Objective: To investigate whether one of the two recently described MD endotypes—defined by either endolymphatic sac degeneration (MD-dg patients) or hypoplasia (MD-hp patients)—is associated with an increased likelihood of undergoing CI. Study Design: Retrospective multicenter cross-sectional study. Setting: Five tertiary referral centers. Patients: CI cohort: 115 adult MD patients with a history of uni- or bilateral CI. Non-CI cohort: 72 MD patients with no CI history. All included patients matched current diagnostic criteria for definite MD. Intervention: Cochlear implantation. Main Outcome Measures: Endotype distribution (MD-dg versus MD-hp) between the CI cohort and the non-CI cohort. The endotype was determined using high-resolution CT data based on the angular trajectory of the vestibular aqueduct, following established protocols. Secondary outcomes included disease laterality, age at MD diagnosis, duration of MD, and pre-CI hearing thresholds. Results: The CI cohort included significantly more MD-hp patients than the non-CI cohort (72% versus 24%, p < 0.0001). The odds ratio of CI for an MD-hp patient relative to an MD-dg patient was 8.4 (95% confidence interval, 4.3–16.1). Pre-CI audiometric data showed no significant differences in hearing thresholds between endotypes, neither in the implanted nor in the non-implanted ear. Conclusions: The MD-hp endotype, frequently associated with bilateral disease and early-age disease onset, is strongly linked to a higher likelihood of CI. Endotyping of MD patients based on endolymphatic sac pathology can effectively stratify their risk of severe hearing loss, guiding personalized audiological follow-up and clinical decisions regarding potential CI.

This study aimed to develop an ex vivo retinal model to examine inflammatory processes in diabetic retinopathy (DR) without animal testing. Porcine eyes were collected from a local abattoir, dissected, and cultivated for four days in five experimental groups: control group (Co), 25 mM and 50 mM mannitol groups (Man25, Man50) as osmotic controls, and 25 mM and 50 mM glucose groups (Glc25, Glc50) as diabetic groups. A TUNEL assay was used to determine relative cell death. Immunofluorescence and quantitative real-time polymerase chain reaction (qRT-PCR) were performed to detect inflammatory markers. An increase in the cell death rate in Man50 (30%), Glc25 (36%) and Glc50 (37%) compared to Co (12%) (p < 0.01, p < 0.001, p < 0.001, respectively) and between Glc25 and Man25 (21%) (p < 0.01) was found. Immunofluorescence staining and qRT-PCR analysis revealed a TNF-α increase in Glc25 compared to Man25 and Co. iNOS was increased in Glc25 vs. Man25 but not in Co vs. Glc25. iNOS gene expression was upregulated with Glc25 treatment compared to Co and Man25 groups. Expression levels of IL-6 and CD31 were significantly higher in Glc25 than in Co and Man25. Glucose treatment increased cell death and inflammation, prompting us to present a DR model for better understanding DR and testing new therapies.

Objective: To determine the effect on the frequency of revision surgery caused by electrode migration (EM) in cochlear implantation by use of an electrode fixation clip combined with a novel surgical technique. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: The investigated institutional cohort included 1052 cases of cochlear implantation with straight electrode arrays from a single manufacturer between 2011 and 2023. Until 2016, the fixation clip was not used, whereas since 2017, the fixation clip and the described novel surgical technique have been applied as an institutional standard in nearly all cases. Intervention: The titanium electrode fixation clip was first introduced and described in 1998 and was CE marked in Europe in 2014. In modification of the original description, a “Reverse Fixation Clip Technique” was applied to optimize the surgical handling and fixation stability. A similar approach has been described recently. Main Outcome Measure: Cumulative incidence of revision surgery caused by EM. Results: The cumulative incidence of revision surgery caused by EM at 3, 5, and 7 years was 0.5%, 1.0%, and 1.9% in the group without the fixation clip (n=461; 43.4%) and 0.0% at all time points in the group with the fixation clip using the “Reverse Fixation Clip Technique” (n=591; 56.6%) (log-rank test P =0.054). No fixation clip-related complications were noted. Conclusion: The application of the fixation clip using the “Reverse Fixation Clip Technique” prevents revision surgery caused by EM in cochlear implantation.

Background/Objectives: Photon-counting computed tomography (PCCT) enables substantial radiation dose reduction while preserving high spatial resolution. Its potential for image-guided navigation in endoscopic sinus surgery (ESS), particularly at ultra-low dose levels, remains insufficiently explored. This study aimed to evaluate the feasibility of PCCT for four different surgical navigation systems at progressively reduced radiation doses. Methods: PCCT datasets of the paranasal sinuses were acquired from two cadaveric specimens using a standard protocol followed by stepwise dose reductions down to 5% of the reference dose. The datasets were used for image-guided navigation with four systems (one optical, three electromagnetic). Registration success, navigation accuracy, and user satisfaction (visual analog scale) were assessed at 100% and 5% dose levels using linear mixed-effects models. Results: Registration was successful for all navigation systems at every dose level. Mean navigation accuracy remained stable despite dose reduction (2.22 ± 1.16 mm at 100% vs. 1.93 ± 1.05 mm at 5% radiation dose; p = 0.364). User satisfaction regarding navigation was consistently high (mean 8.8 ± 0.75) and showed no significant differences between dose levels. Conclusions: PCCT enabled image-guided navigation even at ultra-low radiation doses down to 5% of standard exposure, without compromising navigation accuracy in this initial study. These findings highlight the potential of PCCT to substantially reduce radiation burden while maintaining clinical performance. Further in-human studies are needed.