Early Disruption of the Microbiome Leading to Decreased Antioxidant Capacity and Epigenetic Changes: Implications for the Rise in Autism

Currently, 1 out of every 59 children in the United States is diagnosed with autism. While initial research to find the possible causes for autism were mostly focused on the genome, more recent studies indicate a significant role for epigenetic regulation of gene expression and the microbiome. In this review article, we examine the connections between early disruption of the developing microbiome and gastrointestinal tract function, with particular regard to susceptibility to autism. The biological mechanisms that accompany individuals with autism are reviewed in this manuscript including immune system dysregulation, inflammation, oxidative stress, metabolic and methylation abnormalities as well as gastrointestinal distress. We propose that these autism-associated biological mechanisms may be caused and/or sustained by dysbiosis, an alteration to the composition of resident commensal communities relative to the community found in healthy individuals and its redox and epigenetic consequences, changes that in part can be due to early use and over-use of antibiotics across generations. Further studies are warranted to clarify the contribution of oxidative stress and gut microbiome in the pathophysiology of autism. A better understanding of the microbiome and gastrointestinal tract in relation to autism will provide promising new opportunities to develop novel treatment modalities

Prevention of cochlear implant electrode damage

As the current trend in cochlear implantation is to prescribe cochlear implants for patients with residual hearing and to use electroacoustic stimulation, cochlear implant damage must be prevented. This article summarizes current research endeavors to prevent electrode insertion trauma and resulting hearing loss. Alteration in surgical technique is necessary with each new electrode design. Nontraumatic surgical technique also requires minimizing acoustic trauma due to drilling the cochleostomy, mechanical damage from electrode insertion, potential infection, and fibrosis of the cochlea. The pattern of hearing loss following electrode insertion trauma is an immediate loss that results from direct trauma to the macroscopic elements of the cochlea and a delayed loss that may reflect the activation of inflammatory and cell death pathways. Therapies under investigation include glucocorticoids, inhibitors of cell death pathways, and hypothermia. Electrode insertion trauma-induced hearing loss involves multiple mechanisms ranging from mechanical insertion trauma to activation of inflammatory and cell death pathways. The macroscopic mechanical damage to the cochlea may be prevented by improvement of electrode design and surgical technique. The molecular damage needs further studies to assess the efficacy of novel therapeutic strategies in preserving functional residual hearing

Otoplasty for the Protruded Ear

The prominent ear can produce significant social and psychological effects on an individual. Through the last century, many procedures have been described to correct this deformity. In this review, the authors navigate through the history of otoplasty for the protruded ear, and describe some of the breakthroughs in the procedure. Furthermore, they discuss key measurements that must be kept in mind in preoperative and intraoperative settings. They also describe in more detail some of the more common methods for correcting the protruded ear, as well as postoperative management and common complications faced after surgery