OBJECTIVE: This study investigated the comparative performance of ear, nose, and throat (ENT) physicians in correctly detecting ear abnormalities when reviewing digital otoscopy imaging using 3 different visualization methods, including computer-assisted composite images called \"SelectStitch,\" single video frame \"Still\" images, and video clips. The study also explored clinicians\' diagnostic confidence levels and the time to make a diagnosis.
METHODS: Clinician diagnostic reader study.
METHODS: Online diagnostic survey of ENT physicians.
METHODS: Nine ENT physicians reviewed digital otoscopy examinations from 86 ears with various diagnoses (normal, perforation, retraction, middle ear effusion, tympanosclerosis). Otoscopy examinations used artificial-intelligence (AI)-based computer-aided composite image generation from a video clip (SelectStitch), manually selected best still frame from a video clip (Still), or the entire video clip. Statistical analyses included comparisons of ability to detect correct diagnosis, confidence levels, and diagnosis times.
RESULTS: The ENT physicians\' ability to detect ear abnormalities (33.2%-68.7%) varied depending on the pathologies. SelectStitch and Still images were not statistically different in detecting abnormalities (P > .50), but both were different from Video (P < .01). However, the performance improvement observed with Videos came at the cost of significantly longer time to determining the diagnosis. The level of confidence in the diagnosis was positively associated with correct diagnoses, but varied by particular pathology.
CONCLUSIONS: This study explores the potential of computer-assisted techniques like SelectStitch in enhancing otoscopic diagnoses and time-saving, which could benefit telemedicine settings. Comparable performance between computer-generated and manually selected images suggests the potential of AI algorithms for otoscopy applications.

Ernst Weber stated in 1819, based on dissections, that the swimbladder in the European wels (Silurus glanis, Siluridae) and related cyprinids serves as an eardrum and that the ossicles connecting it to the inner ear function as hearing ossicles similar to mammals. In the early 20th century, K. von Frisch showed experimentally that catfishes and cyprinids (otophysines) indeed hear excellently compared to fish taxa lacking auxiliary hearing structures (ossicles, eardrums). Knowledge on hearing in catfishes progressed in particular in the 21st century. Currently, hearing abilities (audiograms) are known in 28 species out of 13 families. Recent ontogenetic and comparative studies revealed that the ability to detect sounds of low-level and high frequencies (4-6 kHz) depends on the development of Weberian ossicles. Species with a higher number of ossicles and larger bladders hear better at higher frequencies (>1 kHz). Hearing sensitivities are furthermore affected by ecological factors. Rising temperatures increase, whereas various noise regimes decrease hearing. Exposure to high-noise levels (>150 dB) for hours result in temporary thresholds shifts (TTS) and recovery of hearing after several days. Low-noise levels reduce hearing abilities due to masking without a TTS. Furthermore, auditory evoked potential (AEP) experiments reveal that the temporal patterns of fish-produced pulsed stridulation and drumming sounds are represented in their auditory pathways, indicating that catfishes are able to extract important information for acoustic communication. Further research should concentrate on inner ears to determine whether the diversity in swimbladders and ossicles is paralleled in the inner ear fine structure.

The tympanic membrane (i.e. eardrum) sits at the interface between the middle and external ear. The tympanic membrane is composed of three layers: an outer ectoderm-derived layer, a middle neural crest-derived fibroblast layer with contribution from the mesoderm-derived vasculature, and an inner endoderm-derived mucosal layer. These layers form a thin sandwich that is often perforated following trauma, pressure changes or middle ear inflammation. During healing, cells need to bridge the perforation in the absence of an initial scaffold. Here, we assessed the contribution, timing and interaction of the different layers during membrane repair by using markers and reporter mice. We showed that the ectodermal layer is retracted after perforation, before proliferating away from the wound edge, with keratin 5 basal cells migrating over the hole to bridge the gap. The mesenchymal and mucosal layers then used this scaffold to complete the repair, followed by advancement of the vasculature. Finally, differentiation of the epithelium led to formation of a scab. Our results reveal the dynamics and interconnections between the embryonic germ layers during repair and highlight how defects might occur.

Hearing is an active process, and recent studies show that even the ear is affected by cognitive states or motor actions. One example are movements of the eardrum induced by saccadic eye movements, known as \"eye movement-related eardrum oscillations\" (EMREOs). While these are systematically shaped by the direction and size of saccades, the consequences of saccadic eye movements and their resulting EMREOs for hearing remain unclear. We here studied their implications for the detection of near-threshold clicks in human participants. Across three experiments, sound detection was not affected by their time of presentation relative to saccade onset, by saccade amplitude or direction. While the EMREOs were shaped by the direction and amplitude of the saccadic movement, inducing covert shifts in spatial attention did not affect the EMREO, suggesting that this signature of active sensing is restricted to overt changes in visual focus. Importantly, in our experiments, fluctuations in the EMREO amplitude were not related to detection performance, at least when monaural cues are sufficient. Hence, while eye movements may shape the transduction of acoustic information, the behavioral implications remain to be understood.SIGNIFICANCE STATEMENT Previous studies suggest that oculomotor behavior may influence how we perceive spatially localized sounds. Recent work has introduced a new perspective on this question by showing that eye movements can directly modulate the eardrum. Yet, it remains unclear whether this signature of active hearing accounts for behavioral effects. We here show that overt but not covert changes in visual attention modulate the eardrum, but these modulations do not interfere with the detection of sounds. Our results provide a starting point to obtain a deeper understanding about the interplay of oculomotor behavior and the active ear.

The delivery of drugs through the skin barrier at a predetermined rate is the aim of transdermal drug delivery systems (TDDSs). However, so far, TDDS has not fully attained its potential as an alternative to hypodermic injections and oral delivery. In this study, we presented a proof of concept of a dual drug-loaded patch made of nanoparticles (NPs) and ultrafine fibers fabricated by using one equipment, i.e., the electrospinning apparatus. Such NP/fiber systems can be useful to release drugs locally through the skin and the tympanic membrane. Briefly, dexamethasone (DEX)-loaded poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBHV) fiber meshes were decorated with rhodamine (RHO)-loaded poly(lactic-co-glycolic acid) (PLGA) NPs, with RHO representing as a second drug model. By properly tuning the working parameters of electrospinning, DEX-loaded PHBHV fibers (i.e., by electrospinning mode) and RHO-loaded PLGA NPs (i.e., by electrospray mode) were successfully prepared and straightforwardly assembled to form a TDDS patch, which was characterized via Fourier transform infrared spectroscopy and dynamometry. The patch was then tested in vitro using human dermal fibroblasts (HDFs). The incorporation of DEX significantly reduced the fiber mesh stiffness. In vitro tests showed that HDFs were viable for 8 days in contact with drug-loaded samples, and significant signs of cytotoxicity were not highlighted. Finally, thanks to a beaded structure of the fibers, a controlled release of DEX from the electrospun patch was obtained over 4 weeks, which may accomplish the therapeutic objective of a local, sustained and prolonged anti-inflammatory action of a TDDS, as is requested in chronic inflammatory conditions, and other pathological conditions, such as in sudden sensorineural hearing loss treatment.

Trauma to the ear is typically attributed to its location in the craniofacial skeleton. TM is prone to rupture, tear, or perforation when traumatized. Etiological factors may be classified according to the pathogenetic mechanisms (air-pressure change, heat, solids, water pressure).
METHODS: This is a prospective study of 70 patients with traumatic tympanic membrane perforation between January 2019 and December 2022. Inclusion and exclusion criteria applied and results interpreted.
RESULTS: Traumatic TM affects all age groups with a mean age of 27.94 ± 4.76 years. Traumatic TM affects all age groups with a mean age of 27.94 ± 4.76 years, with the highest incidence among the middle-aged groups 61.4%. The male-to-female ratio was found to be 1.9:1, with high predominance among male patients (65.7%) with a frequency of 57.1% for slap injury group in our study contrary to others. Spontaneous healing was observed in 88.6% over a follow-up period of 12 weeks in this study. Our study has not shown that associated comorbidities influence healing (P = 0.550). About 45.5% Marginal perforations have not healed in 12 weeks follow-up period as compared to central perforations 5.1%.
CONCLUSIONS: There is a high predominance of TM perforation among male patients in our study may be attributed to activity. Spontaneous healing is more common. Duration of healing was significantly affected by the size of the perforation with longer duration for large perforations and vice versa. It is observed in this study that the duration of spontaneous healing is longer in blast injuries when compared to other kinds of injuries. A significant proportion of marginal perforations that have not healed in our study may be attributed to annular ligament involvement.

Endoscopic optical coherence tomography (OCT) is of growing interest for in vivo diagnostics of the tympanic membrane (TM) and the middle ear but generally lacks a tissue-specific contrast.
To assess the collagen fiber layer within the in vivo TM, an endoscopic imaging method utilizing the polarization changes induced by the birefringent connective tissue was developed.
An endoscopic swept-source OCT setup was redesigned and extended by a polarization-diverse balanced detection unit. Polarization-sensitive OCT (PS-OCT) data were visualized by a differential Stokes-based processing and the derived local retardation. The left and right ears of a healthy volunteer were examined.
Distinct retardation signals in the annulus region of the TM and near the umbo revealed the layered structure of the TM. Due to the TM\'s conical shape and orientation in the ear canal, high incident angles onto the TM\'s surface, and low thicknesses compared to the axial resolution limit of the system, other regions of the TM were more difficult to evaluate.
The use of endoscopic PS-OCT is feasible to differentiate birefringent and nonbirefringent tissue of the human TM in vivo. Further investigations on healthy as well as pathologically altered TMs are required to validate the diagnostic potential of this technique.

The tympanic membrane (TM), is a thin tissue lying at the intersection of the outer and the middle ear. TM perforations caused by traumas and infections often result in a conductive hearing loss. Tissue engineering has emerged as a promising approach for reconstructing the damaged TM by replicating the native material characteristics. In this regard, chitin nanofibrils (CN), a polysaccharide-derived nanomaterial, is known to exhibit excellent biocompatibility, immunomodulation and antimicrobial activity, thereby imparting essential qualities for an optimal TM regeneration. This work investigates the application of CN as a nanofiller for poly(ethylene oxide terephthalate)/poly(butylene terephthalate) (PEOT/PBT) copolymer to manufacture clinically suitable TM scaffolds using electrospinning and fused deposition modelling. The inclusion of CN within the PEOT/PBT matrix showed a three-fold reduction in the corresponding electrospun fiber diameters and demonstrated a significant improvement in the mechanical properties required for TM repair. Furthermore, in vitro biodegradation assay highlighted a favorable influence of CN in accelerating the scaffold degradation over a period of one year. Finally, the oto- and cytocompatibility response of the nanocomposite substrates corroborated their biological relevance for the reconstruction of perforated eardrums.

Despite the high success rate of autologous grafts in tympanic membrane repair, clinical alternatives are required for the closure of unresponsive chronic perforations that can lead to recurring infection and hearing loss. Tissue engineering and regenerative medicine approaches have emerged as another strategy to repair the eardrum, in addition to negating the need for donor tissue harvest and related surgical iatrogenicities. This review highlights the main approaches using biomaterials, growth factors, and cell therapies towards the healing of complex TM perforations. In addition, we discuss the challenges and advances for the development of reliable animal models, which will allow the optimisation and development of novel techniques. Finally, we indicate technologies that are currently used clinically and others that are closer to the market. The advances here discussed on tissue engineering and regenerative medicine strategies applied to the field of TM perforations will allow otologists, surgeons, and researchers to better bring novel technologies to the bedside as well as to develop new ones.

The middle ear is part of the ear in all terrestrial vertebrates. It provides an interface between two media, air and fluid. How does it work? In mammals, the middle ear is traditionally described as increasing gain due to Helmholtz\'s hydraulic analogy and the lever action of the malleus-incus complex: in effect, an impedance transformer. The conical shape of the eardrum and a frequency-dependent synovial joint function for the ossicles suggest a greater complexity of function than the traditional view. Here we review acoustico-mechanical measurements of middle ear function and the development of middle ear models based on these measurements. We observe that an impedance-matching mechanism (reducing reflection) rather than an impedance transformer (providing gain) best explains experimental findings. We conclude by considering some outstanding questions about middle ear function, recognizing that we are still learning how the middle ear works.