A vascularized nasoseptal flap (NSF) provides a novel transnasal option for repairing soft palatal fistulas when traditional transoral flaps have failed or are unavailable, potentially avoiding the morbidity of regional or free tissue transfer. In the current patient who had an 8 × 6 mm soft palatal fistula, the NSF was harvested from the septum and nasal floor, rotated through the nasopharynx to cover the fistula, and was suture-fixated transorally to the mobile soft palate to promote stable adherence and healing. Closure was successful, which resolved her nasal regurgitation, partially improved her velopharyngeal function, and did not cause Eustachian tube dysfunction.

Patulous Eustachian tube dysfunction (PETD) is an uncommon condition characterized by an abnormally patent Eustachian tube, leading to symptoms such as aural fullness and autophony. Rapid weight loss is a recognized risk factor due to loss of peritubal adipose support. With the increasing use of semaglutide and other glucagon-like peptide-1 receptor agonists for obesity management, substantial and rapid weight reduction has become more common, raising the potential for underrecognized otologic complications. A 79-year-old male presented with intermittent bilateral aural fullness and ear "popping" without associated pain, vertigo, or systemic symptoms. His history was notable for intentional weight loss of approximately 200 lb following initiation of semaglutide therapy. Otoscopic examination was unremarkable, and prior tympanometry demonstrated normal middle ear pressure. In the absence of findings suggestive of obstructive Eustachian tube dysfunction, a clinical diagnosis of patulous Eustachian tube dysfunction was made. The patient was managed conservatively with hydration, intranasal saline, and avoidance of decongestants. Rapid, extreme weight loss associated with GLP-1 receptor agonist therapy may precipitate PETD and should be considered in patients presenting with aural fullness and normal middle ear findings. Recognition of this association supports appropriate conservative management and may prevent unnecessary interventions.

Cholesteatoma is an abnormal accumulation of keratinizing squamous epithelium within the middle ear that can behave in a locally destructive manner and erode the ossicular chain. Chronic inflammation and Eustachian tube dysfunction is thought to drive this process. We present a temporal bone specimen from a 38-year-old woman with a lifelong history of right-sided otorrhea and conductive hearing loss, who died of hypoxic-ischemic brain injury after cardiac arrest. Histologic examination revealed a cholesteatoma eroding the incus, with marked regional variation in perimatrix inflammation ranging from mild fibrosis to dense inflammatory infiltration with neovascularization. Notably, areas of more severe inflammation corresponded to a thicker, hyperplastic epithelial matrix, illustrating within a single specimen the spatial link between the inflammatory microenvironment and epithelial proliferation proposed to underlie cholesteatoma progression and local tissue destruction.

Background/Objectives: The modified inflation-deflation test (MIDT) is a physiological test used to evaluate eustachian tube function in patients with tympanic membrane perforation. However, the clinical characteristics and diagnostic value of MIDT have not been fully established. This study aimed to investigate the characteristics of MIDT findings in normal function and patients with Eustachian tube dysfunction (ETD) classified by sonotubometry. Methods: We retrospectively assessed 192 ears of 181 patients with tympanic membrane perforation who underwent sonotubometry and MIDT. Based on sonotubometry findings, 117 ears were classified into the normal function group and 75 ears into the ETD group. The MIDT parameters of the groups, including the first opening pressure (OP1), first closing pressure (CP1), residual pressure after three openings (RP3), and pressure difference between OP1 and CP1 were compared. Correlation and receiver-operating characteristic (ROC) analyses were performed. Results: The ETD group had significantly higher OP1, CP1, and RP3 levels than the normal function group (all p < 0.001). The pressure difference between OP1 and CP1 was significantly greater for the normal function group. Failure of Eustachian tube opening was observed in 46.7% and 3.4% of ears in the ETD and normal function groups, respectively. Eustachian tube opening duration measured by sonotubometry was negatively correlated with OP1, CP1, and RP3 but positively correlated with the OP1-CP1 difference. ROC analysis identified an optimal cutoff value of 112.50 daPa for the OP1-CP1 difference, yielding a sensitivity of 92.3% and a specificity of 58.7%. Conclusions: MIDT was significantly associated with sonotubometry findings and effectively differentiated ETD from normal Eustachian tube function. These findings support the clinical utility of the MIDT as a physiological tool for assessing Eustachian tube function in patients with tympanic membrane perforation.

Osteomas of the temporal bone are rare benign tumors that, in a small minority of cases, may give rise to secondary cholesteatoma. We report a case in which two independent pathological mechanisms appeared to coexist, resulting in a configuration not previously described in the literature. A 51-year-old woman presented with one year of right-sided otorrhoea and progressive mixed hearing loss unresponsive to antibiotic therapy. High-resolution computed tomography (HRCT) demonstrated a giant sessile osteoma arising from the anterior mastoid cortex with complete external auditory canal (EAC) obstruction. Non-echo-planar diffusion-weighted MRI (non-EPI DWI-MRI) identified cholesteatoma restricted to the middle ear and mastoid antrum, clearly distinct from chronically inflamed mastoid air cells. Intraoperatively, a near-intact tympanic membrane with a small attic retraction pocket formed the anterior boundary; no canal-wall cholesteatoma was present. Canal wall-down (CWD) radical mastoidectomy with osteoma excision and meatoconchoplasty achieved complete disease eradication. Histopathology confirmed compact osteoma and cholesteatoma. The cavity was dry and stable at the three-month follow-up. Upon review of the published case reports of temporal bone osteoma with associated cholesteatoma, no previously reported case combined a giant osteoma of the anterior mastoid cortex with cholesteatoma confined entirely to the middle ear and mastoid behind a structurally preserved tympanic membrane. The intraoperative finding of an attic retraction pocket suggests that Eustachian tube dysfunction may have played an independent contributory role alongside the osteoma. Combined HRCT and non-EPI DWI-MRI was essential for preoperative characterization and surgical planning.

Background/Objectives: Children with normal newborn hearing screening results can develop hearing loss from various causes during their first years of life. Since 2016, a hearing and speech-language pathology screening has been conducted annually in kindergartens in Upper Austria in children aged 4 to 5 years. If an abnormal result is found, further evaluation is recommended. Methods: Data from the kindergarten hearing screening from 2018 to 2025 and hearing and speech screening from 2022/2023 were retrospectively analyzed. In addition, a prospective questionnaire survey was conducted with the parents of children who had an abnormal hearing screening result in 2024/2025. The survey asked whether the parents followed the recommendation for further evaluation and what the outcome of that evaluation was. Results: From 2018 to 2025, between 14,975 (2024) and 17,101 (2020) children were screened annually. The prevalence of abnormal hearing screening results ranged from 5.89% (2020) to 8.17% (2022). Abnormal grammar and articulation were found in 18.68% and 68.28% of the in-depth analyzed screenings of 4-5-year-old children in 2022, respectively. A total of 209 questionnaires were evaluated in the prospective questionnaire study. Approximately 70% of the participating parents reported having their child undergo the recommended evaluation by an ORL specialist. According to the parents, the most frequent cause of hearing impairment was middle ear effusion or Eustachian tube dysfunction. No new cases of sensorineural hearing loss were diagnosed in this population of 209 children, according to the parents surveyed. Conclusions: Nationwide screening in kindergartens allows for the early detection of hearing loss in early childhood, enabling children to receive evaluation and treatment. This is supported by the fact that, according to their parents, almost a quarter of the children with abnormal hearing screening results received a diagnosis requiring treatment from an ORL specialist.