Pott's puffy tumour (PPT) is a rare complication of frontal sinusitis involving subperiosteal abscess and frontal bone osteomyelitis, often leading to serious intracranial sequelae. We report a case of a man in his 50s who presented with progressive, painless forehead swelling despite multiple antibiotic courses. Imaging confirmed bilateral subperiosteal collections and a right-sided epidural empyema. Initial management included broad-spectrum antibiotics, endoscopic sinus surgery and external drainage. Due to persistent collections, a second-stage osteoplastic approach was performed, resulting in complete resolution. Cultures were sterile, possibly due to early antibiotic administration. The patient completed 6 weeks of parenteral antibiotics and remained symptom-free at the 8-month follow-up. This case highlights the importance of early recognition, imaging and surgical management of PPT to prevent complications. An individualised, combined endoscopic and external approach may be essential in advanced presentations.

BACKGROUND Hemangiomas are relatively common in the head and neck but rarely involve the external auditory canal (EAC). Surgical approaches for EAC hemangiomas vary, and optimal surgical management remains unclear. CASE REPORT We present 2 cases of hemangioma involving the EAC. Case 1 involved a 68-year-old man who presented with a sensation of fullness in the left ear. Case 2 involved a 62-year-old woman who presented with right-ear fullness, hearing loss, and persistent tinnitus. Preoperative assessment included otologic examination, computed tomography, magnetic resonance imaging, and corresponding auditory evaluations. Imaging across both cases consistently revealed well-defined soft-tissue masses confined to the EAC, accompanied by localized bony irregularities but preserving the middle ear structures. Both patients underwent complete trans-canal excision with concurrent skin flap reconstruction. Histopathological analysis of the excised specimens confirmed the diagnosis of cavernous hemangioma in each case. At 1-year follow-up, both patients achieved full symptom resolution, intact canal anatomy, and no recurrence. CONCLUSIONS In our 2 cases, trans-canal resection combined with local flap reconstruction served as a practical approach for EAC cavernous hemangiomas, resulting in symptom resolution and preservation of canal integrity at the 1-year follow-up.

Otomycosis is a fungal infection of the external auditory canal that may extend to the tympanic membrane. Although commonly caused by Aspergillus and Candida species, infections due to uncommon fungal pathogens may present diagnostic and therapeutic challenges. We report the case of a 46-year-old woman who presented to the Department of Otorhinolaryngology (ENT) with intense pruritus of the right external auditory canal, associated with a whitish discharge and tympanic perforation on otoscopic examination. Mycological analysis of the ear discharge identified Candida lusitaniae. To our knowledge, this represents the first case of otomycosis due to C. lusitaniae reported in our department, underscoring the importance of accurate fungal identification for guiding appropriate antifungal therapy in atypical or refractory otomycosis.

Epithelioid hemangioma (EH) represents a rare, benign neoplastic vascular proliferation that predominantly manifests within the cutaneous and subcutaneous tissues of the head and neck region. While well-documented in areas such as the scalp and forehead, its primary occurrence within the otolaryngologic tract, specifically involving the auricle and the cartilaginous portion of the external auditory canal, remains exceedingly uncommon. Due to its overlapping clinical and radiological features with other vascular and lymphoid pathologies, EH poses a significant diagnostic challenge for clinicians and pathologists alike. This case report highlights the importance of differential diagnosis with similar vascular and lymphoid conditions.

Computational models of the middle ear are typically developed within the linear range of the middle ear's response, which corresponds to typical sounds in daily life. Understanding middle-ear biomechanics under high-intensity sounds is also important for assessing potential auditory damage under adverse conditions. In this study, a finite-element (FE) model of the human middle ear plus the external ear canal is presented, employing a first-order Ogden hyperelastic material formulation and time-domain nonlinear analysis to capture nonlinear deformation of soft tissues and the resulting middle-ear response. The model was analyzed using pure-tone pressure excitations applied at the ear canal entrance over the 80 Hz to 8 kHz frequency range and 110 to 180 dB sound pressure levels (SPL). The ear canal pressure near the tympanic membrane (TM) and full-field three-dimensional response of the middle ear structures were examined. Across the investigated frequency range, the simulated middle-ear motion exhibited a transition from predominantly piston-like behavior at low frequencies, up to 1 kHz, to increasingly intricate multi-modal and multi-directional vibration patterns at higher frequencies. Nonlinear behaviors became increasingly significant at high frequencies and high stimulus levels, including compressive/expansive pressure-displacement relationships, waveform distortions, and the emergence of non-harmonic spectral components. The model developed in this study provides a computational framework for studying nonlinear sound transmission through the middle ear and its implications for high-intensity acoustic exposure. The findings contribute to a better understanding of middle-ear mechanics under adverse conditions and support future investigations of acoustic trauma and hearing protection strategies.

Ophthalmology relies on heterogeneous examination outputs, including device-generated reports, structured measurements, fundus photographs, optical coherence tomography (OCT), visual field plots, corneal imaging, and multimodal clinical data. Publicly available large language models (LLMs) and multimodal large language models (MLLMs) can process these inputs without study-specific ophthalmic training, creating opportunities for information extraction, interpretation, and clinical decision support. This Mini Review synthesizes 37 peer-reviewed studies evaluating such models across ophthalmic examination types and task layers. The evidence shows a consistent task gradient. Structured extraction and constrained calculations are generally more reliable than open-ended image interpretation, multimodal diagnosis, or treatment planning. Performance improves when inputs are standardized, clinical context is provided, and prompts or decision rules are constrained, but remains sensitive to report layout, image preprocessing, prompt design, and model updates. Common limitations include retrospective or public datasets, small or selected cohorts, limited external validation, possible training-data contamination, inconsistent reporting of prompts and model access, and a focus on technical accuracy rather than clinical outcomes. Clinical translation therefore requires safeguards matched to task risk: structured outputs and deterministic checks for extraction, traceable evidence and cross-device validation for interpretation, and independent verification, deferral mechanisms, and clinician oversight for decision support. Publicly available LLMs and MLLMs are evolving from report-parsing tools toward broader ophthalmic clinical assistants, but their use should follow a task-layered validation framework in which verification and human oversight increase with the clinical consequences of error.

Background/Objectives: Temporal bone squamous cell carcinoma (TBSCC) is a rare and aggressive malignancy with limited evidence regarding prognostic factors. This systematic review and meta-analysis evaluated the prognostic significance of tumor stage, cervical nodal status, and surgical margin status in patients with TBSCC. Methods: A systematic search of PubMed and Scopus was conducted from database inception to December 29, 2025, in accordance with the PRISMA 2020 statement. Studies reporting hazard ratios (HRs) for overall survival in patients with TBSCC staged according to the modified Pittsburgh classification were included. Pooled HRs were calculated using random-effects models. Results: Thirteen retrospective cohort studies including 801 patients were analyzed. Positive surgical margins were associated with the greatest increase in mortality risk (HR, 4.79, 95% CI, 2.35-9.75; p < 0.001), followed by cervical nodal metastasis (HR, 2.81; 95% CI, 1.72-4.60; p < 0.001) and advanced tumor stage (T3-T4 vs. T1-T2; HR, 2.39; 95% CI, 1.24-4.60; p = 0.009). Sensitivity analyses confirmed the robustness of the pooled estimates. Conclusions: Positive surgical margins, advanced tumor stage, and cervical nodal metastasis were all significantly associated with poorer survival, with positive surgical margins showing the largest pooled association with mortality among the three evaluated factors. Prospective multicenter studies are needed to validate these findings and improve prognostic stratification in this rare malignancy.

Background/Objectives: Hypertension damages the microcirculation, endothelium, and large arteries, yet these domains are rarely assessed together. We examined whether nailfold microvascular abnormalities track the standardized in-hospital blood-pressure phenotype and carotid wall thickness. Methods: Cross-sectional secondary analysis of 217 treated hypertensive adults hospitalized July 2025-June 2026. Phenotyping included nailfold capillaroscopy, flow-mediated dilation, reactive hyperemia index, pulse wave velocity, and carotid ultrasonography. A prespecified exploratory 0-10 microvascular score summarized rarefaction, impaired flow, and morphological abnormalities. Outcomes were the uncontrolled standardized in-hospital BP phenotype (SBP ≥ 140 and/or DBP ≥ 90 mmHg) and mean carotid intima-media thickness (cIMT). Results: Of 217 patients (mean age 61.3 ± 9.9 years; 50.7% men), 145 (66.8%) met the uncontrolled standardized in-hospital BP phenotype. The score was higher in that group (median 3 [IQR 2-4] vs. 2 [1-3], p < 0.001) and correlated with cIMT (Spearman ρ = 0.536; FDR-adjusted p < 0.001). Each point was associated with higher adjusted odds of the uncontrolled standardized in-hospital BP phenotype (OR 1.70, 95% CI 1.31-2.20; p < 0.001) and 0.0076 mm higher cIMT (95% CI 0.0004-0.0147; p = 0.040), attenuated in the expanded sensitivity model (p = 0.138). Conclusions: Greater nailfold microvascular abnormality burden was associated with the uncontrolled standardized in-hospital BP phenotype and an adverse multidomain vascular phenotype. The cIMT association was modest and adjustment-sensitive. These cross-sectional findings concern a protocolized in-hospital BP measurement session and do not establish 24 h, home, or long-term BP control or distinguish sustained uncontrolled hypertension from white-coat or masked uncontrolled BP patterns. Prospective external validation is required.

Background/Objectives: Microtia is frequently associated with temporal bone malformations, but the extent to which external ear phenotype reflects underlying CT-defined anatomy remains uncertain. This study aimed to compare the relationships of Marx severity grading and Nagata morphological classification with temporal bone anatomy in patients with microtia. Methods: This retrospective study included 26 patients with 27 affected ears who had both preoperative external ear photographs and temporal bone computed tomography (CT) examinations. Each affected ear was classified according to the Marx and Nagata systems, and temporal bone anatomy was assessed using the modified Jahrsdoerfer CT scoring system. Associations were evaluated using Spearman rank correlation and permutation-based Jonckheere-Terpstra analysis, with an additional patient-level sensitivity analysis. Results: Considerable variation in Jahrsdoerfer scores was observed within external ear phenotypic categories, with substantial overlap between Marx Grades II and III and lower scores concentrated in Grade IV. The inverse association between Marx grade and Jahrsdoerfer score did not reach conventional statistical significance (ρ = -0.380, p = 0.051), whereas the Jonckheere-Terpstra test identified an overall decreasing trend (permutation p = 0.025). This trend no longer reached statistical significance in the patient-level sensitivity analysis. Nagata classification did not significantly discriminate CT-based radiological severity. Conclusions: Greater external auricular severity may be associated with less favorable temporal bone anatomy, but the relationship was not uniform across successive Marx grades. Marx and Nagata classifications provide complementary phenotypic information, but neither consistently reflected the extent of underlying temporal bone malformation. These preliminary findings emphasize phenotype-CT variability and support individualized CT-based anatomical assessment when imaging is clinically indicated.

Background/Objectives: Accurate diagnosis of middle ear disease remains challenging because otoscopic interpretation is subjective, while many artificial intelligence models depend on manually selected still frames from video examinations. We aimed to develop and internally evaluate LUCID, a systematic framework for automatically identifying the most informative frames in otoscopy videos. Methods: We analyzed 713 otoscopy videos from 491 patients. LUCID combines a ResNet-50 classifier for coarse eardrum-visibility assessment, BC-AdvCAM for weakly supervised eardrum localization and coverage estimation, and an otoscope-specific blur/focus assessment into a within-video frame-ranking score. Automated selections were compared with expert-selected frames through blinded human review and downstream classification. To separate ranking quality from the effects of bag size and multi-frame aggregation, a matched 12-frame control using uniform temporal sampling was evaluated with the same ResNet-50 and attention-based multiple instance learning (ABMIL) pipeline. Results: Among 293 video pairs with complete ratings, algorithm-selected frames were rated equal to or better than expert-selected frames in 74.7% of evaluations on average. However, when an evaluator expressed a non-Equal preference, the expert frame was favored in 71.7% and 70.7% of cases by the two evaluators, respectively; among concordant non-Equal ratings, 80.0% favored the expert frame. BC-AdvCAM achieved an intersection over union of 0.6717 and a Dice similarity coefficient of 0.7924 on a held-out manually segmented test subset. For downstream diagnosis, patient-level mean accuracy for the matched single-frame comparison was 68.79% for LUCID Top-1 versus 72.17% for the expert-selected frame (difference, -3.38 percentage points; 95% exact sign-flip-inversion CI, -6.79 to 0.00; two-sided exact patient sign-flip p = 0.0540). In the matched 12-frame comparison, LUCID Top-12 achieved 78.13% versus 59.41% for Uniform-12 using the identical ABMIL pipeline (difference, +18.71 percentage points; 95% exact sign-flip-inversion CI, +15.79 to +21.63; two-sided exact patient sign-flip p = 2.33 × 10[-10]). Conclusions: In the matched single-frame comparison, the expert-selected frame had the higher observed patient-level mean accuracy, whereas LUCID provided an automated ranking of the full video that substantially improved matched 12-frame ABMIL performance relative to uniform temporal sampling. These results support LUCID as an automated frame-ranking and multi-frame evidence-selection tool, while external validation remains necessary before clinical deployment.

Background/Objectives: Antimicrobial resistance threatens public health globally, and critical access hospitals (CAHs) serving rural communities face structural barriers to implementing antibiotic stewardship programs (ASPs). This study evaluated whether a regional educational intervention could improve antimicrobial stewardship knowledge and implementation among rural healthcare professionals. Methods: A quantitative, quasi-experimental repeated cross-sectional evaluation was conducted following Antibiotic Stewardship conferences in 2023 and 2024. Participants from 38 rural and critical access hospitals completed pre-conference, post-conference, 6-month follow-up, and implementation surveys. Quantitative data were analyzed using descriptive statistics and unpaired chi-square tests, with Fisher's exact test substituted where expected cell counts were below 5, with significance set at p < 0.05. Results: Seventy healthcare professionals participated across both years. Correct identification of the use of an antibiogram to guide empiric (rather than definitive) therapy improved from 27% pre-conference to 58% post-conference (p = 0.029). Confidence in antibiogram interpretation increased from 67% to 100% post-intervention (p = 0.004, Fisher's exact) but declined to 50% (5 of 10) at 6-month follow-up. Knowledge of the minimum isolate threshold required to construct an antibiogram improved from 23% (7 of 30) pre-conference to 64% (7 of 11) at 6-month follow-up (p = 0.026, Fisher's exact). Despite this, prescribing intent for conditions where antibiotics are typically unnecessary showed minimal improvement: recommendations for antibiotic use in middle ear infections decreased from 50% to 36.84%, and for mpox from 20% to 15.79%. All participants reported intent to modify clinical practice; however, time constraints, technology limitations, and lack of resources were consistently cited as primary barriers for implementation across both survey years. Conclusions: A regional educational intervention improved short-term antimicrobial stewardship knowledge and confidence among rural healthcare professionals, but knowledge retention declined over time and structural barriers persisted. Education alone is insufficient; sustained reinforcement and rural-adapted ASP models incorporating protected ASP time, decision-support tools and external partnerships are needed to translate knowledge gains into consistent stewardship practice.