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"Ear diseases"
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How your ears work
Explains how the parts of the ear work to translate sound from the outside world into signals that the brain can understand.
Book
Global burden of hearing impairment and ear disease
Hearing loss can present at birth or be acquired as a result of illness, middle-ear disease, injury, age, overuse of certain medications, and/or induced by exposure to damaging noise levels. There are serious short-term consequences for people living with hearing impairment, including the effects on language acquisition, education, employment and overall wellbeing. There are also complex long-term implications.
This review aimed to present some of the leading causes of ear disease and hearing loss globally, and to identify their impact at both an individual and societal level.
Journal Article
Reproduction of porcine ear necrosis (ear-tip necrosis) following intradermal inoculation of pigs with Fusobacterium necrophorum
Porcine ear necrosis (PEN) (also referred to as ear-tip necrosis, ETN) is a syndrome of global presence and unclear aetiology. Initially reported in the 1950s, many different infectious and non-infectious causes have been suggested as the causative(s) agent(s), but none has been confirmed in controlled studies. Here, we investigated the aetiology of PEN using pure culture of bacteria associated with lesions in controlled animal trials. A commercial farm with no history of ear-tip necrosis was identified and used as the source for 5-week-old pigs. Two independent trials were initially executed with identical designs. Piglets (=12/trial) were intradermally inoculated with either pure cultures of Staphylococcus hyicus or Fusobacterium necrophorum (left ear, n = 10) or sterile media (right ear, n = 10). Two pigs in each trial were not inoculated, serving as sentinels. A third trial used F. necrophorum as the inoculum, 3 pigs as sentinels and 9 as inoculated. All animals were clinically monitored daily following challenge, and an ear score was used to follow disease progression. All ears inoculated with S. hyicus remained lesion free. Four out of ten and 7/9 pigs challenged with F. necrophorum developed lesions undistinguishable from PEN, including necrosis and loss of portions of the ear pinna (P < 0.001). F. necrophorum was isolated from 4/10 and 7/9 pigs that developed necrotic lesions. Histopathology after resolution of necrosis revealed granulomatous tissue. Evidence presented here suggests that F. necrophorum causes PEN-like lesions, as seen in commercial barns. It is therefore suggested as the etiological agent of this syndrome.
Journal Article
Efficient and accurate identification of ear diseases using an ensemble deep learning model
Early detection and appropriate medical treatment are of great use for ear disease. However, a new diagnostic strategy is necessary for the absence of experts and relatively low diagnostic accuracy, in which deep learning plays an important role. This paper puts forward a mechanic learning model which uses abundant otoscope image data gained in clinical cases to achieve an automatic diagnosis of ear diseases in real time. A total of 20,542 endoscopic images were employed to train nine common deep convolution neural networks. According to the characteristics of the eardrum and external auditory canal, eight kinds of ear diseases were classified, involving the majority of ear diseases, such as normal, Cholestestoma of the middle ear, Chronic suppurative otitis media, External auditory cana bleeding, Impacted cerumen, Otomycosis external, Secretory otitis media, Tympanic membrane calcification. After we evaluate these optimization schemes, two best performance models are selected to combine the ensemble classifiers with real-time automatic classification. Based on accuracy and training time, we choose a transferring learning model based on DensNet-BC169 and DensNet-BC1615, getting a result that each model has obvious improvement by using these two ensemble classifiers, and has an average accuracy of 95.59%. Considering the dependence of classifier performance on data size in transfer learning, we evaluate the high accuracy of the current model that can be attributed to large databases. Current studies are unparalleled regarding disease diversity and diagnostic precision. The real-time classifier trains the data under different acquisition conditions, which is suitable for real cases. According to this study, in the clinical case, the deep learning model is of great use in the early detection and remedy of ear diseases.
Journal Article
Clinical and epidemiological aspects in equine aural plaques
The association between aural plaques,
Equus caballus papillomavirus
(EcPV), and the different breeds of horses and risk factors is poorly described. The objective of this study was to determine the clinical prevalence of aural plaques in Mangalarga Marchador (MM) and Quarter Horse (QH) horses in Brazil, to evaluate the association of this prevalence with some risk factors, and to detect the presence of EcPV DNA (types 1–10) in aural plaques biopsies. A total of 400 MM and 425 QH horses, were clinically evaluated. For each horse, an identification form was completed, containing information on breeding, sex, age, presence, and classification of aural plaque lesions, presence of ectoparasites, management type, ear clipping performed, and sensitivity to ear palpation. Biopsies of the lesions were taken from 30 horses and assessed for the presence of EcPV DNA using PCR. Among the MM and QH horses evaluated, 41.5% and 33.6%, respectively, had aural plaques. The MM horses showed a higher frequency of plaques than QH (
p
= 0.02). At least one viral type was identified in 90% of all aural plaque biopsies, with EcPV4 being the most frequently detected in both breeds, followed by EcPV6, EcVP5, EcVP3 and EcPV1 respectively. In one sample, EcPV1 was detected alone, although it had previously been described only in copresence. The copresence of viral DNA the MM 73% (11/15) QH 27% (4/15) horses. Aural plaques are widely distributed, with a higher prevalence of EcPV4. Additionally, MM horses have higher susceptibility and frequency of the disease than QH horses.
Journal Article
Eustachian tube dysfunction: A diagnostic accuracy study and proposed diagnostic pathway
Eustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustachian tube opening and closure, which may be associated with severe symptoms and middle ear disease. Currently the diagnosis of obstructive and patulous forms of ETD is primarily based on non-specific symptoms or examination findings, rather than measurement of the underlying function of the Eustachian tube. This has proved problematic when selecting patients for treatment, and when designing trial inclusion criteria and outcomes. This study aims to determine the correlation and diagnostic value of various tests of ET opening and patient reported outcome measures (PROMs), in order to generate a recommended diagnostic pathway for ETD.
Index tests included two PROMs and 14 tests of ET opening (nine for obstructive, five for patulous ETD). In the absence of an accepted reference standard two methods were adopted to establish index test accuracy: expert panel diagnosis and latent class analysis. Index test results were assessed with Pearson correlation and principle component analysis, and test accuracy was determined. Logistic regression models assessed the predictive value of grouped test results.
The expert panel diagnosis and PROMs results correlated with each other, but not with ET function measured by tests of ET opening. All index tests were found to be feasible in clinic, and acceptable to patients. PROMs had very poor specificity, and no diagnostic value. Combining the results of tests of ET function appeared beneficial. The latent class model suggested tympanometry, sonotubometry and tubomanometry have the best diagnostic performance for obstructive ETD, and these are included in a proposed diagnostic pathway.
ETD should be diagnosed on the basis of clinical assessment and tests of ET opening, as PROMs have no diagnostic value. Currently diagnostic uncertainty exists for some patients who appear to have intermittent ETD clinically, but have negative index test results.
Journal Article
A novel missense variant of the GNAI3 gene and recognisable morphological characteristics of the mandibula in ARCND1
Auriculocondylar syndrome (ARCND) is an autosomal monogenic disorder characterised by external ear abnormalities and micrognathia due to hypoplasia of the mandibular rami, condyle and coronoid process. Genetically, three subtypes of ARCND (ARCND1, ARCND2 and ARCND3) have been reported. To date, five pathogenic variants of GNAI3 have been reported in ARCND1 patients. Here, we report a novel variant of GNAI3 (NM_006496:c.807C>A:p.(Asn269Lys)) in a Japanese girl with micrognathia using trio-based whole exome sequencing analysis. The GNAI3 gene encodes a heterotrimeric guanine nucleotide-binding protein. The novel variant locates the guanine nucleotide-binding site, and the substitution was predicted to interfere with guanine nucleotide-binding by in silico structural analysis. Three-dimensional computer tomography scan, or cephalogram, displayed severely hypoplastic mandibular rami and fusion to the medial and lateral pterygoid plates, which have been recognised in other ARCND1 patients, but have not been described in ARCND2 and ARCND3, suggesting that these may be distinguishable features in ARCND1.
Journal Article
Hemotympanum with a Basilar Skull Fracture
A 15-year-old boy presented with a 1-hour history of hearing loss and pain in the left ear after he had tripped and fallen on the street. An otoscopic examination of the left ear showed blood behind the tympanic membrane.
Journal Article
Ear, nose and throat involvement in granulomatosis with polyangiitis: how it presents and how it determines disease severity and long-term outcomes
Ear, nose and throat (ENT) manifestations in granulomatosis with polyangiitis (GPA) represent the most frequent symptoms at disease onset. The aim of the study was to analyse ENT involvement at diagnosis, as well as how it could influence relapse rate, mortality and disease severity. A retrospective non-controlled cohort study was performed including all consecutive diagnosed GPA from 1996 to 2016 in two rheumatology centres of Northern Italy, focusing particularly on ENT presenting signs and symptoms at baseline. Eighty-nine patients (48.3% females) with new onset GPA were evaluated. They were mostly Caucasian (97.7%), middle aged (mean 54.5 years) and more frequently anti-neutrophil cytoplasmic antibodies (ANCA) positive (78.6%) with PR3 specificity (81.4%). At diagnosis, ENT involvement was reported in 71.9% patients, second only to systemic symptoms. These patients were significantly younger at disease onset (0.013), with less frequent renal involvement (0.014) irrespectively to ANCA status, but with significantly higher Vasculitis Damage Index (VDI) (0.001). The most frequent ENT manifestation was sinonasal involvement (58.4%, 73% of which with nasal inflammation/chronic sinusitis and 48% with nasal crusting), while otologic involvement (mainly otitis media/otomastoiditis) was observed in 34.8%. ENT-GPA patients presented a higher survival rate at 5 years (98.1 vs 77.7%, 0.049), and ENT involvement resulted to be an independent predictor of better outcome (OR 0.37, 95% CI 0.2–0.8, 0.019). Our data confirms that ENT involvement is not only one of the key clinical features of GPA, but also could point out a milder GPA subset with lower renal involvement and lower mortality rate, irrespectively to ANCA status.
Journal Article