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Background: The impact of otolaryngological diseases on sleep quality, anxiety, and depression has garnered significant attention. However, research has primarily focused on unveiling the effects of only one or two specific diseases, without analyzing the impact of multiple concurrent diseases. Furthermore, investigation into the interaction mechanisms among these factors has been lacking. Objectives: This study reveals the effects of different otolaryngological diseases on sleep quality, anxiety, and depression, and investigates their interaction mechanisms. Methods: In total, 2,080 patients with otolaryngological diseases were recruited from six centers in mainland China. Data on sociodemographics, history of smoking and alcohol consumption, diagnosis, anxiety, depression, and sleep quality were collected through hospital information system queries and questionnaires. We uncovered the psychological status and sleep quality of otolaryngology outpatients with different diseases and revealed the interaction mechanisms between these diseases and anxiety, depression, and sleep quality. Multivariable polynomial linear regression models explored the impact of different otolaryngological diseases on anxiety, depression and sleep quality, and mediation analysis explored the interaction mechanisms. Results: Chronic laryngitis, eustachian tube disorders, laryngeal swelling, laryngopharyngeal reflux, neck lymphatic inflammation, snoring, sudden deafness, tinnitus, nasopharyngeal lesions, and trauma had a significant impact on Pittsburgh Sleep Quality Index scores. Chronic tonsillitis, chronic laryngitis, and laryngopharyngeal reflux had a significant impact on Zung Self-Rating Depression Scale scores. Patients with giddiness (P = 0.006) and tinnitus (P = 0.006) tended to have higher Zung Self-Rating Anxiety Scale scores. Anxiety mediated the effect of tinnitus on sleep quality (70.41%; 95% confidence interval [CI]: 40.07, 76.00), and depression also had a mediation effect (13.24%; 95% CI: 4.46, 28.58). Other diseases also exhibited mediating effects and interactions with anxiety, depression, and sleep quality. Conclusions: Sleep quality significantly mediates the relationships of specific otolaryngological diseases with anxiety and depression. Similarly, anxiety and depression play important mediating roles in the relationships of different diseases with sleep quality. By revealing the interactive effects of different otolaryngological diseases on anxiety, depression, and sleep quality, this study could aid early interventions aiming to reduce anxiety and depression and improve patients' sleep quality and quality of life. [ABSTRACT FROM AUTHOR]

We present a case of a perilymphatic fistula (PLF) caused by Eustachian tube air inflation (ETAI) that was diagnosed using cochlin-tomoprotein (CTP) testing and successfully treated using transcanal endoscopic ear surgery to seal the inner ear window. A 77-year-old woman developed hearing loss and dizziness after undergoing ETAI at a local ear, nose, and throat clinic. Despite initial bed rest and steroid pulse therapy, the hearing did not improve, and transcanal endoscopic ear surgery was performed to repair the PLF. The CTP test confirmed the diagnosis of PLF, leading to a significant improvement in the patient's hearing and dizziness symptoms postoperatively. This case highlights the importance of considering PLF as a potential complication of ETAI and the value of CTP testing for diagnosing this condition. [ABSTRACT FROM AUTHOR]

Introduction: Cholesteatoma, a challenging entity in otologic surgery, necessitates a standardized classification system for effective communication among healthcare providers and consistent reporting of surgical outcomes. The ChOLE Classification System, introduced by Linder et al., stages cholesteatoma based on extension (Ch), ossicular chain status (O), life-threatening complications (L), and Eustachian tube function and mastoid pneumatization (E). Methods: We classified 199 patients who underwent cholesteatoma surgery between 2019 and 2023 in our University Hospital to assess the distribution of the ChOLE stages and to examine the relationship between the ChOLE stages and the duration of surgery. Results: This study revealed significant correlations between the ChOLE stage and respective subgroups of the classification and duration of surgery and thus complexity of procedure. Conclusion: Despite limitations, the ChOLE classification proves valuable in predicting surgical complexity and optimizing patient care. Further research is warranted to validate these findings and enhance cholesteatoma management strategies. [ABSTRACT FROM AUTHOR]

The article discusses the short- and long-term neurologic outcomes of patients undergoing an endoscopic endonasal transpterygoid approach (EETPA) for tumor resection. It highlights the main neurologic deficits associated with the approach, such as trigeminal neuropathy, hearing loss, and trismus, and how they evolve over time. The study found that the type of approach, preoperative deficits, and postoperative radiation can impact the resolution of these neurologic deficits. The research aims to provide data-driven patient counseling and optimize the management of neurologic deficits in patients undergoing an EETPA. [Extracted from the article]

The article published in the Journal of Neurological Surgery discusses the challenges of localizing and controlling the upper parapharyngeal internal carotid artery (upper-ppICA) during surgical procedures. The study identifies two anatomical triangles, named the "ACCESS" and "DANGER" triangles, as landmarks for localizing the upper-ppICA during endoscopic approaches to the infratemporal fossa and parapharyngeal spaces. These triangles, consisting of six key points, provide valuable guidance for surgeons in safely accessing and treating tumors or lesions in these regions. [Extracted from the article]

The article discusses a case of spontaneous pneumocephalus without an identifiable cerebrospinal fluid (CSF) leak, where a patient presented with a life-threatening condition. The patient underwent a less invasive surgery involving subtotal petrosectomy and eustachian tube obliteration, which successfully resolved the pneumocephalus. This alternative approach proved to be effective in treating the CSF leak, highlighting a potential option for cases with clinical suspicion of a temporal CSF leak. [Extracted from the article]

The article discusses the use of positron emission tomography (PET) and computed tomography (CT) in detecting cancer in the head, neck, and skull base. It explains how the radiopharmaceutical F-18 flourodeoxyglucose (FDG) is taken up by tumor cells due to their increased glucose utilization, leading to the detection of malignancies. The text also highlights how other factors like foreign body material, infection, and inflammation can mimic the appearance of neoplasms in the skull base, providing examples and insights into PET-CT imaging. [Extracted from the article]

The article "Cadaveric Endoscopic Transmeatal Approach to the Internal Acoustic Canal and the Middle Ear" published in the Journal of Neurological Surgery explores the neurosurgical perspective on using endoscopic techniques to access the middle ear and internal acoustic canal. The study documents step-by-step procedures for this approach, including identifying key anatomical landmarks and utilizing high-speed drills to open the internal acoustic canal. The authors successfully performed the endoscopic transmeatal approach, showcasing its potential as a minimally invasive option for certain cases in lateral skull base surgery. [Extracted from the article]

The article explores the impact of endoscopic transpterygoid eustachian tube management on long-term hearing outcomes in patients undergoing surgery for petroclival region malignancies. The study compares patients who had open resection with those who underwent endoscopic approaches, finding no significant difference in new or persistent hearing loss rates between the two groups. However, the endoscopic group experienced earlier hearing morbidity, more mastoid effusion, and unilateral hearing loss, despite achieving higher rates of gross total resection. The study suggests that further investigation may be needed to determine the optimal eustachian tube management strategy for these patients. [Extracted from the article]

This article from the Journal of Neurological Surgery explores the maneuverability of different surgical approaches in the infratemporal fossa. The endoscopic endonasal approach and the Fisch type C approach were compared using anatomical dissection on human cadaveric specimens. The study found that while the endoscopic approach is feasible for certain lesions, the Fisch type C approach offers enhanced maneuverability at the lateral aspect of the eustachian tube, although it may impact hearing function. This comparative analysis can aid in preoperative surgical planning for lesions in this complex anatomical region. [Extracted from the article]

The article discusses a novel surgical approach to expanding the limits of the endoscopic endonasal approach (EEA) to the petrous apex by incorporating the contralateral transmaxillary approach (CTMA) and stepwise mobilization of the paraclival internal carotid artery (ICA). Anatomic dissections in cadaveric heads showed that this technique significantly increased exposure and resection volume of the petrous apex, allowing for greater removal of the petrous bone. The study suggests that mastering this technique requires extensive training and understanding of anatomy, with further clinical studies needed to validate its safety and efficacy for patients. [Extracted from the article]

The article explores the anatomical study of accessing the petrous apex (PA) through the endoscopic endonasal approach (EEA) and the transorbital endoscopic approach (TOEA). The EEA primarily exposes the inferior and medial aspects of the PA, while the TOEA provides a view of the superior surface. Detailed step-by-step guides for both approaches are provided, emphasizing the importance of understanding the complex anatomy of the region for successful surgeries on PA tumors. [Extracted from the article]

The article discusses the technical nuances of the sublacerum versus supralacerum endoscopic endonasal transclival approach for resection of chordomas and chondrosarcomas. Through anatomical dissections and illustrative cases, the authors highlight key maneuvers and surgical adjuncts required for radical resection in both compartments. The study emphasizes the importance of understanding locoregional anatomy and utilizing specific techniques to ensure safe maximal resection of chondroid tumors, with implications for other lesions like petroclival meningiomas. [Extracted from the article]

Radiotherapy (RTx) is a highly effective treatment for head and neck cancer that can cause concurrent damage to surrounding healthy tissues. In cases of nasopharyngeal carcinoma (NPC), the auditory apparatus is inevitably exposed to radiation fields and sustains considerable damage, resulting in dysfunction. To date, little research has been conducted on the changes induced by RTx in the middle ear and the underlying mechanisms involved. Dexamethasone (DEX) is widely used in clinical practice because of its immunosuppressive and anti-inflammatory properties. The present study investigated the effects and underlying mechanisms of DEX delivered via intratympanic administration on RTx-induced damage to the middle ear and human middle ear epithelial (HMEE) cells. Sprague–Dawley (SD) rats were exposed to fractionated RTx (6.6 Gy/day for 5 days), and middle ear samples were collected at 1 and 4 months. Rats that received RTx presented a significant increase in the thickness of the submucosal layer in the middle ear and disorganization of the ciliated epithelium in the Eustachian tube (ET) mucosa. Importantly, intratympanic administration of DEX 30 min before RTx resulted in a lower degree of damage than that in the control group. Furthermore, DEX pretreatment downregulated the expression of cell death pathway markers in HMEE cells. Our collective results potentially support the use of DEX to reduce radiation-induced damage in the middle ear and may contribute to the development of future studies. [ABSTRACT FROM AUTHOR]

Tinnitus is a phantom auditory perception in the absence of external stimuli which can be caused by various etiologies including infectious causes, neurological etiologies such as whiplash injury and acoustic neuroma, side effects of certain medication and mechanical causes. Neoplasms that block the Eustachian tube (ET) may also lead to tinnitus. This is a case of fibrous dysplasia (FD) seen on Technetium-99m methyl diphosphonate (99mTc-MDP) whole body bone scintigraphy and SPECT/CT causing blockage of the ET. Fibrous dysplasia (FD) is a rare, congenital, and benign neoplasm that affects the bones. FD can be broadly categorized as mono-ostotic and poly-ostotic types. It often extends from its primary site into other bones and may cause symptoms due to compression, which may not be seen by conventional radiological imaging. We present a case of FD in a young woman, who had unilateral right-sided tinnitus and headache. Conventional imaging identified a lesion involving the paranasal bones with no involvement of the temporal bones or middle ear. 99mTc-MDP whole-body bone scintigraphy was performed to delineate the extent of the disease, which revealed complete blockage of the right sided paranasal sinuses that could have led to a Patulous ET (PET), hence indirectly causing tinnitus. This illustrates the role of nuclear medicine imaging, over conventional imaging, in accurately delineating the functional extent of fibrous dysplasia. [ABSTRACT FROM AUTHOR]

A 19-year-old male patient with a history of congenital left oval window defect has had recurrent admissions to a children's hospital for bacterial meningitis since the age of 7. Investigations revealed a left-sided type 1 incomplete partition deformity of the left ear with a congenital oval window defect, leading to communication between the cranium and the middle ear. The patient underwent a left canal wall down mastoidectomy and oval window defect repair, remaining well for 3 years. He experienced two more episodes of bacterial meningitis as he got older, prompting repeated exploratory tympanotomy and repair of the cerebrospinal fluid (CSF) leak after each episode. Recently, he was referred again for recurrent meningitis. Investigations showed a recurrent oval window defect. After undergoing left external ear canal transection, mastoid and middle ear obliteration, and left Eustachian tube obliteration, he remained well without further leaks or meningitis. Congenital oval window defect is rare and may present with recurrent bacterial meningitis secondary to spontaneous CSF leak via the oval window. Radiology plays a crucial role in identifying the source of the CSF leak, facilitating more precise preoperative counseling and surgical intervention. [ABSTRACT FROM AUTHOR]

Background and Objectives: Eustachian tube dysfunction (ETD) is prevalent among patients with ENT disorders, necessitating history-taking, clinical examination, and appropriate investigation for diagnosis. Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) is a valuable tool for subjectively assessing symptom severity related to this condition. This study aims to adapt and validate the ETDQ-7 in Greece, ensuring its accuracy and efficacy in outpatient settings. Subjects and Methods: The ETDQ-7 was translated into Greek following established methodology. Data were collected from 75 Greek patients diagnosed with ETD and 25 control patients without ETD. Participants completed the adapted ETDQ-7 and underwent a clinical examination, with statistical analysis correlating with their ETDQ-7 responses. Statistical analyses were performed to determine the questionnaire's reliability and validity. Results: Internal consistency and item analyses were performed to validate the questionnaire. Face and content validity were confirmed, and patients found the questionnaire easy to administer and complete. Test-retest reliability demonstrated similar internal consistency and a strong correlation between individual items and the total score. Discriminative validity revealed a statistically significant difference between the two patient groups, supporting the usefulness of the Greek version of ETDQ-7 in confirming the diagnosis of ETD. Conclusions: The Greek version of ETDQ-7 proves to be safe and effective for diagnosing ETD in Greek-speaking populations, complementing various investigative methods. [ABSTRACT FROM AUTHOR]

Introduction In recent years, transcanal endoscopic ear surgery (TEES) has gained widespread recognition as an excellent surgical field for blind spots such as the sinus tympani (ST) when compared to microscopic ear surgery (MES). Objective To investigate the postoperative hearing results for pars tensa cholesteatoma and the indications for utilizing endoscopy. Methods The medical records of 16 patients (10 men and 6 women) with pars tensa cholesteatoma, who received initial surgical treatment between 2018 and 2022, were reviewed. We performed MES, TEES, or endoscopy-assisted MES (dual approach) depending on the pathological involvement in the mastoid cavity and ST. Results The mean age of the patients was 45 years, and the surgical techniques utilized were MES in 2 cases, TEES in 7 cases, and dual approach in 7 cases. The preoperative pathological classification was stage I in 3 patients and stage II in 13 patients. The overall surgical success rates of postoperative hearing outcomes were 69% and 50% (1/2 patients) in the TEES group, 71% (5/7 patients) in the MES group, and 71% (5/7 patients) in the dual approach group. The successful cases (n = 11) were significantly younger and demonstrated better mastoid pneumatization than unsuccessful cases (n = 5). Conclusion Endoscopy-assisted MES is appropriate for treating pars tensa cholesteatoma when pathological involvement is present at the deep bottom of the ST. Early surgical intervention and good eustachian tube function are crucial for improving hearing prognosis. Transcanal endoscopic ear surgery can be particularly useful in identifying and removing residual cholesteatoma within the ST. [ABSTRACT FROM AUTHOR]

Ear, nose, and throat (ENT) disease is a disorder that occurs in the eustachian tube in one of the organs, be it the ear, nose, or throat. Early signs of ENT disease include sore throat, painful swallowing, swollen and red tonsils, runny nose, nosebleeds, blocked nose, discharge from the ears, and others. To determine the diagnosis, it is necessary to carry out a physical examination of the ears, nose, and throat as recommended by an expert, namely an ENT doctor. The research carried out was implementing data mining for the diagnosis of ENT diseases using the Naïve Bayes (NB) method. This method was chosen because it can increase the accuracy, efficiency, and accessibility of health services and is also easy to understand and apply to classify ENT disease symptom data. The NB method was used to build an ENT diagnosis classification model and the model performance was evaluated using accuracy, precision, and recall metrics. To increase the accuracy of the NB algorithm predictions, feature selection using a genetic algorithm can be used. Genetic algorithms can help select the most relevant and significant features, improving the accuracy of NB models by eliminating irrelevant or noisy features. By applying this method, predictions for ENT diseases can be produced with an accuracy of 95,67%. [ABSTRACT FROM AUTHOR]

Background/Objectives: Recurrent chronic otitis media (rCOM) is a major cause of hearing impairment, often linked to Eustachian tube (ET) dysfunction. Anatomical abnormalities, such as ET narrowing and obstructions, and functional impairments, including poor pressure regulation, play significant roles in rCOM recurrence. This study aimed to (1) identify anatomical variations of the ET in patients with rCOM using high-resolution imaging; (2) evaluate ET functional status using tympanometry, tubomanometry, and ET function tests; and (3) assess the correlation between anatomical variations and functional impairments in predicting rCOM recurrence. Methods: A cross-sectional study was conducted on 212 patients with rCOM and 212 controls. High-resolution CT and MRI were used to assess ET anatomy, while functional status was evaluated using tympanometry, tubomanometry, and Valsalva maneuver tests. Statistical analyses, including t-tests, Pearson correlation, and Cox proportional hazards models, were applied to examine the relationship between anatomical and functional impairments and rCOM recurrence. Results: Significant anatomical differences were observed in the rCOM group, including ET narrowing (24.53% vs. 11.32%, p = 0.014) and curvature (32.08% vs. 14.15%, p < 0.001). Functional impairments were also more prominent in rCOM patients, with higher ET opening pressure (120.56 ± 14.34 dPa vs. 85.78 ± 12.98 dPa, p < 0.001) and lower Valsalva maneuver success rates (62.32% vs. 89.56%, p < 0.001). Cox regression indicated that anatomical and functional impairments significantly predicted faster recurrence (HR for tympanometry peak pressure = 1.56, p < 0.001). Conclusions: The ETs anatomical and functional impairments are significant predictors of rCOM recurrence. A combined assessment of these factors can improve diagnostic accuracy and guide more targeted interventions to prevent recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Balloon dilation of the eustachian tube has gained ground in the treatment of chronic dysfunction. A new indication for a larger group of patients has emerged, which is characterized by barochallenge only, which affects even more patients. Given the recent validation of the balloon dilation, we set out to explore if this procedure could be useful in treating this specific sub‐group of patients in an in‐office setting. Methods: Balloon dilation was performed using inly nasal cottonoids soaked in 2% tretracainephenylephrine combined with xylocaine nasal spray and lidocaine/prilocaine gel and a mild oral sedative. The effect of eustachian tube balloon dilation on the function of the eustachian tube was evaluated by using the eustachian tube dysfunction questionnaire‐7 (ETDQ‐7) and a VAS score. The questionnaires were completed beforehand and 3 months and 12 months postoperatively to determine subjective surgical success. Results: Two hundred and forty‐six balloon dilation were performed in 132 participants. The results from the ETDQ‐7 questionnaire and VAS scores showed a significant improvement in symptoms during pressurization after eustachian tube balloon dilation (p = 0.0001). A mean pain score during procedure in local anesthesia was 3.4 on a scale from 1 to 10. Conclusion: Eustachian tube balloon dilation significantly reduced symptoms of eustachian tube dysfunction during non‐physiological pressure, which was determined by ETDQ‐7 and Vas scores. Additionally, we found that the procedure is well suited for private practice or the outpatient clinic, using local anesthetics and a mild sedative. Level of Evidence: 4 Laryngoscope, 135:361–365, 2025 [ABSTRACT FROM AUTHOR]

Objective: Tympanostomy tube placement has been shown to decrease systemic antibiotics usage in patients with recurrent acute otitis media. Systemic antibiotics in children are associated with an increase in antibiotic‐associated conditions (asthma, allergic rhinitis, food allergy, atopic dermatitis, celiac disease, overweight/obesity, attention‐deficit hyperactivity disorder [ADHD], autism, learning disability, and Clostridium difficile colonization) later in life. The objective of this study is to estimate whether tympanostomy tube placement is associated with a reduction in antibiotic‐associated conditions in children with recurrent acute otitis media (RAOM). Methods: A retrospective cohort review of electronic medical records from 1991 to 2011 at a large pediatric hospital system was performed identifying 27,584 patients under 18 years old with RAOM, defined by 3 or more episodes of AOM. Antibiotic‐associated conditions were defined using ICD‐9 and ICD‐10 codes. Results: The enrollment population was largely composed of White patients (28.9%), Black patients (30.1%), and Hispanic/Latino patients (16.4%). The number of systemic antibiotics prescribed per encounter was significantly lower in children who pursued tympanostomy tubes (0.14 antibiotics per encounter) versus those who did not (0.23 antibiotics per encounter) (p < 0.001). Patients with RAOM who received tympanostomy tubes were less likely to have diagnoses of overweight/obesity (OR. 0.62 [0.55, 0.68]; p < 0.001), asthma (OR 0.8 [0.74, 0.87]; p < 0.001), allergic rhinitis (OR 0.72 [0.65, 0.81]; p < 0.001), and atopic dermatitis (0.78 [0.71, 0.86]; p < 0.001). Conclusions and Relevance: Tympanostomy tube placement is associated with less systemic antibiotic administration and a decreased incidence of overweight/obesity, asthma, allergic rhinitis, and atopic dermatitis in children diagnosed with RAOM. Level of Evidence: 4 Laryngoscope, 135:423–428, 2025 [ABSTRACT FROM AUTHOR]

The article discusses how the DYRK1A gene contributes to frequent and severe ear infections in individuals with Down syndrome, making it a potential target for therapeutic interventions. Research shows that individuals with Down syndrome are more likely to develop otitis media, leading to chronic hearing impairment. By studying mouse models and human samples, researchers have identified DYRK1A as a key driver of otitis media and potential therapeutic target, offering hope for targeted interventions to improve quality of life for individuals with Down syndrome. [Extracted from the article]

To detect the prevalence of eustachian tube dysfunction in tubotympanic type of chronic otitis media. To correlate eustachian tube dysfunction with surgical outcome of tympanoplasty. This observational study involved 79 patients diagnosed with inactive tubotympanic chronic suppurative otitis media who were planned for type-1 tympanoplasty. The Eustachian tube function preoperatively assessed using the saccharin test, measuring saccharin perception time through otoendoscopic examination. The results were then correlated with graft uptake following tympanoplasty during the follow-up period. This study was conducted over 18 months and sample size was 79. A 68% prevalence of eustachian tube dysfunction based on saccharin perception time was noted. In gross eustachian tube dysfunction category, 8.8% failure rate of tympanoplasty was noted at 3 months follow up.A 1.26% failure rate was noted in partial tube dysfunction. At 6 months follow up period, we noted a graft failure in both gross and partial eustachian dysfunction category which was 11.9% and 3.79% respectively. A correlation among post-operative graft uptake and eustachian tube dysfunction was noted in our study but this was not statistically significant. From our study we noted a high prevalence of eustachian tube dysfunction in CSOM tubotympanic type. Eustachian tube dysfunction is a very common entity that has to be evaluated prior to tympanoplasty surgery. Thus an easy, effective, and cost-effective method like the saccharin test can be used to evaluate eustachian tube function and the surgical outcomes of tympanoplasty as the eustachian tube plays crucial role in middle ear clearance and ventilation. This can guide us to take corrective measures to address the eustachian tube dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: Balloon eustachian tuboplasty (BET) is an emerging treatment for dilatory eustachian tube (ET) dysfunction. However, its efficacy in patients with both chronic suppurative otitis media (COM) and ET dysfunction remains unclear. The objective of the trial was to assess the efficacy and safety of BET versus medical management (MM) alone in adult patients with COM and chronic dilatory ET dysfunction, which was defined by a failed Valsalva maneuver., Methods: In this prospective, multicenter, randomized controlled trial, a total of 116 participants (121 ears) treated between January 2021 and June 2023 were randomly assigned (1:1) to receive either BET with MM or MM alone (fluticasone furoate nasal steroid spray). The short-term primary outcome was the normalization of the Valsalva maneuver at the 8-week follow-up. Secondary outcomes were improved Eustachian Tube Dysfunction Questionnaire- 7 (ETDQ-7) scores and decreased air-bone gap (ABG) analyzed at 8 weeks. Adverse events were monitored in both groups during the follow-up period., Results: Among the 116 participants (121 ears), 60 participants (62 ears) received BET and 56 participants (59 ears) received MM alone. Demographics, baseline characteristics, ETDQ-7 scores, bone conduction thresholds, and ABG did not differ significantly between the groups. In the BET group, 46.8% (29/62, ears) achieved a successful Valsalva maneuver compared with 15.3% (9/59, ears) in the MM-only group (p<0.001). BET group (-6.2±9.4) showed greater subjective symptom improvement than the MM-only group (-2.6±8.6) regarding ETDQ-7 scores (p=0.028). ABG decreased more in the BET group (-5.8±11.4 dB) compared with the MM-only group (-1.2±10.5 dB) (p=0.023). No serious procedure-related or device-related adverse events occurred in either group during the 8-week follow-up., Conclusion: Our trial suggests that BET, combined with MM, demonstrated superiority over MM alone, along with its safety, in treating dilatory ET dysfunction in patients with COM.

Recidivistic cholesteatoma encompasses residual as well as recurrent disease, and can occur in up to 61% of cases. Pediatric disease may have a higher propensity for recidivism. Serial physical examination and MRI including non-EPI DWI sequences are useful in surveillance. Canal wall down approaches with mastoid obliteration may be an approach to reduce recidivism while minimizing the need for mastoid cavity maintenance. Modern techniques of Eustachian tube dilation and endoscopic ear surgery may yet prove particularly helpful in reducing re-retraction and residual disease in the retrotympanum, respectively; however, they require further study., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Skull-based approaches involving the middle fossa (MF) can be complicated by postoperative cerebrospinal fluid (CSF) leaks. Most of these CSF leaks are due to inadvertent entry into the eustachian tube (ET) or incomplete packing of surrounding air cells. Air cells are routinely plugged with bone wax during surgery; however, CSF leaks due to entry into the ET are often not recognized. Our objective was to define a safe zone for drilling that would avoid entry into the ET during MF approaches., Methods: Ten cadaveric specimens were fixed in formalin and injected with latex. Twenty sides were dissected and examined under a microscope. We exposed and identified the petrous internal carotid artery (ICA), ET, and all surrounding anatomical landmarks., Results: We identified a triangle bordered by the lateral aspect of the third division of the trigeminal nerve (V3), the lateral aspect of the petrous ICA, and an imaginary line through the middle meningeal artery connecting V3 to the petrous ICA. This triangle was then bisected at the base, creating a medial and lateral sub-triangle. In all 20 cadaveric exposures, the ET was in the lateral sub-triangle and did not extend into the medial sub-triangle., Conclusion: Our findings demonstrate that entry into the ET while exposing the petrous ICA during MF approaches can be safely avoided by drilling in the medial sub-triangle. Drilling in the lateral sub-triangle will lead to entry into the ET, increasing the risk of a postoperative CSF leak., Competing Interests: There are no conflicts of interest., (Copyright: © 2025 Surgical Neurology International.)