Auricular Research Articles

Dynamic control of the acoustic scene in echolocating bats

Echolocating bats can detect, localize, classify, pursue, and capture night-flying insects in less than a second. During pursuit, aerial hawking bats dynamically change their emitted calls as they approach prey, increasing call rate, reducing call duration, increasing bandwidth, and reducing source level. Additionally, many bat species dynamically control the shape of the emitted echolocation beam by broadening the beam in close proximity to prey. However, the acoustic scene, as experienced by the bats, depends as much on the characteristics of the emitted call as on the shape and orientation of the outer ears. We show that aerial-hawking bats also dynamically modify the shape and orientation of the outer ear in synchrony with changes to the emitted beam during prey pursuit. We believe that it is the combination of all these dynamic changes, both to the emitted call and to the receiving morphology, that underlie the effectiveness with which bats navigate and forage in the night sky.

On the influence of the middle ear on the sound pressure level generated in open and occluded earcanals under a bone-conducted stimulation

The occlusion effect is an acoustic discomfort commonly encountered by earplugs’ users, which corresponds to the increased auditory perception of the bone-conducted sound mainly at low frequencies. This perception is accompanied by the augmentation of the sound pressure level in the earcanal when occluded by the earplug compared to the open case. While the source of the SPL generated in the earcanal in both open and occluded cases is mainly attributed to the vibration of the earcanal wall, the sound radiation of the tympanic membrane that stems from the middle ear vibration is commonly considered as not significant. To investigate this phenomenon, a finite element model that incorporates the middle ear components into a realistic human outer ear is developed. First, the finite element model is evaluated by comparing the acoustic impedance computed at the eardrum surface to literature data obtained on human subjects. Second, the finite element model is used to quantify the contribution of the sound radiation that originates from the middle ear on the sound pressure level generated in both open and occluded earcanals under a bone-conducted stimulation.

Assessment of the distribution and volume of air chambers around the inner auditory canal on high-resolution computed tomography scans of the temporal bone.

Assessment of the distribution and volume of air chambers around the inner auditory canal on high-resolution computed tomography scans of the temporal bone.

Dış Kulak Yolunda Yabancı Cisim Bulunan Çocuk Hastaların Değerlendirilmesi

Aim: The aim of this study is to investigate the demographic characteristics, foreign body (FB) types, treatment approaches and complications of pediatric patients with FB detected in the external ear canal. Methods: The files of pediatric patients who were found to have FBs in the external auditory canal by ENT specialists between December 2020 and February 2022 were retrospectively reviewed. The age, gender, type of FBs, treatment methods and complications of the patients were recorded. Results: A total of 108 patients (66 male (61.1%) and 42 female (38.9%) patients) with FB detected in the external ear canal were included in the study. The patients' ages ranged from 1 to 17 years and the median age was 5.0 (4.0) years. FBs were detected in the right ear in 64 (59.3%) patients, in the left ear in 41 (38.0%) patients, and in both ears in 3 (2.8%) patients. The most common FBs were beads (31.5%), insects (9.3%), pencil tips (8.3%) and cotton (8.3%). Complications were observed in 9.3% of the cases. FBs were removed under outpatient conditions in 100 (92.6%) patients, while they were removed under general anesthesia in 8 (7.4%) patients. Conclusion: FBs in the external ear canal were frequently seen in children aged 5 years and younger. Most of the FBs consisted of inorganic materials such as beads. In order to avoid complications, especially in the presence of a round and hard FB that cannot be removed with simple applications, consultation from an ENT specialist should be requested.

An early report of exoscope-assisted otologic surgery.

Exoscope has been used in otoneurologic surgery in several reports. However, most ear surgeries are performed using either microscope or endoscopy today. The purpose of this study is to present our subjective and objective experience of using this instrument in our institution. Sixteen ears with different severity and condition in 15 consecutive patients were enrolled. A questionnaire with 12 questions was sent to different participants, including surgeons, residents, medical students, and scrub nurses in the operation room. The total score and average score of each item were calculated and analyzed. Exclusive exoscopic operation was performed on 13 patients with 14 procedures. A combination of endoscopy-exoscope and microscope-exoscope was used in one patient, respectively. There were no complications. Hearing recovery or disease extirpation was achieved in most patients. Twenty participants in the operation room filled out the questionnaire. There was no significant difference between the different groups. High ratings were reported in terms of image quality, stereoscopic effects, magnification rate, and the same field of view as the surgeon. Worse ratings were reported in items related to limited working space, increase in eye strain by video observation, and focusing difficulty. Exoscopic ear surgery is feasible, safe, and effective in managing various otologic conditions involving external ear, middle ear, mastoid, and lateral skull base. Its high-definition image quality, stereoscopic effects, sufficient magnification, reliability and teaching value made it a potential instrument in general ear surgeries. Further improvements to current drawbacks can be anticipated.

Facial expression detection using posterior-auricular muscle surface-electromyographic activity

IntroductionFollowing Bell's palsy, 25% of sufferers are left with chronic, difficult to treat involuntary muscle movements (synkinesis). Surface-electromyography (sEMG) biofeedback has an established role in improving muscular coordination. The vestigial posterior auricular muscle (PAM) is the first muscle re-innervated by the facial nerve. This study measured the sEMG signal from PAM in facial animation in healthy subjects and explored the possibility of using PAM in a wearable rehabilitative device. Material and methodsPAMs activity was recorded using sEMG in 41 healthy volunteers during the performance of a set range of facial expressions. To compare results between participants and expressions, the percentage increase from baseline were used. ResultsPAMs activity increased significantly from baseline in response to smiling (110.98%) compared with other facial expressions: closing eyes (7.85%); blowing out cheeks (39.35%); whistling (11.84%), and showing lower teeth (38.24%). PAMs activity increased in proportion to smile intensity: lips together smile (55.18%); open smile (111.98%); full denture smile (130.07%); and, laughing (269.42%). ConclusionThis study demonstrates that measurement of smile intensity is possible via the sEMG signal from the PAM. Further studies investigating the applicability of measuring PAM activity during smiling to enhance and guide facial palsy rehabilitation are ongoing.

Extracellular Vesicles Derived from Auricular Chondrocytes Facilitate Cartilage Differentiation of Adipose-Derived Mesenchymal Stem Cells.

Adipose-derived mesenchymal stem cell (ADSC)-based therapies have been utilized for cartilage regeneration because of their multi-lineage differentiation ability. However, commonly used cartilage inducers such as the transforming growth factor beta-3 (TGF-β3) may be prone to cartilage dedifferentiation and hypertrophy. The directional differentiation of elastic cartilage is limited nowadays. Extracellular vesicles (EVs) have been reported to influence the specific differentiation of mesenchymal stem cells (MSCs) by reflecting the composition of the parental cells. However, the role of auricular chondrogenic-derived EVs (AC-EVs) in elastic chondrogenic differentiation of ADSCs has not yet been reported. AC-EVs isolated from the external ears of swine exhibited a positive effect on cell proliferation and migration. Furthermore, AC-EVs efficiently promoted chondrogenic differentiation of ADSCs in pellet culture, as shown by the elevated levels of COL2A1, ACAN, and SOX-9 expression. Moreover, there was a significantly higher expression of elastin and a lower expression of the fibrotic marker COL1A1 in comparison with that achieved with TGF-β3. The staining results demonstrated that AC-EVs promoted the deposition of cartilage-specific matrix, which is in good concordance with the real-time polymerase chain reaction (RT-PCR) results. Auricular chondrogenic-derived EVs are a crucial component in elastic chondrogenic differentiation and other biological behaviors of ADSCs, which may be a useful ingredient for cartilage tissue engineering and external ear reconstruction. This journal requires that authors 42 assign a level of evidence to each submission to which 43 Evidence-Based Medicine rankings are applicable. This 44 excludes Review Articles, Book Reviews, and manuscripts 45 that concern Basic Science, Animal Studies, Cadaver 46 Studies, and Experimental Studies. For a full description of 47 these Evidence-Based Medicine ratings, please refer to the 48 Table oôf Contents or the online Instructions to Authors 49 www.springer.com/00266 .

The role for cochlear implants in microtia and congenital aural atresia: A case report and a review of literature

Sensorineural hearing loss resulting from microtia and aural atresia is rare due to different embryologic origins of the external and inner ear. Consequently, cochlear implants are seldom performed in patients with microtia and/or aural atresia. Herein we discuss an 8 year-old boy with congenital aural atresia and microtia who underwent cochlear implant surgery for profound hearing loss with good results. A literature review was performed and discussed. Pre-operative planning with high resolution computed tomography and facial nerve monitoring are crucial in identification and preservation of the facial nerve due to the high rate of aberrant anatomy. Careful incision placement is required particularly if pinna reconstruction is considered. Literature review highlighted various surgical approaches as well as different modalities used for intra-operative facial nerve monitoring. Only one patient had intra-operative complications. Cochlear implant is a viable solution in patients with external ear malformations and severe-profound sensorineural hearing loss. Adequate planning and counselling are essential due to the challenges that may occur in microtia and aural atresia.

The ear of the Sima de los Huesos hominins (Atapuerca, Spain).

Previous studies on the morphology of the inner ear (semicircular canals and cochlea) in the Sima de los Huesos hominin sample have provided important results on the evolution of these structures in the Neandertal lineage. Similarly, studies of the anatomy of the external and middle ear cavities of the Sima de los Huesos hominins have also provided important data on the auditory capacities of this European Middle Pleistocene population. The present contribution provides unpublished data on three new middle ear variables from the Sima de los Huesos fossils and compares these data with values from samples of Pan troglodytes, Homo neanderthalensis and Homo sapiens. The results of this analysis are combined with those obtained in previous studies to characterize the anatomy of the outer, middle and inner ear in the Sima de los Huesos fossils, as well as to establish the order of appearance of the features that characterize Neandertal ears. As in other cranial structures, the ear region in the Sima de los Huesos show a mosaic evolutionary pattern that includes primitive traits, others shared exclusively with Neandertals, and others that are specific to the Sima de los Huesos hominins. Neandertals and Sima de los Huesos hominins share two exclusive features of the middle ear that are among the first characteristics of the Neandertal lineage: a long tympanic cavity and a large entrance and exit of the mastoid antrum. Along with these traits, the Sima de los Huesos hominins present two specialized features: large volumes of the tympanic cavity and the mastoid antrum. Finally, the middle ear of the Neandertals is characterized by the presence of small angles between the tympanic axis and the plane of the oval window.

Risk Factors Associated with Chronic Suppurative Otitis Media in Children.

Abstract:
 Introduction: Chronic suppurative otitis media is one of the foremost infections that cause disabling hearing loss among children in underdeveloped countries, ultimately leading to speech delay and a negative impact on children's intellect and mental health.
 Objective: To identify the risk factors associated with chronic suppurative otitis media, for early detection of disease and prevention of its complications.
 Methodology: It prospective study was conducted at the Department of Ear, Nose, and Throat, Suleman Roshan Medical College, Tando Adam, Sindh, from January 2022 to July 2022. All the children ≤ 15 years with a history of chronically discharging ears were included after parental consent. A detailed history was taken and a comprehensive ENT examination was done. Patients with co-existing external ear infections, congenital anomalies, and a history of previous ear surgery were excluded.
 Results: A total of 396 children participated with male preponderance. The majority of the patients were residents of rural areas. The unilateral and mucosal diseases were more prevailed. The commonest communal co morbidity was a nasal allergy. Other risk factors included rural area residency, the low literacy rate of parents, particularly mothers, and high exposure to passive smoking. 
 Conclusion: The occurrence of chronic suppurative otitis media is highly curable by spreading public education about child health care especially the institution of hygienic living conditions and avoidance of exposure to possible allergens especially tobacco smoke.
 
 Keywords: Eustachian tube, Chronic suppurative otitis media, hearing impairment.

Type 1 Tympanoplasty by Interlay Technique for Management of Tympanic Membrane Perforation

Tympanic membrane is the partition between the external ear and middle layer which is a vital component of the human ear. Neglected or maltreated earache, ear discharge and trauma lead to perforation of tympanic membrane. Tympanoplasty is the surgical procedure performed to repair a perforated tympanic membrane, with/without reconstruction of the ossicles, with the aim of preventing reinfection and restoring hearing ability. Type 1 tympanoplasty is the simple closure of the tympanic membrane perforation. To study the outcome of type 1 tympanoplasty operation by interlay technique, a descriptive longitudinal study was conducted among 200 patients in Community Based Medical College Hospital and in private clinics of Mymensingh from January 2012 to December 2021. Our inclusion criteria was population of age ranging from 15 to 55 yrs of both sexes having dry central perforation for at least 6 weeks and exclusion criteria was patient with active stage of chronic suppurative otitis media (CSOM), ossicular discontinuity, sensory neural hearing loss. Data was analyzed by SPSS version 20.0. Prevalence of taking graft was 96.00%. Measured by difference of preoperative air bone gap (ABG) and postoperative ABG of 15 decibel (dB) hearing improvement rate was 90%. Complication was minimal (1%). The complication was infection due to non-compliance with postoperative advice and treatment. Type 1 tympanoplasty done by interlay technique has excellent results both in terms of graft taken and hearing improvement with minimal complications.
 CBMJ 2023 January: Vol. 12 No. 01 P: 67-72

Long-pulsed neodymium-doped yttrium aluminum garnet for hair reduction in pediatric microtia repair.

Microtia is the term for congenital malformation of the ear in which the external and internal ear are absent or malformed. Surgical reconstruction is a common management approach and occasionally requires hair reduction of the newly constructed auricle. Few studies have investigated lasers for this purpose. Weconducteda retrospective chart review of patients seen at a single institution between 2012 and 2021 who underwent laser hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet laser (Nd:YAG). Efficacy ratings were done through review of clinical photographs. Twelve patients were identified with 14 total ears treated. The number of laser treatments varied from 1 to 9 sessions with an average of 5.1 treatments. The majority (8/12) had an "excellent" or "very good" response, one patient had a "good" response, and three were lost to follow-up. Other than pain, there were no side effects documented. Nd:YAG laser was both effective and safe in our pediatric cohort, without any cutaneous side effects in patients with darker skin.

A genetic Study to Darwin's tubercle trait of External ear in the Population of Salah Al –Dein and Kirkuk

A genetic study for the trait of Darwin's tubercle in two ways : first , on a sample consisted of 52 family from Tikrit city in governorate Salah AL-Dein and 125 individual from their sons and 63 family from governorate of Kirkuk and 188 individual from their sons . Secondly , adoption of pedigree analysis method for seven families from governorate of Salah El-Dein and Kirkuk , which confirmed the darwin's tubercle trait is a genetic trait and the presence of tubercle is dominant absence . The results of Presence Darwin's tubercle also revealed different forms : Nodosity tubercle , Enlargement tubercle and Projection. The present study support the truth of single gene locus hypothesis for the inheritance of this trait , in spite of it record the presence of one offspring have darwin's tubercle between two parents do not have darwin's tubercle in one family. The results of the study distribution of phenotypic for the trait showed on a sample consisted of 1415 individual from the citizens of the governorate of Salah Al-Dein (920♂: 495♀) from the original samples (1446) , an elevated percentage of the presence tubercle among the males (99.2%) than the females (98.4%) . The percentage of presence tubercle in the whole population was (98.9%) . Concering the allelic frequency for the gene of darwin's tubercle, the D allele was observed a higher frequency than the d allele in the whole population of the governorate: 0.895, 0.105 for both of them respectively . Expected frequencies of the three genotypes of darwin's tubercle trait , revealed a prevalence of the homozygous (dominant) genotype DD over the homozygous (recessive) and heterozygous genotype in the population of the governorate: 0.801, 0.188, 0.011 for DD , Dd and dd respectively.

Machine-Learning-Based Detecting of Eyelid Closure and Smiling Using Surface Electromyography of Auricular Muscles in Patients with Postparalytic Facial Synkinesis: A Feasibility Study.

Surface electromyography (EMG) allows reliable detection of muscle activity in all nine intrinsic and extrinsic ear muscles during facial muscle movements. The ear muscles are affected by synkinetic EMG activity in patients with postparalytic facial synkinesis (PFS). The aim of the present work was to establish a machine-learning-based algorithm to detect eyelid closure and smiling in patients with PFS by recording sEMG using surface electromyography of the auricular muscles. Sixteen patients (10 female, 6 male) with PFS were included. EMG acquisition of the anterior auricular muscle, superior auricular muscle, posterior auricular muscle, tragicus muscle, orbicularis oculi muscle, and orbicularis oris muscle was performed on both sides of the face during standardized eye closure and smiling tasks. Machine-learning EMG classification with a support vector machine allowed for the reliable detection of eye closure or smiling from the ear muscle recordings with clear distinction to other mimic expressions. These results show that the EMG of the auricular muscles in patients with PFS may contain enough information to detect facial expressions to trigger a future implant in a closed-loop system for electrostimulation to improve insufficient eye closure and smiling in patients with PFS.

The Role of Asymmetry of the Left and Right External Ear of Bottlenose Dolphin (Tursiops truncatus) in the Spatial Localization of Sound

The Role of Asymmetry of the Left and Right External Ear of Bottlenose Dolphin (Tursiops truncatus) in the Spatial Localization of Sound

Epithelial membrane antigen-reactive feline chordoid meningioma in a European wildcat (Felis silvestris)

Meningioma is the most frequent intracranial neoplasm in cats. Here we describe the first case of chordoid meningioma (CM), a rare grade II meningioma subtype, in a 5.5-year-old European wildcat (Felis silvestris) from a Swiss zoo. The wildcat was found dead after a clinical history of neurological signs and clinical suspicion of a carcinoma in the right external ear canal with concurrent chronic otitis. Post-mortem examination revealed a large intracranial, extra-axial and intradural neoplasm that invaded into the right ear canal and had histological features compatible with CM, which has been only reported in humans and dogs. Neoplastic cells expressed vimentin but were negative for glial fibrillary acidic protein, S100 and pancytokeratin. Immunohistochemistry revealed epithelial membrane antigen (EMA) expression in neoplastic cells. To the best of our knowledge, we provide the first evidence of EMA expression in feline meningioma.

3D printed bionic ear and microtia-anotia: Medical and forensic implications.

Advances in science and technology result in continuous upgrading of the medical and clinical fields. These upgrades have been beneficial to many patients suffering from congenital and developmental diseases causing compromised functionality as well as the structural integrity of the affected organs. One such congenital anomaly is the microtia-anotia spectrum, which results in deformities of the external ear, affecting the hearing capability of an individual. The collaboration and integration of electronics in human biology are exemplified by the development of a 3D printed cyborg bionic ear from the patient's own cells, which is implanted to ameliorate microtia and improve the patient's hearing capacity. Since the late nineteenth century, forensic scientists have explored the external ear, establishing the significance of ear biometrics in the identification process. Similarly, ear prints can also play an important role in identifying the felon of a crime. In this regard, we examine the structure and functionality of implanted ears. This communication is an attempt to enlighten investigators on the forensic importance and limitations of the use of bionic ears for identification.

MEDIA ALTERNATIF EKSTRAK UBI JALAR SEBAGAI MEDIA TUMBUH JAMUR Aspergillus sp dan Candida sp PADA SERUMEN TELINGA PETANI DI KELURAHAN DORPEDU KOTA TERNATE

Fungal are plants that require habitat conditions and high humidity. So it is one of the causes of public health problems in Indonesia. Groups at high risk of fungal infection are farmers because one of them is in direct contact with warm and humid areas at work. Otomycosis is a fungal infection that often occurs in the outer ear. Predisposing factors that influence include high humidity, local trauma which is often caused by the habit of using cotton buds, iron hooks and hair strands, long-term use of steroids and a history of dermatomycosis. Otomycosis is one of the common symptoms that are often found in ENT clinics and its prevalence reaches 9% of all patients who show symptoms and signs of otitis externa with Candida Sp and Aspergillus as the fungal species obtained the most from the oscillates. This study aims to determine the presence of fungal growth in the ear serum of farmers in Dorpedu Village. The location of the sampling was conducted in the Dorpedu Village, Ternate City and the location of this research was carried out at the Integrated Laboratory of the Health Polytechnic of the Ministry of Health of Ternate, Department of Medical Laboratory Technology. The method used in this study is to examine the culture and followed by 10% KOH staining. This study used accidental sampling technique with a sample of 20 farmers' ear serumThe results obtained showed that from 20 samples of farmers' ear serum in Dorpedu Village examined, Candida albicans and Aspergillus sp.: Based on the results of the research conducted, it can be seen that from 20 samples of farmer ear serum in Dorpedu Village, it was found that in the sweet potato extract media there were 17 (85%) positive samples of C. albicans, 1 (5%)positive samples of Aspergillus sp. PDA 20 (100%) samples were positive for C. albicans, and 2 (10%) samples were negative on sweet potato extract media where no fungal colonies were found. Sweet potato extract media can be used as an alternative medium for fungal growth.Keywords: Fungal, ear cerumen swab, otomycosis

Cadaver Homologous Banked Fascia Lata in Skull Base Reconstruction: Preliminary Multidisciplinary Experiences.

Skull base reconstruction has been a widely debated issue. Both autologous and heterologous materials have been proposed, however the formers are usually preferred due to their optimal healing outcomes and integration. Nevertheless they are still associated with donor-site functional and aesthetic morbidity. The aim of this study is to report a preliminary experience of different sites defects skull base repair with Cadaver homologous banked fascia lata graft. Patients who underwent reconstruction of skull base defects with Cadaver homologous banked fascia lata between January 2020 until July 2021 were included in the study. Three patients were finally identified for the study. Patient 1 underwent combined craniotomic-endoscopic surgical access for extended anterior skull base neoplasm with subsequent repair with homologous cadaver fascia lata. Patient 2 underwent endoscopic transphenoidal surgery for sellar-parasellar neoplasm. After tumor debulking the surgical cavity was obliterated with homologous cadaver fascia lata. Patient 3 finally had politrauma with otic capsule-violating fracture with profused CSF leak. An endoscopic obliteration of external and middle ear was performed using homologous cadaver fascia lata with blind sac closure of external auditory canal. No graft displacement or reabsorption was observed in these patients at the last follow-up. Cadaver homologous banked fascia lata has proved safety, efficacy and ductility in reconstruction of different skull base defects. Level of Evidence: Level IV-retrospective cohort study.

An automatic facial landmarking for children with rare diseases.

Two to three thousand syndromes modify facial features: their screening requires the eye of an expert in dysmorphology. A widely used tool in shape characterization is geometric morphometrics based on landmarks, which are precise and reproducible anatomical points. Landmark positioning is user dependent and time consuming. Many automatic landmarking tools are currently available but do not work for children, because they have mainly been trained using photographic databases of healthy adults. Here, we developed a method for building an automatic landmarking pipeline for frontal and lateral facial photographs as well as photographs of external ears. We evaluated the algorithm on patients diagnosed with Treacher Collins (TC) syndrome as it is the most frequent mandibulofacial dysostosis in humans and is clinically recognizable although highly variable in severity. We extracted photographs from the photographic database of the maxillofacial surgery and plastic surgery department of Hôpital Necker-Enfants Malades in Paris, France with the diagnosis of TC syndrome. The control group was built from children admitted for craniofacial trauma or skin lesions. After testing two methods of object detection by bounding boxes, a Haar Cascade-based tool and a Faster Region-based Convolutional Neural Network (Faster R-CNN)-based tool, we evaluated three different automatic annotation algorithms: the patch-based active appearance model (AAM), the holistic AAM, and the constrained local model (CLM). The final error corresponding to the distance between the points placed by automatic annotation and those placed by manual annotation was reported. We included, respectively, 1664, 2044, and 1375 manually annotated frontal, profile, and ear photographs. Object recognition was optimized with the Faster R-CNN-based detector. The best annotation model was the patch-based AAM (p < 0.001 for frontal faces, p=0.082 for profile faces and p < 0.001 for ears). This automatic annotation model resulted in the same classification performance as manually annotated data. Pretraining on public photographs did not improve the performance of the model. We defined a pipeline to create automatic annotation models adapted to faces with congenital anomalies, an essential prerequisite for research in dysmorphology.