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Background: Precise preoperative radiological evaluation of aural atresia is of utmost importance for surgical planning. Until now, multislice computed tomography (MSCT) has been used but it cannot adequately visualize small structures such as the stapes. Flat-panel volume CT (fpVCT) with its secondary reconstructions (fpVCT SECO ) offers a high-resolution visualization of the middle ear. New otosurgical planning software also enables detailed 3D reconstruction of the middle ear anatomy., Aim of the Work: Evaluation of the use of fpVCT SECO in combination with an otosurgical planning software for a more accurate diagnosis and treatment of congenital aural atresia., Material and Methods: Seven patients with congenital aural atresia underwent preoperative MSCT (600 µm slice thickness) and corresponding fpVCT (466 µm slice thickness). In addition, fpVCT SECO (99 µm slice thickness) were reconstructed. The Jahrsdoerfer and Siegert grading scores were determined and their applicability in the abovementioned imaging modalities was evaluated. In addition, the malleus incus complex was analyzed in 3D rendering., Results: Imaging with fpVCT SECO enabled reliable visualization of the abnormalities, in particular the ossicular chain. A significant difference in the Siegert grading score was found. In addition, the malleus-incus complex could be visualized better in 3D., Discussion: The introduction of new imaging techniques and surgical planning techniques into the diagnostic concept of aural atresia facilitates the identification of malformed anatomy and enables systematic analysis. This combination can also help to more accurately classify the pathology and thus increase the safety and success of the surgical procedure., Competing Interests: Declarations. Conflict of interest: F.-T. Müller-Graff, J. von Düring, J. Voelker, F. Al-Tinawi, R. Hagen, T. Neun, S. Hackenberg and K. Rak declare that they have no competing interests. This retrospective, anonymized study was conducted in accordance with local guidelines and the principles of the Declaration of Helsinki and Good Clinical Practice and was approved by the local ethics committee (2021050601). The supplement containing this article is not sponsored by industry., (© 2024. The Author(s).)

Background: Moving Ear Syndrome is a rare hyperkinetic disorder., Phenomenology Shown: This Video Abstract illustrates typical backward movements of the right ear associated with pain and discomfort in a man with Moving Ear Syndrome., Educational Value: Moving Ear Syndrome is effectively and safely treatable with EMG-US-guided botulinum toxin injections., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Precise preoperative radiological evaluation of aural atresia is of utmost importance for surgical planning. Until now, multislice computed tomography (MSCT) has been used but it cannot adequately visualize small structures such as the stapes. Flat-panel volume CT (fpVCT) with its secondary reconstructions (fpVCT SECO ) offers a high-resolution visualization of the middle ear. New otosurgical planning software also enables detailed 3D reconstruction of the middle ear anatomy., Aim of the Work: Evaluation of the use of fpVCT SECO in combination with an otosurgical planning software for a more accurate diagnosis and treatment of congenital aural atresia., Material and Methods: Seven patients with congenital aural atresia underwent preoperative MSCT (600 µm slice thickness) and corresponding fpVCT (466 µm slice thickness). In addition, fpVCT SECO (99 µm slice thickness) were reconstructed. The Jahrsdoerfer and Siegert grading scores were determined and their applicability in the abovementioned imaging modalities was evaluated. In addition, the malleus incus complex was analyzed in 3D rendering., Results: Imaging with fpVCT SECO enabled reliable visualization of the abnormalities, in particular the ossicular chain. A significant difference in the Siegert grading score was found. In addition, the malleus-incus complex could be visualized better in 3D., Discussion: The introduction of new imaging techniques and surgical planning techniques into the diagnostic concept of aural atresia facilitates the identification of malformed anatomy and enables systematic analysis. This combination can also help to more accurately classify the pathology and thus increase the safety and success of the surgical procedure., (© 2024. The Author(s).)

Statement of Problem: Making conventional facial impressions can be uncomfortable for the patient and complicated for the prosthodontist. Using facial scanners to digitize faces is an alternative approach. However, the initial costs of the equipment have prevented their widespread use in dental practice, and the accuracy of ear scanning is unclear., Purpose: The purpose of this in vitro study was to investigate the accuracy of a widely used intraoral scanner for digitizing an ear model., Material and Methods: For reference, a silicone model of an ear was scanned with an industrial scanner. Then, the model was scanned 5 times with an intraoral scanner. Five conventional impressions of the model were made with a hydrocolloid impression material and poured with dental stone. The stone casts were then digitized with a desktop scanner. The data sets acquired with the 3 approaches were analyzed by using a 3-dimensional (3D) evaluation software program. Trueness and precision values were calculated for each approach. Linear mixed models with random intercepts were fitted to each sample to evaluate the effects of the impression method on mean deviations (α=.05)., Results: Mean ±standard deviation trueness and precision values were 0.097 ±0.012 mm and 0.033 ±0.015 mm, respectively, for the digital scan, and 0.092 ±0.022 mm and 0.081 ±0.024 mm for the conventional impression, showing a significantly lower deviation in precision for the digital approach (P<.001)., Conclusions: The feasibility of digitizing an ear efficiently by using the investigated intraoral scanner was demonstrated, and similar trueness and significantly better precision values were achieved than when using conventional impressions. These promising results suggest the need for clinical investigations., (Copyright © 2022 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

This study attempts to classify ear morphology for human identification in forensic investigations by distinguishing between the upper auricle and lobule areas. A three-dimensional homologous model of the ear was created using 414 ear images of males aged 17-93 years reconstructed from computed tomography scans of forensic autopsy cases. Morphological changes were visualized using principal component analysis and areas of significant individual differences within the entire ear were identified. The classification criterion images for the upper auricle (ten images) and lobule (12 images) were developed by combining multiple principal component values: components 1-5 for the upper auricle and 1-6 for the lobule. Three-dimensional ear images of the upper auricle and lobule areas from 414 subjects were categorized using a measurement method based on the minimum distance between 5,507 corresponding points. The results indicate the applicability of the criterion images for the morphological classification of ears in this study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could appeared to influence the work reported in this paper. The authors have declared that no competing interests exist., (Copyright: © 2024 Biwasaka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Pressure ulcers present a significant human and economic challenge, lacking a reliable method for early detection. To address this, we developed a system capable of early detection by using cooling stimulation and dynamic data acquisition techniques to monitor blood perfusion and skin temperature. The system consists of laser speckle perfusion imaging and thermal imaging. And we performed simulations to demonstrate that the system is capable of detect tissue damage across multiple layers, from superficial to deep. Testing on a rabbit ear model demonstrated that this approach, which combines dynamic perfusion and temperature parameters, effectively distinguishes early pressure ulcer areas from normal skin with a significant p value of 0.0015. This distinction was more precise compared to methods relying solely on static parameters or one parameter. Our study thereby offers a promising advancement in the proactive management and prevention of pressure ulcers., (© 2024 Wiley‐VCH GmbH.)

Photo-sono therapy (PST) is an innovative anti-vascular approach based on cavitation-induced spallation. Currently, passive cavitation detection (PCD) is the prevalent technique for cavitation monitoring during treatment. However, the limitations of PCD are the lack of spatial information of bubbles and the difficulty of integration with the PST system. To address this, we proposed a new, to the best of our knowledge, cavitation mapping method that integrates Doppler optical coherence tomography (OCT) with PST to visualize bubble dynamics in real time. The feasibility of the proposed system has been confirmed through experiments on vascular-mimicking phantoms and in vivo rabbit ear vessels, and the results are compared to high-speed camera observations and PCD data. The findings demonstrate that Doppler OCT effectively maps cavitation in real time and holds promise for guiding PST treatments and other cavitation-related clinical applications.

Photoacoustic imaging (PAI) utilizes the photoacoustic effect to record both vascular and functional characteristics of a biological tissue. Photoacoustic signals have typically low amplitude that cannot be read efficiently by data acquisition systems. This necessitates the use of one or more amplifiers. These amplifiers are somewhat bulky (e.g., the ZFL-500LN+, Mini-Circuits, USA, or 351A-3-50-NI, Analog Modules Inc., USA). Here, we describe the fabrication and development process of a transducer with a built-in low-noise preamplifier that is encased within the transducer housing. This new, to the best of our knowledge, design could be advantageous for applications where a compact transducer + preamplifier is required. We demonstrate the performance of this compact detection unit in a laser scanning photoacoustic microscopy system by imaging a rat ear ex vivo and a rat brain vasculature in vivo.

Optical-resolution photoacoustic microscopy (OR-PAM) excels in precisely imaging a biological tissue based on absorption contrast. However, existing OR-PAMs are confined by fixed compromises between spatial resolution and field of view (FOV), preventing the integration of large FOV and local high-resolution within one system. Here, we present a non-telecentric OR-PAM (nTC-PAM) that empowers efficient adaptation of FOV and spatial resolution to match the multi-scale requirement of diverse biological imaging. Our method allows for a large-scale transformation in FOV and even surpassing the nominal FOV of the objective with minimal marginal degradation of the lateral resolution. We demonstrate the advantage of nTC-PAM through multi-scale imaging of the leaf phantom, mouse ear, and cortex. The results reveal that nTC-PAM can switch the FOV and spatial resolution to meet the requirements of different biological tissues, such as large-scale imaging of the whole cerebral cortex and high-resolution imaging of microvascular structures in local brain regions.

Relying on the strong optical absorption of hemoglobin to pulsed laser energy, photoacoustic microscopy provides morphological and functional information on microvasculature label-freely. Here, we propose speckle variance photoacoustic microscopy (SV-PAM), which harnesses intrinsic imaging contrast from temporal-varied photoacoustic signals of moving red blood cells in blood vessels, for recovering three-dimension hemodynamic images down to capillary-level resolution within the microcirculatory tissue beds in vivo . Calculating the speckle variance of consecutive photoacoustic B-scan frames acquired at the same lateral position enables accurate identification of blood perfusion and occlusion, which provides interpretations of dynamic blood flow in the microvasculature, in addition to the microvascular anatomic structures. We demonstrate high-resolution hemodynamic imaging of vascular occlusion and reperfusion in the microvasculature of mice ears in vivo . The results suggest that our SV-PAM is potentially invaluable for biomedical hemodynamic investigations, for example, imaging ischemic stroke and hemorrhagic stroke.

Optical coherence tomography angiography (OCTA) is a functional extension of optical coherence tomography for non-invasive in vivo three-dimensional imaging of the microvasculature of biological tissues. Several algorithms have been developed to construct OCTA images from the measured optical coherence tomography signals. In this study, we compared the performance of three OCTA algorithms that are based on the variance of phase, amplitude, and the complex representations of the optical coherence tomography signals for rodent retinal imaging, namely the phase variance, improved speckle contrast, and optical microangiography. The performance of the different algorithms was evaluated by comparing the quality of the OCTA images regarding how well the vasculature network can be resolved. Quantities that are widely used in ophthalmic studies including blood vessel density, vessel diameter index, vessel perimeter index, vessel complexity index were also compared. Results showed that both the improved speckle contrast and optical microangiography algorithms are more robust than phase variance, and they can reveal similar vasculature features while there are statistical differences in the calculated quantities.

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&#95;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., (© 2021. The Author(s).)

We trained a deep learning algorithm to use skin optical coherence tomography (OCT) angiograms to differentiate between healthy and type 2 diabetic mice. OCT angiograms were acquired with a custom-built OCT system based on an akinetic swept laser at 1322 nm with a lateral resolution of ∼13 μm and using split-spectrum amplitude decorrelation. Our data set consisted of 24 stitched angiograms of the full ear, with a size of approximately 8.2 × 8.2 mm, evenly distributed between healthy and diabetic mice. The deep learning classification algorithm uses the ResNet v2 convolutional neural network architecture and was trained on small patches extracted from the full ear angiograms. For individual patches, we obtained a cross-validated accuracy of 0.925 and an area under the receiver operating characteristic curve (ROC AUC) of 0.974. Averaging over multiple patches extracted from each ear resulted in the correct classification of all 24 ears., (© 2021 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of New York Academy of Sciences.)

A miniature endoscope capable of imaging multiple tissue contrasts in high resolution is highly attractive, because it can provide complementary and detailed tissue information of internal organs. Here we present a photoacoustic (PA)-fluorescence (FL) endoscope for optical-resolution PA microscopy (PAM) and FL microscopy (FLM). The endoscope with a diameter of 2.8 mm achieves high lateral resolutions of 5.5 and 6.3 µm for PAM and FLM modes, respectively. In vivo imaging of zebrafish larvae and a mouse ear is conducted, and high-quality images are obtained. Additionally, in vivo endoscopic imaging of a rat rectum is demonstrated, showing the endoscopic imaging capability of our endoscope. By providing dual contrasts with high resolution, the endoscope may open up new opportunities for clinical endoscopic imaging applications.

Background: Salivary gland choristoma (SGCh) is a rare benign tumor reported in several unusual sites, such as the gastrointestinal tract, the optic nerve, and the internal auditory canal, but never reported in the inner ear., Case Presentation: An 8-year-old girl with a history of left profound congenital hearing loss presented to us with ipsilateral progressive severe facial nerve palsy (House-Brackmann Grade VI). The left tympanic membrane was swollen with a pulsatile tumor. Radiological investigations revealed a multilocular tumor in the inner ear extending into the middle ear and internal auditory canal (IAC). We performed a partial resection of the tumor by transmastoid approach to preserve the anatomical structure of the facial nerve. The tumor was pathologically diagnosed as SGCh. Two years after surgery, her facial function recovered to House-Brackmann Grade II and the residual tumor did not show regrowth on MRI., Conclusions: Although the natural course of this rare tumor is unknown, a partial resection is an acceptable treatment procedure when functional recovery of the facial nerve is anticipated.

Objectives: To describe the use of near infrared fluorescence (NIRF) imaging with indocyanine green (ICG) for vascular visualization in two caudal auricular axial pattern flaps (APF)., Animals: Two client-owned cats with upper eyelid masses., Study Design: Clinical case report., Methods: Wide surgical excision with enucleation was performed by using a caudal auricular APF for closure. Flap margins and perforating artery location were approximated with anatomical landmarks. The caudal auricular artery origin was then visualized percutaneously by using an exoscope with NIRF camera and light source after a single 2.5-mg dose of IV ICG. Margins were adjusted as required. The flaps were routinely elevated with continued intraoperative visualization of the artery and rotated to complete closure., Results: After IV ICG administration, fluorescence was initially visualized after 15 to 18 seconds and remained visible for up to 26 minutes. The achieved visualization led to flap margin adjustments in cat 1. Both cats recovered with minimal flap congestion, excellent hair regrowth, and no long-term complications (>186 days). Cat 1 experienced 100% flap survival. Cat 2 experienced 10% partial thickness flap necrosis, but revision was not required, and the flap was healed at recheck 85 days postoperatively., Conclusion: The use of ICG for APF vessel visualization prior to and during flap elevation resulted in transcutaneous visualization of the perforating vessel and improved awareness of vessel location intraoperatively. These two cats experienced excellent flap survival without major complications. This report highlights the potential benefits of ICG NIRF in APF for animals undergoing reconstructive surgery., (© 2021 The American College of Veterinary Surgeons.)

Background: Fetal ear length measurement has been associated with some clinical values: sonographic marker for chromosomal aneuploidy and for biometric estimation of fetal gestational age., Objectives: To establish a baseline reference value for fetal ear length and to assess relationship between fetal ear length and gestational age., Methods: Ear length measurements were obtained prospectively from fetuses in 551 normal singleton pregnancies of 15 to 41 weeks gestation. Normal cases were defined as normal sonographic findings during examination plus normal infant post-delivery. The relationship between gestational age (GA) in weeks and fetal ear length (FEL) in millimeters were analyzed by simple linear regression. Correlation of FEL measurements with GA, biparietal diameter (BPD), Head circumference (HC), Abdominal Circumference (AC), Femur Length (FL) and maternal age (MA) were also obtained., Results: Linear relationships were found between FEL and GA (FEL=0.872GA-2.972). There was a high correlation between FEL and GA (r = 0.837; P = .001). Good linear relationship and strong positive correlation were demonstrated between FEL and BPD, AC, HC, and FL (p<0.05)., Conclusion: The result of this study provides normal baseline reference value for FEL. The study also showed good linear relationship and good correlation between FEL and fetal biometric measurements., (© 2021 Idigo F et al.)

The regulation of vascular permeability is critical in inflammation. It controls the distribution of water and plasma contents such as immunoglobulins in peripheral tissues. To regulate allergic diseases, it is important to study vascular biology especially in inflammation. Since the vascular permeability changes in minutes upon the exposure to proinflammatory mediators, intravital imaging system is a powerful technique to capture such dynamic responses. We here describe how to evaluate vascular permeability in vivo using multiphoton microscopy. We use various sizes of fluorescence-labeled dextran to visualize how leaky the blood vessels are in the steady state and in inflammation. Using this assay system, we can illustrate the dynamic kinetics of vascular permeability in vivo in real-time. This assay system provides a novel convenient way to study vascular biology that is beneficial in the assessment of various animal models of allergic disease.

Ear-EEG is a wearable electroencephalogram-recording device. It relies on recording electrodes that are nested within a custom-fitted earpiece in the external ear canal. The concept has previously been tested for seizure detection in epileptic patients and for sleep recordings in a healthy population. This study is the first to examine the use of ear-EEG recordings for sleep staging in patients with epilepsy, comparing it with standard recordings from scalp-EEG. We use individuals with epilepsy because of their multiple sleep disturbances, and their complex relationship between seizures and sleep, which make this group very likely to benefit from wearable electroencephalogram devices for sleep if it were introduced in the clinic. The accuracy of the ear-EEG against that of the scalp-EEG is compared for sleep staging, and we evaluate features of sleep architecture in individuals with epilepsy. A mean kappa value of 0.74 is found for the agreement between hypnograms derived from ear-EEG and scalp-EEG. Furthermore, it was discovered that sleep stage transition frequency could be contributing to the kappa variation. These findings are related to other ear-recording systems in the literature, and the potentials and future obstacles of the device are discussed., (© 2019 European Sleep Research Society.)

Background: Predominance of blind feeding tube placement makes esophageal tube misplacement and aspiration risk commonplace. Accurate estimation of nose-to-stomach length could reduce this risk. Standards for estimating this length were audited against the length measured from guided tube placement., Methods: This prospective, single-center observational study used electromagnet-guided tube placement to measure the length from nose to gastric body flexure as part of routine care. This measurement was used to audit standard equations used to estimate this length from external measures: xiphisternum-ear-nose + 10 cm (XEN+10), nose-ear-xiphisternum (NEX), and Hanson&#95;A and Hanson&#95;B., Results: From April 23, 2015, to March 2, 2020, measurements were obtained from 200 primary tube placements. Median length to the gastric body flexure (61 cm) was significantly different from that to the pre-gastroesophageal junction flexure (48 cm) or lengths predicted by NEX (51 cm) or Hanson&#95;A (50.5 cm) and Hanson&#95;B (56.1 cm) (all P < .00001) but similar to XEN+10 (61 cm). Esophageal placement was a potential risk for all methods (NEX: 96.3%, Hanson&#95;A: 99.5%, Hanson&#95;B: 86.9%, XEN+10: 43.2%) and a definite risk for most (NEX and Hanson&#95;A: 14.9%, Hanson&#95;B: 1%, XEN+10: 0%)., Conclusions: NEX and Hanson methods of predicting the length from nose to gastric body flexure are too short and risk esophageal misplacement. XEN+10 reduces but does not eliminate this risk. External measurement predictions are clinically unsafe as a guide blind tube placement. Guided placement is recommended., (© 2020 American Society for Parenteral and Enteral Nutrition.)

We report the development of an optically transparent high-frequency ultrasonic transducer using lithium niobate single-crystal and indium-tin-oxide electrodes with up to 90% optical transmission in the visible-to-near-infrared spectrum. The center frequency of the transducer was at 36.9 MHz with 33.9%, at -6 dB fractional bandwidth. The photoacoustic imaging capability of the fabricated transducer was also demonstrated by successfully imaging a resolution target and mouse-ear vasculatures in vivo, which were irradiated by a 532 nm pulse laser transmitted through the transducer.

We develop a multimodal imaging platform, combining depth-resolved scattering contrast from spectral-domain optical coherence tomography (SD-OCT) with complementary, non-contact absorption contrast using photoacoustic remote sensing (PARS) microscopy. The system provides a widefield OCT mode using a telecentric scan lens, and a high-resolution, dual-contrast mode using a 0.26 numerical aperture apochromatic objective. An interlaced acquisition approach is used to achieve simultaneous, co-registered imaging. The SD-OCT modality provides a 9.7 µm axial resolution. Comprehensive in vivo imaging of a nude mouse ear is demonstrated, with the SD-OCT scattering intensity revealing dermal morphology, and PARS microscopy providing a map of microvasculature.

Objective: To depict various temporal bone abnormalities on high-resolution computed tomography in congenital aural atresia patients, and correlate these findings with auditory function test results and microtia subgroup., Methods: Forty patients (56 ears) with congenital malformation of the auricle and/or external auditory canal were evaluated. Auricles were graded according to Marx's classification, divided into subgroups of minor (grades I and II) and major (III and IV) microtia. Other associated anomalies of the external auditory canal, tympanic cavity, ossicular status, oval and round windows, facial nerve, and inner ear were evaluated., Results: Minor and major microtia were observed in 53.6 and 46.4 per cent of ears respectively. Mean hearing levels were 62.47 and 62.37 dB respectively (p = 0.98). The malleus was the most commonly dysplastic ossicle (73.3 vs 80.8 per cent of ears respectively, p = 0.53). Facial nerve (mastoid segment) abnormalities were associated (p = 0.04) with microtia subgroup (80 vs 100 per cent in minor vs major subgroups)., Conclusion: Microtia grade was not significantly associated with mean hearing levels or other ear malformations, except for external auditory canal and facial nerve (mastoid segment) anomalies. High-resolution computed tomography is essential in congenital aural atresia, before management strategy is decided.

In this study, the percent of wormian bones in congenital aural atresia group was higher than healthy group, when tested by the Fisher exact test, there appeared to be no significant statistical difference. However, in congenital aural atresia surgery, surgical manipulation can dislodge these bones causing injury to the surrounding structures. Therefore, the radiologists should report the presence of wormian bones in the peritemporal area.

Background: Detailed investigations of the stapedial muscle (SM) in congenital aural atresia (CAA) patients have yet to be adequately conducted. Objectives: To assess image variations in the mastoid segment of the facial nerve (FN) and SM in CAA. Materials and methods: A total of nine patients comprising of 9 ears with unilateral CAA were studied. The courses of the FN and SM were evaluated from the basic point to 1 mm intervals between the mastoid portion of FN, and measured from the mean X and Y values in each group. Results: The atresia side of FN among the Y values showed significant differences compared to the contralateral side. In terms of the SM, there were no significant differences in both the X and Y values. The stapedial muscle of the CAA patients was located medially to the FN. Conversely, the distance from the PSC to the FN revealed no significant differences with regard to the X and Y values for each group. Conclusion: The current observations revealed that the SM is located more posterior to the FN in CAA patients, and this is mainly attributed to the laterally and anteriorly displaced FN.

In this Letter, we propose a novel triplex-parameter detection method to realize simultaneous radiometric, photoacoustic, and ultrasonic imaging based on single-pulse excitation. The optical attenuation, optical absorption, and acoustic impedance properties can be obtained simultaneously by analyzing the photoacoustic signals and the ultrasonic echo signals. To test the feasibility and accuracy of this method, agar phantoms with different absorption coefficients and elastic coefficients were measured. Then, this method was experimentally verified by imaging a leaf skeleton piece embedded in an agar cylinder. Furthermore, pilot experiments were performed by triplex imaging of pig ear tissue ex vivo to characterize the cartilage and surrounding tissue. Experimental results demonstrated that this technique has future potentials for visualizing and providing the functional and structural information of biological tissues.

The aim of this study was to analyze whether different fixation methods such as freezing or formaldehyde storage for different periods of time have an influence on the recognition of anatomical relevant structures in the middle and inner ear of the cat with conventional computed tomography (cCT) and micro-computed tomography (µCT). Besides, effects of freeze-thaw cycles on determined structures of the ear were investigated by means of histological slices. Three veterinarians with different radiologic expertise evaluated the scans of 30 dissected cat ears anonymously and scored predefined structures in a five-point scale with reference to visually sharp reproducibility and perfect image quality. The total scores of the different fixation groups as well as the ears within a group were compared with each other. Furthermore, an intra-reader examination including an evaluation of the identifiability of specified structures was performed for both imaging methods. cCT as well as µCT-scans have a very low variation coefficient of 1.6% and 2.3%, respectively. The results for the alterations between the different fixation methods show that the changes for cCT-scans are negligible, as the percentage alteration compared to fresh samples ranges in a very small interval with values from 1.0% better to 1.2% worse. µCT-scans are more influenced by the fixation method with a range from 1.3% better to 6.9% worse values. The scans mostly deteriorated after two freeze-thaw cycles (1.8% worse) and after storing the samples for 1 (2.4% worse), respectively, and 3 weeks in formaldehyde (6.9% worse).

Quantifying ear deformity using linear measurements and mathematical modeling is difficult due to the ear's complex shape. Machine learning techniques, such as convolutional neural networks (CNNs), are well-suited for this role. CNNs are deep learning methods capable of finding complex patterns from medical images, automatically building solution models capable of machine diagnosis. In this study, we applied CNN to automatically identify ear deformity from 2D photographs. Institutional review board (IRB) approval was obtained for this retrospective study to train and test the CNNs. Photographs of patients with and without ear deformity were obtained as standard of care in our photography studio. Profile photographs were obtained for one or both ears. A total of 671 profile pictures were used in this study including: 457 photographs of patients with ear deformity and 214 photographs of patients with normal ears. Photographs were cropped to the ear boundary and randomly divided into training (60%), validation (20%), and testing (20%) datasets. We modified the softmax classifier in the last layer in GoogLeNet, a deep CNN, to generate an ear deformity detection model in Matlab. All images were deemed of high quality and usable for training and testing. It took about 2 hours to train the system and the training accuracy reached almost 100%. The test accuracy was about 94.1%. We demonstrate that deep learning has a great potential in identifying ear deformity. These machine learning techniques hold the promise in being used in the future to evaluate treatment outcomes.

Background: Video otoscopy is a valuable tool for the diagnosis and treatment of otitis externa (OE) and otitis media (OM) in dogs. Procedures performed by video otoscopy often are painful and it can be challenging to maintain steady anaesthetic depth and provide smooth anaesthetic recovery. A multimodal approach to analgesia and anaesthesia is ideal to minimize complications associated with high doses of anaesthetic drugs while providing the patient with adequate analgesia., Hypothesis/objective: To describe a technique for regional anaesthesia of the canine ear., Animals: One canine cadaver, obtained as part of a teaching laboratory class for other clinical techniques, with institutional approval, was used for illustration purposes., Results: Clinical technique for regional anaesthesia of the canine ear., Conclusions and Clinical Importance: Nerve blocks for regional anaesthesia are an important aspect of a multimodal anaesthetic approach. A technique for blocking the two major sensory nerves to the canine ear is described., (© 2019 ESVD and ACVD.)

Objective: Complex middle and inner ear malformations are considered an important limitation for cochlear implant (CI) with traditional microscopic techniques. The aim of the present study is to describe the results of the endoscopic-assisted CI procedure in children with malformed ears., Study Design: Case series with chart review of consecutive patients., Setting: Two tertiary referral centers: University Hospital of Verona and University Hospital of Modena, Italy., Subjects and Methods: In total, 25 children underwent endoscopic-assisted cochlear implantation between January 2013 and January 2018. The audiologic and neuroradiologic assessment showed profound hearing loss and malformation of the middle and inner ear in all children. A complete review of anatomic features, surgical results, and audiologic outcomes was performed. The surgical technique is described step-by-step, and the outcomes are detailed., Results: All patients (mean age, 3.6 years; range, 2.8-9 years) underwent a transattical/endoscopic-assisted CI procedure. All children showed varying degrees of auditory benefit, as measured by routine audiometry, speech perception tests, and Categories of Auditory Performance scores (mean, 6). No immediate or late postoperative complications were noted., Conclusion: The endoscopic-assisted approach proved to be successful in cochlear implantation. The direct visualization and magnification allow (1) exploration of the tympanic cavity; (2) confirmation of all anatomic features, with strict control of the course of the facial nerve, round window area, and inner ear; and (3) performance of the cochleostomy with adequate insertion of the array.

Objective: Visualizing cell interactions in blood circulation is of great importance in studies of anticancer immunotherapy or drugs. However, the lack of a suitable imaging system hampers progress in this field., Methods: In this work, we built a dual-channel in vivo imaging flow cytometer to visualize the interactions of circulating tumor cells (CTCs) and dendritic cells (DCs) simultaneously in the bloodstream. Two artificial neural networks were trained to identify blood vessels and cells in the acquired images., Results and Conclusion: Using this technique, single CTCs and CTC clusters were readily distinguished by their morphology. Interactions of CTCs and DCs were identified, while their moving velocities were analyzed. The CTC-DC clusters moved at a slower velocity than that of single CTCs or DCs. This may provide new insights into tumor metastasis and blood rheology., Significance: This in vivo imaging flow cytometry system holds great potential for assessing the efficiency of targeting CTCs with anticancer immune cells or drugs.

To achieve fast imaging and large field of view (FOV), we improved our multimodal imaging system, which integrated optical resolution photoacoustic microscopy, optical coherence tomography (OCT), and confocal fluorescence microscopy in one platform, by combining optical scanning with mechanical scanning. To ensure good focusing of the objective lens over all the imaged area, we employed OCT-guided dynamic focusing. Different from our previous point-by-point dynamic focusing, we employed an area-by-area focusing adjustment strategy, in which each fast optical scanning area has a fixed focusing depth. We have demonstrated the performance of the system by imaging biological samples ex vivo (plant leaf) and in vivo (mouse ear). The system has achieved uniform resolution in an FOV of 10  mm  ×  10  mm with an imaging time of about 5 min.

Photoacoustic microscopy (PAM) is a fast-growing biomedical imaging technique that provides high-resolution in vivo imaging beyond the optical diffusion limit. Depending on the scalable lateral resolution and achievable penetration depth, PAM can be classified into optical resolution PAM (OR-PAM) and acoustic resolution PAM (AR-PAM). The use of a microelectromechanical systems (MEMS) scanner has improved OR-PAM imaging speed significantly and is highly beneficial in the development of miniaturized handheld devices. The shallow penetration depth of OR-PAM limits the use of such devices for a wide range of clinical applications. We report the use of a high-speed MEMS scanner for both OR-PAM and AR-PAM. A high-speed, wide-area scanning integrated OR-AR-PAM system combining MEMS scanner and raster mechanical movement was developed. A lateral resolution of 5  μm and penetration depth ∼0.9-mm in vivo was achieved using OR-PAM at 586 nm, whereas a lateral resolution of 84  μm and penetration depth of ∼2-mm in vivo was achieved using AR-PAM at 532 nm.

Photoacoustic microscopy (PAM) can measure optical absorption-based molecular specificities within tissues. Despite the diffraction-limited lateral resolution in optical-resolution photoacoustic microscopy (OR-PAM), the ongoing challenge is poor axial resolution because of an insufficient ultrasound detection bandwidth, which hampers PAM volumetric imaging. We propose polarization-differential surface plasmon resonance (SPR) sensing for broadband and high-sensitivity photoacoustic (PA) detection, allowing OR-PAM with comparable resolution along lateral and axial directions. This sensor possesses an estimated noise-equivalent-pressure sensitivity of ∼477 Pa over an approximately linear pressure response up to 107 kPa. Moreover, an improved PA detection bandwidth of ∼173 MHz permits an axial resolution (∼7.6 μm) that approaches the lateral resolution (∼4.5 μm) of our OR-PAM system. The capability in spatially isometric micrometer-scale resolution enables in vivo volumetric label-free imaging of the microvasculature of a mouse ear. The SPR sensing technology promises broader applications of PAM in biomedical studies such as microcirculation.

Objective: To assess the association of middle ear volume with long-term hearing outcomes in congenital aural atresia (CAA) repair., Study Design: Retrospective chart and radiological review., Setting: Single academic tertiary referral center., Patients: Children and adults who underwent CAA repair between 1995 and 2016. Patients were divided into "best" and "worst" audiometric groups, based on stability of postoperative air conduction pure-tone average (AC PTA) results. Ten patients were included for study in the "best" group, and 12 in the "worst" group., Intervention(s): CAA repair., Main Outcome Measure(s): Long-term (> 1 yr) postoperative three-tone (500, 1000, 2000 Hz) AC PTA, speech reception threshold (SRT), air bone gap, and semiautomated calculated middle ear volume from preoperative computed tomography (CT) scans., Results: Statistically significant differences were noted between "best" and "worst" groups in AC PTA, SRT, and air bone gap (p < 0.001). Mean middle ear volume in the "best" group was 434.6 mm (range 326.3-602.1 mm) and 339.5 mm (range 199.4-502.1 mm) in the "worst" group (p = 0.02). The majority in both groups were right ears (p = 0.38), and males outnumbered females in the "best" group (9 out of 10; p = 0.018). Preoperative Jahrsdoerfer grading scores were similar between groups (p = 0.31). Mean follow-up for the "best" and "worst" groups was approximately 3.5 and 4.5 yr, respectively., Conclusions: For patients undergoing CAA repair, larger middle ear volume is associated with stable and better long-term audiometric outcomes.

A number of interesting differences become apparent when comparing the hearing systems of terrestrial vertebrates, especially between mammals and non-mammals. Almost all non-mammals possess only a single ossicle, enabling impedance matching and hearing below 10 kHz. The middle ear (ME) evolved as a chain of three ossicles in mammals, enabling sound transmission up to higher frequencies than in similar-sized non-mammals. The relatively low-frequency hearing in non-mammals is associated with audible wavelengths that are significantly larger than the head. Therefore, it is unlikely that localization of the sound source can be obtained by using external cues between the ears (intensity and time difference between both sides), especially when compared to similarly sized mammals. The heads of many non-mammals contain large air-filled cavities, which acoustically couple both MEs. This article studies acoustic responses and sound-source localization capabilities of the coupled MEs of the brown anole (Anolis sagrei), using finite-element modeling. Based on high-resolution μCT data, 3D finite-element models of the ME and interaural cavity were constructed. The parameter values in the ME model were determined such that the response of the isolated ME matches experimental data of literature and the velocity ratio between the tympanic membrane (apex) and footplate reflects the anatomical arrangement of the columellar lever in the anole. It was found from simulation of the coupled ME model that the interaural connection amplifies intensity differences between both sides and thus enhances the capability of sound-source localization. In addition, the interaural canal doubles the phase differences of the incident external sound waves between the eardrums. In isolated ears, generating such phase differences would require head sizes twice as large. Effects of the inner-ear loading on the sound-source localization of the coupled MEs were investigated as well. The inner-ear load lowered the peak velocity ratios between the ears, but created broader plateaus of useful directionality, indicating that inner-ear loading not only influences sound perception but also sound localization in internally connected ears., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Preclinical and clinical studies suggest that optical coherence tomography (OCT) is a useful tool to visualize inflammatory conditions., Objective: The objective of this study was to evaluate the usefulness of combining OCT and various image processing techniques for quantitative assessment of histamine-induced tissue swelling., Methods: Both time-domain and frequency-domain OCT were used on a mouse ear model. The ear thickness and volume before and after histamine challenge were determined from pixel locations in 2D scans and voxel number counting in 3D scans. Swelling kinetics was analyzed on 3D contour mapping. Microvessel network was visualized using speckle decorrelation analysis., Results: OCT images showed that the thickness and volume changes were histamine dose and contact time dependent. The 3D mapping showed that the histamine-induced swelling spread slowly and directionally. OCT data indicated that microvessel opening and vessel dilation occurred prior to tissue swelling., Conclusion: OCT is a robust and quantitative non-invasive imaging tool for assessing skin swelling., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Humans can externalise and localise sound-sources in three-dimensional (3D) space because approaching sound waves interact with the head and external ears, adding auditory cues by (de-)emphasising the level in different frequency bands depending on the direction of arrival. While virtual audio systems reproduce these acoustic filtering effects with signal processing, huge memory-storage capacity would be needed to cater for many listeners because the filters are as unique as the shape of each person's head and ears. Here we use a combination of physiological imaging and acoustic simulation methods to confirm and extend previous studies that represented these filters by a linear combination of a small number of eigenmodes. Based on previous psychoacoustic results we infer that more than 10, and as many as 24, eigenmodes would be needed in a virtual audio system suitable for many listeners. Furthermore, the frequency profiles of the top five eigenmodes are robust across different populations and experimental methods, and the top three eigenmodes encode familiar 3D spatial contrasts: along the left-right, top-down, and a tilted front-back axis, respectively. These findings have implications for virtual 3D-audio systems, especially those requiring high energy-efficiency and low memory-usage such as on personal mobile devices.

Multimodal imaging platforms offer a vast array of tissue information in a single image acquisition by combining complementary imaging techniques. By merging different systems, better tissue characterization can be achieved than is possible by the constituent imaging modalities alone. The combination of optical coherence tomography (OCT) with non-linear optical imaging (NLOI) techniques such as two-photon excited fluorescence (TPEF), second harmonic generation (SHG) and coherent anti-Stokes Raman scattering (CARS) provides access to detailed information of tissue structure and molecular composition in a fast, label-free and non-invasive manner. We introduce a multimodal label-free approach for morpho-molecular imaging and spectroscopy and validate the system in mouse skin demonstrating the potential of the system for colocalized acquisition of OCT and NLOI signals.

Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions., (Copyright © 2019 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: A method of Vibrant Soundbridge (VSB) placement to the round window (RW) via the retrofacial approach with preoperative evaluation of the relationship between the facial nerve (FN) and RW by 3D-CT reconstruction was proposed for the treatment of congenital aural atresia (CAA) patient., Methods: A fenestration to the mesotympanum was made mastoid portion of the FN. During the approach, part of the stapedial muscle was encountered and removed. The RW niche was identified, and the floating mass transducer was placed from an inferior approach into the RW niche., Results: There were no intra-operative or post-operative surgical complications., Conclusion: The VSB placement to the RW via the retrofacial approach with partial removal of the stapedial muscle can be feasible alternative in CAA cases associated with an anteriorly and laterally positioned aberrant FN. Preoperative assessment using 3D CT may facilitate in assessing the feasibility of the approach and implantation of VSB., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Temporal bone high-resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are valuable tools in the evaluation of pediatric hearing loss. Computed tomography is important in the evaluation of pediatric conductive hearing loss and is the imaging modality of choice for evaluation of osseous abnormalities. MR imaging is the modality of choice for evaluation of sensorineural hearing loss. A broad spectrum of imaging findings can be seen with hearing loss in children. HRCT and MR imaging provide complementary information and are often used in conjunction in the preoperative evaluation of pediatric candidates for cochlear implantation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Neuro-otologists rely on the expertise and judgment of a skilled neuroradiologist to identify radiographic abnormalities in the complicated regional anatomy of the temporal bone and middle and posterior fossa, and more importantly, to alert the surgeon to potential operative pitfalls. This article highlights some of the common otologic surgical procedures that stress this important dynamic. The surgical perspective on quick and effective clinical decision-making pearls to keep in mind during a thorough radiographic analysis of the ear and lateral skull base is presented., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We have developed a reflection-mode switchable subwavelength Bessel-beam (BB) and Gaussian-beam (GB) photoacoustic microscopy (PAM) system. To achieve both reflection-mode and high resolution, we tightly attached a very small ultrasound transducer to an optical objective lens with numerical aperture of 1.0 and working distance of 2.5 mm. We used axicon and an achromatic doublet in our system to obtain the extended depth of field (DOF) of the BB. To compare the DOF performance achieved with our BB-PAM system against GB-PAM system, we designed our system so that the GB can be easily generated by simply removing the lenses. Using a 532 nm pulse laser, we achieved the lateral resolutions of 300 and 270 nm for BB-PAM and GB-PAM, respectively. The measured DOF of BB-PAM was approximately 229 μm, which was about 7× better than that of GB-PAM. We imaged the vasculature of a mouse ear using BB-PAM and GB-PAM and confirmed that the DOF of BB-PAM is much better than the DOF of GB-PAM. Thus, we believe that the high resolution achieved at the extended DOF by our system is very practical for wide range of biomedical research including red blood cell (RBC) migration in blood vessels at various depths and observation of cell migration or cell culture., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

In this study, dual-modal fluorescence and photoacoustic microscopy was performed for noninvasive and functional in vivo imaging of inflammation induced by green fluorescent protein (GFP) transfected bacteria in mice ear. Our imaging results demonstrated that the multimodal imaging technique is able to monitor the tissue immunovascular responses to infections with molecular specificity. Our study also indicated that the combination of photoacoustic and fluorescence microscopy imaging can simultaneously track the biochemical changes including the bacterial distribution and morphological change of blood vessels in the biological tissues with high resolution and enhanced sensitivity. Consequently, the developed method paves a new avenue for improving the understanding of the pathology mechanism of inflammation.

Purpose: Posterior calvarial vault expansion using distraction osteogenesis is performed for syndromic craniosynostosis as the first choice. This procedure allows far greater intracranial volume than fronto-orbital advancement (FOA). This study aimed to determine the most suitable timing of posterior distraction or FOA to sufficiently increase the intracranial volume and remodel the skull shape., Patients and Methods: From 2014 to 2017, the authors performed posterior distraction in 13 patients with syndromic craniosynostosis. Data on premature suture fusion, age at first visit, age at surgery, skull thickness, and complications were collected., Results: Five patients underwent posterior distraction at approximately 12 months of age and had no complications, including cerebrospinal fluid leakage or gull wing deformity. However, during the waiting period for the operation, the skull deformity continues to extend upward (turribrachycephaly). To prevent progress of the skull deformity, the authors performed the operation at approximately 6 months of age in 7 patients. However, in 3 of 7 patients whose lambdoid sutures were opening, gull wing deformity occurred. From these results, in a patient with severe Beare-Stevenson syndrome, the authors performed FOA first at 5 months of age, followed by posterior distraction at 12 months of age, and achieved favorable results., Conclusions: Treatment patterns are patient specific and should be tailored to premature suture fusion, specific skull deformity, and required intracranial volume of each patient.

The purpose of this study was to assess the diagnostic performance of 3T MRI after intratympanic injection of gadodiamide for delayed endolymphatic hydrops (DEH), and assess the relationship between endolymphatic hydrops (ELH) and vestibular function in patients diagnosed with DEH and confirmed by 3T MRI. Nineteen patients clinically diagnosed with DEH (11 ipsilateral DEH, 8 contralateral DEH) participated in this study. Diluted gadodiamide was administered to the bilateral tympanic cavity by injection through the tympanic membrane. At 24 hours post-injection, the ELH was evaluated by MRI. Patient vestibular functions were evaluated by caloric testing and cVEMP. ELH was observed in all patients (19/19: positive rate 100%). The distribution patterns of ELH varied between the cochlear or vestibular region. Vestibular ELH was observed in the affected ear in all ipsilateral DEH patients. In the contralateral DEH patients, however, there were individual differences in the distribution patterns of ELH. Six patients (1 ipsilateral DEH, 5 contralateral DEH) had bilateral ELH. No obvious relationships were observed between ELH and vestibular function. ELH distribution was complicated, particularly in the contralateral DEH cases. It was difficult to identify the existence of ELH by vestibular functional testing alone; therefore, 3T MRI is thought to be useful for identifying the affected ear. A significant number of cases had "bilateral" DEH, particularly among the contralateral DEH cases, indicating that we should pay careful attention to this pathology when treating DEH., Competing Interests: The authors have declared that no competing interests exist.

Objective: To establish whether criteria can be used to identify patients who do not need high resolution computed tomography (HRCT) scans before cochlear implant operations, by retrospectively applying a preoperative selection pathway, the Cambridge Cochlear Implant Protocol (CCIP)., Study Design: Retrospective case series., Setting: Tertiary referral center, Queen Elizabeth Hospital, Birmingham, UK (QEHB)., Patients: One hundred adult patients receiving primary cochlear implantation (CI) operations from April 2015 to July 2016 performed at the QEHB who received preoperative HRCTs., Main Outcome Measures: Etiology of hearing loss and anatomical abnormalities were collected by reanalyzing HRCT scans. Patients were retrospectively grouped according to criteria to restrict HRCT use derived from the Cambridge Cochlear Implant Programme (CCIP). The two main outcomes, recorded management change and significant abnormalities, were compared between the two CCIP groups, scanned and not scanned., Results: Twenty-six patients had significant abnormalities detected on imaging, 16 in the scanned group and 10 in the not scanned group (p = 0.152). Five patients had a recorded management change as a result of HRCT scan, four scanned group, one not scanned group (p = 0.107). Significant abnormalities and recorded management change were seen across all etiological subgroups of hearing loss., Conclusion: The anatomy within the temporal bone is variable amongst CI recipients. Recorded management change and significant abnormalities occurred in both CCIP groups and across many etiologies of hearing loss patients. No specific group, based on the etiology of their hearing loss could be identified that do not require preoperative HRCT. Therefore, it is recommended that all CI patients should continue to receive preoperative HRCT imaging.