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.

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.

BackgroundEnvironmental noise is an under-recognised public health hazard in rapidly urbanising low- and middle-income countries. Urban slum residents are disproportionately exposed to chronic transportation and occupational noise, yet community-level evidence linking noise exposure with ear morbidity remains limited in India.ObjectivesTo assess the association between environmental noise exposure and ear morbidity in urban slums of Bhubaneswar, Odisha. To examine behavioural and socio-environmental determinants of ear health among the sample for associations to offer recommendations.MethodsThe study design is a community-based, stratified, cross-sectional study conducted in the urban slums of Bhubaneswar, Odisha, India, stratified into low-, medium-, and high-noise zones. The study population were 384 residents aged 10-50 years selected through stratified random sampling with proportional allocation. The noise stratification is generalised, on the basis of city administrative definitions.Data were collected using a semi-structured questionnaire that assessed socio-demographics, occupational exposure, ear hygiene, and health-seeking behaviour. Clinical ear examination, otoscopy and tuning fork tests were conducted. Logistic limitations did not permit performing pure tone audiometry. Ear health outcomes included normal, ear infection, at risk hearing loss or both. Associations were analysed using the chi-square test and multivariable logistic regression, with statistical significance at p<0.05.ResultsAmong 384 participants, the overall prevalence of ear morbidity was 21.1% (95% CI: 17.2-25.4), including ear infections at 11.2% (95% CI: 8.3-14.8), at-risk hearing loss at 2.6% (95% CI: 1.3-4.8), and combined infection with hearing loss at 7.3% (95% CI: 5.0-10.3). A graded increase in hearing loss risk was observed across noise exposure zones-2.4% in low, 10.9% in medium, and 15.6% in high noise areas (χ[2]=13.21, p=0.001). External ear canal abnormalities were also significantly linked to higher regional noise exposure (χ[2]=19.78, p<0.001). Behavioural factors, including unsafe ear-cleaning practices (χ[2]=24.57, p=0.017), a history of ear infection (χ[2]=39.59, p<0.001), and ear piercing (χ[2]=15.38, p=0.002), showed significant associations with morbidity. Multivariable analysis revealed greater odds of ear morbidity among residents of high-noise zones (AOR≈8.5; 95% CI: 2.9-25.1), emphasising the combined environmental and behavioural risk factors.ConclusionEnvironmental noise exposure is a significant yet under-recognised determinant of ear morbidity among urban slum residents, exacerbated by unsafe hygiene behaviours and limited preventive care. Integrating ear and hearing services within primary health care and strengthening urban environmental regulation are essential. The study supports progress toward SDG 3 (Good Health and Well-Being), SDG 11 (Sustainable Cities and Communities), and SDG 6 (Clean Water and Sanitation) through multisectoral strategies that address environmental and social determinants of ear health. The community-based stratification provides a pragmatic assessment of environmental noise exposure; however, the cross-sectional design and the absence of individual noise exposure measurements and gold-standard hearing assessments (pure-tone audiometry) limit causal inference.

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.

Isolated congenital ossicular chain anomalies (COCAs) are an uncommon cause of conductive hearing loss in patients with a normal external auditory canal and tympanic membrane, and familial clustering is rarely described. We report three siblings with non-progressive conductive hearing loss and normal otoscopic findings. Two siblings exhibited bilateral involvement, whereas the third had unilateral disease with a normal contralateral ear. High-resolution temporal bone computed tomography suggested incudostapedial (I-S) discontinuity caused by defects in the long process of the incus, without external or inner ear anomalies. Exploratory tympanotomy in two siblings confirmed congenital-appearing I-S discontinuity without evidence of chronic otitis media. Ossiculoplasty using autologous incus interposition (type III reconstruction) achieved marked postoperative improvement. There was no reported family history of middle ear malformation outside this sibship, and a targeted next-generation sequencing panel (63 known deafness genes) performed in two siblings did not identify a definitive pathogenic variant. This case series highlights that COCAs can cluster among siblings and may show variable laterality (bilateral and unilateral) within the same family, underscoring the value of early imaging and surgical evaluation when conductive hearing loss persists despite normal tympanic membranes.

Ménière's disease (MD) is an inner ear disorder of poorly understood etiology, and its management remains symptomatic. This review presents novel therapeutic approaches to control vertigo, improve audiological function, and enhance patient outcomes in MD. The literature was reviewed to explore conservative and surgical methods under current investigation. Recent advances in pharmacological therapy target oxidative stress, immune-mediated pathways, and neuromodulatory mechanisms. Clinical trial reports evaluating the efficacy of new oral treatment-ebselen were included. Preliminary report describing treating patients with MD and migaine with rimegepant was analyzed. Novel strategies to improve betahistine bioavailability were also reviewed. Authors reported modifications to intratympanic steroid therapy with OTO-104 and SPT-2101 (sustained-release intratympanic dexamethasone hydrogel). Contemporary surgical approaches increasingly aim to preserve hearing and, when feasible, partial vestibular function. Among surgical techniques, endolymphatic sac surgery with various modifications, endolymphatic duct blockage, canal plugging, and transcanal neurectomy were analyzed. Advances in pharmacological and surgical strategies offer new options for MD symptom control, but their effectiveness remains to be confirmed in larger, long-term trials. At the same time, these innovative therapeutic approaches provide valuable insights into the underlying pathophysiological mechanisms of the disease and may stimulate further research into its etiology. A better understanding of disease etiology is essential for developing causal treatments.

Objective:To analyze the clinical efficacy of tympanoplasty in patients with chronic suppurative otitis media（CSOM） complicated by fungal infection through a prospective randomized controlled study, and to explore the optimal surgical timing for chronic otitis media patients accompanied by fungal infection. Methods:A total of 92 patients diagnosed with chronic otitis media who were admitted to Yinchuan First People's Hospital from December 2024 to December 2025 were enrolled in this study. All subjects underwent preoperative microbiological examinations（including fungal smear counting and culture）, otoendoscopy, Zurich Chronic Middle Ear Inventory-21（ZCMEI-21） assessment, and pure-tone audiometry. According to the results of preoperative electronic otoendoscopy and microbiological tests, the patients were divided into the non-fungal infection group（n=58） and the fungal infection group（n=34）. The 34 patients in the fungal infection-complicated group were randomly assigned to the control group（n=17, receiving systemic antifungal treatment preoperatively） and the experimental group（n=17, without preoperative systemic antifungal treatment） using the double-blind design. All 92 patients underwent electronic otoendoscopy at 2, 4, 8, and 12 weeks postoperatively, and the time to dry ear was recorded during follow-up. ZCMEI-21 assessment and pure-tone audiometry were re-evalutaed at 12 weeks after surgery. Results:①There was no statistically significant difference in the preoperative and postoperative air-bone gap improvement （ΔABG=preoperative ABG-postoperative ABG） among the three groups（P>0.05）. ②No statistically significant difference was observed in the postoperative time to dry ear among the three groups（P>0.05）. ③The tympanic membrane healing rate showed no statistically significant difference among the three groups（P>0.05）. ④The ZCMEI-21 scale scores were not statistically different among the three groups（P>0.05）. However, in terms of medical resource utilization reflected by the scale, statistically significant differences were found between the blank group and the experimental group, as well as between the control group and the experimental group（P<0.05）. Conclusion:Patients with chronic otitis media complicated by external auditory canal fungal infection can undergo otoendoscopy-assisted tympanoplasty without preoperative systemic antifungal treatment, achieving clinical efficacy comparable to those without fungal infection.

A woman in her 20s presented with a 3-month history of progressive right-sided otalgia. Otoendoscopic examination revealed a greyish mass occluding more than 75% of the external auditory canal. Biopsy confirmed well-differentiated squamous cell carcinoma. High-resolution CT demonstrated cortical erosions of the anterior and posterior bony external auditory canal with mastoid involvement. The patient underwent two-handed endoscopic lateral temporal bone resection using the Justtach ASM2 endoscope holder, combined with superficial parotidectomy and selective neck dissection. Histopathological examination confirmed complete excision with negative margins. The patient received adjuvant chemoradiation therapy and remains disease-free at follow-up. This case demonstrates the technical feasibility of a two-handed endoscopic approach for temporal bone malignancy resection, though larger studies are needed to establish its efficacy compared with conventional microscopic techniques.

A man in his 50s, with a history of cervical spondylosis, presented with acute right-sided tongue swelling, dysarthria and dysphagia. Although tongue deviation was present, unilateral tongue oedema led to initial suspicion of angio-oedema and malignancy; however, blood tests and tongue MRI did not lead to a definitive diagnosis. Tranexamic acid was prescribed for presumed angio-oedema; however, at follow-up, rightward tongue deviation persisted without any other neurological deficits. Localised tenderness was noted over the right occipital area, corresponding to the atlanto-occipital joint. Imaging revealed an osteophyte compressing the outlet of the right hypoglossal canal with joint fluid, raising suspicion of hypoglossal nerve palsy due to cervical spondylosis with possible involvement of calcium pyrophosphate deposition disease although this was not confirmed. This case highlights the importance of considering neurogenic causes of unilateral tongue swelling and recognising cervical spondylosis as a cause.

Adeno-associated virus (AAV)-based gene therapy has demonstrated transformative potential in treating hereditary hearing loss (HHL). Investigating factors that influence AAV transduction in target and non-target organs is critical for improving therapeutic precision and safety. Given the postnatal maturation of the murine inner ear and compartmentalized structure of the cochlea, we evaluated whether developmental age or delivery routes affect AAV-PHP.eB tropism in cochlear hair cells (HCs) and adjacent brain regions. Following round window membrane (RWM), posterior semicircular canal (PSCC), or utricle delivery, neonatal mice showed robust OHC transduction (vs. minimal in juveniles), while IHC transduction remained consistently high across age groups. Across all three delivery routes, brain AAV transduction was significantly higher in neonates than in juveniles. Despite this, AAV genome copies were more highly enriched in the injected inner ear than in the brain at both ages. Dye-tracing experiments demonstrated distinct spatial distribution patterns following three inner ear delivery routes, with the cochlear aqueduct (CA) identified as the primary conduit for intracranial spread post-injection. These findings provide guidance for the design of studies in mouse models of deafness, particularly with respect to cochlear hair cell subtype targeting, therapeutic timing, and safety assessment of AAV-PHP.eB-based therapies for hearing loss.