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Topic:Thoroughbreds

Thoroughbreds are a breed of horse known for their agility, speed, and spirit, often associated with horse racing and equestrian sports. Originating from crossbreeding native English mares with imported Arabian, Barb, and Turkoman stallions, Thoroughbreds have a well-documented pedigree that traces back to the late 17th and early 18th centuries. This breed is characterized by a refined head, deep chest, and long legs, contributing to their athletic capabilities. Thoroughbreds are primarily bred for their performance in racing but are also utilized in other equestrian disciplines. This page compiles peer-reviewed research studies and scholarly articles that explore the genetics, physiology, and performance characteristics of Thoroughbreds, as well as their management and welfare in various equine activities.
A longitudinal study of radiodensity and radiographic appearance of the proximal sesamoid bones in Thoroughbred racehorses.
Equine veterinary journal    August 21, 2025   doi: 10.1111/evj.70075
Boros K, Dyson S, Pollard D, Nagy A.There are limited data on long-term follow-up of radiographic changes of the proximal sesamoid bones (PSBs) in Thoroughbred racehorses. The effect of training and racing on radiodensity of the PSBs in live Thoroughbreds has not been described. Objective: To follow radiographic changes of the PSBs in racehorses over 2 years and describe alterations in overall radiodensity. Methods: Prospective cohort study. Methods: Forty yearlings were enrolled at the first examination (T0). Re-examinations were performed four times, approximately 6 months apart, on 31 (T1), 23 (T2), 13 (T3) and 8 (T4) horse...
Exploring Monthly Variation of Gait Asymmetry During In-Hand Trot in Thoroughbred Racehorses in Race Training.
Animals : an open access journal from MDPI    August 20, 2025   Volume 15, Issue 16 2449 doi: 10.3390/ani15162449
Pfau T, Forbes B, Sepulveda-Caviedes F, Chan Z, Weller R.Based on fundamental mechanics, movement and force associate head and pelvic movement asymmetry with asymmetry of force production. We investigate, how often racehorses undergoing strenuous training regimens show evidence of switching between "preferred" limbs, i.e. one limb producing increased force, when assessed at monthly intervals? We hypothesize that clinical asymmetry thresholds designed for "detecting lameness" are frequently exceeded and that when applying previously established Thoroughbred-specific repeatability values, horses rarely switch between showing left- and right-sided asym...
A fitness tracker can be used interchangeably with a reference method for underwater single-lead electrocardiography but not heart rate variability analysis in swimming horses.
American journal of veterinary research    August 12, 2025   1-8 doi: 10.2460/ajvr.25.04.0113
Kisilevich Q, O'Connor SGP, Bayly WM, Léguillette R.To validate a single-lead ECG fitness tracker device (FT) against the reference multilead ECG recording device (RM) for heart rate (HR) and HR variability (HRV) monitoring of horses during routine swimming. Unassigned: 40 race-fit Thoroughbred racehorses were used for 5 days in May 2024. Surface ECG recordings were obtained simultaneously from the FT and RM devices in horses swimming 63.65 m across a pool. Electrocardiograms were reviewed and artifacts corrected when necessary, and correlations were analyzed between the 2 devices for HR and HRV parameters. Descriptive statistics and Bland-Altm...
Characteristics and spatio-temporal distribution of fetal loss in thoroughbred mares in New South Wales, Australia.
Preventive veterinary medicine    July 29, 2025   Volume 244 106635 doi: 10.1016/j.prevetmed.2025.106635
Wilson CS, Carrick J, Begg A, Shearer P, Stewart M, Brookes VJ.Despite emerging disease syndromes in Australian Thoroughbred horses in recent years, there is no formal surveillance for fetal loss in the industry. This study aimed to characterise the distribution of equine pregnancy loss > 45 days of gestation in a major Thoroughbred breeding region to provide insights into causes, prevention, and surveillance feasibility. Methods: Data were collected from 574 fetal loss submissions to veterinary pathology services between February 2015 and November 2021. Variables included date of fetal loss, gestational age, diagnosis, foal weight, and mare age. Dia...
Turf track surface interaction with speed and musculoskeletal injury risk in Thoroughbred racehorses.
Equine veterinary journal    July 24, 2025   doi: 10.1111/evj.70003
Legg KA, Gibson MJ, Gee EK, Rogers CW.Injury modelling based on changes in speed and stride characteristics of racehorses has become a primary industry focus for the Thoroughbred racing industry. However, speed and stride characteristics are strongly associated with track condition; therefore, reliable quantification of surface variables for use in future models is imperative. Objective: This study aimed to understand the interaction of objective turf track condition score (TCS) measurement with racing speed and injury in flat racing Thoroughbred horses. Methods: Retrospective time series analysis. Methods: Race-day data from 16 f...
A retrospective study of radial fractures in racehorses in California, 2006-2022. Schild CO, Nyaoke A, Asin J, Henderson EE, Blea JA, Stover SM, Uzal FA.Radial fractures are relatively uncommon (0-1%) injuries in postmortem studies of racehorses, and few cases have been published. We describe here a series of 42 cases of radial fractures observed in California racehorses. Autopsy findings from all racehorses submitted for postmortem examination between 2006 July 1 and 2022 June 30 that had a recorded radial fracture were evaluated. We included 42 horses (30 Thoroughbreds, 12 Quarter Horses), most of which were 3-5-y-old. Catastrophic radial fracture was observed in 30 (71%) horses; in the remaining 12 (29%) horses, the fracture of the radius w...
The Level of Thiol-Oxidised Plasma Albumin Is Elevated Following a Race in Australian Thoroughbred Horses.
Veterinary medicine and science    July 11, 2025   Volume 11, Issue 4 e70487 doi: 10.1002/vms3.70487
James C, Lloyd EM, Arthur PG.The extent to which muscle strain or tears are affecting race performance in horses is unknown because it is difficult to objectively identify muscle damage. One approach includes the use of physiological markers in blood. Recently, we linked the level of plasma thiol-oxidised albumin, an oxidative stress biomarker, to muscle damage in humans. Objective: This aim of this work was to investigate whether the level of plasma thiol-oxidised albumin was elevated in the days following a thoroughbred horse race. Methods: 'In vivo' experiments. Methods: Blood collection was performed by each trainer a...
Owner-Observed Behavioral Characteristics in Off-the-Track Thoroughbreds (OTTTBs) in Equestrian Second Careers.
Animals : an open access journal from MDPI    July 11, 2025   Volume 15, Issue 14 2046 doi: 10.3390/ani15142046
Knox AL, Fenner K, Zsoldos RR, Wilson B, McGreevy P.The off-the-track Thoroughbred's (OTTTB's) suitability for equestrian retraining and rehoming should always be subject to behavioral considerations. Certain attributes may be advantageous to a horse's racing performance but unfavorable to their prospects off the track. It is important to gain a non-biased understanding of how Thoroughbreds (TBs) in equestrian disciplines compare with other horses behaviorally, to minimize risks of poor welfare and safety outcomes. The current study used owner-reported information ( = 1633) from the Equine Behavior Assessment and Research Questionnaire (E-BARQ)...
Influence of pituitary pars intermedia dysfunction on reproductive performance in Thoroughbred mares.
Journal of equine veterinary science    July 9, 2025   Volume 152 105651 doi: 10.1016/j.jevs.2025.105651
Murase H, Wachi S, Matsuyama R, Makita K, Sato F.Pituitary pars intermedia dysfunction (PPID) is an age-related disease considered to have a negative impact on fertility. To understand the true impact of PPID on fertility, the influence of age must be considered. Objective: This study aimed to assess the impact of PPID on fertility while accounting for the effect of aging. Methods: A total of 332 Thoroughbred mares aged 10-20 years and managed across 137 private farms in Hidaka, Hokkaido, Japan were classified as PPID, equivocal, or non-PPID based on plasma adrenocorticotropic hormone concentration in 2019 and 2020. The prevalence of PPID an...
Striking a Balance: Stakeholder Perceptions of Risk in Horse Racing.
Equine veterinary journal    July 7, 2025   doi: 10.1111/evj.14561
McCarthy J, Cameron-Whytock HA, Bennet ED.Thoroughbred racing is a major industry, and in recent years, public concerns about equine safety have become more prominent, particularly in relation to on-track injuries and fatalities. This has challenged the industry's social licence to operate (SLO). Objective: To investigate and elucidate how UK and Irish racing stakeholders perceive risks to racehorses on race day and how those risks should be managed. Methods: Qualitative analysis of stakeholder perspectives using a constructionist approach. Methods: Twelve stakeholders from veterinary, communication and regulatory sectors within racin...
Pharmacokinetics/pharmacodynamics analysis of trimethoprim and sulfamethoxazole for methicillin-resistant Staphylococcus aureus infection after intravenous and per os administration in Thoroughbred horses.
Journal of equine veterinary science    July 7, 2025   Volume 152 105640 doi: 10.1016/j.jevs.2025.105640
Kuroda T, Minamijima Y, Niwa H, Mita H, Nomura M, Ohta M.A pharmacokinetics/pharmacodynamics (PK/PD) approach was used to determine the dosage regimens of trimethoprim/sulfamethoxazole for methicillin-resistant Staphylococcus aureus (MRSA) infections after intravenous (IV) and per os (PO) administration in horses. Methods: Trimethoprim/sulfamethoxazole plasma concentrations were measured in six horses after a single IV administration of 15 mg/kg (2.5 mg/kg trimethoprim and 12.5 mg/kg sulfamethoxazole) and PO administration of 30 mg/kg (5.0 mg/kg trimethoprim and 25.0 mg/kg sulfamethoxazole). The data were modeled using a nonlinear mixed-effects mode...
Exploring the distinctive characteristics of gut microbiota across different horse breeds and ages using metataxonomics.
Frontiers in cellular and infection microbiology    July 7, 2025   Volume 15 1590839 doi: 10.3389/fcimb.2025.1590839
Qin X, Xi L, Zhao L, Han J, Qu H, Xu Y, Weng W.Gut microbiota exerts a pivotal function in host nutrient metabolism and maturation of the mucosal immunity. Analyzing the reciprocal interaction between horses and gut microbiota constitutes a crucial aspect of scientific feeding practices. This study aims to investigate the differences in gut microbiota among Hequ horses, Mongolian horses, and Thoroughbred horses, as well as between Thoroughbred horses at two age stages. Unassigned: Paired-end sequencing with a read length of 2×250 bp targeting the V3-V4 region of the 16S rRNA gene in fecal samples was carried out. Subsequently, differences...
Short- and long-term survival, complications, return to racing, and racing performance of 150 racehorses with medial condylar fractures of the third metacarpal/metatarsal bone treated by internal fixation (2000-2020).
Veterinary surgery : VS    July 4, 2025   Volume 54, Issue 6 1176-1184 doi: 10.1111/vsu.14308
Ruspi BD, Bramlage LR, Ruggles AJ, Slone SA.To report the rate of survival, rate of return to racing, and quality of racing performance following surgical fixation of medial condylar fractures. Methods: Retrospective study. Methods: A total of 150 Thoroughbred and Standardbred racehorses surgically treated for medial condylar fracture (100 lag screw fixation, 50 plate fixation). Methods: Medical records, radiographs, and racing databases (2000-2020) were reviewed to collect signalment, fracture characteristics, fixation methods, survival rate, and complication rate. Change in racing performance was assessed using Wilcoxon rank sum tests...
Reproductive success in Thoroughbred broodmares post large colon resection or colopexy.
Veterinary surgery : VS    July 1, 2025   doi: 10.1111/vsu.14304
Knudsen AR, Marsh JS, Pye JL.To describe reproductive performance in Thoroughbred broodmares post-large colon resection and to compare to performance post-colopexy. Methods: A single-institution retrospective study. Methods: A total of 29 client-owned horses: post-large colon resection (LCR) n = 19, post-colopexy: n = 10. Methods: Thoroughbred broodmares that survived until discharge following LCR (Group R) or colopexy (Group P) between 2006 and 2023 were included. Clinical data were collected from clinical records. Breeding and foaling data were collected from the Australian and New Zealand Studbooks. Statistical...
Dietary nonstructural carbohydrates influence synthesis of mare milk carbohydrates and yield.
Journal of animal science    June 26, 2025   Volume 103 skaf213 doi: 10.1093/jas/skaf213
Pyles MB, Fowler AL, Crum AD, Hayes SH, Schendel RR, Lawrence LM.Mare milk is the primary source of nutrients for neonatal foals and contains various carbohydrates. Milk oligosaccharides are complex carbohydrates that are resistant to enzymatic digestion and provide support for the immune system and developing microbiome in the neonate. However, factors influencing the synthesis of milk carbohydrates in the mare are not well understood. This study aimed to determine the effects of dietary nonstructural carbohydrate (NSC) on mare milk composition and yield. Thoroughbred mares were paired by age and last breeding date then randomly assigned to one of two diet...
Plasma metabolomic profiling during peri-parturition in healthy Thoroughbred mares.
Equine veterinary journal    June 25, 2025   doi: 10.1111/evj.14550
Li J, Matsumoto T, Liu H, Li C, Murase H, Yamamoto Y, Nagaoka K.Accurate prediction of the timing of parturition is crucial to ensure the health and well-being of both mares and foals. However, equine pregnancies are characterised by significant variability in gestation length, unique endocrine mechanisms, and subtle physiological changes before parturition. Objective: To investigate the characteristic changes in the peripheral metabolites of mares before and after parturition using metabolomic approaches. Methods: Longitudinal in vivo metabolic study. Methods: Plasma samples (n = 95) were collected from successfully foaling Thoroughbred mares (n =â€...
Ultrasonographic diagnosis of caudoproximal humeral stress fracture in thoroughbred racehorses.
Equine veterinary journal    June 22, 2025   doi: 10.1111/evj.14546
Vaughan B, McKerney ER, Wollenberger C, Cloninger A, Spriet M, Galuppo L, Stover SM.Humeral stress fractures in racehorses can progress to catastrophic fracture if unrecognised. Scintigraphy is the gold standard diagnostic technique but is limited by accessibility and cost. It was hypothesised that ultrasonography could be used to visualise caudoproximal humeral stress fractures. Objective: To determine the utility of ultrasonography to identify caudoproximal humeral stress fractures in racehorses. Methods: Clinical case series. Methods: Seven racehorses that had a clinical history consistent with the presence of a humeral stress fracture were examined using humeral ultrasono...
The Thoroughbred Theory: Influence of Breed on Performance at the CCI5*-L Level of Eventing.
Animals : an open access journal from MDPI    June 18, 2025   Volume 15, Issue 12 doi: 10.3390/ani15121796
Walz KR, McCormick ME, Fedorka CE.Breed bias exists within many of the top disciplines of equestrian sport. Therefore, the objective of this study was to evaluate the influence of breed on performance at the CCI5*-L level of eventing. To do so, the results of all CCI5*-L events from 2014 to 2024 were assessed. Initially, Thoroughbreds were compared to all non-Thoroughbreds, and this was followed by assessing the ten primary breeds. Data included penalties accrued in dressage, cross country, show jumping, and overall. Additionally, the likelihood of completing each phase was assessed. It was found that Thoroughbreds accrued mor...
Reduction in endemic equine herpesvirus type-1 and type-4 infection among Thoroughbred yearlings through an updated vaccination program.
Journal of equine science    June 12, 2025   Volume 36, Issue 2 67-74 doi: 10.1294/jes.36.67
Bannai H, Kambayashi Y, Kume K, Takebe N, Endo Y, Kawanishi N, Nemoto M, Tsujimura K.The endemic situation of respiratory disease caused by equine herpesvirus type-1 (EHV-1) and type-4 (EHV-4) was investigated in a training facility for Thoroughbred yearlings in Japan. Vaccination typically starts in mid-September or early October-only after all yearlings have arrived-leaving those introduced earlier unprotected. To bridge this immunity gap, a revised vaccination program that started earlier was implemented. In 2021-2022 and 2022-2023, yearlings were allocated to three groups according to their introduction dates. Each group received a live EHV-1 vaccine (Equi N Tect ERP, Niss...
Sudden death in a Thoroughbred stallion: cardiac tamponade due to transverse aortic rupture with bone metaplasia and calcification.
Journal of equine science    June 12, 2025   Volume 36, Issue 2 75-79 doi: 10.1294/jes.36.75
Maeda Y, Kanno C, Sugiyama M, Yamamoto R, Sato S, Ando R, Noda R, Kawaguchi H, Takahashi F.A 17-year-old Thoroughbred stallion died suddenly after grazing. Necropsy revealed massive hemorrhage in the pericardial sac, suggesting cardiac tamponade. Aortic perforation was observed at the aortic origin, and hemorrhage was observed in and around the epicardium. Superficial observation of the aortic lumen revealed a transverse tear of the aortic wall at the bases of the right semilunar valve and septal semilunar valve. Fibro-osseous changes with calcification were histopathologically observed at the site of the rupture. A nodular goiter was observed in the left thyroid gland. The horse di...
Multiomic analysis of different horse breeds reveals that gut microbial butyrate enhances racehorse athletic performance.
NPJ biofilms and microbiomes    May 24, 2025   Volume 11, Issue 1 87 doi: 10.1038/s41522-025-00730-w
Li C, Li X, Liu K, Xu J, Yu J, Liu Z, Mach N, Ni W, Liu C, Zhou P, Wang L, Hu S.Gut microbes play a vital role in host physiology, but whether specific bacterial functions contribute to the exceptional athletic performance of racehorses needs to be better understood. Here, we identify an association of gut butyrate-producing bacteria with athletic performance in racehorses (Thoroughbred horse). Butyrate-producing bacteria and microbial butyrate synthesis genes were significantly enriched in the racehorse gut, and the GC-MS results confirmed this conclusion. Using a mouse model, we demonstrated that sodium butyrate is sufficient to increase treadmill run time performance. ...
Effect of birth month on endocrine function in Thoroughbred foals born in Hokkaido, the northern part of Japan.
The Journal of veterinary medical science    May 23, 2025   Volume 87, Issue 7 804-815 doi: 10.1292/jvms.25-0061
Ishimaru M, Kume K, Murase H, Sato F, Matsui A, Ohmura H, Taya K.Thoroughbreds born early in the year are believed to have an advantage in racing. However, the development of endocrine functions in early-born foals in the cold winter climate is unclear. The present study was conducted to elucidate the effect of birth month on the development of endocrine function in Thoroughbred foals born from February to May in Hokkaido by comparing hypothalamic-pituitary axis, adrenal and thyroid functions from birth to 24 weeks of age. Eighty-seven Thoroughbred foals were used to compare the changes in circulating luteinizing hormone (LH), follicle-stimulating hormone (...
Preliminary Study on the Genetic Structure and Functional Candidate Genes of Grassland-Thoroughbreds Based on Whole-Genome Resequencing.
Animals : an open access journal from MDPI    May 19, 2025   Volume 15, Issue 10 doi: 10.3390/ani15101462
Ding W, Gong W, Bou T, Shi L, Lin Y, Shi X, Li Z, Wu H, Dugarjaviin M, Bai D, Zhao Y.Speed and endurance are the primary goals in racehorse breeding. The Grassland-Thoroughbred is a newly developed breed in northern China that combines speed, endurance, and environmental adaptability. However, current research on the genetic background of this breed and the genes associated with athletic performance remains limited. We conducted whole-genome resequencing on Mongolian (MG), Thoroughbred (TB), Xilingol (XL), and Grassland-Thoroughbred (CY) horses, generating 3813.74 Gb of clean data after quality control. The number of transitions was significantly higher than that of transversi...
Whole-Genome Resequencing Analysis of Copy Number Variations Associated with Athletic Performance in Grassland-Thoroughbred.
Animals : an open access journal from MDPI    May 18, 2025   Volume 15, Issue 10 1458 doi: 10.3390/ani15101458
Ding W, Gong W, Bou T, Shi L, Lin Y, Shi X, Li Z, Wu H, Dugarjaviin M, Bai D.Copy number variation (CNV) is an important source of genetic variation. However, studies utilizing whole-genome sequencing to investigate CNVs in horse populations and their effects on traits remain relatively limited. This study aims to address the lack of research on the impact of copy number variation (CNV) on racing performance in horse populations, providing new insights for locally bred racing breeds. We analyzed 60 offspring derived from the crossbreeding of Thoroughbred horses and Xilingol horses. These horses were temporarily named "Grassland-Thoroughbred" and were divided into two g...
Heterogeneity of ultrasonic wave properties in ex vivo cortical bone of racehorse.
The Journal of the Acoustical Society of America    May 16, 2025   Volume 157, Issue 5 3771-3779 doi: 10.1121/10.0036642
Kodama S, Maeda T, Mita H, Tamura N, Chiba K, Matsukawa M.Despite the prevalence of lower limb disease in racehorses, outdoor bone evaluation equipment is lacking. Consequently, a secure and cost-effective field screening system for bones is required to identify early-stage leg illness. Elastic stiffness cannot be measured using x-ray techniques and is closely associated with bone quality, which is recognized as a significant determinant of fracture risk. Quantitative ultrasound has garnered attention as a viable option, offering insights into elastic stiffness. Understanding the characteristic behaviors of ultrasonic wave properties (velocity, atten...
Thermal Effects of High-Intensity Laser Therapy on the Temporomandibular Joint Area in Clinically Healthy Racehorses-A Pilot Study.
Animals : an open access journal from MDPI    May 15, 2025   Volume 15, Issue 10 doi: 10.3390/ani15101426
Soroko-Dubrovina M, Zielińska P, Dudek KD, Śniegucka K, Nawrot K.The aim of the present study was to assess the thermal effects of high-intensity laser therapy (HILT) on the temporomandibular joint (TMJ) area of clinically healthy Thoroughbred racehorses. The study was conducted on 21 clinically healthy Thoroughbreds in regular training. The horses were subjected to thermographic examinations before and immediately after a HILT session to measure changes in the body surface temperature in the TMJ area. The left TMJ was subjected to therapy, while the contralateral joint served as a control. Statistically significant differences in the body surface temperatu...
Racing and sales performance in Thoroughbred yearlings after carpal osteochondral fragment removal.
Equine veterinary journal    May 15, 2025   doi: 10.1111/evj.14532
Debald DC, Stanton VL, Sandow CB, Rodgerson DH, Spirito MA, Hunt RJ, Menarim BC.While radiographically evident carpal osteochondral fragments (COF) in Thoroughbred yearlings impair sales, their impact on future racing performance has been minimally investigated. Objective: To assess the impact of COF on Thoroughbred yearling sales and racing performance, and whether these are improved by arthroscopic removal. We hypothesised that surgical removal of COF improves Thoroughbred yearling sales and racing performance. Methods: Retrospective observational. Methods: Using clinical records from years 2015-2018, 46 Thoroughbred yearlings with COF were identified and allocated to a...
Equine epiglottitis: Diagnosis, treatment and outcome.
Equine veterinary journal    May 15, 2025   doi: 10.1111/evj.14528
Jimenez C, Hogan P, Belaghi R, Curtiss A.Epiglottitis is an uncommon upper airway pathology manifested endoscopically by mucosal oedema, reddening and thickening of the epiglottic mucosa. Literature on epiglottitis in horses is sparse. Objective: To describe the diagnosis, treatment and outcome of Thoroughbred and Standardbred racehorses diagnosed with epiglottitis at a single centre. A secondary objective is to demonstrate the efficacy of inhaled and topical anti-inflammatories for this condition. Methods: Retrospective case series. Methods: Medical records (2009-2023) were reviewed for racehorses treated for epiglottitis. Data coll...
Effect of a ventral midline colopexy on large colon volvulus recurrence and days to next live foal in Thoroughbred broodmares.
Veterinary surgery : VS    May 7, 2025   Volume 54, Issue 5 952-961 doi: 10.1111/vsu.14269
Warren AS, Werner LA, Thombs LA, Rodgerson DH, Spirito MA, Sandow CB, McCracken MJ.To report the impact of ventral midline colopexy on colic, recurrence of large colon volvulus (LCV) and time to next live foal. Methods: Retrospective case control study. Methods: A total of 188 Thoroughbred broodmares surgically treated for LCV (2016-2020). Methods: Horses treated for LCV were grouped based on whether they received a colopexy (CP) or did not (NCP). All broodmares that underwent a second LCV surgery were subsequently categorized into two groups: those that received a colopexy (RCP) and those that did not (NRCP). Differences in the number of horses with large colon compromise, ...
Computed tomography of the equine temporohyoid joint: Association between imaging changes and potential risk factors.
Equine veterinary journal    May 5, 2025   doi: 10.1111/evj.14495
Dash RF, Perkins JD, Chang YM, Morgan RE.Temporohyoid osteoarthropathy (THO) is characterised by bone proliferation and cartilage ossification caused by infectious and degenerative conditions, amongst others. Objective: To describe the variable appearance of the temporohyoid joint (THJ) on computed tomography (CT) and investigate associations between CT changes and potential risk factors. Methods: Cross-sectional study. Methods: Head CT examinations were assessed. A grading system was developed for osseous proliferation (grade 0 [normal] to 3 [severe]) and tympanohyoid cartilage change (grade 0 [normal] to 3 [complete ossification])....