Deep Spatial-Spectral Joint-Sparse Prior Encoding Network for Hyperspectral Target Detection.

Hyperspectral target detection aims to locate targets of interest in the scene, and deep learning-based detection methods have achieved the best results. However, black box network architectures are usually designed to directly learn the mapping between the original image and the discriminative features in a single data-driven manner, a choice that lacks sufficient interpretability. On the contrary, this article proposes a novel deep spatial-spectral joint-sparse prior encoding network (JSPEN), which reasonably embeds the domain knowledge of hyperspectral target detection into the neural network, and has explicit interpretability. In JSPEN, the sparse encoded prior information with spatial-spectral constraints is learned end-to-end from hyperspectral images (HSIs). Specifically, an adaptive joint spatial-spectral sparse model (AS 2 JSM) is developed to mine the spatial-spectral correlation of HSIs and improves the accuracy of data representation. An optimization algorithm is designed for iteratively solving AS 2 JSM, and JSPEN is proposed to simulate the iterative optimization process in the algorithm. Each basic module of JSPEN one-to-one corresponds to the operation in the optimization algorithm so that each intermediate result in the network has a clear explanation, which is convenient for intuitive analysis of the operation of the network. With end-to-end training, JSPEN can automatically capture the general sparse properties of HSIs and faithfully characterize the features of background and target. Experimental results verify the effectiveness and accuracy of the proposed method. Code is available at https://github.com/Jiahuiqu/JSPEN.

SpectralGPT: Spectral Remote Sensing Foundation Model.

The foundation model has recently garnered significant attention due to its potential to revolutionize the field of visual representation learning in a self-supervised manner. While most foundation models are tailored to effectively process RGB images for various visual tasks, there is a noticeable gap in research focused on spectral data, which offers valuable information for scene understanding, especially in remote sensing (RS) applications. To fill this gap, we created for the first time a universal RS foundation model, named SpectralGPT, which is purpose-built to handle spectral RS images using a novel 3D generative pretrained transformer (GPT). Compared to existing foundation models, SpectralGPT 1) accommodates input images with varying sizes, resolutions, time series, and regions in a progressive training fashion, enabling full utilization of extensive RS Big Data; 2) leverages 3D token generation for spatial-spectral coupling; 3) captures spectrally sequential patterns via multi-target reconstruction; 4) trains on one million spectral RS images, yielding models with over 600 million parameters. Our evaluation highlights significant performance improvements with pretrained SpectralGPT models, signifying substantial potential in advancing spectral RS Big Data applications within the field of geoscience across four downstream tasks: single/multi-label scene classification, semantic segmentation, and change detection.

Prevention of Recurrent Benign Paroxysmal Positional Vertigo: The Role of Combined Supplementation with Vitamin D and Antioxidants.

Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA® (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with "insufficient" or "deficient" vitamin D blood levels, treated with daily oral supplementation of LICA®, vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with "sufficient" vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a "sufficient" serum concentration of vitamin D who received supplementation with a compound of LICA® and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (−2.32, 95% CI: 3.41−1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV.

The Navigation Ability Test (NAT 2.0): From Football Player Performance to Balance Rehabilitation in Chronic Unilateral Vestibular Loss.

AIM OF THE STUDY: in humans, spatial orientation consists of the ability to move around the environment through memorized and pre-programmed movements, according to the afferent sensory information of the body and environmental analysis of the Central Nervous System (CNS). The purpose of this study is to analyze the abilities of professional athletes, such as footballers, to use mental navigation systems, cognitive maps, and memorized motor patterns in order to obtain better physical performance and to obtain useful information for training both non-sports subjects and vestibular patients for rehabilitation purposes. MATERIALS AND METHODS: all the motor performances of sportsmen, healthy non-sporting subjects, or vestibular patients are based on the acquisition of visual-spatial and training information. In this study, we analyzed the visual-spatial performance of 60 trained sportsmen (professional footballers), 60 healthy non-sports subjects, and 48 patients affected by chronic unilateral vestibular loss by means of the Navigation Ability Test 2.0. A score based on the number of targets correctly reached in the various tests quantifies the degree of performance of the subjects. RESULTS: NAT 2.0 scores progressively improve from vestibular subjects to healthy non-sporting subjects to footballers. NAT 2.0 scores improve in all three subject groups as the number of tasks performed in all patient groups increases, regardless of gender and age. CONCLUSIONS: the analysis of performance data through NAT 2.0 in athletes (footballers) opens new perspectives for rehabilitation purposes, regardless of age, sex, and training conditions, both in healthy non-sporting subjects to improve their sporting potential and in patients affected by chronic vestibular dysfunction, in order to optimize their motor skills and prevent falls.

Treatment de-escalation for HPV+ oropharyngeal cancer: A systematic review and meta-analysis.

Human Papillomavirus (HPV) related oropharyngeal carcinoma (OPC) carries a better prognosis compared with HPV-counterparts, thereby pushing the adoption of de-intensification treatment approaches as new strategies to preserve superior oncologic outcomes while minimizing toxicity. We evaluated the effect of treatment de-intensification in terms of overall survival (OS), progression-free survival (PFS), locoregional and distant control (LRC and DM) by selecting prospective or retrospective studies, providing outcome data with reduced intensification versus standard curative treatment in HPV+ OPC patients, with a systematic analysis till September 2020. The primary outcome of interest was OS. Secondary endpoints were PFS, LRC, and DM expressed as HR. A total of 55 studies (from 1393 screened references) were employed for quantitative synthesis for 38 929 patients. Among n = 48 studies with data available, de-intensified treatments reduced OS in HPV+ OPCs (HR = 1.33, 95% CI 1.17-1.52; p < 0.01). In de-escalated treatments, PFS was also decreased (HR = 2.11, 95% CI 1.65-2.69; p < 0.01). Compared with standard treatments, reduced intensity approaches were associated with reduced locoregional and distant disease control (HR = 2.51, 95% CI 1.75-3.59; p < 0.01; and HR = 1.9, 95% CI 1.25-2.9; p < 0.01). Chemoradiation improved survival in a definitive curative setting compared with radiotherapy alone (HR = 1.42, 95% CI 1.16-1.75; p < 0.01). When adjuvant treatments were compared, standard and de-escalation strategies provided similar OS. In conclusion, in patients with HPV+ OPC, de-escalation treatments should not be widely and agnostically adopted in clinical practice, as therein lies a concrete risk of offering a sub-optimal treatment to patients.

Target Detection With Unconstrained Linear Mixture Model and Hierarchical Denoising Autoencoder in Hyperspectral Imagery.

Hyperspectral imagery with very high spectral resolution provides a new insight for subtle nuances identification of similar substances. However, hyperspectral target detection faces significant challenges of intraclass dissimilarity and interclass similarity due to the unavoidable interference caused by atmosphere, illumination, and sensor noise. In order to effectively alleviate these spectral inconsistencies, this paper proposes a novel target detection method without strict assumptions on data distribution based on an unconstrained linear mixture model and deep learning. Our proposed detector firstly reduces interference via a specifically designed deep-learning-based hierarchical denoising autoencoder, and then carries out accurate detection with a two-step subspace projection, aiming at background suppression and target enhancement. Additionally, to generate representative background and reliable target samples required in the detection procedure, an efficient spatial-spectral unified endmember extraction method has been developed. Performance comparison with several state-of-the-art detection methods and further analysis on four real-world hyperspectral images demonstrate the effectiveness and efficiency of our proposed target detector.

Modeling dengue vector population with earth observation data and a generalized linear model.

Mosquitoes propagate many human diseases, some widespread and with no vaccines. The Ae. aegypti mosquito vector transmits Zika, Chikungunya, and Dengue viruses. Effective public health interventions to control the spread of these diseases and protect the population require models that explain the core environmental drivers of the vector population. Field campaigns are expensive, and data from meteorological sites that feed models with the required environmental data often lack detail. As a consequence, we explore temporal modeling of the population of Ae. aegypti mosquito vector species and environmental conditions- temperature, moisture, precipitation, and vegetation- have been shown to have significant effects. We use earth observation (EO) data as our source for estimating these biotic and abiotic environmental variables based on proxy features, namely: Normalized difference vegetation index, Normalized difference water index, Precipitation, and Land surface temperature. We obtained our response variable from field-collected mosquito population measured weekly using 791 mosquito traps in Vila Velha city, Brazil, for 36 weeks in 2017, and 40 weeks in 2018. Recent similar studies have used machine learning (ML) techniques for this task. However, these techniques are neither intuitive nor explainable from an operational point of view. As a result, we use a Generalized Linear Model (GLM) to model this relationship due to its fitness for count response variable modeling, its interpretability, and the ability to visualize the confidence intervals for all inferences. Also, to improve our model, we use the Akaike Information Criterion to select the most informative environmental features. Finally, we show how to improve the quality of the model by weighting our GLM. Our resulting weighted GLM compares well in quality with ML techniques: Random Forest and Support Vector Machines. These results provide an advancement with regards to qualitative and explainable epidemiological risk modeling in urban environments.

[Smell and taste in CoViD-19 patients: the forgotten sense.] / L'olfatto e il gusto nei pazienti CoViD-19: il senso dimenticatoTempi di recupero della funzionalità olfattoria e gustativa nei pazienti CoViD-19.

AIM: The aim of the retrospective study is to determine whether CoViD-19 positive patients with olfactory and gustatory dysfunction have the ability to recover chemoreceptorial loss, unlike other viral and inflammatory diseases in which the damage is partial and in some cases is permanent. MATERIALS AND METHODS: The study examined 75 patients admitted, from March to April 2020, at the Poliambulanza Foundation with CoViD-19. In 53 out of 75 patients, chest X-rays were positive for infiltration and/or pleural effusion. Two weeks after discharge, two rhinopharyngeal swabs were performed with negative results for CoViD-19. Enlisted patients responded to a questionnaire, upon informed consent, called the Questionnaire for Olfactory Dysfunction (QOD) which evaluates the severity of the disorder and social impact. In the second phase of the study we carefully researched the recovery times of olfactory dysfunction and dysgeusia. RESULTS AND CONCLUSIONS: The analysis of the scores of the Olfactory Dysfunction Questionnaire CoViD-19 (QOD) recorded the total recovery in all patients of olfactory and gustatory function with an average time of 17.4 days. This study reveals that Coronavirus does not cause a permanent olfactory and gustatory loss. The olfactory and gustatory impairment has been recognized as a distinctive sign of CoViD-19, but should not be considered as a favorable prognostic index.

Navigation Ability Test: a new specific test to asses spatial orientation ability in football players and healthy subjects.

BACKGROUND: This paper describes a new specific test to asses spatial and orientation abilities: Navigation Ability Test (NAT). The goal of this study was to determine if football players and normal subjects use vestibular information to keep track of their positions while walking through the Navigation Ability Test. METHODS: This study was conducted on a total of 120 patients undergoing Navigation Ability Test (NAT): 60 football players and 60 normal subjects were recruited on the basis of no history of vertigo/balance disorders and a negative otoneurological instrumental examination and the second group of the football players were recruited from Division B, Division Under-21 and Women's League. Patients who met the inclusion criteria were enrolled in the study. RESULTS: Our results showed differences between sexes during navigation tasks are not related to spatial learning per se, but appear to be the consequence of difference in ability to effectively use specific types of distal information such as room geometry. The NAT showed that the route-times walked with eyes closed are always longer than in normal people and mistakes improve with training. CONCLUSIONS: These results show that NAT could suggest to the coach and trainers valuable information about the characteristics of the players and how they should play in the field. Although there are some intrinsic difficulties, for example in creating patient-specific versions of the test, preliminary normative data indicate that this original test is workable and provides important information in therapy rehabilitation for vestibular disorder.

The Characteristics of Severe Chronic Upper-Airway Disease (SCUAD) in Patients with Allergic Rhinitis: A Real-Life Multicenter Cross-Sectional Italian Study.

BACKGROUND: There are few studies regarding severe chronic upper-airway disease (SCUAD) that represents an important socioeconomic problem for the treatment of rhinitis and associated comorbidities, particularly asthma. OBJECTIVES: The aim of our study is to evaluate the prevalence of this pathology in patients with allergic rhinitis (AR) in real life, to phenotype allergic patients with SCUAD, and to identify which factors are related to the severity of the disease. METHODS: We studied 113 patients with uncontrolled AR despite optimal adherence to therapy according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in a multicenter Italian study, analyzing comorbidity, use of additional drugs, not scheduled visits, and the number of emergency room admissions. RESULTS: Our data suggest that polysensitization is the only statistically significant factor correlating with SCUAD. Asthma does not seem to represent a correlating factor. An important finding is the poor use (20%) of allergy immunotherapy (AIT), although patients were suffering from AR and the ARIA guidelines recommend the use of AIT in moderate/severe AR. CONCLUSIONS: The SCUAD population seems not to have a specific phenotype; there is a greater presence of SCUAD in polysensibilized patients, perhaps a sign of greater inflammation.

Corrigendum: Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects.

[This corrects the article DOI: 10.3389/fneur.2018.00395.].

Integrated Diagnostic Model That Incorporates Epstein-Barr Virus DNA, Imaging, and Nasal Endoscopy to Stratify Primary Tumor and Lymph Nodes in a Patient with N1 Nasopharyngeal Carcinoma: Multidisciplinary Management.

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy, with a high metastatic potential. Epstein-Barr virus (EBV) infection plays a fundamental role, even if it is not well understood. The diagnosis of the disease in its early stage is infrequent. Imaging studies, positron emission tomography scans in addition to clinical examination, endoscopic examination, and biopsy provide information on the extent of the disease. The application of neoadjuvant chemotherapy followed by concomitant chemoradiation can improve the control of NPC. In March 2016, a 54-year-old male with NPC cT1 cN2 cM0, stage III (8th edition of American Joint Committee on Cancer (AJCC) staging system) underwent to a two-step treatment: induction chemotherapy by TPF regimen (docetaxel, cisplatin, 5-fluorouracil), followed by concomitant chemoradiotherapy (weekly cisplatin). The quantity of free plasma EBV-DNA can be related to the disease stage, and the detection of EBV-DNA during follow-up can be predictive of distant metastases. Especially, either plasma or serum EBV-DNA titer is estimated to reflect tumor volume. Biologically, such EBV-DNA reflects reproduced or released DNA from dead or dying tumor cells. On the other hand, EBV-specific DNA released as exosome may reflect the biological feature of the alive NPC tumor cell. The follow-up is ongoing after 21 months from a complete response.

Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects.

Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined "episodic symptoms which may be associated with migraine." The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks.

Clinical Features, Familial History, and Migraine Precursors in Patients With Definite Vestibular Migraine: The VM-Phenotypes Projects.

OBJECTIVE: The aim of this work was to assess through a questionnaire the features of vertiginous episodes, accompanying symptoms, familial history, and migraine precursors in a sample of 252 subjects with a diagnosis of definite vestibular migraine. BACKGROUND: Migraine is a common neurological disorder characterized by episodic headaches with specific features. About two-thirds of cases run in families, and patients may refer symptoms occurring in infancy and childhood, defined as episodic syndromes that may be associated with migraine. Migraine is associated with episodic vertigo, called vestibular migraine, whose diagnosis mainly relies on clinical history showing a temporary association of symptoms. METHODS: In this cross-sectional multicentric study, 252 subjects were recruited in different centers; a senior specialist through a structured questionnaire assessed features of vestibular symptoms and accompanying symptoms. RESULTS: The age of onset of migraine was 23 years, while onset of vertigo was at 38 years. One hundred and eighty-four subjects reported internal vertigo (73%), while 63 subjects (25%) reported external vertigo. The duration of vertigo attacks was less than 5 minutes in 58 subjects (23%), between 6 and 60 minutes in 55 (21.8%), between 1 and 4 hours in 29 (11.5%), 5 and 24 hours in 44 (17.5%), up to 3 days in 14 (5.5%), and more than 3 days in seven (2.8%); 14 subjects (5.5%) referred attacks lasting from less than 5 minutes and up to 1 hour, nine (3.6%) referred attacks lasting from less than 5 minutes and up to 1 to 4 hours, six (2.4%) referred attacks lasting from less than 5 minutes and up to 5 to 24 hours, and five (2%) cases referred attacks lasting from less than 5 minutes and up to days. Among accompanying symptoms, patients referred the following usually occurring, in order of frequency: nausea (59.9%), photophobia (44.4%), phonophobia (38.9%), vomiting (17.8%), palpitations (11.5%), tinnitus (10.7%), fullness of the ear (8.7%), and hearing loss (4%). In total, 177 subjects referred a positive family history of migraine (70.2%), while 167 (66.3%) reported a positive family history of vertigo. In the sample, 69% of patients referred at least one of the pediatric precursors, in particular, 42.8% of subjects referred motion sickness. The age of onset of the first headache was lower in the subsample with a familial history of migraine than in the total sample. Among the pediatric precursors, benign paroxysmal vertigo - BPV, benign paroxysmal torticollis, and motion sickness were predictive of a lower age of onset of vertigo in adulthood; cyclic vomiting was predictive for vomiting during vertigo attacks in adults. CONCLUSIONS: Our results may indicate that vestibular symptoms in pediatric patients may act as a predisposing factor to develop vestibular migraine at an earlier age in adulthood.

Integration of Administrative, Clinical, and Environmental Data to Support the Management of Type 2 Diabetes Mellitus: From Satellites to Clinical Care.

A very interesting perspective of "big data" in diabetes management stands in the integration of environmental information with data gathered for clinical and administrative purposes, to increase the capability of understanding spatial and temporal patterns of diseases. Within the MOSAIC project, funded by the European Union with the goal to design new diabetes analytics, we have jointly analyzed a clinical-administrative dataset of nearly 1.000 type 2 diabetes patients with environmental information derived from air quality maps acquired from remote sensing (satellite) data. Within this context we have adopted a general analysis framework able to deal with a large variety of temporal, geo-localized data. Thanks to the exploitation of time series analysis and satellite images processing, we studied whether glycemic control showed seasonal variations and if they have a spatiotemporal correlation with air pollution maps. We observed a link between the seasonal trends of glycated hemoglobin and air pollution in some of the considered geographic areas. Such findings will need future investigations for further confirmation. This work shows that it is possible to successfully deal with big data by implementing new analytics and how their exploration may provide new scenarios to better understand clinical phenomena.

On The Correlation Between Geo-Referenced Clinical Data And Remotely Sensed Air Pollution Maps.

This work presents an analysis framework enabling the integration of a clinical-administrative dataset of Type 2 Diabetes (T2D) patients with environmental information derived from air quality maps acquired from remote sensing data. The research has been performed within the EU project MOSAIC, which gathers T2D patients' data coming from Fondazione S. Maugeri (FSM) hospital and the Pavia local health care agency (ASL). The proposed analysis is aimed to highlight the complexity of the domain, showing the different perspectives that can be adopted when applying a data-driven approach to large variety of temporal, geo-localized data. We investigated a set of 899 patients, located in the Pavia area, and detected several patterns depicting how clinical facts and air pollution variations may be related.

A kinetic model-based algorithm to classify NGS short reads by their allele origin.

Genotyping Next Generation Sequencing (NGS) data of a diploid genome aims to assign the zygosity of identified variants through comparison with a reference genome. Current methods typically employ probabilistic models that rely on the pileup of bases at each locus and on a priori knowledge. We present a new algorithm, called Kimimila (KInetic Modeling based on InforMation theory to Infer Labels of Alleles), which is able to assign reads to alleles by using a distance geometry approach and to infer the variant genotypes accurately, without any kind of assumption. The performance of the model has been assessed on simulated and real data of the 1000 Genomes Project and the results have been compared with several commonly used genotyping methods, i.e., GATK, Samtools, VarScan, FreeBayes and Atlas2. Despite our algorithm does not make use of a priori knowledge, the percentage of correctly genotyped variants is comparable to these algorithms. Furthermore, our method allows the user to split the reads pool depending on the inferred allele origin.

Urban area extent extraction in spaceborne HR and VHR data using multi-resolution features.

Detection of urban area extents by means of remotely sensed data is a difficult task, especially because of the multiple, diverse definitions of what an "urban area" is. The models of urban areas listed in technical literature are based on the combination of spectral information with spatial patterns, possibly at different spatial resolutions. Starting from the same data set, "urban area" extraction may thus lead to multiple outputs. If this is done in a well-structured framework, however, this may be considered as an advantage rather than an issue. This paper proposes a novel framework for urban area extent extraction from multispectral Earth Observation (EO) data. The key is to compute and combine spectral and multi-scale spatial features. By selecting the most adequate features, and combining them with proper logical rules, the approach allows matching multiple urban area models. Experimental results for different locations in Brazil and Kenya using High-Resolution (HR) data prove the usefulness and flexibility of the framework.

Acute otitis media and facial nerve paralysis in adults.

OBJECTIVE: The pathophysiology and treatment of facial nerve paralysis associated with acute otitis media are still under debate. The objective of this study was to review treatment strategies and extent of recovery in adult patients with the aim of defining a standard treatment protocol for this rare pathologic condition. STUDY DESIGN: Retrospective chart review. SETTING: University hospital, tertiary referral center. PATIENTS: Between 1993 and 2000, 11 patients were admitted for facial nerve paralysis secondary to acute otitis media. There were six women and five men without a history of chronic middle ear disease, who ranged in age from 21 to 71 years. Facial palsy was graded with the House-Brackmann scale: four patients had Grade III palsy, six had Grade IV palsy, and one patient had Grade V palsy. Bacteriologic examination of middle ear fluid was performed in four patients Streptococcus pneumoniae was observed in one patient, and the remaining three cultures were negative. INTERVENTIONS: All patients were treated with parenteral ampicillin-sulbactam or a third-generation cephalosporin in conjunction with oral or intravenous corticosteroids, except in a single patient with diabetes mellitus who received antibiotics alone. Myringotomy alone or with ventilation tube application was performed in eight patients. A simple mastoidectomy without facial nerve decompression was used in a patient with sudden impairment to Grade VI paralysis and worsening otitis after an initial improvement. RESULTS: Normal facial function returned in all patients, independently of the grade of the paralysis, the treatment strategy, or the outcome of the middle ear disease. The time of recovery varied from 2 weeks to 3 months, except for one patient who underwent mastoidectomy and in whom normal function returned in 10 months. CONCLUSIONS: The treatment of facial nerve paralysis secondary to otitis media should be as conservative as possible, using antibiotics and corticosteroids. Myringotomy and a ventilation tube should be added when spontaneous perforation of the tympanic membrane is not present. Mastoidectomy should be performed only when it is necessary to treat otitis media. Facial nerve decompression should not be necessary.