (S.pneumoniae, Streptococcus spp., Staphylococcus spp.). In 81.8% of cases of SPOM we started with recommended ceftriaxone, but absence of positive dynamics, severity of the course of the inflammatory process required correction of SPMT and transition to meropenem. Timely diagnosis, clear tactics of medical care, including the choice of effective SPMT using, including de-escalation schemes, led to favorable outcomes in 87.9% of patients.

Outcomes and device use in children with bone-conduction hearing devices in South Africa.

Bone-conduction hearing devices (BCHD) can provide hearing solutions in settings where middle ear pathology is rife. Describe functional hearing outcomes and device use of children fitted with BCHD. Retrospective review of 79 children fitted with BCHD between January 2017 and May 2022. Outcomes included device use and subjective reports measured with the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) and the Teachers' Evaluation of Aural/Oral Performance of Children (TEACH). Analysis of variance established association between mean data logging and type and degree of hearing loss. Thematic analyses were done for qualitative outcomes. Average usage was 7.0 h/day (5.4 SD; range 0.1-24). PEACH ratings indicated 93.3% of children wore their BCHD 'always' or 'often', with 80% displaying Typical auditory performance at 1-month follow-up. TEACH ratings indicated 84.2% of children wore their BCHD 'always' or 'often', with 78.9% showing typical auditory behaviour. Increased usage was noted for conductive, mixed, moderate and severe hearing losses. There was a mean delay of 17.2 months (23.4 SD; range 0-90) between age of diagnosis and fitting. Thematic analyses identified two main themes: advantages and barriers to BCDH use. Average device use fell short of the internationally recommended 10 h/day. Higher BCHD use was associated with higher functional listening performance scores. Long waiting times for medical or surgical intervention for conductive hearing losses can delay BCHD fitting.Contribution:Limited information is available to examine outcomes in children fitted with BCHD.

Contemporary mechanics of conductive hearing loss

The middle ear plays a critical role for the conversion of acoustic energy to mechanical vibrations that subsequently enter the cochlea. It is middle ear impedance matching through ossicular coupling that has enabled land-dwelling vertebrates to hear soft airborne sounds. Conductive hearing loss may result from damage to the delicate middle ear structures following infection, trauma or rapid pressure changes. An understanding of the mechanics of the middle ear significantly improves the oto-surgeon's ability to effectively diagnose conductive hearing loss, localize the responsible lesion and then effectively correct the conduction abnormality. This article reviews some of the basic knowledge of middle ear mechanics for sound transmission, highlights recent advances in developing new techniques to assist in diagnosis of middle ear disease, and finally sheds light on future research aimed at improving the diagnosis and management of middle ear pathology.

Tinnitus features and masking in patients with normal hearing and with high frequency hearing loss

To access tinnitus features and effectiveness of its masking in relation to sensorineural hearing loss (SHL), gender, age, affected side and tinnitus pitch. 53 patients (32 (60.4%) females and 21 (39.6%) males) aged 20 to 46 years with unilateral chronic tinnitus without any external or middle ear pathology were enrolled in the study. All patients underwent pure tone audiometry, evaluating SHL, tinnitus pitch and tinnitus masking. Pure-tone thresholds were measured at all standard frequencies from 0.25 to 8 kHz, and at 10 kHz, 12.5 kHz, 14 kHz, 16 kHz, and 20 kHz. Normal hearing at the studied frequencies was observed in 24 patients, and 29 patients were found to have SHL. Patients with high-frequency SHL identified tinnitus pitch more often identified tinnitus pitch compared to those with normal hearing (75.9% vs. 45%, respectively; p=0.02). Tinnitus pitch in patients with normal hearing was 8 (6-13) kHz, whereas in all patients with SHL tinnitus pitch was always located in the range of maximum hearing loss and reached 10 (8-12) kHz. The mean tinnitus pitch, which was successfully masked, was 8 Hz, and tinnitus pitches with mean value above 12 kHz were not associated with effective masking (p=0.04). No statistically significant differences were found between the effectiveness of tinnitus masking and the affected side, gender, presence of SHL. The higher tinnitus pitch (above 12 kHz) was more common in younger patients and was associated with less successful masking. Our study included patients of predominantly young age (up to 48 years old), in whom, probably, the factors influencing the tinnitus characteristic differ and have a correlation with anxiety-depressive spectrum disorders prevailing at a younger age. In this regard, further research is needed.