Choristomas are rare benign developmental lesions composed of histologically normal tissue located in an abnormal (ectopic) anatomical site. Their occurrence in the middle ear is uncommon and may mimic more common pathologies such as chronic otitis media or cholesteatoma, often leading to diagnostic challenges. We report a 16-year-old female who presented with chronic left ear discharge and hearing loss for 8 years. Examination revealed bilateral grade I microtia with a narrow external auditory canal. Pure tone audiometry showed bilateral conductive hearing loss, and high-resolution computed tomography demonstrated a soft-tissue mass in the left middle ear and mastoid with ossicular erosion. A transmeatal exploratory tympanotomy was performed, revealing an encapsulated small brown soft-tissue mass limited to the tympanic cavity complete excision done. Histopathological examination confirmed a mixed heterotopic tissue choristoma composed of skin, adnexal structures, fibroadipose tissue, muscle, cartilage, and salivary gland elements. The postoperative course was uneventful, with hearing improvement and no recurrence at 6-month follow-up. This case highlights the importance of considering middle-ear choristoma in the differential diagnosis of chronic otorrhea and conductive hearing loss to avoid misdiagnosis and unnecessary aggressive treatment.

Introduction Middle-ear and mastoid mucosal inflammation that persists for at least six weeks with discharge is known as chronic suppurative otitis media (CSOM). It is prevalent in India, and fungal infections contribute to a notable proportion of cases. Irrational use of steroids and antibiotics is associated with increased fungal isolates. This study aims to evaluate the presence, profile, and antifungal susceptibility (AFST) of fungi in CSOM patients, using Sensititre™ YeastOne® (Thermo Fisher Scientific, Waltham, MA, USA) colorimetric broth microdilution for yeasts and disk diffusion for moulds, although bacterial causes are well established. Materials and methods This study was a one-year cross-sectional study conducted in the Department of Microbiology in collaboration with the Departments of Microbiology and ENT-Head & Neck Surgery. This one-year cross-sectional study included patients aged 12 years or older with purulent ear discharge lasting at least six weeks. Samples of middle ear exudate were gathered and prepared for mounting and culture in 10%-20% potassium hydroxide (KOH). Isolates of yeast or mould were identified at the species level using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS; Bruker Daltonics, Bremen, Germany). For the isolated yeasts, AFST was performed using the Sensititre™ YeastOne® colourimetric broth microdilution method in accordance with the CLSI M27-A3 standard, and results were interpreted according to the M60 guideline. The data were collected in an Excel sheet (Microsoft® Corp., Redmond, WA, USA), and the statistical analysis involved both descriptive and inferential techniques. Results A total of 136 clinical samples were analyzed in the study. Of these, 27 (19.9%) were KOH positive, including 12 (44.4%) that were culture negative. Overall, 30 samples (22.1%) were culture positive, of which 15 (50%) were KOH negative. The overall fungal prevalence in the study was 42 (30.9%). Among the 30 culture-positive cases, six (20%) were moulds, and 24 (80%) were yeasts. Candida albicans (n = 9) was less common than non-albicans Candida (NAC) isolates (n = 15); however, it was the most prevalent single yeast species among culture isolates (30%). Trichomonascus ciferrii and Candida auris each had four (13.3%) isolates. Candida orthopsilosis (3, 10.0%), Candida metapsilosis (2, 6.7%), and Candida tropicalis (2, 6.7%) were among the other yeasts found. Aspergillus fumigatus was the most prevalent species among mould isolates (3, 10.0%), followed by Aspergillus flavus (1, 3.3%), Aspergillus niger (1, 3.3%), and Fusarium solani (1, 3.3%). After performing AFST on yeast isolates, most isolates showed resistance to one or more antifungal drugs tested, particularly C. auris and T. ciferrii isolates. Conclusion There is currently a change in the fungal etiological pattern in CSOM patients, with increased isolation of new species, including T. ciferrii, C. auris, C. orthopsilosis, and C. metapsilosis. Identification of fungi to the species level is crucial for treatment, as many yeast species have demonstrated resistance to one or more antifungal drugs. Echinocandins and amphotericin B continue to work, but yeasts - particularly NAC species, like C. auris and T. ciferrii - often exhibit significant azole resistance.

Classic Mowat-Wilson syndrome (MWS) is characterized by distinctive facial features (widely spaced eyes, broad eyebrows with a medial flare, low-hanging columella, prominent or pointed chin, open-mouth expression, and uplifted earlobes with a central depression), congenital heart defects with predilection for abnormalities of the pulmonary arteries and/or valves, Hirschsprung disease and/or chronic constipation, genitourinary anomalies (particularly hypospadias in males), and hypogenesis or agenesis of the corpus callosum. Most affected individuals have moderate-to-severe intellectual disability. Speech is typically limited to a few words or is absent, with relative preservation of receptive language skills. Growth restriction with microcephaly and epilepsy are also common. Most affected people have a happy demeanor and a wide-based gait that can sometimes be confused with Angelman syndrome.

Streptococcus pneumoniae remains a global health concern, causing diseases from sinusitis, otitis media, to invasive pneumococcal diseases (IPD), such as bacteremia, bacteremic pneumonia, empyema, and meningitis. Key IPD risk factors include age under five or over 50 years, chronic medical conditions, and lifestyle factors. In Taiwan, IPD incidence has declined following national immunization program. However, morbidity and mortality remain substantial, particularly among older adults. There are two types of pneumococcal vaccines, polysaccharide conjugate vaccines (PCV) and pneumococcal polysaccharide vaccines (PPSV). These vaccines target specific IPD serotypes but may lead to serotype replacement. In Taiwan, the available/forthcoming vaccines include PCV13, PCV15, PCV20, PCV21, and PPSV23, with numbers indicating serotype coverage. This guidance, developed and endorsed by eight national academic societies, serves as an adjunct to the Taiwan Advisory Committee on Immunization Practices recommendations. Using the GRADE framework, it provides evidence-based recommendations for adult pneumococcal vaccination. It emphasizes health promotion to assist healthcare professionals in vaccine selection tailored to current local epidemiology and individual vaccination history. A shared decision-making approach is encouraged, considering individual vulnerabilities, exposure risks, and lifestyle factors. This guidance addresses optimal timing, dosing schedules, coadministration, and safety; grounded in immunological evidence on efficacy, effectiveness, and immunogenicity. In recognition of feasibility of implementation, single-dose PCV20 or PCV21 is proposed as a simplified alternative to complex sequential strategies. However, PCV21 is recommended only where PCV7 serotypes are well controlled or no longer prevalent. This guidance reflects evolving pneumococcal vaccination strategies in response to serotype dynamics and availability of higher-valency conjugate vaccines.

Chronic rhinosinusitis (CRS) is common worldwide in adults, but development of CRS has rarely been studied longitudinally in birth-cohorts. The aim was to investigate development of upper airway symptoms from childhood to young adulthood and to identify early risk factors for CRS at 24 years, in a population-based birth cohort.

Lymphoepithelioma-like carcinoma typically arises in the nasopharynx. Primary occurrence in the middle ear with subsequent intracranial extension remains exceedingly rare, and its diagnosis is often challenging owing to the paucity of detailed clinicoradiological data. Herein, we describe a case of an 82-year-old male presenting with a 2-year history of left-sided hearing loss, a 3-year history of left facial asymmetry (including mouth deviation and eyelid insufficiency), and a 10-day history of nausea/vomiting. His medical history included chronic otitis media. Imaging studies revealed a left cerebellopontine angle mass and chronic left otomastoiditis. Subtotal tumor resection was performed, and pathological analysis confirmed the diagnosis of lymphoepithelioma-like carcinoma. The patient received only supportive care and survived for 23 months. This case report aimed to emphasize the need for clinicians consider atypical cerebellopontine angle tumors in patients with chronic otitis media from Epstein-Barr virus-endemic regions and highlight the importance of a comprehensive diagnostic and therapeutic approach.