Genetically modified pigs:Emerging animal models for hereditary hearing loss

Hereditary hearing loss(HHL),a genetic disorder that impairs auditory function,significantly affects quality of life and incurs substantial economic losses for society.To investigate the underlying causes of HHL and evaluate therapeutic outcomes,appropriate animal models are necessary.Pigs have been extensively used as valuable large animal models in biomedical research.In this review,we highlight the advantages of pig models in terms of ear anatomy,inner ear morphology,and electrophysiological characteristics,as well as recent advancements in the development of distinct genetically modified porcine models of hearing loss.Additionally,we discuss the prospects,challenges,and recommendations regarding the use pig models in HHL research.Overall,this review provides insights and perspectives for future studies on HHL using porcine models.

基于EAR算法的司机疲劳驾驶检测系统

为有效减少司机疲劳驾驶导致的交通事故发生率,设计了一套基于EAR算法的司机疲劳驾驶检测系统。系统由硬件和软件两部分构成。硬件部分包括STM32单片机、OLED12864液晶显示模块、DS18B20温度传感器模块、光电测速传感器模块、CN-TTS语音播报模块、ESP8266数据存储和传输模块以及K210人脸识别模块。软件部分采用EAR检测算法进行疲劳检测。通过单片机和手机上运行的APP双端监测,系统能够实时监测司机状态,在司机出现疲劳特征时发出提醒,从而有效避免疲劳驾驶带来的安全隐患。经测试,系统的综合准确率达到92.4%,能够有效提醒司机避免疲劳驾驶。

Review of 6 Years of Middle Ear Surgery in the ENT-Laryngology Department of the Donka National Hospital and a Literature Review

Introduction: Middle ear surgery is increasingly performed in our department. Our goal was to take stock of this activity in the ENT department of the Donka National Hospital. Equipment and Methods: It was a descriptive and retrospective study;it involved 71 patients’ records operated from January 1, 2018 to December 31, 2023. We included the files of patients who had a middle ear surgery including the post-operative report and follow-up. Incomplete or illegible records were excluded. The parameters studied were epidemiological, otoscopic, tomodensitometric, surgical indications, surgical techniques and results. Results: We recorded 71 middle ear surgeries out of 548 ENT surgeries, the prevalence was 12.96%. The average age was 23 years (type-deviation = 17, 29 years) with extremes of 3 to 75 years. According to the preoperative audiometry, the deafness was medium (48.8%), mild (36.9%) and severe (14.3%). The operative indications were among others: perforation of the tympanic sequellar (52.5%), chronic otomastoiditis (23.8%), cholesteatoma (15%) and seromuqueous otitis (8.7%). We performed 70 tympanoplasties (90.9%), 50 mastoidectomies (64.9%) and 7 trans-tympanic aerators (9.1%). One month after surgery, the neotympanum was constituted in 86%, and the hearing gain was between 11 and 15 dB in 18.3% of cases. Conclusion: Middle ear surgery was infrequent. Young subjects are the most concerned. Tympanoplasty and mastoidectomy are the main surgical techniques. The anatomical and functional results are appreciable.

Evaluation of Ear and Facial Indices of Ibibio and Efik Female Children of Akwa Ibom and Cross River States, Nigeria

Background: The ear and face are indispensable and distinctive features for hearing and identification. Objectives: This study was designed to generate anthropometric data of the ear and facial indices of females of Efik and Ibibio children in Cross River and Akwa Ibom States, show morphological and aesthetic differences and ethnicity. Methods: A total of 600 female children (300 Efiks and 300 Ibibios) aged 2 to 10 years that met the inclusion criteria were chosen from selected primary schools in Calabar Municipality, Calabar South of Cross River State and from Uyo, Itu of Akwa Ibom State, Nigeria. Standardized measurements of face length, face width, ear length, and ear width were taken with a spreading caliper;the facial (proscopic) and ear (auricular) indices were determined. Results: Efik subjects presented a mean face length of 8.36 ± 0.06 cm, face width of 11.04 ± 0.04 cm, ear length of 4.92 ± 0.02 cm, and ear width of 3.06 ± 0.01 cm. Ibibio subjects had mean values for face length, face width, ear length, and ear width as 8.17 ± 0.05 cm, 10.75 ± 0.05 cm, 4.77 ± 0.03 cm, and 2.94 ± 0.02 cm respectively. The mean facial index and ear index for Efik subjects were 75.68 ± 0.31 and 62.16 ± 0.27 respectively;while the mean facial and ear indices for Ibibio subjects were 74.79 ± 0.36 and 61.80 ± 0.34 respectively. Statistical analysis demonstrated significant differences in face length, ear length, ear width and facial index, with the Efik subjects having higher values than Ibibio subjects (p Conclusion: The results showed hypereuryproscopic face as the prevalent face type among females of both ethnic groups, therefore can be of importance in sex, ethnic, and racial differentiation, and in clinical practice, aesthetics and forensic medicine.

Influence of ear tags on the results of body composition analysis in mice

Background:The aim of this study was to investigate the influence of marking meth-ods on the outcomes of body composition analysis and provide guidance for the se-lection of marking methods in mouse body composition analysis.Methods:Male C57BL/6J mice aged 6 weeks were randomly assigned for pre-and post-ear tagging measurements.The body composition of the mice was measured using a small animal body composition analyzer,which provided measurements of the mass of fat,lean,and free fluid.Then,the mass of fat,lean and free fluid to body weight ratio was gained.Further data analysis was conducted to obtain the range and coeffi-cient of variation in body composition measurements for each mouse.The distribution of fat and lean tissue in the mice was also analyzed by comparing the fat-to-lean ratio.Results:(1)The mass of all body composition components in the ear tagging group was significantly lower than that in the control group.(2)There was a significant in-crease in the range and coefficient of variation of body composition measurements between the ear tagging group and the control group.(3)The fat-to-lean ratio in the ear tagging group was significantly lower than that in the control group.Conclusions:Ear tagging significantly lowered the results of body composition analy-sis in mice and higher the results of measurement error.Therefore,ear tagging should be avoided as much as possible when conducting body composition analysis experi-ments in mice.

The environment,especially the minimum temperature,affects summer maize grain yield by regulating ear differentiation and grain development

Ear differentiation,grain development and their interaction with factors in the growing environment,such as temperature,solar radiation and precipitation,greatly influence grain number and grain weight,and ultimately affect summer maize production.In this study,field experiments involving different sowing dates were conducted over three years to evaluate the effects of temperature factors,average solar radiation and total precipitation on the growth process,ear differentiation,fertilization characteristics,grain filling and yield of summer maize varieties with different growth durations.Four hybrids were evaluated in Huang-Huai-Hai Plain(HHHP),China from 2018 to 2020 with five different sowing dates.The results showed that the grain yield formation of summer maize was strongly impacted by the environment from the silking(R1)to milking(R3)stage.Average minimum temperature(AT_(min))was the key environmental factor that determined yield.Reductions in the length of the growing season(r=–0.556,P<0.01)and the total floret number on ear(R^(2)=0.200,P<0.001)were found when AT_(min) was elevated from the emerging(VE)to R1 stage.Both grain-filling rate(R^(2)=0.520,P<0.001)and the floret abortion rate on ear(R^(2)=0.437,P<0.001)showed quadratic relationships with AT_(min) from the R1 to physiological maturity(R6)stage,while the number of days after the R1 stage(r=–0.756,P<0.01)was negatively correlated with AT_(min).An increase in AT_(min) was beneficial for the promotion of yield when it did not exceeded a certain level(above 23°C during the R1–R3 stage and 20–21°C during the R1-R6 stage).Enhanced solar radiation and precipitation during R1–R6 increased the grain-filling rate(R^(2)=0.562,P<0.001 and R^(2)=0.229,P<0.05,respectively).Compared with short-season hybrids,full-season hybrids showed much greater suitability for a critical environment.The coordinated regulation of AT_(min),ear differentiation and grain development at the pre-and post-silking stages improved maize yield by increasing total floret number and grain-filling rate,and by reducing the floret abortion rate on ear.

Squamous Cell Carcinoma of the Middle Ear: Case Report and Literature Review

Malignant tumors originating from the middle ear are rare. The literature identifies chronic inflammation and Human Papillomavirus (HPV) infection as the most common risk factors. A CT scan to assess bony invasion and an MRI to evaluate soft tissue involvement, depth of invasion, and perineural invasion, followed by a biopsy, are indispensable for diagnosis and treatment. There is no standard treatment for squamous cell carcinoma of the middle ear, however, most reported cases are treated with surgical resection followed by postoperative radiotherapy. Given the challenges of achieving complete surgical excision, radiotherapy plays a crucial role in controlling middle ear cancers, as demonstrated in our case. We present a case of squamous cell carcinoma of the middle ear in a 63-year-old female with a history of chronic suppurative otitis media. The patient underwent a right subtotal petrosectomy without lymph node dissection followed by concurrent chemoradiotherapy. At the one-year follow visit, no recurrence or metastasis was detected.

m^(6)A modification of lncRNA in middle ear cholesteatoma

Objective:Middle ear cholesteatoma is a non-tumorous condition that typically leads to hearing loss,bone destruction,and other severe complications.Despite surgery being the primary treatment,the recurrence rate remains high.Therefore,exploring the molecular mechanisms underlying cholesteatoma is crucial for discovering new therapeutic approaches.This study aims to explore the involvement of N6-methyladenosine(m^(6)A)methylation in long non-coding RNAs(lncRNAs)in the biological functions and related pathways of middle ear cholesteatoma.Methods:The m^(6)A modification patterns of lncRNA in middle ear cholesteatoma tissues(n=5)and normal post-auricular skin tissues(n=5)were analyzed using an lncRNA m^(6)A transcriptome microarray.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analyses were conducted to identify potential biological functions and signaling pathways involved in the pathogenesis of middle ear cholesteatoma.Methylated RNA immunoprecipitation(MeRIP)-PCR was used to validate the m^(6)A modifications in cholesteatoma and normal skin tissues.Results:Compared with normal skin tissues,1525 lncRNAs were differentially methylated in middle ear cholesteatoma tissues,with 1048 showing hypermethylation and 477 showing hypomethylation[fold change(FC)≥3 or<1/3,P<0.05].GO enrichment analysis indicated that hypermethylated lncRNAs were involved in protein phosphatase inhibitor activity,neuron-neuron synapse,and regulation ofα-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid(AMPA)receptor activity.Hypomethylated lncRNAs were associated with mRNA methyltransferase activity,secretory granule membrane,and mRNA methylation.KEGG analysis revealed that hypermethylated lncRNAs were mainly associated with 5 pathways:the Hedgehog signaling pathway,viral protein interaction with cytokines and cytokine receptors,mitogen-activated protein kinase(MAPK)signaling pathway,cytokine-cytokine receptor interaction,and adrenergic signaling in cardiomyocytes.Hypomethylated lncRNAs were mainly involved in 4 pathways:Renal cell carcinoma,tumor necrosis factor signaling pathway,transcriptional misregulation in cancer,and cytokine-cytokine receptor interaction.Additionally,MeRIP-PCR confirmed the changes in m^(6)A methylation levels in NR_033339,NR_122111,NR_130744,and NR_026800,consistent with microarray analysis.Real-time PCR also confirmed the significant upregulation of MAPK1 and NF-κB,key genes in the MAPK signaling pathway.Conclusion:This study reveals the m^(6)A modification patterns of lncRNAs in middle ear cholesteatoma,suggests a direction for further research into the role of lncRNA m^(6)A modification in the etiology of cholesteatoma.The findings provide potential therapeutic targets for the treatment of middle ear cholesteatoma.

DeepBio:A Deep CNN and Bi-LSTM Learning for Person Identification Using Ear Biometrics

The identification of individuals through ear images is a prominent area of study in the biometric sector.Facial recognition systems have faced challenges during the COVID-19 pandemic due to mask-wearing,prompting the exploration of supplementary biometric measures such as ear biometrics.The research proposes a Deep Learning(DL)framework,termed DeepBio,using ear biometrics for human identification.It employs two DL models and five datasets,including IIT Delhi(IITD-I and IITD-II),annotated web images(AWI),mathematical analysis of images(AMI),and EARVN1.Data augmentation techniques such as flipping,translation,and Gaussian noise are applied to enhance model performance and mitigate overfitting.Feature extraction and human identification are conducted using a hybrid approach combining Convolutional Neural Networks(CNN)and Bidirectional Long Short-Term Memory(Bi-LSTM).The DeepBio framework achieves high recognition rates of 97.97%,99.37%,98.57%,94.5%,and 96.87%on the respective datasets.Comparative analysis with existing techniques demonstrates improvements of 0.41%,0.47%,12%,and 9.75%on IITD-II,AMI,AWE,and EARVN1 datasets,respectively.

Ear keloid and epidermal cyst following auricular cartilage harvest for rhinoplasty:A case report

BACKGROUND This case report highlights a rare instance of concurrent keloid and epidermal cyst development at an ear cartilage harvest site following rhinoplasty in a 25-year-old woman.Both conditions,which typically stem from skin trauma,seldom occur together,demonstrating the exceptional characteristics of this case.CASE SUMMARY The patient underwent successful surgical removal of both the keloid and the epidermal cyst.Postoperative treatment included the use of silicone sheets,gel,and oral tranilast to reduce scarring.No recurrence was observed over a 6-mo follow-up period,indicating effective management of the condition.CONCLUSION The effective management of complex skin trauma cases underscores the need for individualized treatment strategies in plastic surgery.

Effects of Drilling in Mastoid Cavity over Hearing in the Contralateral Ear

In advanced otological surgeries, powered instruments form an indispensable part. The risk of deterioration to hearing in the operated ear is a commonly discussed issue, however, there remains a possibility of affecting the hearing in the contralateral ear due to transcranial vibration. So in this study we aimed to assess the possibility of the non-operated ear being affected by the noise generated during ear surgeries and whether it is temporary or permanent in nature. Methodology: This study included 63 patients diagnosed with unilateral disease who underwent mastoid surgery. Preoperatively all the patients were subjected to Pure tone audiometry (PTA), Transient evoked otoacoustic emission (TEOAE) and Distortion product otoacoustic emission (DPOAE). Patients were operated using both cutting and diamond burrs of ranging from sizes 1 - 6 mm. Total drilling time was recorded. Results: Post-operative hearing evaluation was done at 1 week, 4 weeks and 12 weeks. The sound emitted by various burrs was recorded by Sound Level Meter. Out of the total 58 patients that followed up, 46 showed change in at least one of the hearing parameters. Patients showing changes had a higher drilling time as compared to those with no changes. Of these, the changes associated with the total drilling time and with cutting burr time were found to be significant. The hearing changes seen on PTA, TEOAE and DPOAE were transient in nature with only one patient having a persistent decreased high frequency threshold at the end of 12 weeks. It was also found that cutting burrs produce more sound as compared to diamond burrs and a larger size burr of a type produces more sound than a smaller one of its type. Conclusion: The drilling of mastoid bone during ear surgeries can transiently impair the hearing in the contralateral ear which is of great significance in patients with only one hearing ear.

Bilateral Middle Fossa Floor Meningiomas Invading the Middle Ear

This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.

Endoscopic push through tragal cartilage tympanoplasty: A 10-year retrospective review of our technique and outcomes

BACKGROUND Endoscopic ear surgery(EES)provides a magnified,high-definition view of the otological surgical field.EES allows otologists to avoid surgical incisions and associated postoperative complications.It is an ideal technique for the perfor-mance and teaching of tympanoplasty.AIM To examine the efficacy of total Endoscopic Push Through Tragal Cartilage Tympanoplasty(EPTTCT),at our institution over a 10-year period.METHODS A retrospective analysis of 168 cases of EPTTCT for closure of small to medium tympanic membrane perforations from 2013-2023 was conducted.Patient sex,age range(pediatric vs adult),etiology of injury,success rate,complications,and postoperative hearing status were collected.RESULTS Graft uptake results indicated success in 94%of patients,with less than a 2%complication rate.Postoperative pure tone audiometry demonstrated hearing status improvement in 69%of patients.CONCLUSION EPTTCT has been shown to be effective in tympanic membrane perforation closures with minimal complications.This study further demonstrates the efficacy and safety of these procedures in a single-center review.

Evaluation of the Effect and Efficiency of Ear Tip Bloodletting Combined with Xianfang Huoming Yin in the Treatment of Early-Stage Wheals

Objective:To evaluate the effect and efficiency of ear tip bloodletting combined with Xianfang Huoming Yin(XFH)in the treatment of early-stage wheals.Methods:70 patients with early-stage wheals admitted from September 2020 to September 2022 were divided into two groups by randomized numerical table method,with 35 cases/group.Both groups received conventional treatment,the control group combined with XFH,and the observation group combined with ear tip bloodletting therapy and XFH.Conscious symptom scores,ocular indexes,therapeutic effects,and sleep quality between the two groups were compared.Results:After the treatment,the patients in the observation group had lower self-awareness symptom scores and sleep quality scores as compared to those in the control group;the diameter of the mass in the observation group was smaller than that of the control group after treatment;the average tear film rupture time and the time taken for the first non-contact tear film to rupture were longer in the observation group than those in the control group;the total effective rate of the treatment in the observation group was higher than that of the control group(P<0.05).Conclusion:Ear tip bloodletting combined with XFH was ideal for the treatment of early-stage wheals and has a high effective rate.

EARS计划在结直肠癌外科患者中的应用效果分析

目的对结直肠癌外科患者治疗过程中,快速康复(enhanced recovery after surgery,ERAS)计划的应用价值进行分析。方法选择2020年7月1日—2022年3月1日常德市第一人民医院普通外科结直肠癌患者150例,按随机数字表法分为研究组与对照组,每组各75例,分别对患者进行传统开腹手术+EARS计划与传统开腹手术治疗,分析两组并发症、炎症因子水平、首次下床活动时间、进食时间、术后住院天数、排气时间、排便时间、满意度。结果研究组术后住院天数、排便、首次下床活动、进食、排气时间等指标均短于对照组,差异有统计学意义(P<0.05)。治疗有效率比较,研究组高于对照组,差异有统计学意义(P<0.05)。对照组并发症发生率高于研究组,差异有统计学意义(P<0.05)。研究组炎症因子水平均低于对照组,差异有统计学意义(P<0.05)。结论EARS计划推广价值较高,可以抑制炎症因子水平,提升治疗效果,预后效果显著。

Hyaluronic acid injection in the auricular base for the aesthetic correction of lying ears:A retrospective study

Background Ears play an important role in facial profiles.Lying ears are not perceived favorably in Asian cultures;therefore,surgical procedures are implemented to adjust this defect.However,surgery has complications and requires recovery time.We introduced a hyaluronic acid(HA)injection technique to aesthetically improve ear prominence.Methods This retrospective study examined 25 Chinese patients aged 20-47 years with congenital lying ears who received HA injections in the auricular base at Shanghai Ninth People’s Hospital and Hangzhou Yijie Medical Cosmetology Clinic between November 2019 and December 2022.The average injection volume was 6.32±1.22 mL in the auricular base unilaterally,and the follow-up time ranged from 6 to 24 months.Morphological measurement data were recorded.Two-dimensional(2D)and three-dimensional(3D)images were obtained to evaluate the effects.Results All patients showed improvements in ear prominence.The cranioauricular angle(CAA)increased from 22.24°±4.53°to 65.90°±5.38°immediately post-injection and was maintained at 49.18°±4.74°6 months later.The ear projection(EP)increased from 14.75±2.72 mm to 26.26±2.94 mm immediately post-injection and was 22.51±2.68 mm after 6 months.No serious complications were noted.Conclusion HA injection in the auricular base effectively corrected the lying ears and aesthetically optimized the facial profile.It also had a face-lift effect that made the face look younger and more compact.The injection procedure was minimally invasive and required no recovery period.The effect was maintained for a long time and was satisfactory.

Fine-Grained Soft Ear Biometrics for Augmenting Human Recognition

Human recognition technology based on biometrics has become a fundamental requirement in all aspects of life due to increased concerns about security and privacy issues.Therefore,biometric systems have emerged as a technology with the capability to identify or authenticate individuals based on their physiological and behavioral characteristics.Among different viable biometric modalities,the human ear structure can offer unique and valuable discriminative characteristics for human recognition systems.In recent years,most existing traditional ear recognition systems have been designed based on computer vision models and have achieved successful results.Nevertheless,such traditional models can be sensitive to several unconstrained environmental factors.As such,some traits may be difficult to extract automatically but can still be semantically perceived as soft biometrics.This research proposes a new group of semantic features to be used as soft ear biometrics,mainly inspired by conventional descriptive traits used naturally by humans when identifying or describing each other.Hence,the research study is focused on the fusion of the soft ear biometric traits with traditional(hard)ear biometric features to investigate their validity and efficacy in augmenting human identification performance.The proposed framework has two subsystems:first,a computer vision-based subsystem,extracting traditional(hard)ear biometric traits using principal component analysis(PCA)and local binary patterns(LBP),and second,a crowdsourcing-based subsystem,deriving semantic(soft)ear biometric traits.Several feature-level fusion experiments were conducted using the AMI database to evaluate the proposed algorithm’s performance.The obtained results for both identification and verification showed that the proposed soft ear biometric information significantly improved the recognition performance of traditional ear biometrics,reaching up to 12%for LBP and 5%for PCA descriptors;when fusing all three capacities PCA,LBP,and soft traits using k-nearest neighbors(KNN)classifier.

Barley FASCIATED EAR genes determine inflorescence meristem size and yield traits

In flowering plants,the inflorescence meristem(IM)provides founder cells to form successive floral meristems,which are precursors of fruits and seeds.The activity and developmental progression of IM are thus critical for yield production in seed crops.In some cereals,such as rice(Oryza sativa)and maize(Zea mays),the size of undifferentiated IM,which is located at the inflorescence apex,is positively associated with yield traits such as spikelet number.However,the relationship between IM size and yieldrelated spike traits remains unknown in the Triticeae tribe.Here we report that IM size has a negative correlation with yield traits in barley(Hordeum vulgare).Three FASCIATED EAR(FEA)orthologs,HvFEA2,HvFEA3,and HvFEA4,regulate IM size and spike morphogenesis and ultimately affect yield traits.Three HvFEAs genes are highly expressed in developing spikes,and all three loss-of-function mutants exhibit enlarged IM size,shortened spikes,and reduced spikelet number,which may lead to reduced grain yield.Natural variations identified in HvFEAs indicate selection events during barley domestication.We further reveal that HvFEA4,as a transcription factor,potentially targets multiple pathways during reproductive development,including transcriptional control,phytohormone signaling,and redox status.The roles of barley FEA genes in limiting IM size and promoting spikelet formation suggest the potential of increasing yield by manipulating IM activity.

Viability and hatchability of brine shrimp Artemia franciscana cysts after passing through the digestive system of eared grebes Podiceps nigricollis

Brine shrimp Artemia franciscana provide food for many migrating and staging birds that spend summer and fall on Great Salt Lake,Utah,USA.Artemia produce live young and cysts(hard-walled eggs);these cysts are commercially harvested on Great Salt Lake and support a large industry in Utah.It is unclear the impact that millions of hungry birds have on the Artemia population in the lake.To help assess that,this study evaluated cyst viability(percentage of cysts that contain an embryo)and hatchability(percent of cysts that hatch)from cysts that had passed through the digestive tract of eared grebes Podiceps nigricollis and cysts obtained directly from Great Salt Lake at the same site where each grebe was collected.Hatchability was significantly higher for cysts collected from the water column(19%)than from the stomach(0.3%)or intestines(3%)of eared grebes.Viability also was significantly different for cysts collected from the water column(29%),stomach(0.7%),and intestines(5%).These results indicate that eared grebes nutritionally benefit from eating cysts and that they may be an important food source for grebes in late fall after the adult population of Artemia dies off due to the water becoming too cold.Also,enough cysts survive their passage through the digestive system that grebes can vector hatchable cysts to other waterbodies.

Acute Mastoiditis Clinical Course and Management in Patients Presented to Khartoumar Ear, Nose and Throat Hospital during the Period from November 2017 to November 2019

Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoiditis. This study aims to view the clinical presentation and management approaches in Khartoum Ear, Nose and Throat Hospital. Methodology: This is a prospective case series and a hospital-based study conducted at Khartoum Ear, Nose and Throat Hospital during the period from November 2017 to November 2019. A total of 61 patients were included in the study. Results: The median age at presentation is 5 years old, males are more affected than females with a ratio of 1.35:1, and the mean duration of symptoms prior to hospital admission was 9.6 days. The most common presenting symptoms were otalgia (83.3%), ear discharge (83.3%) and post-auricular swelling (83.3%), and the most common signs at admission were tenderness over the mastoid (95.1%), retroauricular swelling and protrusion of the auricle (82%), and redness over the mastoid (77%). The abnormal tympanic membrane was found in all patients with central perforation being the commonest finding (73.8%), and bulging tympanic membrane (21.3%). 34.4% of patients received oral antibiotics before admission and the mean duration of symptoms prior to admission increased significantly in those who received antibiotics 12.7 days in comparison to those who didn’t 8.3 days. Only 52.5% of patients had a past history of recurrent acute otitis media, and 8.2% had a past history of acute mastoiditis. All the patients with recurrent mastoiditis had a past history of recurrent acute otitis media. Computed Tomography (CT) scans were obtained for 50.8% and 83.9% of those scans showed coalescent mastoiditis. Further evidence of intracranial extension was found in 6.5% and Magnetic Resonance Imaging (MRI) was obtained for them. Of the study group, 67.2% presented with subperiosteal abscess, 4.9% with facial nerve palsy and 3.3% with brain abscess. Thirteen patients with no complications were managed initially with injectable and topical antibiotics and were successful in only 6 of them (46%), abscess incisions and drainages were needed in 46 patients and were successful in 34 of them (73.9%). Eighteen patients (29.5%) needed mastoidectomy and all of them were managed successfully (100%). One patient (1.6%) was referred for intracranial abscess drainage in a specialized hospital, also one patient (1.6%) initially presented with intracranial abscess died on the second day of admission and 96.8% were discharged in good condition. The mean duration of hospital stay was 7.5 days. Conclusion: Patients present to the hospital after a prolonged period with a higher rate of complications, and the delayed presentation increased significantly in patients who received oral antibiotics prior to admission. Conservative medical treatment in non-complicated acute mastoiditis was ineffective in more than half of the patients and abscess incision and drainage and/or mastoidectomy are often necessary for the management.