Malassezia spp. are commensal yeasts of canine skin that may act as opportunistic pathogens. The aim of this study was to assess the presence, distribution and numbers of Malassezia spp. on the skin and external ear canal in clinically healthy Golden Retrievers and Bernese Mountain Dogs, to evaluate the influence of breed, age and sex, and to compare the findings with previously published cytological reference values. Fifty clinically healthy Golden Retrievers and 50 Bernese Mountain Dogs were included in the study. Both external ear canals and six body sites (perioral region, chin, axilla, interdigital spaces, inguinal region and dorsum) were sampled. The external ear canals were sampled using a sterile cotton swab, while the skin sites were sampled using the adhesive tape technique. The slides obtained were microscopically examined, and the number of Malassezia spp. was recorded. All data were statistically analyzed. Malassezia spp. were observed in all dogs, with different distributions in ear and skin areas. Malassezia spp. counts were significantly higher in Golden Retrievers than in Bernese Mountain Dogs at all skin sites. No significant difference was observed between breeds in the external ear canal. Forty-nine (98%) Golden Retrievers and 35 (74%) Bernese Mountain Dogs showed a mean skin number of Malassezia spp. per oil immersion field (OIF) above the 1 yeast/OIF literature threshold commonly used in the presence of clinical signs. No relationship was found between the mean value of Malassezia spp. per microscopic field and sex or age in either breed. The results show that Golden Retrievers have higher Malassezia spp. counts across all evaluated skin sites compared with Bernese Mountain Dogs. Whether higher baseline Malassezia spp. populations contribute to clinical yeast overgrowth requires further investigation. No significant difference in external ear canal Malassezia spp. counts was observed between breeds; however, the mean values recorded in both populations exceeded cytological reference values for healthy dogs. These findings indicate that cytological Malassezia spp. counts in clinically healthy dogs may vary according to breed and anatomical site. Diagnostic interpretation should therefore integrate cytological findings with clinical signs, breed, site, and sampling method. Further studies are required to establish normal reference intervals for Malassezia spp. per microscopic field based on breed and anatomical site.

Waterbirth has become a widely adopted alternative to a conventional delivery, with well-documented maternal benefits, but there is an ongoing debate regarding neonatal safety. We would like to report a case of a 10-day-old male neonate who developed acute otitis externa (AOE) following waterbirth. Despite the rare occurrence of this disease in children under 2 years of age, prompt diagnosis and timely initiation of appropriate therapy led to a full recovery. This case represents a previously undocumented, yet plausible, complication of waterbirth and underscores the importance of careful neonatal ear assessment and preventive measures in aquatic deliveries.

Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann-Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia.

Lumbar foraminal stenosis grading contributes to surgical-level selection, but automated four-grade classification remains challenging. Published pipelines for this dataset reach approximately 65% four-class accuracy, and deep classifiers offer no anatomical rationale. We investigated whether interpretable, millimeter-scale morphometry from segmentation masks improves grading beyond a deep image model. We analyzed the LSS-MRI-AISSLab sagittal T2-weighted dataset (469 patients, 2979 expert-graded foramina spanning L1-L2 through L5-S1 bilaterally on a four-grade scale). Ten morphometric descriptors were computed from mid-sagittal polygon segmentations and scaled to millimeters using each patient's recorded pixel spacing. A dual-branch network combined a fine-tuned ResNet-18 embedding of each foraminal region of interest with the morphometric vector through an ordinal regression head. Foraminal regions were supplied from expert bounding-box annotations; automated localization within the full sagittal examination was not evaluated. Four configurations (nominal softmax, appearance-only, anatomy-only, and fusion) were compared on a locked patient-level test set of 94 patients after five-fold cross-validation, with quadratic weighted kappa (QWK) as the primary endpoint and patient-clustered bootstrap inference. Feature-grade correlations were reported pooled and adjusted for lumbar level. Fusion achieved QWK 0.813 (95% confidence interval [CI] 0.769-0.847) and 75.3% four-class accuracy. Appearance-only was statistically indistinguishable (QWK 0.806; delta QWK +0.006, 95% CI -0.023 to 0.036, p = 0.68), whereas anatomy-only reached 0.444, and a level-and-side-only reference reached 0.314. Boundary discrimination was strong (area under the curve 0.92-0.99), 98.3% of predictions fell within one grade, and performance was consistent across scanner vendors. Morphometric associations were confounded by level: the apparent spondylolisthesis effect (rho -0.349) disappeared after adjustment (rho -0.000), while disc height, null when pooled (rho +0.021), emerged as a genuine within-level effect (rho -0.108). A fine-tuned ordinal image classifier achieved strong agreement for four-grade lumbar foraminal stenosis classification. The evaluated segmentation-derived morphometric features did not improve performance beyond imaging alone, and several apparent anatomic associations reflected confounding by lumbar level. External and prospective validation in complete clinical MRI workflows are needed before implementation.

Pott's puffy tumour (PPT) is a rare condition defined by subperiosteal abscess formation following osteomyelitis of the frontal bone. Complications can be severe and involve intracranial progression.Here, we present a rare case of a PPT due to an Aggregatibacter aphrophilus infection of odontogenic origin in a young adult patient with a history of bilateral cheilognathopalatoschisis. Due to the unusual location of the abscess, the diagnosis was initially missed, leading to a delay of more than 1 month until adequate treatment. Odontogenic treatment was initiated as source control, external drainage of the abscess was performed and intravenous and later oral antibiotics were administered, which, despite relatively poor treatment adherence, ultimately led to adequate control of the infection without the need for further surgical intervention. The current case is the first report to highlight cleft palate-and consequent poorer oral health-as a potential predisposing condition for PPT.

Facial nerve schwannomas arising in the accessory parotid gland region are extremely rare, and paediatric cases have not been reported previously. We present the case of a girl in middle childhood who developed a painless, gradually enlarging mass in the mid-cheek area. Radiologic evaluation revealed a well-defined lesion with imaging features suggestive of a benign neoplasm. A transoral surgical approach was chosen to avoid cutaneous scarring and minimise surgical morbidity. Complete excision was achieved without injury to the facial nerve or Stensen's duct, and histopathology revealed a benign schwannoma. The postoperative course was uneventful, and no evidence of recurrence was observed during a 3-year follow-up, with the preservation of optimal aesthetic appearance and function. This case highlights the importance of including schwannomas in the differential diagnosis of mid-cheek masses in paediatric patients and supports the transoral approach as a safe and effective alternative to external approaches, even in this age group.

Cerebrospinal fluid (CSF) otorrhea represents a breach of the temporal bone separating the subarachnoid space from the middle ear and carries a significant risk of meningitis. While most cases are associated with trauma or prior skull base surgery, congenital fistulas may remain occult until unmasked by otologic procedures. We report the case of a five-year-old male with bilateral profound sensorineural hearing loss and previously unknown labyrinthine anomalies who developed high-flow, pulsatile clear otorrhea during routine left ear myringotomy for recurrent otitis media. Immediate concern for CSF leak prompted fluid collection for beta-2 transferrin analysis and urgent surgical management. Subsequent exploration via lateral temporal bone resection revealed a congenital inner ear fistula with active CSF egress from the vestibule through the oval window. The leak was successfully managed using a multilayer closure technique including vestibular packing with temporalis fascia, cartilage reinforcement, Eustachian tube obliteration, pedicled temporalis muscle flap coverage, and blind sac external auditory canal closure. This case illustrates the recognition and acute intraoperative management of an unanticipated high-flow CSF leak during a routine pediatric otologic procedure, and supports preoperative temporal bone imaging in children with profound sensorineural hearing loss before middle-ear instrumentation. Untreated, such leaks carry a significant risk of life-threatening meningitis.

Cochlear implantation (CI) in patients with CHARGE syndrome presents unique surgical challenges due to complex external, middle, and inner ear malformations. We describe the case of a 3-year-old Japanese boy for whom simultaneous transcanal CI under endoscopic guidance and external auditory canal closure were performed. This approach enabled safe electrode placement and resulted in favorable auditory outcomes, representing a potential novel surgical option for CI in patients with CHARGE syndrome. There are few reports of this type of surgical intervention, and the present case highlights the feasibility and clinical benefits of individualized surgical planning for CI in anatomically complex patients.

Introduction Early detection through universal newborn hearing screening (UNHS) and timely intervention can improve speech, language, and cognitive outcomes. However, limited awareness among caregivers remains a major barrier to early identification and management. This study performed a situation analysis of parental knowledge, attitudes, and practices (KAP) to identify strategic barriers and inform a targeted health communication strategy. Methods A cross-sectional, questionnaire-based study was conducted at a tertiary care hospital in North India from November 2023 to October 2024. A total of 494 participants were recruited. Data were collected through a pre-validated, semi-structured questionnaire administered via face-to-face interviews in Hindi. The tool collected data on knowledge of risk factors and early diagnosis, attitudes toward screening and treatment, and practices related to prevention and care-seeking. Following data collection, a situation analysis and SWOT (strengths, weaknesses, opportunities, and threats) matrix were developed using the Johns Hopkins "P-Process" framework to synthesize raw findings into a strategic roadmap. Results The situation analysis revealed a "service-utilization paradox": while 420 (85.0%) of participants supported newborn hearing screening, a profound "follow-up apathy" existed, with 454 (91.9%) incorrectly perceiving subsequent testing as unnecessary. Knowledge of "visible" risks like ear discharge (459, 92.9%) and measles (405, 82.0%) was high, but awareness of "invisible" prenatal and perinatal risks, such as NICU stays and maternal infections, remained poor. The SWOT analysis identified high graduate-level literacy and vaccination compliance (396, 80.2%) as core strengths and opportunities. However, these were countered by a lack of awareness of government facilities (30, 6.1%) and an external threat of outcome pessimism, where fewer than half of the participants believed normal speech development was possible for affected children. Conclusions The study underscores a strategic opportunity to leverage high vaccination compliance by integrating hearing health education into immunization clinics. Targeted communication strategies must focus on addressing follow-up apathy and outcome misconceptions to bridge the gap between initial screening and long-term rehabilitation.

Rhabdomyosarcoma of the temporal bone is an uncommon but important malignant mimic of pediatric otomastoiditis. We describe a 4-year-old boy who presented with persistent right-sided otorrhea after an upper respiratory tract infection, followed by an external auditory canal mass and progressive right peripheral facial nerve paralysis. Temporal bone computed tomography showed soft-tissue opacification of the right external auditory canal, tympanic cavity, mastoid antrum, and mastoid air cells. Magnetic resonance imaging demonstrated an irregular, heterogeneously enhancing lesion involving the same regions and adjacent to the expected course of the facial nerve canal. Initial imaging favored otomastoiditis with possible cholesteatoma. Biopsy revealed a malignant small round cell soft-tissue tumor infiltrating the subepithelial stroma. Immunohistochemistry showed desmin positivity and nuclear MyoD1 and myogenin positivity, supporting rhabdomyoblastic differentiation; embryonal rhabdomyosarcoma was favored. This case emphasizes that persistent pediatric otorrhea with an aural mass, blood-stained discharge, facial paralysis, or extensive temporal-bone soft tissue should prompt early imaging and biopsy to avoid diagnostic delay.

Aneurysms and pseudoaneurysms predominantly affect the high-pressure arterial system; venous manifestations are exceedingly rare. While the internal jugular vein is the most common cervical site-typically following catheterisation-external jugular vein (EJV) pseudoaneurysms are far less common. Although usually managed conservatively, surgery may be indicated in select cases.A preteen girl presented with a 3-month history of a painless, compressible, right-sided neck mass that enlarged during the Valsalva manoeuvre. There was no history of trauma.Sonographic evaluation demonstrated focal EJV dilatation (3.1 cm×0.9 cm) with peripheral echogenic components. Contrast-enhanced CT confirmed a 2.5 cm×1.7 cm×2.5 cm enhancing saccular mass with vascular continuity to the EJV.Surgical excision was performed. Histopathology revealed dilated vascular channels with organising thrombi and recanalisation, consistent with the diagnosis.Despite the rarity, EJV pseudoaneurysms should be included in the differential diagnosis of paediatric neck masses.

A 9-year-old cat presented with an inflammatory discharge and a polypoid mass located in the left ear canal, penetrating the tympanic membrane. The polypoid mass was removed surgically using traction-avulsion but not submitted for histological examination. Subsequently, the cat underwent computed tomography of the head, which revealed an irregular mass located in the left tympanic bulla. The mass was resected surgically during external ear canal ablation, with lateral osteotomy of the tympanic bulla, and submitted for histological examination. The tumour consisted of papillary structures lined by a single layer of cylindrical, ciliated cells with basally oriented, oval nuclei, minimal atypia, very low mitotic count and periodic acid-Schiff-positive mucin within the cytoplasm. The tumour cells immunolabelled for cytokeratins, and the Ki67 index was 10.4. Based on these findings, tympanic papillary adenoma was diagnosed. Although the clinical signs initially resolved after surgery, the tumour recurred within 17 months, as confirmed by histological examination. The recurred tumour showed an increased mitotic count and Ki67 index (18.6) compared with the primary tumour. This case report presents the clinical outcome, radiological and histological features of tympanic papillary adenoma in a cat, a very rare entity with no direct analogue in human pathology.

The peripheral auditory system of dolphins comprises specialised bony, fatty, vascular, and neural structures adapted for underwater hearing and diving physiology. These include the external ear canal, acoustic fat bodies, sinuses, and associated neurovascular networks, which together support sound conduction, protection, and possibly sensory functions. Despite advances in gross anatomical description, the detailed integration of these tissues, particularly the innervation, neurovascular organisation, and their functional implications, remains poorly understood. Previous studies have described the presence of sensory nerve formations and vascular plexuses, but their arrangement, connectivity, and relation to each other are unresolved. Here, we combine macroscopic dissection, DICE-µCT, histology, and high-resolution confocal microscopy to characterise several neurovascular and sensory components of the dolphin peripheral auditory system in several delphinid species. Macroscopic dissection and DICE-µCT revealed the traditional acoustic fat body distribution with detailed morphology of the posterolateral extension that is not well-known. The cranial nerve distribution, and specifically the mandibular nerve branching patterns, are described in detail. Confocal microscopy uncovered a stratified neurovascular plexus around the external ear canal with a complex sensory system comprising lamellar corpuscles, Merkel cell-neurite complexes, and intraepithelial nerve fibres. Notably, the lamellar corpuscles formed a continuous, three-dimensional neural network with frequent merging and splitting of axonal bundles, shared perineuria, and vascular integration, features not observed in previous studies. Our findings demonstrate that the dolphin external ear canal and surrounding structures form a sophisticated, multimodal somatosensory organ, integrating structural, vascular, and neural specialisations likely adapted for proprioceptive mechanosensation in the aquatic environment. This study provides insights into the integration of the various components of the peripheral hearing apparatus. Future studies integrating anatomical, electrophysiological, and biomechanical approaches are needed to fully elucidate these adaptations.