It is an honor to write this tribute to Jacob Sade´ (1925, Berlin–2020, Tel Aviv), a teacher, physician, ear surgeon, scientist, scholar, Chairmen of ENT departments, Israeli Ear Nose and Throat Society president, medical journal editorial board member, initiator, and organizer of international societies (Politzer society and the Mediterranean Society of Otology and Audiology), from whatever perspective, he stood apart as someone very special. Jacob Sade´ was committed to his patients who continued to seek his medical advice up until his final days, as well as to his research that focused on middle ear cleft under-aeration, a term coined by him as opposed to the narrower term, eustachian tube dysfunction meant to describe this condition. Jacob Sade´’s exceptionally long and illustrious medical career started in 1943, after graduating from the Herzliya Hebrew Gymnasium in Tel-Aviv. He first studied biology at the Hebrew University in Jerusalem, and continued at the University of Geneva, Switzerland, where he studied medicine, graduating in 1951. He returned to Israel to work at the Sheba Medical Center. However he soon moved to the Massachusetts Eye and Ear Infirmary at Harvard University hospital in Boston to specialize in Otolaryngology, followed by a year of research as a research instructor at Washington University in St. Louis. In 1959, Jacob Sade´ returned to the Sheba Medical Center at Tel Hashomer, Israel as senior ENT surgeon and in 1967, he was invited to HaEmek Medical Center, Afula, to establish the first ENT department there. In 1971, he established the ENT department in Meir Medical Center, Kfar Saba, and served as head of the ENT department until 1990. From 1990 onwards, he continued working with patients in his busy private practice where he also mentored many young ENT specialists in the field of Otology. Jacob Sade´ was a role model for a Surgeon-Scientist, long before the term was ever coined. Concomitant with his busy clinical appointments he was deeply and actively involved in research. In 1966, he was nominated as a senior lecturer at the Hebrew University in Jerusalem and in 1967, he joined the Weizmann Institute of Science as a visiting professor and stayed there for 4 years at the Polymer Department, headed by Prof. Aharon Katzir researching in the field of Otology. From 1974 to 1980, he served as an established scientist at the office of the chief scientist of the Israel Ministry of Health. In 1975, Jacob Sade´ was nominated a full professor at the Tel Aviv University, in 1975 to 1976 as a visiting professor in the ENT department at the University of Iowa, and in 1979 as a visiting professor at Boston University. In 1985, Jacob Sade´ was appointed Incumbent of the Felix and Sara Dumont Chair of Hearing Disorders Research at Tel Aviv University. From 1986 to 1990, Jacob Sade´ served as President of the Israeli Ear Nose and Throat Society. In 1998, he became head of the committee for coordinating ear research of the International Federation of Oto-Rhino-Laryngological Societies and in 1990, he established and directed (until 2010) the Ear Research Laboratory in the department of Bioengineering at the Tel Aviv University, where in 1993 he was nominated as professor emeritus. During his career he organized several international conferences, both in Israel and abroad, conferences that professionals still remember today as milestones in the field of Otology. Jacob Sade´ encouraged his students to follow “a line” in their research, as he called it, in order to contribute to our field. In this pursuit, absolute accuracy in presenting the results was paramount, as well as writing our papers in such a way that they stood the test of time so dozens of years later we still think they are suitable for publication. For every word in his hundreds of scientific publications, journal papers, chapters in books, and books, he was personally responsible for the scientific accuracy. He edited and re-edited them reaching an unbelievable number of versions until perfection was achieved. Indeed, his scientific publications are often being cited today, thus fulfilling his hopes. His research line focused on the “chronic otitis media syndrome,” and under-aeration of the middle ear cleft, the link between the different chronic otitis media entities. Early in his career he became an expert on middle ear and eustachian tube histology, including the technique of preparing the histologic slides. He was ready to view endless number of slides in order to be able to see what middle ear and Eustachian tube histology and histopathology were willing to reveal. Jacob Sade´ was the first to describe the mucociliary system of the middle ear. His clinical studies were based on following-up his patients, where he endeavored to understand the natural history and the sequalae of middle ear diseases. Based on his and others’ early measurements of middle ear gas composition, which showed the gas composition of the middle ear cleft to be similar to that of the mix venous blood, he suspected that the gas composition and consequently the gas pressure in the middle ear cleft is controlled not only by gas flow through the eustachian tube, as was commonly accepted, but also by bilateral diffusion between the middle ear cleft cavities and the blood flowing in their mucosa. The last period of his scientific career was dedicated to in-depth basic research on the partial pressures of the different middle ear gases, the relationship between the mastoid volume and middle ear pressure as well as on the fluctuation in middle ear pressure as expressed by the position of the tympanic membrane. Again, diving deeply into the technology needed in order to perform these measurements, he became an expert on using a mass spectrometer. When nevertheless a general theory regarding the middle ear gas equilibrium could not be established, he tried to look for the solution also in ears of large aquatic mammals, and enjoyed the adventures that faraway overseas research had to offer. Jacob Sade´ was famous among his many friends and colleagues for being extremely interesting and enjoyable company. He was an innovative thinker, a visionary spirit with a great sense of humor, not to mention being a scholar of history, literature, and global politics. And on top of all of that he was able to express all this, not only in Hebrew and English, but also in French and German in his typical sophisticated way. He was also extremely interested in other people knowledge and was a unique and active listener. In addition to his devotion to his work Jacob Sade´always spent a lot of time with his family, his wife Ruth, his children, Yoav, Ayelet, Nadav, and Ron and his grandchildren. He treasured long family dinners, listening to his children and grand-children telling him about their activities, thoughts and plans. Jacob Sade´’s life was a life well lived. He will be missed by many, but never will he be forgotten by those who were fortunate enough to have known him. Michal Luntz, MD President of the Israel Society for Auditory Research Ben-Gurion University of the Negev, Israel 16 Bet-El Street Suite 81, Tel Aviv, 6908712, Israel [email protected]; [email protected]

INTRODUCTION Cholesteatoma is the most severe middle ear disease. In most cases cholesteatoma results from under-aeration of the middle ear cleft. It is characterized by otorrhea and hearing loss, and may lead to severe complications, intra- and extra-cranial. There is no non-surgical treatment for cholesteatoma. Surgical treatment is the only option. Cholesteatoma is diagnosed by micro-otoscopy. When cholesteatoma is suspected and otoscopy is inconclusive, imaging is mandatory. The goal of treatment in cholesteatoma is to achieve a stable and safe ear. In most cases, upon diagnosis, cholesteatoma is quite extensive and mastoidectomy is needed. Choice of surgery [Canal wall up mastoidectomy with tympanoplasty (the more conservative alternative), Canal wall down (radical) mastoidectomy with meatoplasty or Canal wall down (radical) mastoidectomy with reconstruction of external ear canal, tympanoplasty and mastoid obliteration], depends on the extent of the disease, the anatomic relationship between the sensitive structures that protrude into the walls of middle ear and mastoid cavities and the bony destruction that had already been caused by the disease. Hearing rehabilitation should lead to a stable, predictable, symmetric and as close as possible to normal hearing threshold. In many cases the solution is external or implantable hearing devices. Cholesteatoma has a high recidivism rate that leads to repeated surgery. In order to diagnose and treat cholesteatoma recidivism, a structured follow-up is needed after cholesteatoma surgery, with periodical otoscopy (every 6-12 months) and MRI (every 1-2 years). When cholesteatoma recidivism is diagnosed, surgery is indicated before the disease grows and becomes infected.

Objectives: To evaluate outcomes of BAHA Connect® and BAHA Attract® implantations, and to examine the prognostic utility of a preimplantation Softband®-attached processor trial. Study Design: Retrospective case review Setting: Tertiary referral center. Patients: Patients who underwent Connect® (19 ears) and Attract® (25 ears) implantation between 2007 and 2017. Intervention: BAHA® implantation. Main Outcome Measures: Unaided air conduction (AC), bone conduction (BC), and speech reception thresholds (SRTs), as well as free field (FF) aided with Softband®-attached processor and with implant-attached processor thresholds. Results: Serviceable implant-attached processor PTA0.5,1,2 kHz (≤35 dB HL) was achieved in 89 and 88% of the Connect® and the Attract® ears, respectively, while at 4 kHz this was achieved in 68 and 32% of the Connect® and the Attract® ears, respectively (p = 0.032). Significantly more Connect® ears showed alignment between FF aided with implant-attached processors thresholds and BC thresholds. The alignment between the Softband®-attached processors thresholds and implant-attached processors thresholds was similar in the two groups. Both groups exhibited similar positive improvement in the quality of life questionnaires Conclusions: Accessibility to sound with the implant-attached processor is well predicted by the pre-implantation Softband® trial, both in the BAHA Connect® and in the BAHA Attract® ears. Hearing rehabilitation targets at 0.5, 1, and 2 kHz are met by most Connect® and Attract® ears, while at 4 kHz the outcome with Attract® is poorer. This information should be presented to the patient during consultation prior to a decision as to the type of BAHA® device to be implanted.

BACKGROUND:Many unilateral cochlear implant (CI) users have residual hearing in the nonimplanted ear, allowing them to use bimodal hearing. Assessing the hearing aid (HA) contribution is important.OBJECTIVE:To examine the contribution of a contralateral HA in unilateral CI users with severe-profound hearing loss (HL) in the non-implanted ear to phonetic features perception.Participants and method: Monosyllabic word test in noise was used to assess the phonetic features perception in 29 adult bimodal users with severe-profound HL and only minimal speech recognition using HA alone in the nonimplanted ear.RESULTS:For all consonants and vowel features, participants scored better in the bimodal condition than in the CI-alone condition. Better low frequencies thresholds in the HA ear correlated with better perception of phonetic features in the bimodal condition.CONCLUSION:CI/HA users with only minimal speech recognition using HA alone in the nonimplanted ear extract low-frequency information provided by the HA ear and combine it with information coming from the implanted ear.Significance: The results of the study provide a reasoning for unilateral CI users to insist on using a contralateral HA as long as contralateral implantation is not performed, and suggest how to monitor the benefit derived from the HA.

BACKGROUND:After cochlear implantation (CI) there is concern regarding the potential risks of spread of middle ear infection along the electrode array into the cochlea and central nervous system and regarding late sequela of otitis media (OM): eardrum perforation, atelectasis and cholesteatoma. The age for implantation in children overlaps the peak age incidence of acute OM (AOM) and secretory OM (SOM) and delay of implantation reduces the potential benefit from the intervention. Therefore, control of OM by inserting ventilating tubes (VT) is widely performed in pediatric CI candidates who also suffer from otitis media.OBJECTIVES:To refine indications for VT insertion in candidates for cochlear implantation who also suffer from OM.METHODS:Of 200 children referred for CI and implanted one after another, 126 were classified as OM-prone, 98 due to AOM and 28 due to SOM. The rate of development of late sequela of middle ear disease was compared between the two subgroups of OM-proneness.RESULTS:A total of 15 children (7.5%) developed late sequela of middle ear disease; all belonged to the SOM group; 3.5% developed eardrum perforation; 3.5% atelectasis and 0.5% cholesteatoma.CONCLUSIONS:Pre-CI VT insertion in children with SOM who underwent CI did not prevent development of late sequela of middle ear disease; VT insertion with the object of preventing late sequela of middle ear disease in CI candidates who suffer from SOM only is not required; in otitis-prone children a long term oto-microscopic follow-up is needed in order to identify late sequela of middle ear disease.

Acute mastoiditis (AM) related intra-cranial complications (ICC) are prevalent and may be diagnosed and treated promptly. Infectious ICC are diagnosed using brain imaging and will be missed without it. Nevertheless most clinicians base their decision to perform brain imaging on clinical suspicious only. The aim of the study was to see whether there's an association between rate of imaging performance and therefore the diagnosis of ICC in AM. Google scholar, PubMed, Medline, EMBASE, Web of science and Cochrane websites were searched from 1992 to 2017 (last search conducted on November 2017) using the key words: acute mastoiditis, otomastoiditis, imaging and intracranial complications in English only with no restrictions regarding age of patients. The database search yielded 1071 studies. 40 studies were found to be suitable for the meta-analysis. The rates of ICC were found to be significantly higher in centers where brain imaging was mandatory done, as compared to centers where brain imaging was performed ???as needed???, supported clinical presentation. A typical clinical combination on which centers based their indication for imaging in AM patients was hard to elucidate. Available publications (up to 2017) don't offer high grade clinical evidence based measures for outlining the AM patient who is at a high risk for developing ICC. ICC are under-diagnosed in centers where brain imaging is performed within the minority (<50%) of AM patients, supported unintentional clinical judgment only. Sometimes chronic subdural hematoma are often developed following posttraumatic subdural hygroma. the aim of this study is to analyze its incidence, the duration required for his or her conversion, and characteristic CT and MR findings of subdural hygroma and chronic subdural hamatoma. We studied 8 patients with persistent posttraumatic subdural hygroma which consequently developed chronic subdural hamatoma. The patients were examined with CT initially and followed-up with CT in 3 and MR in 5. We analyzed the placement of the lesion, the change of the density or signal intensity, the change of the scale, and therefore the degree of enhancement and mass effect. The duration required for the formation of hematoma was 48-166 days (mean, 76 days). The characteristic CT findings of subdural hygroma were a crescentric lesion with CSF density along the inner table with-out contrast enhancement. The mass effect was minimal. The CT findings of chronic subdural hematoma were higher density than that of hygroma all told cases, increase in thickness and size in 3 cases, and contrast enhancement along the inner membrane of the hematoma in 5 cases. The signal intensities of the subdural hygroma were similar to those of CSF on both T1 and T2 weighted images, whereas, those of chronic subdural hamatoma were higher. The increased signal intensity on T1 weighted MR images and increased attenuation or contrast enhancement of the lesion on CT may suggest the conversion of subdural hygroma into chronic subdural hematoma. Sometimes chronic subdural hematoma may be developed following posttraumatic subdural hygroma. the aim of this study is to research its incidence, the duration required for his or her conversion, and characteristic CT and MR findings of subdural hygroma and chronic subdural hamatoma. We studied 8 patients with persistent posttraumatic subdural hygroma which consequently developed chronic subdural hamatoma. The patients were examined with CT initially and followed-up with CT in 3 and MR in 5. We analyzed the situation of the lesion, the change of the density or signal intensity, the change of the dimensions, and also the degree of enhancement and mass effect. The duration required for the formation of hematoma was 48-166 days (mean, 76 days). The characteristic CT findings of subdural hygroma were a crescentric lesion with CSF density along the inner table with-out contrast enhancement. The mass effect was minimal. The CT findings of chronic subdural hematoma were higher density than that of hygroma all told cases, increase in thickness and size in 3 cases, and contrast enhancement along the inner membrane of the hematoma in 5 cases. The signal intensities of the subdural hygroma were just like those of CSF on both T1 and T2 weighted images, whereas, those of chronic subdural hamatoma were higher. The increased signal intensity on T1 weighted MR images and increased attenuation or contrast enhancement of the lesion on CT may suggest the conversion of subdural hygroma into chronic subdural hematoma We are proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2021 and to implement certain recent legislation. We are also proposing to form changes referring to Medicare graduate medical education (GME) for teaching hospitals. additionally, we are providing the market basket update which will apply to the rate-of-increase limits surely hospitals excluded from the IPPS that are paid on an affordable cost basis, subject to those limits for FY 2021. We are proposing to update the payment policies and also the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2021. during this FY 2021 IPPS/LTCH PPS proposed rule, we are proposing changes to the new technology add-on payment pathway sure antimicrobial products and other changes to new technology add-on payment policies, and togather market-based rate information on the Medicare cost report for cost reporting periods ending on or after January 1, 2021, and requesting discuss a possible market based MS-DRG relative weight methodology beginning in FY 2024 that we may adopt during this rulemaking. We are proposing to ascertain new requirements or revise existing requirements for quality reporting by acute care hospitals and PPS-exempt cancer hospitals

Otologic manifestations are known to occur in patients with idiopathic intracranial hypertension (IIH), but the occurrence of sensorineural hearing loss, especially in pediatric populations, has been addressed in only a few reports. Here, we describe a pediatric patient who presented with IIH and severe bilateral hearing loss. The patient's hearing loss was diagnosed as a form of auditory neuropathy (AN) and resolved after prompt treatment of the increased intracranial pressure. This case points to a possible association between IIH and AN and suggests that IIH may potentially be a reversible cause of AN spectrum disorder. Laryngoscope, 129:E407-E411, 2019.

his case is difficult. Meningitis in patients with inner ear malformations is associated with bacteria (e.g., S. pneumoniae and Haemophilus influenzae) that colonize the upper airways. The prevalence of oropharyngeal colonization with GBS is low (≈5%), explaining the rarity of GBS meningitis (10). Unlike for pneumococcal meningitis, which can be prevented at least partially by vaccination, no vaccine is available for GBS. Our report adds another example to the growing spectrum of invasive GBS disease beyond infancy. GBS is uniformly susceptible to penicillin; therefore, treatment directed at common causes of bacterial meningitis is also appropriate for GBS (1,10). Cochlear implant recipients with symptoms of fever, otitis media, or headache should be carefully assessed; if meningitis is diagnosed, GBS should be considered as a possible causative organism.

Objectives: To characterize the clinical presentation of pediatric patients who, upon AM diagnosis, also had imaging-diagnosed ICCs (ID-ICCs); to define the group of AM patients at risk of developing ID-ICCs; and to update knowledge about organisms causing AM. Study design: Analysis of all AM patients admitted between 1997 and 2018 and treated according to an obligatory protocol including both brain imaging and sampling for bacterial culture upon clinical diagnosis of AM. Results: Of 166 admitted patients (0.5-19 years old) 22 (13%) already had ID-ICCs. In patients who, on admission, had already received antibiotics for acute otitis media (AOM) and also had CRP (C-reactive protein) levels above 93.5 mg/L, the risk of ID-CC was increased by 22.5-fold (P < 0.0001). Bacterial culture results were available for all patients and were positive in 115 (69%). Organisms most commonly found in patients without prior antibiotic treatment were group A Streptococcus pyogenes (53%), Streptococcus pneumoniae (23%), and Haemophylus influenzae (11%), while with prior antibiotic treatment they were Fusobacterium necrophorum (21%), Streptococcus pyogenes (18%) and Pseudomonas aeruginosa (18%). Conclusions: Since the risk of ID-ICC in patients with the abovementioned CRP and prior antibiotic treatment was significantly higher than in the others, these high-risk patients should undergo diagnostic imaging on admission. Antibiotic treatment prior to AM development may promote growth of non-AOM pathogen.

Background: Many adults with moderate-profound hearing loss whose speech recognition has deteriorated and are no longer benefitting from hearing aids (HAs) could benefit from cochlear implantation (CI). Of these, only <5% are implanted. In order to inform eligible patients about expected results and ease the route to implantation, better guidelines for candidate selection are needed. Objectives: To provide reliable guidelines by determining, in a well-characterized group of implantees, the minimal expected post-CI scores for monosyllabic (MS) word recognition. Patients and methods: In total, 20 adults unilateral implantees considered (prior to implantation) straightforward CI candidates were assessed >= 20 months post-CI. Their post-CI CI-aided thresholds and MS word recognition were compared to their pre-CI scores. In addition, SSQ12 scores were evaluated post-CI. Results: Post-CI, thresholds were 40 dB or better in all participants, and 35 dB or better in 95% of them. 90% scored 60% or better on MS words in quiet. In speech noise all scored 15-60% and 50% scored 45-60%. Poorer unaided pre-CI thresholds yielded greater patient satisfaction. Conclusions: Adults with moderate-profound hearing loss, whose speech recognition has deteriorated, are no longer benefitting from HAs and fulfil defined criteria for straightforward CI, should be referred for formal CI candidacy evaluation.

The use of imaging in otosclerosis for diagnosis, preoperative assessment , and follow-up has the potential to give the clinician an additional tier of patient evaluation and validation of diagnosis. Before stapes surgery , imaging may help avoid unnecessary middle ear explorations in nonotosclerotic cases, prevent potential complications, and assist in appropriate patient counseling regarding management expectations. Postoperatively, following unsuccessful air-bone gap closure in stapes surgery or conductive hearing deterioration following initial successful closure of the air bone gap, imaging can be used to determine the prosthesis position in the middle ear.

Objectives/Hypothesis To identify and analyze factors influencing the outcome of facial nerve palsy (FNP) in a pediatric population. Study Design Retrospective study. Methods Sixty‐seven pediatric patients (72 consecutive cases) diagnosed with and treated for FNP were divided into two severity subgroups. Associations between recovery in these groups and categorical variables were assessed using the Fisher exact test and for age using the t test. Results Mean age on admission was 12.0 ± 4.5 years. Neither FNP outcome (graded by severity) nor improvement rates (expressed as the percentage of patients achieving a higher FNP grade over time) were influenced by gender, affected side, presence of polyneuropathy, etiology, or recurrent or familial FNP. In cases with comparable final outcome, improvement rates of those diagnosed with severe FNP on presentation (38.9% of cases) were significantly higher than mild‐to‐moderate FNP. Of the 47 patients who attended a follow‐up examination 2 months after discharge, 70.2% have already recovered (by at least one House‐Brackmann [H‐B] grade) by the time they were discharged, whereas 90.9% achieved H‐B grade ≤2, and 72.3% fully recovered (H‐B grade 1) 2 months postdischarge. Adding antiviral medication did not affect FNP improvement rates or outcomes. Conclusions Rates of infectious and traumatic etiology in our patients were higher than reported for adults, but the most common etiology—as in those adults—was idiopathic. Routine extended diagnostic workup was not helpful, and antiviral medications were ineffective. The prognosis of FNP in pediatric patients is excellent, with 90% recovery by 2 months after initial presentation. Level of Evidence 4 Laryngoscope , 127:1175–1180, 2017

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Introduction Acute mastoiditis (AM) is a medical emergency that mandates prompt diagnosis and treatment. Nevertheless, its management often differs between otorhinolaryngologists (ORLs) and pediatricians (PEDs) working in emergency departments. We sought to characterize the similarities and differences between management protocols of these 2 disciplines. Methods A voluntary electronic questionnaire, including 17 items pertaining to pediatric AM management, was sent to all the 20 otorhinolaryngology and their corresponding pediatric emergency departments nationwide. Each department sent 1 filled out questionnaire. The response rate was 100%. Results Eighteen (90%) ORLs are notified when a child with suspected AM arrives. Medical history collected by both disciplines was similar-previous otologic history (100%), previous antibiotic use (100%), and pneumococcal conjugate vaccination status (60%)-whereas acute otitis media risk factors were more important to PEDs (13 [65%] PEDs, 10 [50%] ORLs). According to 85% to 90% of ORLs and PEDs, imaging was not mandatory upon admission. According to 14 (70%) PEDs and 16 (80%) ORLs, imaging was overall performed in less than 50% of patients during hospitalization. Intravenous ceftriaxone and cefuroxime were the most common first-line antibiotic treatments (8 [40%] ORLs, 10 [50%] PEDs), with a mean treatment duration of 7 to 10 days. Eighteen (90%) of the ORLs, compared with 15 (75%) PEDs, reported that myringotomy (with or without ventilating tube insertion) was performed upon diagnosis (P = 0.05). Conclusions The management of pediatric AM is generally similar by both disciplines. The use of imaging studies is mild-moderate. We call for a national registry and encourage the publication of guidelines.

Introduction: Hearing loss is considered a common complication and sequela of chronic otitis media (COM). The loss is usually conductive, but sensorineural involvement also occurs. Clinically significant sensorineural hearing loss (SNHL) has been reported in adults with COM; however its significance in children is still unclear. The aim of the study is to assess the severity of SNHL in single sided COM, in a group of children, using the contra-lateral healthy ear as a control and to define risk factors for the development of SNHL in COM. Characterizing these risk factors will assist in better defining treatment indications for COM and thus reduce the occurrence of SNHL.

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The development of hypertrophic scars and keloids is a relatively common complication of different otologic procedures involving incision of the skin behind the ear. This case report aims to describe the successful treatment of keloids that developed following ear surgeries that have been performed via a retro-auricular approach (cochlear implantation and the removal of cholesteatoma) by an intralesional cryosurgery method. Two patients who were previously operated for an extensive pediatric cholesteatoma and one patient who underwent a cochlear implant surgery have developed large keloids at the radix helix. The keloids were treated under local anesthesia by the intralesional cryosurgery method. Over a 6-month period, the scars gradually flattened and became paler and the clinical symptoms of itchiness, pain, and tenderness have significantly been reduced. No complications were documented, and there were no recurrences in a follow-up period of 30 months. This case report demonstrates that intralesional cryosurgery provides the surgeon with an effective method to treat keloid scars following the removal of cholesteatoma or cochlear implantation, thus improving the quality of life and body image and enabling the patients to use the implanted device in an adequate and satisfactory way.Level of Evidence: Level V, therapeutic study.

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