Auricular Research Articles

Performance of an Automated Detection Algorithm to Assess Objective Pulsatile Tinnitus.

In this paper we describe an automated detection algorithm that objectively detects pulsatile tinnitus (PT) and investigate its performance. Sound measurements were made with a sensitive microphone placed in the outer ear canal in 36 PT-patients referred to our tertiary clinic, along with a registration of the heart rate. A novel algorithm expressed the coherence between the recorded sound and heart rate as a pulsatility index. This index was determined for 6 octave bands of the recorded sound. We assessed the performance of the detection algorithm by comparing it with the judgement of 3 blinded observers. The algorithm showed good agreement compared with the majority judgement of the blinded observers (ROC AUC 0.83). Interobserver reliability for detecting PT in sound recordings by the three blinded observers was substantial (Fleiss's κ=0.64). The algorithm may be a reliable alternative to subjective assessments of in-canal sound measurements in PT-patients, thus providing clinicians with an objective measure to differentiate between subjective and objective pulsatile tinnitus.

Brachytherapy in the Treatment of Non-Melanoma Skin Peri-Auricular Cancers-A Retrospective Analysis of a Single Institution Experience.

This paper presents the results of a retrospective analysis of 33 patients treated with contact or interstitial high-dose-rate (HDR) brachytherapy for skin cancers of the outer ear, involving the auricle and the skin of the adjacent area. Brachytherapy was used both as a definitive treatment (15 patients-43%) and adjuvant treatment after surgery (18 patients-57%). The basic criterion for adjuvant treatment was a positive or narrow (<1 mm) resection margin. Fraction doses from 3 to 7 Gy per fraction were used at intervals from six hours (interstitial brachytherapy) to a maximum of seven days (contact brachytherapy). The treatment time ranged from 1 to 42 days, and the total dose range was 7 to 49 Gy. The follow-up was 29.75 months (range 2-64). In the group of patients treated with adjuvant therapy, in the patients with post-radiation reaction, the mean time from surgery to the start of brachytherapy was 7.72 ± 3.05 weeks, the median was 8 (6-12) weeks, and in the group without post-radiation reaction, the mean time was 11.13 ± 4.41 weeks, the median time was 11 weeks (8-14). The risk of a post-radiation reaction increased significantly more often in patients with more advanced disease. In the case of contact brachytherapy, the post-radiation reaction occurred significantly more often (14/21 patients-43%) than in the case of interstitial brachytherapy (3/11 patients-9.4%). In patients with post-radiation reactions, a significantly larger volume of the skin receiving a dose of 200% was found, and the volume receiving a dose of 150% was close to statistical significance. The mean volume of the skin receiving a 200% dose in the group with post-radiation reactions was 28.05 ± 16.56 cm3, the median was 24.86 (0.5-52.3) cm3, and the mean volume in the group without post-radiation reaction was 17.98 ± 10.96 cm3, median 14.95 (3.9-44.96) cm3. The result was statistically significant (Z = 2.035, p = 0.041). Interstitial HDR (high-dose-rate) brachytherapy for non-melanoma skin cancers around the ear is highly effective, short, and has a relatively low burden on the patient. The toxicity of the treatment was low. In the case of contact brachytherapy, the toxicity profile is slightly higher but acceptable for patients. This method is preferred in patients in whom interstitial brachytherapy is impossible to perform due to anatomical and logistical reasons. The unquestionable advantage of contact brachytherapy is its ability to be performed on an outpatient basis without the need to stay in the hospital. No severe and late CTCAE ≥III and late RTOG ≥III toxicity was observed. In patients after surgery, in order to minimise the risk of radiation reaction, it is optimal to start treatment at least eight weeks after surgery. In the presence of extensive lesions, the use of interstitial brachytherapy seems to be more advantageous, especially when the expected volume of healthy skin in the dose range of 200% and 150% is above 15 cm3 and 50 cm3, respectively.

Combined spectroscopic, biochemical and chemometric approach toward finding of biochemical markers of obesity

BackgroundEarly-stage detection of subclinical obesity-driven systemic changes is a challenging area of medical diagnostics, where the most popular existing measures – such as body mass index – BMI – often fall short of providing a realistic estimate of adiposity and, therefore, of ongoing pathologies at the systemic, tissue and cellular level. In the quest for identifying new more robust diagnostic markers, whole-organ analysis of chemical elements is a promising approach for identifying candidate proxies of obesity status in the system. MethodsTotal Reflection X-ray fluorescence (TXRF) coupled with biochemical assays, chemometrics and statistical validation was used as a new integrated pipeline for marker identification in external ear samples of obese animals. The specimens were taken from obese animals fed a high calorie diet as well as from lean intact animals fed a standard diet. ResultsThe most significant differences in the content of K, Fe, Br, and Rb between the studied groups of the animals were identified. However, with the methodology applied Rb was found the most robust biochemical discriminator of early-stage obesity effects, as validated by the logistic regression model. We observed no relationship between the levels of the elements consumed by the animals and their apparent content in the earlobe tissue samples. ConclusionsOur preliminary study confirms that obesity alters tissue trace metal metabolism and shows the proposed new approach as an accurate and reliable methodology for detecting tissue elemental obesity-related alterations. General significanceThis result can be of practical significance for designing new point-of-care systems for obesity screening tests, taking advantage of direct/indirect Rb measurements.

Distribution of Earlobe Attachment among Kalabari People of Southern Nigeria

Background: In documenting anthropological characteristics of a population, the earlobe attachment is one of the anthropological parameters that is considered. Indigenous populations in Nigeria have had some of their anthropological features documented. Hence, this study was aimed at determining the distribution of earlobe attachment among the Kalabari people of Southern Nigeria. Materials and Methods: The study was descriptive and cross-sectional which involved a total of 1342 subjects which comprised 671 males and 671 females who were sampled conveniently. The participants were all from Kalabari ethnic group in Rivers State (south-south) Nigeria. All subjects included in the study were indigenes of the Kalabari extraction, participants who had distortions or any form of structural anomaly of the external ear were excluded. Results and Discussions: The distribution of earlobe attachment based on gender and total population showed thus: males [free 390(58.1%), attached 281(41.9%), total 671(100.0%)]; females [free 407(60.6%), attached 290(39.4%), total 671(100.0%)]; Total population gave thus [free 797(59.4%), attached 571(40.6%), total 1,342(100.0%)]. Conclusion: The attached and detached (free) earlobes were both more frequent in the females than the males. In general, the ratio of free (detached) and attached is 8:6. The study revealed that free (detached) earlobe was more frequently distributed than the attached among the Kalabari people. Keywords: Earlobe, Attached, Detached/free, Kalabari, Nigeria.

A methodological comparison of discriminant function analysis and binary logistic regression for estimating sex in forensic research and case-work.

The purpose of this study is to assess the accuracy of two multivariate statistical approaches for estimating sex from human external ear anthropometry, namely, discriminant function analysis (DFA) and binary logistic regression (BLR). A cross-sectional sample of 497 participants (233 males and 264 females) aged 18-35 years (24.42 ± 5.17) was obtained from Himachal Pradesh state of North India. Both the ears of the participants (994) were examined for anthropometric measurements. A total of 12 anthropometric measurements were taken independently on the left and right ear of each individual with the help of a pair of sliding calipers using a standard method. The sex of the population groups was discriminated against using binary logistic regression and discriminant function analysis. The predictive percentage of sex estimation computed from both the models were substantially the same, that is, 76.3% from DFA and 76.2% from BLR, with nearly comparable (∼0.02) sensitivity, specificity, positive predictive value, and negative predictive values, whereas the values of correct predicted percentage were 0.1% higher in DFA than BLR. Moreover, the other comparison metrics, such as classification error, B-index, and Matthews correlation coefficient indicated that both models performed equally well. The study highlighted that if the assumptions of the statistical methods are met, both methods are equally capable of discriminating the population depending on sex. The study recommends that the discriminant function analysis and binary logistic regression may be used synonymously in forensic research and case-work pertaining to the estimation of sex and various other forensic situations.

Sound energy absorbance changes in the elderly with presbycusis with normal outer and middle ear.

This study aimed to investigate the wideband tympanometry (WBT) findings in the elderly with presbycusis who have normal outer and middle ears according to otoscopic examination and traditional tympanometry, and to determine whether there is a relationship between the middle ear wideband absorbance value and the pure tone air-bone gap (ABG) observed especially at mid-high frequencies in the elderly. The study included 30 elderly with presbycusis (> 65years old, presbycusis group) and 30 healthy individuals (control group) between the ages of 18 and 55. Pure tone air conduction and bone conduction thresholds of all participants were determined and WBT was applied to all participants. Resonance frequency (RF), absorbance ratios at peak pressure (PPAR) and ambient pressure (APAR) values were analyzed. The RF value of the presbycusis group was lower than the control group (p < 0.05). APAR and PPAR values at 2000 and 4000Hz and mean absorbance values of the presbycusis group were lower than the control group (p < 0.05). APAR was higher at 500Hz in males than females (p < 0.05), but there was no difference between genders in RFs (p > 0.05). A moderate negative correlation was observed between ABG and both PPAR and APAR at 4000Hz in presbycusis group (p < 0.05). it was determined that there was a decrease in RF and absorbances at 2000 and 4000Hz in the elderly with presbycusis. Aging affects not only the inner ear but also the conduction mechanism of the middle ear. Our findings may be effective in a more accurate and reliable interpretation of WBT in the elderly with presbycusis.

Time-varying caloric vestibular stimulation for the treatment of neurodegenerative disease.

Time-varying caloric vestibular stimulation (tvCVS) is a new form of non-invasive neuromodulation similar to, but different from, diagnostic caloric vestibular stimulation (CVS). Using a non-invasive, solid-state delivery device, tvCVS has been successfully used in a human clinical trial with Parkinson's disease (PD) subjects. Additionally, the effects of tvCVS on brain activation have been studied in healthy human subjects using transcranial Doppler sonography (TCD) and functional magnetic resonance imaging (BOLD fMRI). A novel finding in the TCD and fMRI studies was the induction of cerebral blood flow velocity (CBFv) oscillations. How such oscillations might lead to the observed clinical effects seen in PD subjects will be discussed. Enabling studies of tvCVS with rodents is an attractive goal in support of explorations of the mechanism of action. Male Wistar rats were used in a proof-of-concept study described herein. Rats were anesthetized (isoflurane) and ventilated for the duration of the tvCVS runs. Time-varying thermal stimuli were administered using a digital temperature controller to modulate Peltier-type heater/cooler devices. Blunt ear bars conveyed the thermal stimulus to the external ear canals of the rats. Different thermal waveform combinations were evaluated for evidence of successful induction of the CVS effect. It was found that bilateral triangular thermal waveforms could induce oscillations in CBFv both during and after the application of tvCVS. These oscillations were similar to, but different from those observed in awake human subjects. The establishment of a viable animal model for the study of tvCVS will augment ongoing clinical investigations of this new form of neuromodulation in patients with neurodegenerative disease.

CeruminousSyringocystadenoma papilliferum: An Extremely Rare Neoplasm of the External Ear

Abstract Introduction/Objective Syringocystadenoma papilliferum (SCAP) is a rare benign adnexal tumor derived from the apocrine or the eccrine sweat glands on the face or the scalp. Ceruminous glands are modified apocrine glands in the external auditory canal and produce cerumen that helps the ear canal against physical damage and microbial invasion. Neoplastic transformation of these glands is even rarer among these benign tumors. Methods/Case Report Here we report a case of a 29-year-old female with a three-month history of progressively worsening right-sided ear pain, muffled hearing, aural fullness, and right-sided shooting aches. She reported that her ear felt sensitive to touch and was painful if she lay on it. Previous treatments included steroids and oral antibiotics without any improvement in symptoms. A physical exam revealed a right narrow ear canal with a cystic mass to the superior lateral canal wall. A CT Temporal Bone showed a 1 cm oval soft tissue lesion in the lateral osseous portion of the right external auditory canal with no underlying osseous erosions identified. This is nonspecific, and neoplasm cannot be excluded. The decision was made for excision. The mass ruptured during excision with dishwater appearing fluid. Microscopic examination showed papillae lined by bilayered glandular epithelium projecting into a cystic lumen. Well defined myoepithelial cell layer is appreciated. Decapitation secretions and plasma cells are noted to be present in the stroma. A final diagnosis of Syringocystadenoma papilliferum is made. Results (if a Case Study enter NA) NA. Conclusion Ceruminous Syringocystadenoma papilliferum is an extremely rare benign tumor of the ceruminous glands of the external ear. Complete excision is the treatment of choice

Clinical application of a self-developed suction-irrigation device in endoscopic ear surgery for attic cholesteatoma

Objective: To introduce a new self-developed irrigation device(SID) that does not employ a sheath or an irrigation-suction system and evaluate to its efficiency in transcanal endoscopic ear surgery (TEES) for attic cholesteatoma. Methods: 38 patients who were subjected to TEES for attic cholesteatoma between October 2019 to June 2021 were included in this study, including 17 males and 21 females with an average age of (38.6±11.9) years. SID and underwater continuous drilling were used during operation. Width of endoscope and irrigation speed were measured when SID was applied. The operating time, surgical view and complications were compared between two groups. Results: The width of the endoscope was 3.5-4.6 mm in diameter and the irrigation speed was 20-40 ml/min when SID was used. SID cleaned the lens at the tip of the endoscope and created a clear field of view during TEES. The operation time was (86.6±18.1) min. The skin of the external ear canal was found injured during operation in 3 patients, but there were no complications such as necrosis of the flap, stenosis of external ear canal, sensorineural hearing loss, facial paralysis and cerebrospinal fluid leakage. Conclusions: SID is simple and enhances the efficacy of TEES, providing a new irrigation choice in TEES for attic cholesteatoma.

External and middle ear influence on envelope following responses.

Considerable between-subject variability in envelope following response (EFR) amplitude limits its clinical translation. Based on a pattern of lower amplitude and larger variability in the low (<1.2 kHz) and high (>8 kHz), relative to mid (1-3 kHz) frequency carriers, we hypothesized that the between-subject variability in external and middle ear (EM) contribute to between-subject variability in EFR amplitude. It is predicted that equalizing the stimulus reaching the cochlea by accounting for EM differences using forward pressure level (FPL) calibration would at least partially improve response amplitude and reduce between-subject variability. In 21 young normal hearing adults, EFRs of four modulation rates (91, 96, 101, and 106 Hz) were measured concurrently from four frequency bands [low (0.091-1.2 kHz), mid (1-3 kHz), high (4-5.4 kHz), and very high (vHigh; 8-9.4 kHz)], respectively, with 12 harmonics each. The results indicate that FPL calibration in-ear and in a coupler leads to larger EFR amplitudes in the low and vHigh frequency bands relative to conventional coupler root-mean-square calibration. However, improvement in variability was modest with FPL calibration. This lack of a statistically significant improvement in variability suggests that the dominant source of variability in EFR amplitude may arise from cochlear and/or neural processing.

Clues for facial canal dehiscence in chronic otitis media

Introduction and objectivesThe goal of this study was to determine the impact of external and middle ear findings in the incidence of facial canal dehiscence (FCD) during mastoidectomy for chronic otitis media. Material and methodsWe examined the operative details of 186 patients who underwent primary tympanomastoidectomy for chronic otitis media between January 2015 and January 2020 retrospectively.In this study we only evaluated the second portion of the facial nerve canal. ResultsThe global prevalence of FCD was 22.6% (42/186 patients) with a higher incidence, of 38.7% (36/93), in patients with chronic otitis media with cholesteatoma (C-COM).Associations were found between facial canal dehiscence, labyrinthine fistula (p˂ .001) and facial nerve paralysis (p˂ .001).Ossicular erosions were observed at a significant level in patients with facial canal dehiscence, the incidence of FCD was significantly higher (p=.005, Odds ratio 5.489) when malleus and incus were eroded, incus plus stapes were eroded (p=.014; OR 4.059) and malleus, incus, and stapes together were eroded (p=.002; OR 4.929). ConclusionsThis study revealed an incidence of facial canal dehiscence of 22.6%. It also revealed that the presence of lateral semicircular canal fistula is associated with a higher prevalence of facial canal dehiscence.The same was noted in the case of some ossicular erosions, especially the combinations of eroded malleus and incus, incus and stapes, and all 3 ossicles.These findings raise awareness about the usefulness of middle ear findings in predicting FCD, thus providing valuable information for the otological surgeon to avoid iatrogenic injuries.

Frameworks for Total Ear Reconstruction: Past, Present and Future Directions

Total ear reconstruction describes surgical approaches aimed toward restoring the external ear to correct acquired or congenital deformities. Frameworks for auricular reconstruction have undergone substantial evolution over the past century and are broadly categorized as either autologous or alloplastic in nature. Recently, advances in tissue engineering, regenerative medicine and materials science have opened new avenues for recreating the cartilaginous and soft tissue structures of the ear through development of cutting-edge 3D constructs derived from a patient's own cells in a process known as bioprinting. This review outlines the historical approaches to frameworks for ear reconstruction and provides an updated synopsis and appraisal of current bioprinting efforts.

Clinical and biochemical footprints of inherited metabolic diseases. IX. Metabolic ear disease.

Damages to the ear are very diverse and can depend on the type of inherited metabolic diseases (IMD). Indeed, IMDs can affect all parts of the auditory system, from the outer ear to the central auditory process. We have identified 219 IMDs associated with various types of ear involvement which we classified into five groups according to the lesion site of the auditory system: congenital external ear abnormalities, acquired external ear abnormalities, middle ear involvement, inner ear or retrocochlear involvement, and unspecified hearing loss. This represents the ninth issue in a series of educational summaries providing a comprehensive and updated list of metabolic differential diagnoses according to system involvement.

Deciphering Epigenetic Backgrounds in a Korean Cohort with Beckwith-Wiedemann Syndrome.

Beckwith-Wiedemann syndrome (BWS) is a congenital overgrowth disorder caused by genetic or epigenetic alterations at two imprinting centers (ICs) in the 11p15.5 region. Delineation of the molecular defects is important for prognosis and predicting familial recurrence. We evaluated epigenetic alterations and potential epigenotype-phenotype correlations in Korean children with BWS. Forty children with BWS with proven genetic or epigenetic defects in the 11p15.5 region were included. The phenotype was scored using the BWS consensus scoring system. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA), bisulfite pyrosequencing, a single-nucleotide polymorphism microarray, and CDKN1C sequencing were used for confirmative diagnosis. Patients met the criteria for genetic testing, with a mean clinical score of 5.4±2.0. Methylation alterations were consistent between MS-MLPA and bisulfite pyrosequencing in all patients. Twenty-six patients (65.0%) had IC2 loss of methylation (IC2-LoM), 11 (27.5%) had paternal uniparental disomy (patUPD), and one (2.5%) had IC1 gain of methylation. Macroglossia and external ear anomalies were more common in IC2-LoM than in patUPD, and lateralized overgrowth was more common in patUPD than in IC2-LoM (all P<0.05). Methylation levels at IC2 were inversely correlated with birth weight standard deviation score (r=-0.476, P=0.014) and clinical score (r=-0.520, P=0.006) in the IC2-LoM group. Comprehensive molecular analysis of the 11p15.5 region revealed epigenotype-phenotype correlations in our BWS cohort. Bisulfite pyrosequencing can help clarify epigenotypes. Methylation levels were correlated with fetal growth and clinical severity in patients with BWS.

Major Burns After Lightning Strikes at Field: Case Report

Lightning injuries can cause multi-organ damage such as burns, ear damage, and nervous system damage. The type of Burns in this trauma consists of linear or flash burns, punctate burns, thermal injuries, Lichtenburg figures, and combination wounds which are generally superficial and heal faster. Lightning strikes also cause ear damage in the form of perforation of the tympanic membrane, bleeding, and micro fractures in the cochlea. The sequelae in lightning injury survivors consist of permanent brain injury, chronic pain syndrome, peripheral neuropathy, and blindness. This case is a man, 20 years old, working as a farmer, referred to the hospital because he was struck by lightning while working in the middle of the rice fields during heavy rain. There were complaints of pain, heat throughout the body, and decreased hearing in both ears in the anamnesis. Physical examination showed a general condition within normal limits. Local status examination found burns as large as 31.5% of the body area, with 2a degree burns (partial thickness) on the chest, back, upper and lower limbs. Examination of the outer and middle ear revealed no abnormalities. The principle of the treatment refers to the electric burns treatment with initial therapy in fluid resuscitation, evaluation of ECG, adequate analgesia, and wound care. The advanced phase of the treatment focuses on treating the burns and evaluating the hearing loss. Adequate care for nine days showed that the wound was epithelialized by 60% of the total wound area and without any other complaints. This case is essential to be studied considering that Indonesia's natural conditions allow for lightning strikes, especially during the rainy season, so lightning is a threat to farmers as a part of the agro-industrial community.&#x0D; Keywords: Lightning injuries, burns, agroindustrial

Association among the morphological characteristics of the human ear – An approach towards forensic identification

Introduction and objectivesThe human external ear has intricate anatomy due to the presence of elevated and depressed structures which form the morphological characteristics of the external ear. It has been observed that they have some form of interdependence. Therefore, the present study is aimed to investigate the association amongst the morphological characteristics of the external ear and its feasibility for forensic identification. Material and methodsA cross-sectional sample of 497 participants (233 males and 264 females) aged 18–35 years (24.42 ± 5.17) was taken for the study. The data was collected from the district Solan of Himachal Pradesh, North India. Both the ears of the participants were examined for various morphological characteristics. The shape of the external ear, the contour shape of the supero-anterior, superior and supero-posterior helix, and other morphological characteristics were analyzed and classified based on the shape, rolling, contour shape, the strength of the elevated structures, and other factors. The associations between the morphological characteristics were investigated using chi-square and correspondence analysis, while Cramer’s V test was used to determine the strength of the association. ResultsA total number of 33 morphological characteristics were considered for the present study. Each morphological characteristic was compared with the other 32 parameters. Therefore, a total number of 1056 (33 ×32) pairs were examined, with only 587 pairs showing a statistically significant association. The shape of the external ear, for example, has a significant association with 25 out of 32 morphological characteristics, including rolling of the superior and posterior helix, the contour shape of the supero-anterior, superior, supero-posterior helix, etc. Moreover, all the statistically significant pairs were subjected to correspondence analysis to evaluate the measure of their association. Wide rolled superior helix, for example, is closely associated with a round-shaped external ear, implying that if a person has a wide rolled superior helix, he or she is more likely to have a round-shaped external ear. ConclusionThe present study has explored and developed the database of the association of the morphological characteristics of the external ear. The database may be useful in predicting the shape and size of the external ear from some of these characteristics. The findings could be utilized during facial reconstruction in forensic examinations and the reconstruction of deformed ears. This study, therefore, finds that the morphological features of the ear are an important addition to the arsenal of the forensic investigator.

Auricular Reconstruction: Modifications to Classification and Surgical Approach

PURPOSE: One of the primary treatments for microtia is two-stage autogenous auricular reconstruction. The first stage involves a costal cartilage framework inset, and the second stage elevates the framework using fascial flaps, wedge cartilage grafts, and skin grafts. We present modifications to the conceptual classifications and surgical approach to auricular reconstruction with a focus on small concha-type microtia. MODIFICATION OF TECHNIQUE: 1) Microtia is classified into four sub-categories: lobule type, conchal type, small concha-type, and anotia. Planning the surgical approach begins with accurately identifying the category. Small concha-type microtia is often overlooked or thought to be a simple indentation in the conchal bowl region. The small concha is often a cavity, instead of an indentation, and located anteriorly to the normal conchal bowl. 2) The proper location of the ear can be determined by constructing an ‘auricular rectangle,’ a term coined by the senior author that utilizes multiple topographic references of the unaffected side in unilateral microtia: top of upper helix, caudal end of lobule, Frankfurt Horizontal line, shape of hairline, and face mask. If the face is asymmetrical like in severe hemifacial microsomia, identification of the auricular rectangle is more challenging and perfect symmetry is less attainable. Identifying the proper location of the ear is crucial to gauge if the vestige is in a surgically-usable location. 3) Surgical technique has evolved from a V- to W-shaped incision along the posterior surface of the auricle to maximize the skin surface area and create the deep concha. The W-shape also creates a superior advancement of the vestige. If the vestige is located at the same height as the unaffected side, the flap is more U-shaped. Additionally, the W-shape can be made asymmetric to create the desired 10-15 degree posterior inclination of the ear framework. 4) The hallmark of small concha-type microtia is that the small concha is not located in the correct anatomic location, so the skin flap elevated off the indent is too anteriorly positioned to be used for the tragus as much of the literature suggests. The small concha skin pocket should instead be excised. 5) After vestigial cartilage is removed and the cartilage framework is inserted around the subcutaneous pedicle of W-flap, the anterior lobule flap and transposed W-flap are closed. Temporary suction is applied to adhere the skin envelope to the framework. The final location and posterior inclination of the ear is determined, which reveals the areas of redundant skin, typically the anterior helix. Although conventional teachings do not include skin trimming, the senior author finds that horizontal wound closure has been successful in providing uninterrupted blood supply while preventing ischemia after years of training under Satoru Nagata and years of independent practice. CONCLUSION: These modifications advance our understanding of microtia classifications and how the surgical approach can be tailored to best utilize each component of the vestige. The functional outcomes of auricular reconstruction are especially important in light of the coronavirus disease 2019 (COVID-19) pandemic where the ability to wear masks relies on external ear function.

Outcomes Following Proton Radiotherapy for Pediatric Salivary Gland Tumors

<h3>Purpose/Objective(s)</h3> In contrast to adult salivary gland tumors, our institutional guidelines in children utilize lower radiation doses, smaller target margins, and proton therapy to minimize radiation to the developing skull base anatomy. Furthermore, we do not routinely recommend prophylactic nodal irradiation or elective neck dissection. Previous series of children treated with adjuvant radiation therapy report 5-year local control ∼85%. Herein we report treatment outcomes using our pediatric approach. <h3>Materials/Methods</h3> Twenty-seven consecutive pediatric patients were treated with proton therapy between 2006 and 2020 for mucoepidermoid carcinoma (n= 13), acinic cell carcinoma (n= 5), adenoid cystic carcinoma (n= 4), pleomorphic adenoma (n= 2), myoepithelial carcinoma (n= 1), adenocarcinoma (n= 1), and sialoblastoma (n= 1) at our institution. The 8 patients with radiographic lymphadenopathy (cN1) underwent neck dissection prior to presentation (7/8 selective dissections involving <4 nodal levels). The most common indications for adjuvant radiotherapy were microscopic positive or close (<1 mm) margins (n=15), perineural invasion (PNI; n=9), high-grade histology (n=6), and gross residual disease (n=4). Radiotherapy was delivered in sequential plans using 2 clinical target volumes (CTV1, CTV2). Gross tumor volume (GTV=CTV2) included the residual tumor and tumor bed. CTV1 received 50.4 Gy and was defined as GTV + 1 cm and the at-risk neck if indicated. The dose to CTV2 depended on histology, grade, and margin status. The median total dose was 64.8 Gy (range, 61.2-70.2 Gy). Only 3 patients underwent prophylactic nodal irradiation. Toxicity data was graded based on CTCAE v3 or v4 using patient-reported and physician-reported outcomes according to our prospective outcome registry. <h3>Results</h3> The median follow-up was 5.5 years. Overall survival was 100% and local control was 96% with a single local recurrence seen in a patient with gross unresectable disease. There were no nodal recurrences. In terms of acute toxicity, 3 patients experienced mucositis requiring opioid pain medication and 2 patients developed grade 3 radiation dermatitis. The most serious late toxicity involved the ear or auditory system including 4 patients requiring hearing aids, 1 with chronic otitis media, 1 with osteonecrosis of the mastoid bone, and 1 with external ear canal stenosis. Four additional patients reported variable hearing loss not requiring hearing aids. Other serious late toxicity included 1 patient with persistent trismus, 1 with growth hormone deficiency, and 1 with excessive dental caries along the ipsilateral maxilla. No secondary malignancies nor toxicities grade ≥ 4 were seen. <h3>Conclusion</h3> An approach of conservative neck management and moderate-dose proton radiotherapy delivered to small volumes resulted in excellent disease control and limited toxicity in children with common salivary gland tumors at elevated risk of local recurrence.

The spread of dogs’ otitis in Odesa city

Inflammation of the external ear in dogs is a widespread pathology in 20 % of sick animals that come to veterinary medicine clinics. The purpose of the work was to monitor the spread of otitis in dogs for 2021 in Odesa. To solve this goal, several tasks were set: to study the spread of otitis among dogs by breed, age, and sex; to study the spread of Malassezia otitis among dogs; to determine the seasonality of otitis in dogs. The data from the journal of registration of sick animals of the veterinary clinic of Odessa (VetKOiN) served as the material. Data concerning sick animals from the logbook were entered into tables, and statistical analysis was carried out. Dogs of Pugs and Mestizo made up the most significant number of sick animals with otitis (10.4 % each); the French Bulldog breed accounts for 9.1 %, the Pekinese and Labrador breeds – 6.5 % each, the Clamber Spaniel breed – 5.2 %. Such dog breeds as Jack Russell Terrier, Chihuahua, Spitz, German Shepherd, and Cane Corso account for 3.9 %; Bull Terrier, East European Shepherd, and Retriever – 2.6 % each; Grünendal, Husky, Samoyed, Kangal, Dachshund, Scottish Shepherd, Shar-Pei, Bolonka, Beagle, American Cocker Spaniel, Shih-Tzu, Laika, Fox Terrier, Staffordshire Terrier, Pit Bull Terrier, American Bully, Breton, Bernese Mountain Dog, English Bulldog breeds – 1.3 % each. Animals between the ages of 1 and 5 years suffer mostly from canine otitis (64 %) and animals under the age of 1 year suffer less(10 %). Animals older than five years make up 26 %. The gender of dogs is not important in otitis spreading: females account for 49 % of sick animals, and males – 51 %. Malassezia otitis in dogs occurred in 38 % of cases. Dogs of Pug breeds comprised the largest percentage of sick animals (13.8 %), French bulldog and Pekingese breeds – (10.3 % each). The Bull Terrier, Jack Russell Terrier, and Chihuahua breed each account for 6.9 %. Otitis was registered every month during the year. An increase in the incidence was observed in April (9.1 %), May (13.0 %), June (7.8 %), July (15.6 %), August (13.0 %), September (10.4 % ) and November (10.4 %). So otitis was more often registered in dogs in the warm season. In the future, the spread, etiology, and most effective treatment regimens of various forms of otitis in dogs will be studied.

A Population-Based Analysis of Treatment, Survival, and Demographics in Otologic Malignancies

Introduction: Otologic (external ear, middle ear, and temporal bone) malignancies are relatively uncommon tumors. Their location adjacent to vital structures such as the carotid artery, jugular vein, otic capsule, and temporal lobe makes treatment potentially challenging. Objective: The purpose of this study was to examine overall survival outcomes in patients with otologic malignancies obtained via a population-based cancer database. Methods: A search of the Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients treated for external ear, middle ear, and temporal bone malignancies from 1973-2018. Demographic and overall survival data were compiled and analyzed using Kaplan-Meier and logistic regression analysis. Results: The SEER database identified 9317 patients with otologic malignancies. Multivariate analysis of the SEER data showed that age, race, sex, subsite, histopathological type, overall stage, T, N, and M stage, and treatment type significantly affected overall survival. Conclusion: This study examined data on demographics, treatment, and survival of patients with otologic malignancies utilizing the population-based SEER database. Overall stage and T, N, and M stages, patient age, sex, race, treatment type, and histopathological type all appear to significantly impact overall survival. Patients treated with surgery as part of their treatment regimen appeared to have higher 5-year overall survival than patients treated nonsurgically.