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Monsanto RDC, Kasemodel ALP, Tomaz A, Elias TGA, Paparella MM, Penido NDO. Evaluation of vestibular symptoms and postural balance control in patients with chronic otitis media. J Vestib Res 2021; 30:35-45. [PMID: 32083607 DOI: 10.3233/ves-200691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Evidence to support potential links between chronic otitis media (COM) and vestibular impairment/postural balance control issues is lacking. OBJECTIVE To investigate whether COM associates with vestibular symptoms, balance problems, and abnormalities in vestibular function tests. METHODS We selected 126 patients with COM and excluded patients with any identifiable underlying causes for vestibular dysfunction. Fifty-two healthy volunteers were included as controls. All subjects underwent anamnesis, physical examination, posturography, and video-head impulse tests. RESULTS We found a high prevalence of vestibular symptoms (58.4%) among patients with COM, while only 2% of the controls had vestibular symptoms. There was a positive correlation between COM activity with the presence of tinnitus and vestibular symptoms (P < 0.05). Clinical vestibular tests were abnormal in 63% of patients with COM, and those positively associated with presence of vestibular symptoms. Posturography results shown worse postural balance control in patients with COM as compared with controls, especially in the limit of stability (LOS) (Mean LOS, COM = 157.56 cm2; controls = 228.98 cm2; p < 0.001) and worse results in the test with eyes closed while standing on a foam mattress (sway area, COM = 10.91 cm2; controls = 5.90 cm2; p < 0.001) in patients with COM as compared with controls. We did not observe differences in the average vestibuloocular reflex gains in the video-head impulse test between our COM and control groups. CONCLUSIONS Our results show that COM associates with higher prevalence of vestibular symptoms and abnormalities in clinical vestibular function tests, and worse postural control as compared with controls. Among patients with COM, the activity of the middle-ear inflammation seemed to positively associate with the severity of hearing and balance problems.
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Affiliation(s)
- Rafael da Costa Monsanto
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil).,Department of Otolaryngology Head & Neck Surgery, University of Minnesota (Minnesota, MN, USA)
| | - Ana Luiza Papi Kasemodel
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil)
| | - Andreza Tomaz
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil)
| | - Thais Gomes Abrahão Elias
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil)
| | - Michael Mauro Paparella
- Department of Otolaryngology Head & Neck Surgery, University of Minnesota (Minnesota, MN, USA).,Paparella Ear Head & Neck Institute (Minnesota, MN, USA)
| | - Norma de Oliveira Penido
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil)
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Monsanto RDC, Penido NDO, Uchiyama M, Schachern P, Paparella MM, Cureoglu S. Quantitative assessment of cochlear and vestibular ganglion neurons in temporal bones with chronic otitis media. Eur Arch Otorhinolaryngol 2020; 278:331-338. [PMID: 32488375 PMCID: PMC10123924 DOI: 10.1007/s00405-020-06094-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE In this study, we aimed to determine whether or not COM leads to loss of spiral and Scarpa ganglion neurons. METHODS From the human temporal bone (HTB) collection at the University of Minnesota we selected human temporal bones with COM, defined as the presence of clinically intractable tissue abnormalities in the middle ear (cholesteatoma, perforation of the eardrum, granulation tissue, fibrosis, tympanosclerosis, and cholesterol granuloma). We also selected HTBs from donors with no ear diseases as controls. We quantitatively analyzed the number of spiral and Scarpa ganglion cells and compared the results obtained in the control and study groups. RESULTS In both COM and control groups we observed a significant negative correlation between age and number of both spiral (R = -0.632; P < 0.001; 95% CI - 0.766 to - 0.434) and Scarpa ganglion (R = - 0.404; P = 0.008; 95% CI - 0.636 to - 0.051) cells. We did not find any significant differences in the number of spiral ganglion cells (in total or per segment) or in the density of Scarpa ganglion cells (in each vestibular nerve or both) in the COM group as compared with controls (P > 0.05). CONCLUSIONS AND RELEVANCE Our results did not demonstrate significant loss of cochlear or vestibular peripheral ganglion neuron loss in HTBs with COM as compared with controls.
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Affiliation(s)
- Rafael da Costa Monsanto
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), R dos Otonis, 700 - piso superior - Vila Clementino, São Paulo, SP, 04037-004, Brazil.
| | - Norma de Oliveira Penido
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), R dos Otonis, 700 - piso superior - Vila Clementino, São Paulo, SP, 04037-004, Brazil
| | - Mio Uchiyama
- Department of Otolaryngology, Showa University, Tokyo, Japan.,Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Schachern
- Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael M Paparella
- Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA.,Paparella Ear Head and Neck Institute, Minneapolis, MN, USA
| | - Sebahattin Cureoglu
- Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
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Cordeiro FP, da Costa Monsanto R, Kasemodel ALP, de Almeida Gondra L, de Oliveira Penido N. Extended high-frequency hearing loss following the first episode of otitis media. Laryngoscope 2018; 128:2879-2884. [DOI: 10.1002/lary.27309] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/18/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Francisco Polanski Cordeiro
- Department of Otolaryngology-Head and Neck Surgery; Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM); São Paulo Brazil
| | - Rafael da Costa Monsanto
- Department of Otolaryngology-Head and Neck Surgery; Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM); São Paulo Brazil
| | - Ana Luiza Papi Kasemodel
- Department of Otolaryngology-Head and Neck Surgery; Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM); São Paulo Brazil
| | - Luiza de Almeida Gondra
- Department of Otolaryngology-Head and Neck Surgery; Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM); São Paulo Brazil
| | - Norma de Oliveira Penido
- Department of Otolaryngology-Head and Neck Surgery; Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM); São Paulo Brazil
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Monsanto RDC, Kasemodel ALP, Tomaz A, Paparella MM, Penido NDO. Current evidence of peripheral vestibular symptoms secondary to otitis media. Ann Med 2018; 50:391-401. [PMID: 29699430 DOI: 10.1080/07853890.2018.1470665] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The association between otitis media and vestibular symptoms has been hypothesized in the past. Thus, in this study, we aimed to critically analyze (based in a systematic review of the literature) whether patients who have otitis media are at greater risk of developing vestibular impairment or not. METHODS We performed a systematic review of the literature and identified potentially relevant articles reporting vestibular symptoms and results of vestibular function tests in patients with otitis media through searches of the PubMED, Web of Science, Scopus, and Google Scholar databases. The quality of the final set of records was assessed using the "Newcaste-Ottawa Scale". RESULTS Of the 2334 records searched, 43 met our inclusion and exclusion criteria, and those included 2250 patients. The records comprised 20 longitudinal studies, 21 cross-sectional studies, and 2 case reports. Regarding the type of otitis media studied, 25 examined vestibular impairment in otitis media with effusion, 6 acute otitis media, and 12 chronic otitis media. Results of anamnesis, clinical exams, and several vestibular function tests are reported and critically discussed. CONCLUSION Most studies evaluating the association between otitis media and vestibular symptoms have potential methodological flaws. Clinical evidence suggests that patients with otitis media have increased chances for having vestibular symptoms, delayed acquisition of developmental milestones, and abnormalities in several vestibular function tests as compared with controls. Future studies with rigorous methodology aiming to assess the clinical significance (and prognostic factors) of the association between otitis media and vestibular impairment are warranted. Key message Several studies demonstrated long-term sequelae secondary to otitis media. However, the evidence supporting those assumptions are based in low-quality evidence. Thus, better structured studies are warranted to better understand the clinical relevance of such association.
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Affiliation(s)
- Rafael da Costa Monsanto
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Ana Luiza Papi Kasemodel
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Andreza Tomaz
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Michael M Paparella
- b Department of Otolaryngology , University of Minnesota , Minneapolis , MN , USA.,c Paparella Ear, Head & Neck Institute , Minneapolis , MN , USA
| | - Norma de Oliveira Penido
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
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Segade F, Daly KA, Allred D, Hicks PJ, Cox M, Brown M, Hardisty-Hughes RE, Brown SDM, Rich SS, Bowden DW. Association of the FBXO11 gene with chronic otitis media with effusion and recurrent otitis media: the Minnesota COME/ROM Family Study. ACTA ACUST UNITED AC 2006; 132:729-33. [PMID: 16847180 PMCID: PMC1904347 DOI: 10.1001/archotol.132.7.729] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The FBXO11 gene is the human homologue of the gene mutated in the novel deaf mouse mutant jeff (Jf), a single gene model of otitis media. We have evaluated single nucleotide polymorphisms (SNPs) in the FBXO11 gene for association with chronic otitis media with effusion/recurrent otitis media (COME/ROM). DESIGN A total of 13 SNPs were genotyped across the 98.7 kilobases of genomic DNA encompassing FBXO11. Data were analyzed for single SNP association using generalized estimating equations, and haplotypes were evaluated using Pedigree Disequilibrium Test methods. PATIENTS The Minnesota COME/ROM Family Study, a group of 142 families (619 subjects) with multiple affected individuals with COME/ROM. MAIN OUTCOME MEASURES Genetic association of COME/ROM with polymorphisms in FBXO11. RESULTS The FBXO11 SNPs are contained in a single linkage disequilibrium haplotype block. Ten of the 13 SNPs were sufficiently polymorphic in the sample to permit analysis. In univariate genetic analysis, 1 reference SNP (hereinafter rs) (rs2134056) showed nominal evidence of association to COME/ROM (P = .02), and 2 SNPs approached significance (rs2020911, P = .06; rs3136367, P = .09). In multivariable analyses, including known risk factors for COME/ROM (sex, exposure to smoking, attending day care centers, no prior breastfeeding, and having allergies), the evidence of independent association was reduced for each SNP (eg, rs2134056, from P = .02 to P = .08). In subsequent analyses using the Pedigree Disequilibrium Test, the association of FBXO11 SNP rs2134056 (P = .06) with COME/ROM was confirmed. Incorporating multiple SNPs in 2- and 3-locus SNP haplotypes, those haplotypes containing rs2134056 also exhibited evidence of association of FBXO11 and COME/ROM (P values ranging from .03 to .10). CONCLUSION We have observed evidence consistent with an association between polymorphisms in FBXO11, the human homologue of the Jeff mouse model gene, and COME/ROM.
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Affiliation(s)
- Fernando Segade
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Hardisty RE, Erven A, Logan K, Morse S, Guionaud S, Sancho–Oliver S, Jackie Hunter A, Brown SDM, Steel KP. The deaf mouse mutant Jeff (Jf) is a single gene model of otitis media. J Assoc Res Otolaryngol 2003; 4:130-8. [PMID: 12943368 PMCID: PMC3202714 DOI: 10.1007/s10162-002-3015-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Otitis media is the most common cause of hearing impairment in children and is primarily characterized by inflammation of the middle ear mucosa. Yet nothing is known of the underlying genetic pathways predisposing to otitis media in the human population. Increasingly, large-scale mouse mutagenesis programs have undertaken systematic and genome-wide efforts to recover large numbers of novel mutations affecting a diverse array of phenotypic areas involved with genetic disease including deafness. As part of the UK mutagenesis program, we have identified a novel deaf mouse mutant, Jeff (Jf). Jeff maps to the distal region of mouse chromosome 17 and presents with fluid and pus in the middle ear cavity. Jeff mutants are 21% smaller than wild-type littermates, have a mild craniofacial abnormality, and have elevated hearing thresholds. Middle ear epithelia of Jeff mice show evidence of a chronic proliferative otitis media. The Jeff mutant should prove valuable in elucidating the underlying genetic pathways predisposing to otitis media.
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Affiliation(s)
- Rachel E. Hardisty
- MRC Mammalian Genetics Unit and UK Mouse Genome Centre, Harwell, OX11 0RD, UK
| | - Alexandra Erven
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK
| | - Karen Logan
- MRC Mammalian Genetics Unit and UK Mouse Genome Centre, Harwell, OX11 0RD, UK
| | - Susan Morse
- MRC Mammalian Genetics Unit and UK Mouse Genome Centre, Harwell, OX11 0RD, UK
| | - Sylvia Guionaud
- Frimorpho Ltd., Chemin du Musee 12, C.P. 191, 1705 Fribourg, Switzerland
| | - Sara Sancho–Oliver
- Frimorpho Ltd., Chemin du Musee 12, C.P. 191, 1705 Fribourg, Switzerland
| | - A. Jackie Hunter
- GlaxoSmithKline, New Frontiers Science Park, Harlow, CM19 5AW, UK
| | - Steve D. M. Brown
- MRC Mammalian Genetics Unit and UK Mouse Genome Centre, Harwell, OX11 0RD, UK
| | - Karen P. Steel
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK
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Paparella MM, Djalilian HR. Etiology, pathophysiology of symptoms, and pathogenesis of Meniere's disease. Otolaryngol Clin North Am 2002; 35:529-45, vi. [PMID: 12486838 DOI: 10.1016/s0030-6665(02)00019-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endolymphatic hydrops is the pathologic feature associated with Meniere's disease. The development of endolymphatic hydrops appears to arise from multifactorial inheritance with alteration of endolymphatic homeostasis. Various factors associated with the phenomenon of hydrops include functional or anatomic obstruction of endolymphatic flow, malabsorption of endolymph, genetic anomalies, vasodilation, allergy, viral infection, and autoimmunity.
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Affiliation(s)
- Michael M Paparella
- Minnesota Ear, Head, and Neck Clinic, Suite 200, 701 25th Avenue South, Minneapolis, MN 55454, USA.
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da Costa SS, Alves de Souza LC, Ribeiro de Toledo Piza M. The flexible endaural tympanoplasty: pathology-guided, pathogenesis-oriented surgery for the middle ear. Otolaryngol Clin North Am 1999; 32:413-41. [PMID: 10393777 DOI: 10.1016/s0030-6665(05)70143-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The flexible approach to tympanoplasty has been found to be adaptable to various forms of pathologic conditions found in the temporal bone, including inflammation and infection, congenital stenosis, benign and malignant tumors, and traumatic injuries. This approach finds its best indication among all pathologic conditions in the temporal bone, in the surgical treatment of otitis media, and its sequelae. A procedure conceived to treat this dynamic process must be adaptable to new circumstances and new findings and be ready to manage unexpected situations. The flexible tympanoplasty is a step-wise approach designed to explore the contents of the middle ear methodically and in the process disclose, confirm, and often treat disease.
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Affiliation(s)
- S S da Costa
- Department of Otolaryngology, School of Medicine, Universidade Federal do Rio Grande do Sul, Brasil
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