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.

Background Chronic suppurative otitis media (CSOM) is a major cause of preventable hearing loss, particularly in developing countries. The emergence of multidrug-resistant pathogens has made empirical antibiotic therapy increasingly challenging. This study aimed to investigate the bacteriological profile, antimicrobial resistance pattern, and genotypic characteristics of drug-resistant bacterial isolates from patients with CSOM in a tertiary care setting. Methodology A hospital-based cross-sectional descriptive study was conducted among 111 patients with CSOM over one year. Ear discharge specimens were subjected to Gram staining, bacterial culture, biochemical identification, antimicrobial susceptibility testing using the Kirby-Bauer disc diffusion method (HiMedia Laboratories Pvt. Ltd., Mumbai, India) according to Clinical and Laboratory Standards Institute (CLSI), phenotypic detection of resistant organisms, and polymerase chain reaction (PCR) for mecA gene detection in methicillin-resistant Staphylococcus aureus (MRSA). Associations between culture positivity and demographic or clinical variables were analyzed using the Chi-square test. Results Among 111 participants, 68 (61.3%) were females, and 101 (91.0%) were adults. Culture positivity was observed in 90 (81.1%) patients, while 21 (18.9%) showed no bacterial growth. Gram-negative bacilli constituted 62 (68.9%) of isolates, with Pseudomonas aeruginosa being the predominant pathogen (50, 45.1%), followed by S. aureus (22, 19.8%) and Klebsiella pneumoniae (9, 8.1%). Meropenem demonstrated 100% sensitivity against P. aeruginosa and K. pneumoniae, while linezolid showed 100% sensitivity against S. aureus. MRSA accounted for 14/22 (63.6%) S. aureus isolates, and all MRSA isolates (14/14, 100%) were positive for the mecA gene by PCR, confirming genotypic methicillin resistance. Extended-spectrum β-lactamase (ESBL) production was detected in 12/59 (20.3%) Gram-negative isolates. Culture positivity was significantly associated with gender (P = 0.040) and age (P < 0.001) but not with complications (P = 0.617). Conclusions P. aeruginosa remains the predominant pathogen causing CSOM, with a substantial burden of multidrug resistance, including MRSA and ESBL-producing organisms. Routine culture, antimicrobial susceptibility testing, and molecular detection of resistance genes are essential for guiding appropriate therapy, optimizing antimicrobial stewardship, and improving clinical outcomes in CSOM.

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.

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.

Asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and eosinophilic otitis media (EOM) share type 2 inflammatory pathways. Although type 2-targeted biologic therapies have shown efficacy for these diseases, some patients exhibit dissociated responses to a single biologic. A case of severe asthma with CRSwNP and EOM that showed dissociated responses to biologic therapies and was successfully managed by biologic switching is reported. A 55-year-old man with asthma, recurrent CRSwNP requiring multiple surgeries and oral corticosteroid-dependent EOM was referred to our hospital. Nineteen months after starting dupilumab, EOM and endoscopic and radiological findings of CRSwNP improved partially. However, his nasal symptoms and olfactory dysfunction persisted, and asthma remained uncontrolled. After switching from dupilumab to mepolizumab, asthma control, nasal symptoms and olfactory dysfunction improved, and EOM remained well controlled. Careful monitoring of disease activity and consideration of biologic switching may help achieve optimal control in patients with type 2 united airway diseases.

Periostin is a matricellular protein that binds to its receptors, which include several integrin molecules but mainly αvβ3 integrin on cell surfaces, thereby transducing its signals into cells. Almost 20 years have passed since we found that periostin is involved in the pathogenesis of asthma, which marked the first evidence of its involvement in allergic diseases. Over the past 2 decades, cumulative evidence has demonstrated that periostin plays important roles in the onset or progress of many allergic diseases such as chronic rhinitis with nasal polyp, atopic dermatitis (AD), allergic conjunctivitis, eosinophilic esophagitis, eosinophilic otitis media, allergic rhinitis, and eosinophilic granulomatosis with polyangiitis. Starting from the observation of highly expressed periostin in the lesions of these diseases, periostin studies have expanded to include how periostin contributes to the generation of allergic phenotypes, how measurement of periostin is useful as a biomarker for allergic diseases, and recently how periostin inhibitors can improve allergic diseases. Periostin contributes to the generation of allergic phenotypes by acting as a matricellular protein on many cells, including both non-immune and immune cells. Based on the characteristics of periostin as a surrogate biomarker of interleukin-13, a signature cytokine of type 2 inflammation, serum periostin has been used as a biomarker for stratifying endotypes, estimating disease severity, predicting or monitoring the efficacy of therapeutic drugs, and predicting disease relapse or recurrence. Moreover, a lot of attention is now being paid to periostin in body fluids such as tears and sputum as a biomarker directly reflecting type 2 inflammation. Since it has been shown that periostin evokes itch in AD, we hope to see the development of a novel therapeutic agent for AD targeting periostin/αvβ3 integrin. Here we summarize the discovery and characteristics of periostin, as well as questions and/or problems regarding periostin that remain to be resolved.

Acute mastoiditis represents the most common complication of acute otitis media in childhood and, despite a declining incidence in the era of vaccine prevention, remains a clinically significant entity. Particularly in infants and immunocompromised patients, symptoms may be nonspecific, thereby complicating early diagnosis. The present review provides a structured overview of the etiology, pathophysiology, diagnostic workup, and therapeutic management of acute and chronic mastoiditis, with special emphasis on interdisciplinary aspects.The pathogen spectrum is age-dependent and subject to epidemiological shifts driven by vaccination programs and external factors such as the COVID-19 pandemic. In acute cases, Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes predominate, whereas chronic mastoiditis frequently exhibits a polymicrobial flora including Pseudomonas aeruginosa and anaerobic pathogens. Diagnosis remains primarily clinical and is supported by imaging modalities (CT, MRI).Treatment is stage-dependent and may be conservative (high-dose intravenous antibiotic therapy, with or without ventilation tube placement) or surgical (mastoidectomy). Interdisciplinary management involving otolaryngology, pediatrics, (pediatric) radiology, neuropediatrics, and infectious diseases is of crucial importance-particularly in complicated courses such as abscess formation, labyrinthitis, facial nerve palsy, Gradenigo's syndrome, or intracranial complications.Special consideration is given to high-risk populations, including infants, immunocompromised patients, and children with cochlear implants, in whom atypical clinical courses and biofilm formation necessitate tailored management strategies. Follow-up care includes structured audiological assessment, vaccination counseling, and parental education aimed at preventing recurrence. A coherent, stage-oriented interdisciplinary treatment algorithm combined with close clinical re-evaluation by the surgical team enables effective management while reducing the rate of operative interventions-consistent with current international standards.