Brain-computer interfaces (BCIs) hold significant promise in medical applications, particularly for detecting consciousness in patients with disorders of consciousness (DoC). However, conventional BCIs often rely on visual stimuli, which limits their accessibility for visually impaired patients. To expand the applicability of BCIs to a wider range of patients, this study introduces an advanced auditory BCI system. The system incorporates an auditory paradigm utilizing stimulus-related semantic backgrounds and an improved EEG-Inception prototype network with ECA (ECAEI-ProNet). To validate the effectiveness of the proposed system, Experiment 1 was conducted to compare it against three control conditions: Condition 1, which included related backgrounds and stimuli; Condition 2, which included unrelated backgrounds and stimuli; and Condition 3, which presented no background. The results demonstrated that utilizing stimulus-related semantic backgrounds significantly improved BCI classification performance while eliciting event-related potentials (ERP) patterns associated with semantic consistency in subjects. Additionally, the two improvements made to the ECAEI-ProNet model, building upon EEG-Inception, enhanced the model's classification performance. Our proposed paradigm and classification model achieved online accuracies of 88.8$\pm$ 9.1%. To evaluate the clinical feasibility of the proposed BCI system, we applied it to 17 patients with DoC in Experiment 2. Results indicated that seven patients achieved online accuracy significantly above the chance level ($>$64%). Among them, the three highest-performing patients (P3, P5, and P12) showed improvements in both CRS-R scores and clinical diagnosis at the three-month follow-up. These findings suggest that the proposed auditory BCI system may offer preliminary information relevant to residual consciousness-related processing in some patients with DoC.

Optimal processing of our environment relies on the integration of information across sensory modalities. The pulvinar is known to play a key role in visual and face processing, but its involvement in auditory and tactile domains remains poorly understood. Here, we used fMRI localizer tasks to characterize pulvinar functional organization and connectivity during face, voice, and tactile processing. We reproduce the activation of the ventro-medial pulvinar during face perception and describe condition-dependent changes in pulvinar connectivity with face-processing areas, together with reduced connectivity with early visual and default mode network regions. Small clusters overlapping the medial pulvinar were also observed during air-puff stimulation of the face, hand, and foot, accompanied by condition-dependent changes in pulvino-cortical connectivity as a function of the stimulated body part, although these effects were detected at exploratory statistical thresholds. No reliable positive pulvinar activation was detected during voice or non-voice stimulation within the sensitivity limits of the present paradigm. Overall, these results highlight robust visual pulvinar responses and suggest a possible, but preliminary, involvement of the medial pulvinar in tactile processing, together with context-dependent patterns of functional connectivity with cortical areas.

Background Conductive hearing loss (CHL) is a significant contributor to hearing impairment, especially in low-income settings. Chronic suppurative otitis media (CSOM) is often a dominant cause in developing regions. This study examined the causes and clinical profiles of patients with CHL at Khartoum Ear, Nose and Throat (ENT) Hospital. Methods We conducted a retrospective descriptive cross-sectional study of 106 patients diagnosed with CHL (confirmed by audiometry or tuning-fork testing) who presented between October 2021 and March 2022. Demographic data, etiologies, and associated symptoms were extracted from medical records and analysed descriptively. Results The cohort (mean age 27 years) comprised 61 (57.5%) female patients, predominantly young adults with 54 (51%) patients aged 18-35 years. CSOM was the leading cause of CHL, affecting 50 (47.2%) patients, far exceeding other etiologies. Smaller proportions were due to ear canal foreign bodies in seven (6.6%) participants, external auditory polyps in seven (6.6%), otosclerosis in five (4.7%), and various others (each <4%). The majority of cases were acquired, seen in 99 cases (93.4%) and only four (3.8%) were congenital cases. Most patients had mild-to-moderate hearing loss, with 50 (47.2%) patients reporting progressive loss. Common accompanying symptoms included ear discharge in 70 people (66.0%), tinnitus in 62 (58.9%), ear pain in 61 (57.5%), vertigo in 36 (34.0%), and ear itch in 28 (26.4%) participants. Conclusion CSOM predominated as the etiology of CHL in this Sudanese ENT hospital, reflecting a high burden of preventable ear infection. The findings underscore the need for early detection and management of CSOM and related conditions to reduce CHL. The data from this study highlights the need for public health intervention in tackling preventable infectious diseases in Khartoum.

Necrotizing otitis externa (NOE) is a severe and potentially life-threatening infection of the external auditory canal, particularly affecting elderly diabetic or immunocompromised patients. Pseudomonas aeruginosa is the most frequently isolated pathogen. Among fungi, Aspergillus and Candida spp. are the most commonly implicated. Nevertheless, Scedosporium sp. has also emerged as a notable pathogen in NOE. We report the case of a 67-year-old woman with poorly controlled diabetes who presented with persistent right-sided otorrhea and otalgia, complicated by facial paralysis. Imaging revealed bone erosion consistent with NOE. Mycological analysis of ear swabs identified Scedosporium sp. This case highlights the importance of considering fungal pathogens in refractory cases of otitis externa, particularly in high-risk patients. It underscores the need for early mycological investigations to ensure appropriate antifungal therapy.

Vestibulocochlear infarct, most commonly associated with infarction of a terminal branch of the anterior inferior cerebellar artery, presents with acute vertigo and sensorineural hearing loss. It often mimics peripheral vestibular disorders and may show no abnormal findings on neuroimaging, making the diagnosis particularly challenging. Without appropriate treatment, permanent unilateral hearing loss can significantly impair patients' quality of life. This review synthesizes findings from recent studies regarding the clinical characteristics, diagnostic approach, and therapeutic strategies of this condition. Patients typically present with prolonged vertigo (>24 hours), unilateral hearing loss, tinnitus, and imbalance. On examination, peripheral signs such as a positive head impulse test or horizontal-rotatory nystagmus may be observed, while the only indicator of a central origin is the hearing loss, often subtle or unnoticed even by the patient. Vascular comorbidities, including hypertension and diabetes mellitus, constitute key risk factors. Diagnostic difficulties arise from overlap with idiopathic sudden sensorineural hearing loss and vestibular neuritis; a vascular origin may account for up to 15-20% of acute audio-vestibular syndromes in high-risk populations. Early thrombolysis or antiplatelet therapy may improve outcomes, though thrombolysis is rarely administered due to the lack of imaging evidence. For diagnosis, video head impulse testing, audiometry, and MR neuroimaging are essential. Management relies on vestibular and auditory rehabilitation for persistent vertigo and secondary stroke prevention. Our review highlights the underdiagnosis of vestibulocochlear stroke and advocates for an integrated neuro-otological and vascular diagnostic protocol in patients presenting with vertigo and hearing loss to facilitate faster and more effective treatment. Orv Hetil. 2026; 167(33): 1309-1317.

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.

A previously healthy 20-year-old woman was admitted to our hospital because of psychobehavioral alterations, generalized seizure, and post-ictal drowsiness. Six weeks before this admission, depression developed, followed by dysgeusia, anorexia, hearing loss, auditory hallucinations, logoclonia, and generalized seizures, leading to the first hospitalization. On admission, the temperature was 37°C. She was awake, well oriented, but had logoclonia. Brain MRI and electroencephalography (EEG) were both unremarkable, but cerebrospinal fluid (CSF) analysis revealed 7 cells/μl. After admission, she began to exhibit a variety of psychosomatic symptoms, such as altered sense of time, visual disturbances, visual hallucinations, and phonological paraphasia, and logoclonia. On day 4 she was once discharged home, but 4 days later, she was re-admitted to the hospital because of recurrence of seizure. An EEG recorded on day 1 revealed epileptiform discharges arising from the Cz and Pz. CSF-restricted oligoclonal bands were detected. Because of the suspicion of autoimmune encephalitis, the patient was treated with 3 cycle of intravenous high-dose methylprednisolone and 4 rounds of plasma exchanges, resulting in resolution of seizures; however, cognitive impairment and an altered sense of time persisted. Antibody test results came back positive for GluN1 (estimated CSF antibody titers, 1:4) with neuropil staining on rat brain immunohistochemistry, confirming the diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, but no myelin oligodendrocyte glycoprotein antibodies were detected. No ovarian teratoma was found. Following rituximab therapy, cognitive function improved. This case highlights that a forme fruste of anti-NMDAR encephalitis can be attributed to low titers of GluN1 antibodies, and cause a variety of psychosomatic symptoms, without development of typical spectrum of anti-NMDAR encephalitis. Careful assessment is required for appropriate diagnosis and treatment.