Permanent Loss Research Articles

How Do Enriched Speech Acoustics Support Language Acquisition in Children With Hearing Loss? A Narrative Review.

Language outcomes of children with hearing loss remain heterogeneous despite recent advances in treatment and intervention. Consonants with high frequency, in particular, continue to pose challenges to affected children's speech perception and production. In this review, the authors evaluate findings of how enriched child-directed speech and song might function as a form of early family-centered intervention to remedy the effects of hearing loss on consonant acquisition already during infancy. First, they review the developmental trajectory of consonant acquisition and how it is impeded by permanent pediatric hearing loss. Second, they assess how phonetic-prosodic and lexico-structural features of caregiver speech and song could facilitate acquisition of consonants in the high-frequency range. Last, recommendations for clinical routines and further research are expressed.

Orbital Cellulitis Secondary to Dacryocystitis: A Case Series and Literature Review.

This study aimed to determine risk factors, and describe management and outcomes in patients who developed orbital cellulitis secondary to dacryocystitis. Multicenter retrospective case series with 18 patients and review of published cases. The mean age was 62 years, 56% were female and 50% had recurrent dacryocystitis. Visual acuity was reduced in the affected eye with a mean of 0.27 logMAR (Snellen 20/40) which improved to 0.15 logMAR (Snellen 20/30) at final follow up. Two cases (12%) had dacryoliths and 1 patient had sarcoidosis within the lacrimal sac. Gram-positive bacteria were identified in 73% (11/15), gram-negative bacteria in 13% (2/15), and mixed infection in 13% (2/15), respectively. Cases who had dacryocystorhinostomy as definitive treatment, either acutely (n = 3) or electively (n = 10) had full resolution. Transcutaneous drainage of the medial wall abscess in 10 patients helped resolve acute cellulitis. Four patients declined dacryocystorhinostomy after transcutaneous drainage; 2 had repeated dacryocystitis and orbital cellulitis, while 2 had no further infective episodes. One immunosuppressed patient had rapid progression to non-perception-of-light vision due to fungal invasion. Forty-six published cases reported up to 28% permanent loss of vision (perception-of-light and non-perception-of-light). Dacryoliths were discovered in 17% of published cases. Orbital cellulitis complicating dacryocystitis appears to be related to recurrent dacryocystitis and possibly the presence of dacryoliths. Immunosuppression is identified as a poor prognostic factor in this series. While transcutaneous drainage works well as a temporizing measure, dacryocystorhinostomy either done acutely or deferred until resolution of orbital cellulitis is required for definitive cure.

Etiopathological study of Ardita w.s.r. to Facial Paralysis - An observational study

Ardita is one of the Vata Vyadhis which is caused by aggravation of Vata. Ardita has been enlisted amongst the eighty types of Nanatmaja Vata Vyadhis. The vitiation of Vata especially aggravation of Vata causes ‘Ardita’ as mentioned in almost all Ayurvedic classics. Acharya Charaka has included Sharirardha in Ardita while Sushruta has considered only face or upper part of the body is affected in Ardita. Ardita can be co-related with facial paralysis on the basis of its signs and symptoms mentioned in texts. Here, temporary suspension or permanent loss of function, especially loss of sensation or voluntary motion of unilateral side of face is considered. It occurs due to any injury or inflammation to facial-VIIth cranial nerve, which leads to partial or total loss of movement of unilateral face. Actually, facial paralysis leads to a disability of interaction by loss of facial expression, which is a major part of human communication. It may reoccur or leave synkinesis. Modern science found drugs like steroid and Antivirals etc. for it, also surgical and other treatments are available for facial paralysis. Yet, its recurrence and synkinesis also reported. Facial function plays an integral part in everyday lives disability of both verbal communication and facial expressions are hampered in Ardita. It is a condition that causes temporary weakness or paralysis of muscles in face.

Cerebral Death: Unraveling the Mystery of the Silent Mind

The permanent loss of all brain stem functions, such as breathing, awareness, and cranial nerve reflexes, is known as brain stem death (BSD), and it presents a significant medical and ethical issue. While other bodily functions, such as heart activity and circulation, can be maintained with medical intervention, BSD is defined by the cessation of brain stem activity. The key characteristic that distinguishes BSD from other conditions, such as coma or a persistent vegetative state, is the complete and irreversible loss of brain stem function—a critical control centre for basic physiological processes. Diagnosing BSD requires strict clinical criteria and diagnostic testing to confirm the full and permanent nature of the condition. This typically involves a comprehensive neurological examination, assessment of cranial nerve reflexes, and confirmation through additional tests, such as cerebral blood flow studies or electroencephalography (EEG). A diagnosis of BSD carries significant ethical and legal implications, particularly in relation to organ donation, as it often plays a role in identifying potential donors. The ethical considerations surrounding BSD include its impact on families, the distinction between death and end-of-life care, and the challenges posed by varying legal and cultural perspectives. It highlights the importance of a clear diagnosis, obtaining informed consent, and adhering to established medical protocols to uphold human dignity and ethical standards. As medical technology advances and societal views evolve, the discussion around brain stem death continues to be a critical issue in both bioethics and modern medical practice.

Preparation of PBAT/PLA Blend Microporous Foam With Excellent Resilience and Cushioning Properties by scCO2 Technology Through Improving Compatibility

ABSTRACTThe lightweight microcellular foams of polybutylene adipate terephthalate/polylactic acid (PBAT/PLA) with high mechanical strength and excellent resilience and buffering properties were reported using supercritical CO2 foaming technology. The effects of an epoxy chain extender (ST‐CE37B) on the mechanical properties, rheological properties, and dispersion morphology of PBAT/PLA blends were studied. The results showed that ST‐CE37B can act as compatibilizers and the PBAT/PLA blend with 0.5 phr ST‐CE37B exhibited the highest tensile strength (22 MPa). The PBAT/PLA foam with 0.7 phr ST‐CE37B, expansion ratio of 8.0 displayed the minor cell diameter (19.3 μm) and highest cell density (5.44 × 107 cells/cm3), the compressive strength was greater than that of pure PBAT/PLA foam, and the permanent strain was less than 15%. Therefore, compared with other foams, it can withstand larger stress according to the cushioning performance. In addition, this work also discussed the compression rebound performance (resilience) test of foam with the same blending sample, the same cell density, and different cell structures. It was found that foam with a larger cell size (49.2 μ m) showed lower permanent deformation and energy loss coefficient. This study provides a feasible method for preparing high microporous PBAT/PLA foam, expands the application range of biodegradable foam, and has research significance.

Giant Cell Arteritis: A review of current knowledge and new biological treatment options

Introduction and objective Giant cell arteritis (GCA) is the most common primary systemic vasculitis in Europe. It mainly affects individuals over the age of fifty, its incidence increases with age. The most common clinical manifestation is bilateral headache accompanied by systemic symptoms. The disease may be associated with serious complications, such as permanent vision loss, stroke or rupture of aortic aneurysm. The aim of this study is to discuss the current knowledge about giant cell arteritis and new possibilities of biological treatment. Review methodsTo prepare this review, PubMed and Google Scholar databases were used, searching the following terms: “giant cell arteritis,” “temporal arteritis,” “giant cell arteritis biological treatment,” “giant cell arteritis biological therapy,” “giant cell arteritis treatment,” “giant cell arteritis epidemiology.” The search results were limited to publications from 2007 to 2024, as well as key studies from earlier years, including original papers and randomized, double-blind, placebo-controlled studies. Brief description of the state of knowledgeThe pathogenesis of GCA remains unclear. Since inflammatory factors appear to play an important role, new therapeutic strategies are aimed in direction to interfere these pathways. Setting a diagnosis of GCA requires imaging studies or a temporal artery biopsy. The results of current treatment with high doses of glucocorticoids are unsatisfying, which has led to ongoing research into new therapeutic options. SummaryEarly diagnosis and initiation of treatment are crucial for preventing occurrence of complications. Although the current treatment regimen is effective, it leads to many side effects and does not prevent relapses. This highlights the need to better understand the pathomechanism of the disease to develop more precise therapeutic strategies, including biological treatment.

The diagnosis and treatment progress of infectious endophthalmitis.

Endophthalmitis is a blinding disease that may lead to permanent vision loss. The diagnosis of endophthalmitis relies on clinical findings. It is crucial to identify causative microorganisms in time for subsequent treatment and saving vision. For a long time, cultures of vitreous and/or aqueous humours have been the gold standard for the diagnosis of endophthalmitis. The development of modern molecular diagnostic techniques has brought new opportunities for identifying pathogens rapidly and improving sensitivity. Intravitreal antibiotic injection has the become standard treatment option for infectious endophthalmitis in clinical practice, however, the role and timing of pars plana vitrectomy remains controversial. Moreover, the development of new drugs for intravitreal injection and posterior segment drug delivery systems is expected to achieve the transition from invasive to non-invasive management. Thus, endophthalmitis is an ophthalmic emergency and timely diagnosis and treatment are crucial for preserving vision.

Prognosticators of Optic Nerve Imaging in Malignant Pseudotumor Cerebri Syndrome.

Pseudotumor cerebri (PTC) syndrome is a disorder of increased intracranial pressure, most commonly affecting overweight women of childbearing age. Malignant PTC (MPTC) is a rare presentation that involves rapidly worsening vision, often necessitating surgical intervention to prevent permanent vision loss. The goal of this study was to determine whether radiographic findings of PTC are predictive of MPTC and the final visual outcome. Charts of patients diagnosed with PTC based on the modified Dandy criteria were reviewed. Snellen best-corrected visual acuity (BCVA), automated perimetry mean deviation (APMD), and papilledema grade were documented from the initial and final follow-up examinations. The MRI images were read by 2 neuroradiologists blinded to the clinical diagnosis, and consensus findings were obtained. The patients were classified into malignant and nonmalignant PTC groups. Malignant was defined as BCVA ≤ 20/200 or APMD ≤ -7 dB, and acute onset of symptoms. The sensitivity and specificity of each MRI finding for detecting MPTC was determined. Generalized linear model with random effect and backward model selection was performed to identify which radiographic findings were predictive of final BCVA, APMD, and papilledema grade. Overall, 114 eyes (57 malignant/57 nonmalignant) were included. No MRI finding has both sensitivity and specificity for MPTC reaching 60%. The highest sensitivity (86%) was flattening of the posterior globes and unilateral or bilateral transverse sinus stenosis. The highest specificities were completely empty sella (86%), enhancement (84%), and diffusion restriction (81%) of the prelaminar optic nerves. The presence of vertical tortuosity of the optic nerves was predictive of better final BCVA (P = 0.003) and better final APMD (P = 0.011). While papilledema grade was higher in MPTC, no MRI finding was predictive of papilledema grade. No single MRI finding has both high sensitivity and specificity for diagnosing MPTC. Vertical tortuosity of the optic nerves may be predictive of better final BCVA and APMD.

May-Hegglin, another Cause of Cataract: Case Report and Review

May-Hegglin anomaly (MHA) is a rare autosomal dominant genetic disorder characterized by the presence of large, abnormally shaped platelets (macrothrombocytes), thrombocytopenia, and distinctive leukocyte inclusions known as Döhle-like bodies. First described by the German physician Heinrich May in 1909 and further characterized by Swiss hematologist Otto Hegglin in 1945, MHA is part of a group of disorders collectively referred to as the MYH9-related diseases, which also include Sebastian syndrome, Fechtner syndrome, and Epstein syndrome. A 41-year-old male presents with a 10-year history of thrombocytopenia and a recent development of bilateral cataracts over the past three years. The patient reports that the thrombocytopenia has been resistant to corticosteroid treatment. He has experienced occasional episodes of mild bleeding, including easy bruising, epistaxis, and petechiae, but no severe hemorrhagic events. He denies any history of significant trauma, surgeries, or other major medical conditions. There is no known family history of similar hematological or ophthalmological issues. One of the primary ophthalmological concerns in MHA is the increased risk of retinal hemorrhages. Thrombocytopenia, a hallmark of MHA, predisposes patients to bleeding complications due to insufficient platelet numbers [3, 4]. The retinal vasculature, being highly sensitive to changes in hemostasis, is particularly vulnerable. Retinal hemorrhages can manifest as dot-blot hemorrhages or more extensive preretinal hemorrhages, potentially leading to vision impairment. Regular ophthalmologic examinations are crucial for early detection and management of these hemorrhages to prevent permanent vision loss. This case underscores the importance of considering MYH9-related disorders in patients presenting with thrombocytopenia resistant to standard treatments and associated with atypical clinical features, such as cataracts and leukocyte inclusions. Comprehensive diagnostic evaluations, ...

Circular RNA HIPK3 mediates epithelial–mesenchymal transition of retinal pigment epithelial cells by sponging multiple microRNAs

Epithelial–mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells plays key roles in the pathogenesis of multiple vitreoretinal diseases, leading to profound and permanent vision loss. Circular RNAs (circRNAs) are widespread and functional endogenous RNAs that could regulate gene expression in eukaryotes. The functions of circRNAs in mediating EMT has been reported in several diseases. In the current study, we investigated the role of circRNA HIPK3 (circHIPK3) in EMT process of RPE cells (RPE-EMT). circHIPK3 is one abundant circRNA generated from the second exon of HIPK3 mRNA. We found that circHIPK3 expression was significantly increased in TGF-β1-induced RPE-EMT model. Silencing of circHIPK3 attenuated TGF-β1-induced RPE-EMT process, whereas forced expression of circHIPK3 could trigger EMT in RPE cells. Mechanistically, circHIPK3 regulates RPE-EMT process via sponging multiple microRNAs (miRNAs). This study provides novel insights into the mechanism of RPE-EMT. Targeting circHIPK3 might serve as a therapeutic strategy in RPE-EMT associated vitreoretinal diseases.

Palovarotene (Sohonos), a synthetic retinoid for reducing new heterotopic ossification in fibrodysplasia ossificans progressiva (FOP): history, present, and future

Abstract Retinoids are metabolic derivatives of vitamin A and play crucial roles in the regulation of various tissues and organs during prenatal and postnatal development. Active retinoids, like all-trans-retinoic acid, are synthesized in the cytoplasm and subsequently interact with nuclear retinoic acid receptors (RARα, RARβ, and RARγ) to enhance transcription of specific genes. In the absence of retinoids, RARs can still bind to response elements of target genes but repress their transcription. Chondrogenic cell differentiation and cartilage maturation in the growth plate require the absence of retinoid signaling and transcriptional repression by unliganded RARs. This led to the hypothesis that synthetic retinoid agonists may be pharmacological agents to inhibit those cellular processes and counter the excessive formation of cartilage and bone in conditions like heterotopic ossification (HO). HO can be instigated by diverse culprits including trauma, invasive surgeries, inflammatory disorders, or genetic conditions. One such genetic disease is fibrodysplasia ossificans progressiva (FOP), a rare disorder driven by activating mutations in the ACVR1 gene. Patients with FOP have severe and progressive HO formation in soft tissues, leading to extensive permanent loss of mobility and increased mortality. Synthetic retinoid agonists selective for RARα or RARγ showed efficacy against injury-induced and genetic HO in mouse models. The RARγ agonists showed the highest effectiveness, with palovarotene being selected for clinical trials in patients with FOP. Post-hoc analyses of phase II and phase III clinical trials show that palovarotene has significant disease-modifying effects for FOP, but with significant risks such as premature growth plate closure in some younger subjects. This review provides an overview of retinoid and RAR roles in skeletal development and discusses the identification of palovarotene as a potential FOP therapy, the clinical data supporting its regulatory approval in some countries, and the potential applications of this drug for other relevant disorders besides FOP.

Poor semen quality is associated with impaired antioxidant response and acute phase proteins and is likely mediated by high cortisol levels in Brucella-seropositive dromedary camel bulls

Brucellosis in dromedary camel bulls leads to either temporary or permanent loss of fertility. Camel brucellosis is associated with both orchitis and epididymitis. However, the clinical signs of camel brucellosis are not clear as those in cattle. Therefore, this study aimed to diagnose camel brucellosis based on a serological screening using Rose Bengal plate test (RBPT) followed by competitive ELISA. To understand the impact of brucellosis on camel bull fertility, this study aimed to examine the semen characteristics, evaluate the testicular histopathology, examine hormonal profile, antioxidants and acute phase proteins (APP). A total of 150 mature bulls were used in this study. Blood samples were collected for serological, hormonal, and biochemical analysis. This study revealed that 6.6% and 7.3% of the examined bulls were Brucella-seropositive using RBPT and competitive ELISA, respectively. The Brucella-seropositive dromedary bulls showed poor semen quality, pathological changes orchitis, and lower testosterone. Moreover, our findings showed a higher cortisol level, and significant impairments in the measured APP and antioxidants in Brucella-seropositive bulls. In conclusion, the Brucella-seropositive dromedary bulls showed lower fertility due to poor semen quality and lower testosterone levels. Such lower fertility is likely mediated by high cortisol levels, and impaired APP and antioxidants’ defense response.

Comprehensive Management of Cholesteatoma in Otitis Media: Diagnostic Challenges, Imaging Advances, and Surgical Outcome.

Background: This study presents a comprehensive analysis of cholesteatoma of the middle ear, focusing on its clinical presentation, diagnostic imaging, and treatment outcomes. Cholesteatomas are defined by the keratinized squamous epithelium within the middle ear, leading to significant bone erosion, often affecting the ossicular chain and surrounding structures. Methods: The study explores various mechanisms involved in cholesteatoma progression, including enzymatic lysis, inflammatory responses, and neurotrophic disturbances. The study conducted a retrospective clinical and statistical review of 580 patients over a 20-year period (2003-2023), highlighting the role of advanced imaging, including computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWI), in preoperative planning and postoperative follow-up. Results: Findings revealed that early detection and intervention are crucial in preventing severe complications such as intracranial infection and hearing loss. Surgical treatment primarily involved tympanoplasty and mastoidectomy, with a recurrence rate of 1.55% within two years. The study underscores the importance of integrating imaging advancements into clinical decision-making to enhance patient outcomes and suggests further investigation into molecular mechanisms underlying cholesteatoma progression and recurrence. Histopathological and microbiological analysis was performed to identify pathological patterns and microbial agents. Conclusions: The study highlights the importance of early diagnosis and intervention to prevent complications such as intracranial infections and permanent hearing loss, while also emphasizing the role of advanced imaging techniques in the management and long-term monitoring of cholesteatoma patients.

Improved intracochlear biopolymeric drug delivery system: an in vivo study

Background The delivery of drugs into the inner ear is a challenging field of study due to the complex cochlear anatomy and physiology. The creation of an intracochlear device that allows for short- and long-term intracochlear delivery of the drugs with a minimal invasive technology is needed to prevent or treat conditions that can potentially prevent the development of permanent hearing loss. Aim This study intends to test the efficacy of DXM-infused PLGA microneedles created in our laboratory in an in vivo animal model of acute ototoxic injury. Material and Methods Twenty-four male Norway Brown rats were randomized into four groups, three of which groups received an intratympanic injection of ethacrynic acid and kanamycin. Two of these groups underwent the placement of an intracochlear microneedle blended or not with dexamethasone, and two groups underwent implantation of a plain microneedle, one of without prior exposure to the ototoxic agent to confirm in vivo biocompatibility. Animals were then followed with a weekly auditory brainstem response testing until day 28 after surgical intervention. Result and Conclusion Our intracochlear device demonstrated biocompatibility and produced no hearing changes after its implantation in the control group. Inserted DXM-blended microneedles prevented hearing deterioration in those animals exposed to an ototoxic environment.

Pediatric open-globe injury: Current perspectives, surgical principles, and literature review

Abstract Open-globe injury (OGI), referring to the full-thickness violation of the eye wall, is a severe consequence of ocular trauma which can lead to permanent vision loss. Here, we review the current literature on pediatric OGI including a focused review of studies published in the past 10 years. Scoring systems for final visual prognosis, important aspects of clinical examination, and imaging at the point of care are discussed. We furthermore provide an overview of primary and secondary surgical management of the initial OGI and sequelae. Amblyopia management differentiates pediatric from adult visual rehabilitation following OGI, and we discuss the current state-of-the-art approaches for the prevention of vision loss.

Challenges in managing severe homozygous protein c deficiency: a case report.

Protein C deficiency is a rare autosomal recessive disorder associated with a high risk of thromboembolic complications. This case report describes the challenges in managing a 23-year-old woman with severe homozygous protein C type 1 deficiency diagnosed since early infancy. Her medical history included misdiagnosed cellulitis, recurrent thrombosis, and permanent vision loss in one eye. The laboratory workup confirmed a diagnosis of severe protein C deficiency. Management involved a combination of fresh frozen plasma (FFP), protein C concentrate, warfarin, and heparin, with ongoing challenges due to recurrent thrombosis and anaphylaxis to FFP. This case highlights the challenges in the diagnosis and management of severe protein C deficiency. Although current treatment options provide partial control, further research is crucial to develop safer and more effective therapies to improve long-term outcomes for affected patients.

PKHD1L1 is required for stereocilia bundle maintenance, durable hearing function and resilience to noise exposure

Polycystic Kidney and Hepatic Disease 1-Like 1 (PKHD1L1) is a human deafness gene, responsible for autosomal recessive deafness-124 (DFNB124). Sensory hair cells of the cochlea are essential for hearing, relying on the mechanosensitive stereocilia bundle at their apical pole for their function. PKHD1L1 is a stereocilia protein required for the formation of the developmentally transient stereocilia surface coat. In this study, we carry out an in depth characterization of PKHD1L1 expression in mice during development and adulthood, analyze hair-cell bundle morphology and hearing function in aging PKHD1L1-deficient mouse lines, and assess their susceptibility to noise damage. Our findings reveal that PKHD1L1-deficient mice display no disruption to bundle cohesion or tectorial membrane attachment-crown formation during development. However, starting from 6 weeks of age, PKHD1L1-deficient mice display missing stereocilia and disruptions to bundle coherence. Both conditional and constitutive PKHD1L1 knockout mice develop high-frequency hearing loss progressing to lower frequencies with age. Furthermore, PKHD1L1-deficient mice are susceptible to permanent hearing loss following moderate acoustic overexposure, which induces only temporary hearing threshold shifts in wild-type mice. These results suggest a role for PKHD1L1 in establishing robust sensory hair bundles during development, necessary for maintaining bundle cohesion and function in response to acoustic trauma and aging.

Repercussion of Primary Nucleation Pathway: Dementia and Cognitive Impairment.

Neurodegenerative diseases, such as Alzheimer's, Parkinson's, and prion disease, are characterized by the conversion of normally soluble proteins or peptides into aggregated amyloidal fibrils. These diseases result in the permanent loss of specific types of neurons, making them incurable and devastating. Research on animal models of memory problems mentioned in this article contributes to our knowledge of brain health and functionality. Neurodegenerative disorders, which often lead to cognitive impairment and dementia, are becoming more prevalent as global life expectancy increases. These diseases cause severe neurological impairment and neuronal death, making them highly debilitating. Exploring and understanding these complex diseases offer significant insights into the fundamental processes essential for maintaining brain health. Exploring the intricate mechanisms underlying neurodegenerative diseases not only holds promise for potential treatments but also enhances our understanding of fundamental brain health and functionality. By unraveling the complexities of these disorders, researchers can pave the way for advancements in diagnosis, treatment, and ultimately, improving the lives of individuals affected by neurodegenerative diseases.

Early Surgery and High Dose Steroids in Treating Patients with Indirect Traumatic Optic Neuropathy: A Meta-Analysis and Systematic Review

Introduction: Optic nerve injury is a devastating cause of permanent visual loss after blunt or penetrating injury occurring in up to 7% of head trauma cases. No single treatment strategy and timing of intervention has proved optimal. Timely and appropriate management is key to improving visual outcomes. We compared whether immediate surgical decompression or steroids would lead to improvement of visual outcomes in individuals with indirect traumatic optic neuropathy. Methods: We searched from several online databases and included studies of patients with direct Optic nerve injury, those who received combined treatment with surgery and steroids, and those with delayed initiation of treatment were excluded. Results: The final search yielded eleven eligible studies. Both interventions showed similar results in improvement of visual function (RR 2.35, 95% CI 0.87 to 6.34, p=0.09, I2 0%). Both early and late intervention also showed similar results in improvement of visual function (RR 1.72, 95% CI 0.89 to 3.35, p=0.11, I2 61%). Among patients who underwent early surgical decompression, the rate of visual acuity improvement was 73% with those who underwent transcranial surgery and 69% with those who underwent endoscopic surgery. Conclusion: This study shows that immediate surgical decompression and early high dose steroid administration are equally effective in improving visual function. Patients with no light perception (NLP) and light perception (LP) pre treatment resulted to better visual improvement with steroids while those with counting fingers (CF) and more than CF pre treatment, resulted to better visual improvement with surgical decompression.

Evaluation of Permanent Nipple-Areola Complex Sensitivity Loss Following Reduction Mammoplasty.

Predictors for permanent nipple-areola complex (NAC) insensitivity after reduction mammoplasty are sparsely defined. We analyze factors associated with NAC insensitivity over a long-term follow-up. A retrospective analysis of reduction mammoplasties on 1598 breasts performed by four surgeons from March 2015-February 2023 was conducted. Data on patient demographics, intraoperative factors, and postoperative complications were collected from patient records. Analysis was conducted by breast, separated into breasts with NAC insensitivity (permanent and transient) and those without. Wilcoxon rank sum test for continuous variables and Fisher's exact test or Pearson's Chi-square test for categorical variables evaluated differences between the groups. Univariate and multivariate logistic regression analyzed the association of pedicle choice with NAC insensitivity onset and permanence. Of 1598 breasts, 9.8% had loss of NAC sensation, of which 49.0% had permanent loss. 51.0% regained sensitivity, taking an average of 116 days (median 64, range 6-798) to regain sensation. NAC-insensitive breasts had a longer sternal notch-NAC (p<0.001) and NAC-IMF (p<0.001) measurements, greater weight removed (p<0.001), and fat necrosis co-complication (p=0.022). Greater weight removed (p=0.044) and longer sternal notch-NAC measurements (p=0.011) were associated with permanent insensitivity. The superomedial pedicle was associated with an increased rate of transient NAC insensitivity, while the inferior pedicle with a decreased rate. There was no significant association between pedicle choices and permanent insensitivity. Transient loss of NAC sensitivity is associated with pedicle choice, while breasts with permanent insensitivity were more likely to have longer breast measurements and a greater amount of tissue removed.