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Gurberg J, Dean M, Kawai K, Toivonen J, Poe D. Long-term efficacy of balloon dilation of the pediatric Eustachian tube: A six-year matched cohort study. Am J Otolaryngol 2024; 45:104208. [PMID: 38154198 DOI: 10.1016/j.amjoto.2023.104208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE Balloon dilation of the Eustachian tube (BDET) has not been evaluated extensively in children outside of retrospective case series. The purpose of this study is to report the long-term safety and efficacy of this procedure in children with matched controls. MATERIALS AND METHODS This is a two-center retrospective matched cohort study. Children having undergone tympanostomy tube (TT) placement and adenoidectomy with recurrence of symptoms underwent BDET at an academic affiliated multi-specialty practice. Comparison was made with children receiving TT at a tertiary medical center, matching for number of prior TT, prior adenoidectomy, age, and sex. Outcome measures were risk of failure and the need for additional surgery. Kaplan-Meier survival plots were used to compare risk of failure. RESULTS Thirty-three Eustachian tubes were dilated in 20 patients, aged 14 months-14 years. All patients had previously undergone TT insertion and adenoidectomy. Patients undergoing BDET had normal post-operative tympanograms in 80 % of cases. Mean follow up was 6.7 years with 2 patients failing in the BDET group and 8 in the TT insertion group. Dilated patients had a significantly lower risk of failure than those who underwent TT insertion (adjusted HR: 0.18; 95 % CI: 0.04, 0.81; p = 0.03). The probability of being failure free at six years was 88 % (95 % CI: 71, 95 %) in the BDET cohort and 53 % (95 % CI: 33, 70 %) in the TT insertion cohort. There were no complications. CONCLUSIONS BDET appears to be safe and possibly superior to TT placement in children with refractory Eustachian tube dysfunction. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Joshua Gurberg
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States of America.
| | - Marc Dean
- Ear and Sinus Institute, Vitruvius Institute of Medical Advancement, Texas Tech Health Sciences Center, United States of America
| | - Kosuke Kawai
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States of America
| | - Joonas Toivonen
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States of America; Department of Otolaryngology - Head and Neck Surgery, Turku University Hospital, University of Turku, Finland
| | - Dennis Poe
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, United States of America
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Han C, Wang H, Wang Y, Hang C, Wang Y, Meng X. The silent reservoir? SARS-CoV-2 detection in the middle ear effusion of patients with Otitis media with effusion after omicron infection. Am J Otolaryngol 2024; 45:104229. [PMID: 38422555 DOI: 10.1016/j.amjoto.2024.104229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This multicenter, prospective study is designed to investigate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the Middle Ear Effusion (MEE) of patients developing Otitis Media with Effusion (OME) subsequent to an Omicron infection. The objective is to elucidate any potential association between the virus and the condition. METHODS This study, conducted from January to June 2023, spanned the Otolaryngology departments of two medical institutions in Eastern China. Patients manifesting OME subsequent to Omicron infection from both hospitals were subjected to comprehensive otolaryngological assessments, including pure-tone audiometry (PTA), tympanometry, otoscopic examination, and nasopharyngolaryngoscopy. Subsequently, MEE samples extracted from these patients were analyzed through RT-PCR to detect SARS-CoV-2. RESULTS In this study, 23 patients (32-84 years; 57.5 ± 14.8 mean age; 47.8 % male) presented OME in 25 ears post-Omicron infection, with 21 (91.3 %) exhibiting unilateral symptoms. The median duration from infection to MEE sampling was 21 days (IQR: 25-46; range: 11-150). Predominantly, 64.0 % exhibited Type B tympanograms, and fluid accumulation was observed in 88.0 % of ears. SARS-CoV-2 was detected in 3 MEE samples (12.0 %), with cycle threshold values ranging between 25.65 and 33.30. CONCLUSIONS Our study highlights the potential effects of COVID-19 on the middle ear, suggesting a link between SARS-CoV-2 and OME onset. The virus, a significant contributor to OME, is detectable in the MEE nearly a month post-Omicron infection, indicating a potential alteration in OME treatment strategies and a risk of recurrence, emphasizing the necessity for otolaryngologist vigilance.
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Affiliation(s)
- Chengzhou Han
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Huifang Wang
- Department of Clinical Laboratory, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Ying Wang
- Department of Otolaryngology, Wuxi Huishan District Qianqiao Street Community Health Service Center, 22 Qianqiao Street, Huishan District, Wuxi 214153, PR China
| | - Chao Hang
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Yangyang Wang
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Xiangming Meng
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China.
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Ai M, Liu X, Lin Y, Deng H, Yu F. Efficacy of balloon Eustachian tuboplasty plus tympanostomy tube insertion in postirradiation otitis media with effusion. Am J Otolaryngol 2024; 45:104301. [PMID: 38688091 DOI: 10.1016/j.amjoto.2024.104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE This study aimed to compare the efficacy of balloon Eustachian tuboplasty (BET) plus tympanostomy tube insertion (TTI) and simple TTI for postirradiation otitis media with effusion (OME) in patients with nasopharyngeal carcinoma. METHOD This study included 36 patients (51 ears) with OME after the first radiotherapy course for nasopharyngeal carcinoma and categorized them into the BET + TTI and simple TTI groups. Effective rates, pure tone hearing threshold, Eustachian tube function score, and complication incidences were compared. RESULTS The effective rates of the BET+TTI and TTI groups were 93.75 % and 75 %, respectively, with no statistically significant difference (P = 0.29). The pure tone hearing threshold examination at 9 months postoperatively revealed significantly lower mean air-pure tone and air-bone gap in both the BET + TTI and TTI groups than preoperatively. Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores at every postoperative visit were significantly higher than preoperative scores in the two groups (all P < 0.05); ETDQ-7 score reduction in the BET + TTI group at 3, 9, and 12 months postoperatively was significantly higher than that in the TTI group. Otorrhea and recurrence both occurred in the BET+TTI and TTI groups, but the BET+TTI group demonstrated a lower incidence. CONCLUSION BET + TTI is an effective treatment method for postirradiation OME.
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Affiliation(s)
- Maomao Ai
- Department of Otorhinolaryngology and Head and Neck Surgery, Guangzhou Red Cross Hospital, China.
| | - Xiaoping Liu
- Department of Otorhinolaryngology and Head and Neck Surgery, Guangzhou Red Cross Hospital, China
| | - Ying Lin
- Department of Otorhinolaryngology and Head and Neck Surgery, Guangzhou Red Cross Hospital, China
| | - Haiyan Deng
- Department of Otorhinolaryngology and Head and Neck Surgery, Guangzhou Red Cross Hospital, China
| | - Feng Yu
- Department of Otorhinolaryngology and Head and Neck Surgery, Guangzhou Red Cross Hospital, China
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Gisselsson-Solen M, Gunasekera H, Hall A, Homoe P, Kong K, Sih T, Rupa V, Morris P. Panel 1: Epidemiology and global health, including child development, sequelae and complications. Int J Pediatr Otorhinolaryngol 2024; 178:111861. [PMID: 38340606 DOI: 10.1016/j.ijporl.2024.111861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To summarise the published research evidence on the epidemiology of otitis media, including the risk factors and sequelae associated with this condition. DATA SOURCES Medline (PubMed), Embase, and the Cochrane Library covering the period from 2019 to June 1st, 2023. REVIEW METHODS We conducted a broad search strategy using otitis [Medical Subject Heading] combined with text words to identify relevant articles on the prevalence, incidence, risk factors, complications, and sequelae for acute otitis media, otitis media with effusion, and chronic suppurative otitis media. At least one review author independently screened titles and abstracts of the retrieved records for each condition to determine whether the research study was eligible for inclusion. Any discrepancies were resolved by reviewing the full text followed by discussion with a second review author. Studies with more than 100 participants were prioritised. RESULTS Over 2,000 papers on otitis media (OM) have been published since 2019. Our review has highlighted around 100 of these publications. While the amount of otitis media research on the Medline database published each year has not increased, there has been an increase in epidemiological studies using routinely collected data and systematic review methodology. Most of the large incidence studies have addressed acute otitis media (AOM) in children. Several studies have described a decrease in incidence of AOM after the introduction of conjugate PCV vaccines. Similarly, a decrease was noted when rates of coronavirus disease of 2019 (COVID-19) were high and there were major public health efforts to reduce the spread of infection. There have been new studies on OM in adults and OM prevalence in a broader range of countries and population subgroups. CONCLUSION Overall, the rates of severe and/or suppurative OM appeared to be decreasing. However, there is substantial heterogeneity between populations. While better use of available data is informative, it can be difficult to predict rates of severe disease without accurate examination findings. Most memorably, the COVID-19 pandemic had an enormous impact on the research and clinical services for otitis media for most of the period under review. IMPLICATIONS FOR PRACTICE The use of routinely collected data for epidemiological studies will lead to greater variability in the definitions and diagnostic criteria used. The impact of new vaccines will continue to be important. Some of the lessons learned during the COVID-19 pandemic concerning behaviours that reduce spread of respiratory viruses can hopefully be used to decrease the burden of otitis media in the future. There are still many countries in the world where the burden of otitis media is not well described. In countries where otitis media has been studied over many years, new potential risk factors continue to be identified. In addition, a better understanding of the disease in specific subgroups has been achieved.
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Affiliation(s)
- Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden.
| | - Hasantha Gunasekera
- Children's Hospital Westmead Clinical School, University of Sydney, Australia
| | | | - Preben Homoe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zeeland University Hospital, Koege, Denmark
| | - Kelvin Kong
- School of Medicine and Public Health, Newcastle, Australia
| | - Tania Sih
- Medical School University of Sao Paolo, Brazil
| | | | - Peter Morris
- Menzies School of Health Research Charles Darwin University Darwin, Australia
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Shi D, Zhao H, Chen G, Jin X, Wu Z, Wang J, Chen J. The association between reflux and otitis media with effusion. Am J Otolaryngol 2024; 45:104211. [PMID: 38199075 DOI: 10.1016/j.amjoto.2023.104211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/25/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Dike Shi
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Hanxin Zhao
- Department of Endocrinology and Metabolism, Zhejiang University Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Guofeng Chen
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Xiaoli Jin
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Zhiwei Wu
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Jun Wang
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Jian Chen
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
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Mohamed NM, Abdelhamid AM, Aref M, Abdelhafeez M, Faris Alotabi H, Mohammed Abdelrahman DS, Elwany NE. Role of cytokines and Th17/Tregs imbalance in the pathogenesis of otitis media with effusion. Modulation of Notch1/Hes1/mTORC1/S6k1 signalling pathway underlies the protective effect of astaxanthin. Int Immunopharmacol 2024; 128:111521. [PMID: 38246005 DOI: 10.1016/j.intimp.2024.111521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024]
Abstract
Otitis media with effusion (OME) is a recurrent middle ear inflammatory condition. It may be complicated by acquired hearing loss and speech impairment especially in children. Accordingly, the current study aimed to assess the role of cytokines and the imbalance of Th17/Tregs in the pathogenesis of OME. Additionally, the protective effect of astaxanthin and its mechanisms related to Notch1/ Hes1/mTORC1/S6K1 signalling were investigated. METHODS Forty-eight children were grouped as follow: G1: control healthy group G2: acute otitis media (AOM) group, G3: OME group. In the lipopolysaccharide (LPS) induced OME rat model, 15 rats were randomised into: G1: normal control group, G2: LPS group, and G3: astaxanthin treated group. RESULTS Biochemical analysis of the children's peripheral blood samples showed that IL1β, IL-2, IL-4, IL-6, IL-17, and IL-23 were significantly elevated, while TGF-β was significantly decreased in AOM and OME patients (group 2 and 3). In the LPS- induced OME rat model, astaxanthin treatment resulted in suppression of IL-17, IL-6, TNF-α, Muc5A, TFF3, NICD, Hes1, mTORC1, and S6K1 in rat middle ear mucosa. Furthermore, astaxanthin significantly downregulated RORγ while upregulating FoxP3 and restored the balance between Th17/Tregs. Moreover, astaxanthin improved the histopathological picture of the inflamed middle ear mucosa. CONCLUSIONS Proinflammatory cytokines as well as Th17/Tregs imbalance play a crucial role in the pathogenesis of AOM and OME. Additionally, astaxanthin alleviated LPS- induced OME in rats through suppression of Notch1/ Hes1/mTORC1/S6K1 pathway, and regulation of Th17/Tregs.
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Affiliation(s)
- Noura Mostafa Mohamed
- Department of Basic Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, 11671 Riyadh, Saudi Arabia.
| | | | - Mohamed Aref
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, Zagazig University, Egypt.
| | - Marwa Abdelhafeez
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Hadil Faris Alotabi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, 11671 Riyadh, Saudi Arabia.
| | - Doaa Sayed Mohammed Abdelrahman
- Department of Clinical Science, College of Medicine, Princess Nourah bint Abdulrahman University, 11671 Riyadh, Saudi Arabia.
| | - Nisreen E Elwany
- Clinical Pharmacology Department, Faculty of Medicine, Zagazig University, Egypt.
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Cao J, Liu W, Yang Z, Qu G, Zhong C. Causal Relationship Between Body Mass Index and Risk of Otitis Media with Effusion in Children: A Mendelian Randomization Study. Indian J Otolaryngol Head Neck Surg 2024; 76:1410-1418. [PMID: 38440649 PMCID: PMC10909010 DOI: 10.1007/s12070-023-04161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/19/2023] [Indexed: 03/06/2024] Open
Abstract
Background Body mass index(BMI) in children appears to be associated with Otitis media with effusion(OME) in observational studies, but the causal relationship is not clear. Methods A two-sample Mendelian randomization (MR) study was used to explore the causal relationship between childhood BMI and OME in people of European ancestry. Genome-wide association studies (GWAS) of childhood BMI were used as exposures (n = 61,111), while GWAS of OME were used as outcomes (n = 429,290). The weighted inverse variance method (IVW) was used as a baseline method to test for causality. In addition, MR-Egger, simple mode analysis, weighted median, and weighted mode were used as complementary methods.MR-PRESSO analysis, MR-Egger intercept analysis, and Cochran's Q statistical analysis were also used to detect possible directional heterogeneity and polymorphism. To assess this association, we used ratios (OR) with 95% confidence intervals (ci). All statistical analyses were performed in R. Results We selected 22 genome-wide significant single nucleotide polymorphisms (SNPs) from GWAS as instrumental variables (IVW). the IVW approach showed evidence supporting a causal relationship between BMI and OME in children (β = 0.265, SE = 0.113, P = 0.018). MR-Egger regression showed that targeted polymorphisms were unlikely to bias the results bias (intercept=-0.022; P = 0.488), but there was no causal relationship between BMI and OME (β = 0.584, SE = 0.465, P = 0.224). Although the results of the IVW and MR Egger analyses were not consistent, the IVW analysis maintained higher precision, and the Cochran Q test, heterogeneity and polymorphism tests showed no heterogeneity, no directionality and no polymorphism. Conclusions MR studies suggest that genetically predicted body mass index in childhood is associated with an increased risk of OME. Notably, given the limitations of this study, the mechanism of association between body mass index and OME in childhood needs further investigation. These results support the importance of effective management of obesity, which may reduce OME occurrence and decrease OME recurrence.
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Affiliation(s)
- Jingwen Cao
- Otolaryngology Head and Neck Surgery, The 940th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Lanzhou, China
- Ningxia Medical University, Yinchuan, China
| | - Wei Liu
- Ningxia Medical University, Yinchuan, China
- Key Laboratory of Stem Cells and Gene Province, Lanzhou, China
| | | | - Gaoya Qu
- Ningxia Medical University, Yinchuan, China
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Faibish G, Kaplan D, Knaanie A, Elsaeid S, Ziv O. The effect of ventilation tube insertion in pediatric cochlear implantation candidates with otitis media with effusion on postoperative complications. Int J Pediatr Otorhinolaryngol 2024; 176:111784. [PMID: 37988918 DOI: 10.1016/j.ijporl.2023.111784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Otitis media with effusion (OME) is a common finding in pediatric cochlear implant(CI) candidates and may be managed by inserting ventilation tubes. This study aimed to compare postoperative complication rates in children who underwent CI without and with OME, including patients who were treated without and with ventilation tube insertion. METHODS A population-based retrospective cohort study was conducted, including all CI patients, under ten years of age, at our institution, between 2007 and 2020. The study's population was divided into three groups based on their middle ear status at CI: 1) OME previously treated with VT, 2) untreated OME, and 3) normal-aerated ears. Postoperative complications of the groups were reviewed and served as our primary outcome measure. RESULTS Of the 257 implanted ears included, 53, 42, and 162 ears belonged to the VT-treated OME, untreated OME, and aerated groups, respectively. Acute mastoiditis (AM) rate was significantly higher in the OME group compared to the aerated groups (9.5 % vs. 2.5 %, p = 0.0134) and in the VT-treated compared to the untreated OME groups (15.1 % vs. 2.3 %, p = 0.0356). Similarly, the rate of developing chronic suppurative otitis media without cholesteatoma (CSOMWC) was significantly higher in the OME compared to the aerated groups (12.6 % vs. 2.5 %, p = 0.0011) and in the VT-treated compared to the untreated OME groups (18.8 % vs. 4.7 %, p = 0.0366). Other complications rated were very low and similar between the groups. No other statistical difference was found between the groups. CONCLUSION VT insertion in pediatric CI candidates with OME increased postoperative AM and CSOMWC. We believe that, at least in our population, VT introduction prior to CI, for OME, surgery should be avoided.
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Affiliation(s)
- Guy Faibish
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel
| | - Daniel Kaplan
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel; Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | - Sabri Elsaeid
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel; Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Ziv
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel; Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Zhang Y, Yang F, He Y, Yan S, Bai Y, Jin Y, Shi H, Liu J, Zhang Z, Luan F. Otitis media with effusion in adults during the SARS-CoV-2 epidemic. Sci Prog 2024; 107:368504241231659. [PMID: 38356273 PMCID: PMC10868486 DOI: 10.1177/00368504241231659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVES The purpose of this study was to investigate the fluctuations in the prevalence of individuals diagnosed with otitis media with effusion (OME) during the SARS-CoV-2 pandemic, while also evaluating the persistence of SARS-CoV-2 in middle ear effusion (MEE) and assessing the effectiveness of tympanocentesis as a treatment modality for OME in this specific period. METHODS The total number of outpatients and patients diagnosed with OME in our department was recorded for January 2022 and January 2023. Thirty patients (aged 15-86 years) were categorized into two groups: group A (n = 12), who developed OME during their SARS-CoV-2 infection and group B (n = 18), who experienced OME after the resolution of SARS-CoV-2 infection. All patients underwent otoendoscopic tympanocentesis (without a ventilation tube), where MEE and nasopharyngeal secretions were simultaneously collected for SARS-CoV-2 detection by polymerase chain reaction. The time interval from SARS-CoV-2 infection to tympanocentesis, results of SARS-CoV-2 detection, preoperative and postoperative average hearing threshold, and Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores were documented. RESULTS The proportion of outpatients with OME in January 2023 was higher than that in January 2022. There were five patients who had positive test results for SARS-CoV-2 on MEE after tympanocentesis. These 5 patients underwent tympanocentesis at a mean of 28 ± 7.28 days following confirmation of SARS-CoV-2 infection. The ETDQ-7 scores of group A exhibited a reduction from 21.85 ± 4.8 to 10.00 ± 4.07 following tympanocentesis, while the ETDQ-7 scores of group B also demonstrated a decrease from 21.22 ± 4.65 to 10.11 ± 3.68 after undergoing tympanocentesis. The tympanocentesis was effective in both groups. CONCLUSIONS The study confirmed that the proportion of outpatients with OME in the Clinics of Otolaryngology during the SARS-CoV-2 epidemic increased significantly. SARS-CoV-2 RNA was detectable in MEE of COVID-19-related OME patients. Tympanocentesis was therapeutic for OME during SARS-CoV-2 infection, which facilitated viral clearance in MEE.
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Affiliation(s)
- Yu Zhang
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Feifei Yang
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanan He
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sinan Yan
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yushuang Bai
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yifan Jin
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Shi
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingrui Liu
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhanchi Zhang
- Department of Human Anatomy, Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Neurodegenerative Disease Mechanism, Hebei Medical University, Shijiazhuang, China
| | - Feng Luan
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Shi D, Zhao H, Chen G, Jin X, Wu Z, Wang J, Chen J. The effects of treating GERD on the outcomes of otitis media with effusion: A systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104061. [PMID: 37806281 DOI: 10.1016/j.amjoto.2023.104061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Gastroesophageal reflux disease (GERD) may cause otitis media with effusion (OME). However, whether treating GERD can benefit patients with OME has not been well studied. METHODS We systematically searched PubMed, Embase, Cochrane Library, and Wanfang databases. The search period was from the establishment of the databases until December 31, 2022. Clinical studies related to GERD treatment on the outcomes of OME were included. Two reviewers independently conducted literature screening and data extraction according to the inclusion and exclusion criteria. To evaluate the quality of the included studies, we used the NOS assessment tool and the RevMan 5.4. Subgroup analysis was conducted to reduce the risk of heterogeneity, and Egger and Begg funnel plots were used to evaluate publication bias. Meta-analysis was performed using Stata14.0 and Review Manager 5.4 software. RESULTS Finally, 21,744 patients from 16 studies were included. The results showed that the rate of GERD in OME patients was 0.56 (95 % confidence interval (CI): 0.33, 0.79), while it was 0.04 (95 % CI: 0.03, 0.05) in the adult GERD population. The combined risk ratio (RR) of OME in patients with versus without GERD was 1.58 (95 % CI: 1.35, 1.85; p < 0.01). The efficacy rate of GERD treatment in OME patients was 0.59 (95 % CI: 0.44, 0.74), especially for those with chronic OME (0.64, 95 % CI: 0.36, 0.92). Compared to the control group, treatment with GERD improved the symptoms and efficacy of OME (OR = 1.65; 95 % CI: 0.95, 2.85; p > 0.05). The hearing loss cure rate was 0.70 (95 % CI: 0.57, 0.82). CONCLUSION GERD has been suggested to be a high-risk factor for OME. Treatment of GERD can improve the symptoms of OME. However, further studies are required to verify these findings.
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Affiliation(s)
- Dike Shi
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Hanxin Zhao
- Department of Endocrinology and Metabolism, Zhejiang University Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Guofeng Chen
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Xiaoli Jin
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Zhiwei Wu
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Jun Wang
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
| | - Jian Chen
- Department of Gastroenterology Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
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Jahangiri R, Hashemi SB, Kohan E, Babaei A. Cochlear Implantation with a Combined Approach: A Case Report. Iran J Otorhinolaryngol 2024; 36:377-380. [PMID: 38259692 PMCID: PMC10800144 DOI: 10.22038/ijorl.2023.75088.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024]
Abstract
Introduction Ear symptoms of granulomatosis with polyangiitis can range from ear fullness and otalgia to conductive or sensory neural hearing loss and sudden deafness. Cochlear implantation in these patients faces two challenges: access to the round window and control of mastoid and middle ear inflammation. The combined approach in cochlear implantation is a classic trans-facial recess approach facilitated by a trans-canal view. Case Report In this case report, we present the "combined approach" in a 20-year-old lady with granulomatosis with polyangiitis who underwent cochlear implantation successfully using the combined approach. Conclusion Post-operative results suggest that the "combine approach" seems to be a safe, easy, and fast cochlear implantation technique for chronic otitis media with an atelectatic middle ear and retracted tympanic membrane or narrow facial recess space. It is a single-stage surgery that has no need for the obliteration of the ear and has less morbidity.
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Affiliation(s)
- Reza Jahangiri
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Seyed Basir Hashemi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Elahe Kohan
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Amirhossein Babaei
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
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12
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Rasheed AM, Abbas AM, Hilal SA, Homadi NJ. Adenoidectomy and Endoscopic Myringotomy with and without ventilation tube insertion for Treatment of Otitis Media with Effusion in 6-12 years old Children. Int Tinnitus J 2023; 27:27-33. [PMID: 38050881 DOI: 10.5935/0946-5448.20230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Otitis Media with Effusion (OME) is frequently caused by adenoiditis in children. OME is arguably one of the most common disorders that impairs hearing, speech development, and causes learning issues as a result. However, treatment options are debatable. AIM This study aims to evaluate if inserting a ventilation tube in conjunction with adenoidectomy is significantly superior to adenoidectomy in conjunction with myringotomy alone in terms of hearing outcome in 6-12 years old children with OME. Patients and Methods: In this prospective controlled clinical study, 33 children; 66 ears, with ages ranging from 6-12 years (19 males and 14 females) diagnosed as cases of bilateral OME and varying degrees of adenoid hypertrophy were included. The patients were randomized into two groups; group I (17 patients; 34 ears) underwent adenoidectomy and endoscopic myringotomy alone, whereas the 16 patients;32 ears, in group II underwent adenoidectomy and endoscopic myringotomy together with ventilation tube insertion. Measurement of pure tone hearing threshold was achieved pre-operatively and at the end of 1st and 3rd postoperative months. The means of the pure tone hearing threshold averages of the patients in both groups were compared. Independent samples t-test was used to define the association between the two means. RESULTS Pre-operatively, the means of pure tone hearing threshold averages were 27.3 ± 2.670 dB in group I patients and 29.5 ± 2.865 dB in group II patients. At the end of 1st and 3rd post-operative months, the pure tone hearing threshold average means in group I patients were 18.2 ± 2.689dB and 14.8 ± 2.735 dB respectively, while the means in group II patients were 10.6 ± 1.742 dB and 3.5 ± 1.158 dB respectively. Independent samples t-test revealed a statistically significant difference between group I and group II patients regarding the means of pure tone hearing threshold averages at the end of the 1st and the 3rd post-operative months (P value=0.015 and 0.003 respectively). CONCLUSION In terms of hearing level, ventilation tube insertion in conjunction with adenoidectomy is statistically superior to adenoidectomy with myringotomy alone in the treatment of OME.
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Affiliation(s)
- Ahmed Muhei Rasheed
- Department of Surgery-otolaryngology, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Azzam Muhsin Abbas
- Department of Surgery-otolaryngology, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Shamil Abbood Hilal
- Department of Surgery-otolaryngology, College of Medicine, University of Baghdad, Baghdad, Iraq
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Rasheed AM. Is Topical Nasal Steroid Useful for Treatment of Otitis Media with Effusion in Children? Int Tinnitus J 2023; 27:62-67. [PMID: 38050887 DOI: 10.5935/0946-5448.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Otitis media with effusion is a common and important pediatric clinical problem; it is the leading cause of hearing impairment in children. Medical treatment remains controversial. AIM To evaluate the usefulness of using topical nasal steroids in the treatment of otitis media with effusion. PATIENTS AND METHODS Between November 2019 and October 2022, a prospective controlled clinical study was carried out in the department of otolaryngology at Al-Jerrahat Teaching Hospital in Medical City, Baghdad, Iraq. This study comprised 40 patients with bilateral otitis media with effusion (23 males, 17 females). Two groups were created for the patients. Patients in group A (20 patients) were treated with mometasone furoate nasal spray; 1 puff (50 µg) in each nostril daily for 2 weeks, while the 20 patients in group B were treated with saline nasal spray; 1 puff in each nostril daily for 2 weeks. At the end of the first and second weeks of treatment, otoscopic examination was used to monitor the patients. At the end of the second post-treatment week, pure tone audiometry and tympanometry were performed again. Normal otoscopic results, a type A tympanogram, and enhanced pure tone hearing threshold average to be ≤20 dB HL within 0, 5, 1, and 4 KHz were used to characterize resolution of OME. The association between two means was determined using an independent sample t-test, while the association between categorical variables was determined using an X2-test. RESULTS At the end of 2nd post-treatment week, there was no significant difference regarding improvement of otitis media with effusion regarding otoscopic, audiometric, and tympanometric results in both groups (P-value >0.05). CONCLUSION Topical nasal steroid is unuseful for the treatment of otitis media with effusion in the short-term.
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Affiliation(s)
- Ahmed Muhei Rasheed
- Department of Surgery-Otolaryngology, College of Medicine, University of Baghdad, Baghdad, Iraq
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Kitaya S, Suzuki J, Ikeda R, Sato A, Adachi M, Shirakura M, Kobayashi Y, Shirakura S, Suzuki Y, Imai Y, Katori Y. Impact of palatoplasty techniques on tympanic membrane findings and hearing prognosis in children with cleft palate. Int J Pediatr Otorhinolaryngol 2023; 174:111747. [PMID: 37820571 DOI: 10.1016/j.ijporl.2023.111747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Children with cleft palate (CP) are at high risk of developing otitis media with effusion (OME) due to Eustachian tube (ET) dysfunction. Palatoplasty has been reported to decrease the frequency of middle ear disease and improve ET function, and although various techniques have been developed, there is no consensus on the differences in the impact of different techniques on the middle ear. The purpose of this study was to determine the differential effects of palatoplasty on middle ear function and hearing. METHODS We performed a retrospective observational survey of pediatric patients who underwent palatoplasty for CP between June 2010 and October 2018 at Tohoku University Hospital. Cases were divided into three groups depending on the palatoplasty procedures performed: the push-back palatoplasty group, the two-flap palatoplasty group, and the Furlow double-opposing Z-plasty group. We examined the differences in clinical characteristics between patients who underwent each procedure. The primary outcome variable was tympanic membrane (TM) findings, and the secondary outcome was hearing test results. RESULTS Children who underwent the two-flap palatoplasty had a higher tympanostomy tube (TT) insertion rate and a higher total number of TT insertions than those who underwent the Furlow double-opposing Z-plasty or the push-back palatoplasty. The TM retraction rate tended to be lower in the Furlow double-opposing Z-plasty group than in the push-back palatoplasty group or the two-flap palatoplasty group. The hearing test results at the last visit were not significantly different among the three groups. CONCLUSIONS Children who underwent the two-flap palatoplasty had a higher rate of TT insertions, potentially increasing the risk of TM perforation. In contrast, the Furlow double-opposing Z-plasty group had a lower tendency for TM regression, possibly due to improved ET function and reduced incidence of OME. It is important to understand the advantages and disadvantages of each technique before selecting one suitable for the child's cleft and arch width. Additionally, it is important to conduct regular follow-up of TM findings and hearing test results even after palatoplasty.
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Affiliation(s)
- Shiori Kitaya
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, School of Medicine, Shiwa, Iwate, Japan
| | - Akimitsu Sato
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mika Adachi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masayuki Shirakura
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shiho Shirakura
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuka Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshimichi Imai
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Fan Y, Gao R, Shang Y, Tian X, Zhao Y, Chen X. Presence of SARS-CoV-2 in middle ear fluid and characterization of otitis media with effusion in patients with COVID-19. Int J Infect Dis 2023; 136:44-48. [PMID: 37660727 DOI: 10.1016/j.ijid.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES This study sought to determine whether SARS-CoV-2 is present in the middle ear fluid (MEF) of patients with COVID-19 who have otitis media with effusion (OME). METHODS A case-control study was designed to detect SARS-CoV-2 and six other common respiratory viruses (influenza A virus, influenza B virus, respiratory syncytial virus, adenovirus, human rhinovirus [HRV], and mycoplasma pneumonia) by polymerase chain reaction (PCR) in the MEF of patients with OME. Follow-up tests, including pure-tone audiometry and tympanometry, were conducted. RESULTS In the COVID-19 group, 18 of 27 MEF specimens were PCR-positive for SARS-CoV-2, with cycle thresholds ranging from 24.9-42.2. And one patient tested positive for the HRV. In the control group, all 15 MEF specimens were PCR-negative for SARS-CoV-2, but two patients tested positive for the HRV. After treatment for OME, 11 patients (40.7%) reported complete resolution, 14 (51.9%) reported improvement, and two (7.4%) reported no change. The average improvement in hearing was 14.5 ± 8.1 dB, and the average air-bone gap decrease was 13.5 ± 9.0 dB. CONCLUSION This study confirmed the presence of SARS-CoV-2 in the MEF of patients who were previously COVID-19-positive suggesting a possible association between COVID-19 and OME. OME should be considered a possible symptom of COVID-19.
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Affiliation(s)
- Yue Fan
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ruzhen Gao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yingying Shang
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xu Tian
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xingming Chen
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Baird SM, Wong D, Levi E, Robinson P. Otolaryngological burden of disease in children with primary ciliary dyskinesia in Victoria, Australia. Int J Pediatr Otorhinolaryngol 2023; 173:111722. [PMID: 37699305 DOI: 10.1016/j.ijporl.2023.111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES The aim of this study was to summarize the otolaryngological manifestations amongst children with primary ciliary dyskinesia (cwPCD) to improve diagnosis, investigations and management amongst otolaryngologists. METHODS A retrospective review of primary ciliary dyskinesia (PCD) diagnoses at our institution over an 8-year period between January 2014 and October 2022 was conducted. Patient characteristics, diagnosis, otolaryngological symptomatology, treatment and outcomes were recorded. RESULTS 24 patients were identified. Thirteen patients (54%) had documented conductive hearing loss on audiological evaluation; with 11 (85%) requiring hearing aids. Six patients (25%) underwent middle ear ventilation tube (MEVT) insertion with 67% experiencing post-MEVT otorrhoea. Twenty children (83%) reported chronic nasal discharge however only 3 (13%) reported nasal obstruction. Nine patients (38%) had symptoms consistent with sleep disordered breathing with 79% of them requiring operative management with adenotonsillectomy. CONCLUSION Middle ear effusion is common amongst cwPCD and should be managed with conservative measures due to the significant burden of post-MEVT otorrhoea. Sinonasal symptoms rarely need surgical intervention. Many otolaryngological symptoms of PCD are often underreported, particularly sleep-disordered breathing. Paediatric PCD patients should be managed in a multidisciplinary team with routine and tailored therapies to manage all aspects of the condition.
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Affiliation(s)
- Samantha M Baird
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Daniel Wong
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Eric Levi
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Philip Robinson
- Department of Respiratory Medicine, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
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Lou Z. Tympanomastoid cholesterol Granulomas presenting as a Blue Eardrum in children. BMC Surg 2023; 23:159. [PMID: 37312115 DOI: 10.1186/s12893-023-02069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 06/03/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE(S) This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children. METHODS The clinical records of children diagnosed with CG were retrospectively reviewed. RESULTS The total of 17 children (20 ears) with CGs were included in this study. Endoscopy revealed pars flaccida retractions and lipoid tissue deposition behind the intact blue tympanic membrane (TM). CT scan revealed bony erosion and extensive soft tissue in the middle ear and mastoid. No ossicular chain destruction was found. All 20 ears underwent canal wall-up mastoidectomy and ventilation tube (VT) insertion, 3 sets of VT were performed in 5 ear and 2 sets in one. The residual perforation was seen in 2 ears following VT. The CT revealed well-pneumatized antra and tympanic cavities at postoperative 12-24 months. CONCLUSION(S) The CG should be suspected for the patients with yellow lipoid deposition behind the blue TM. CT of CG usually revealed bony erosion and extensive soft tissue in the middle ear and mastoid. Mastoidectomy combined with VT insertion and etiological treatment have a favorable prognosis for CG in children.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu central Hospital, Yiwu city, 322000, Zhejiang provice, China.
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Zeng J, Deng W, Yu J, Xiao L, Chen S, Zhang X, Zeng L, Chen D, Li P, Chen Y, Zhang H, Shu F, Wu M, Su Y, Li Y, Cai Y, Zheng Y. A deep learning approach to the diagnosis of atelectasis and attic retraction pocket in otitis media with effusion using otoscopic images. Eur Arch Otorhinolaryngol 2023; 280:1621-7. [PMID: 36227348 DOI: 10.1007/s00405-022-07632-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study aimed to develop and validate a deep learning (DL) model to identify atelectasis and attic retraction pocket in cases of otitis media with effusion (OME) using multi-center otoscopic images. METHOD A total of 6393 OME otoscopic images from three centers were used to develop and validate a DL model for detecting atelectasis and attic retraction pocket. A threefold random cross-validation procedure was adopted to divide the dataset into training validation sets on a patient level. A team of otologists was assigned to diagnose and characterize atelectasis and attic retraction pocket in otoscopic images. Receiver operating characteristic (ROC) curves, including area under the ROC curve (AUC), accuracy, sensitivity, and specificity were used to assess the performance of the DL model. Class Activation Mapping (CAM) illustrated the discriminative regions in the otoscopic images. RESULTS Among all OME otoscopic images, 3564 (55.74%) were identified with attic retraction pocket, and 2460 (38.48%) with atelectasis. The diagnostic DL model of attic retraction pocket and atelectasis achieved a threefold cross-validation accuracy of 89% and 79%, AUC of 0.89 and 0.87, a sensitivity of 0.93 and 0.71, and a specificity of 0.62 and 0.84, respectively. Larger and deeper cases of atelectasis and attic retraction pocket showed greater weight, based on the red color depicted in the heat map of CAM. CONCLUSION The DL algorithm could be employed to identify atelectasis and attic retraction pocket in otoscopic images of OME, and as a tool to assist in the accurate diagnosis of OME.
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Téblick S, Ruymaekers M, Van de Casteele E, Boudewyns A, Nadjmi N. The effect of soft palate reconstruction with the da Vinci robot on middle ear function in children: an observational study. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00045-0. [PMID: 36914451 DOI: 10.1016/j.ijom.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023]
Abstract
Cleft palate is associated with a high prevalence of middle ear dysfunction, even after palatal repair. The aim of this study was to evaluate the effects of robot-enhanced soft palate closure on middle ear functioning. This retrospective study compared two patient groups after soft palate closure with a modified Furlow double-opposing Z-palatoplasty technique. Dissection of the palatal musculature was performed using a da Vinci robot in one group and manually in the other. Outcome parameters were otitis media with effusion (OME), tympanostomy tube use, and hearing loss during 2 years of follow-up. At 2 years post-surgery, the percentage of children with OME had reduced significantly to 30% in the manual group and 10% in the robot group. The need for ventilation tubes (VTs) decreased significantly over time, with fewer children in the robot group (41%) than those in the manual group (91%) needing new VTs during postoperative follow-up (P = 0.026). The number of children presenting without OME and VTs increased significantly over time, with a faster increase in the robot group at 1 year post-surgery (P = 0.009). Regarding hearing loss, significantly lower hearing thresholds were recorded in the robot group from 7 to 18 months postoperatively. To conclude, beneficial effects of robot-enhanced surgery were recorded, suggesting a faster recovery when the soft palate was reconstructed using the da Vinci robot.
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Affiliation(s)
- S Téblick
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - M Ruymaekers
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - E Van de Casteele
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium; Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Antwerp, Belgium; All for Research vzw, Antwerp, Belgium
| | - A Boudewyns
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - N Nadjmi
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium; Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Antwerp, Belgium; OMFS Program, University of Antwerp, Antwerp, Belgium
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Zong H, Lou Z, Lou Z, Chen Z. Low-temperature plasma radiofrequency ablation tuboplasty and myringotomy: A preliminary report. Am J Otolaryngol 2023; 44:103766. [PMID: 36592553 DOI: 10.1016/j.amjoto.2022.103766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the efficacy of Low-temperature plasma radiofrequency ablation (RF) tuboplasty and myringotomy for treating chronic otitis media with effusion (COME) with chronic obstructive eustachian tube dysfunction (COETD) involving hypertrophic tissue of the ET orifice. METHODS AND MATERIALS This was a prospective study of 43 ears with COME and COETD who underwent RF tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, tympanometry results, and TM status. Success was defined by an improvement in tympanogram type and Valsalva maneuver. Follow-up ranged from 4 weeks to 12 months. RESULTS A total of 43 ears (43 patients) were included in the study. Mucosal hypertrophy of the ET orifice was seen in 35 (81.4 %) patients, while polypoid tissue was observed in 8 (18.6 %) patients. All patients completed the 12-month follow-up, the success rate was 95.3 % (41/43) at postoperative 3 months, 39/43 (90.4 %) at postoperative 6 months, and 37/43 (86.0 %) at postoperative 12 months. No procedure-related serious adverse events were reported for any patient, and there were no cases of patulous ET. Stenosis/scar of anterior-post wall in the ET orifice occurred in two patients at 6 months postoperatively and in one patient at 12 months postoperatively, which the Valsalva maneuver was positive. Thus, no further treatment was applied for the ET orifice in 3 patients. The risk of stenosis of the ET orifice was 3/47 (6.4 %). CONCLUSIONS RF eustachian tuboplasty may be an effective treatment for patients with COME, COETD and hypertrophic mucosa in the ET orifice, particularly as an adjunct to balloon tuboplasty.
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Affiliation(s)
- Huiqin Zong
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 jiangdong road, Yiwu City 322000, Zhejiang Provice, China
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 jiangdong road, Yiwu City 322000, Zhejiang Provice, China.
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
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Yousefi J, Raeisi Z, Saeedi M, Hasanalifard M, Hosini SM, Abolghasemi R. The effect of ventilation tube insertion in central auditory processing disorders in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol 2023; 167:111498. [PMID: 36868147 DOI: 10.1016/j.ijporl.2023.111498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Otitis media with effusion is one of the most common diseases among children. The purpose of this research is to investigate whether the resolvement of conductive hearing loss from the insertion of a ventilation tube also improves central auditory processing disorders in children with otitis media with effusion. METHOD In this cross-sectional study, 20 children between 6 and 12 years old were diagnosed with otitis media with effusion and 20 normal children were included in the study. The central auditory processing status was evaluated in all patients before ventilation tube insertion and after six months by Speech Discrimination Score, Speech Reception Threshold, Words-in-Noise, Speech in Noise, Consonant Vowel in Noise tests, and the results were compared. RESULTS The mean score of Speech Discrimination Score and Consonant Vowel in Noise tests in the control group were significantly higher than the patient group before ventilation tube insertion and after surgery, in the patient group, the mean scores increased significantly. The mean scores of the Speech Reception Threshold, Words-in-Noise, and Speech in Noise tests in the control group were significantly lower than the patient group before ventilation tube insertion and after the operation, in the patient group, the mean scores significantly decreased. After VT insertion, these tests were close to the control group. CONCLUSION Restituting normal hearing by ventilation tube treatment improves central auditory abilities as shown in speech reception, speech discrimination, the ability to hear, the ability to recognize monosyllabic words, and the power of speech in the presence of noise.
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Affiliation(s)
- Jaleh Yousefi
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran; Department of ENT, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Zahra Raeisi
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran; Department of ENT, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Masoumeh Saeedi
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran; Department of ENT, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mahdieh Hasanalifard
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Seyed Morteza Hosini
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Reyhaneh Abolghasemi
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran.
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22
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Zhang Q, Qiang Y, Xie M, Liu X, Guo R, Shi Y, Ma S, Cheng L, Liu H, Luo H. The effect of OSA on the negative pressure and acoustic compliance of middle ear cavity in children. Int J Pediatr Otorhinolaryngol 2023; 165:111457. [PMID: 36701819 DOI: 10.1016/j.ijporl.2023.111457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/31/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To explore the effect of obstructive sleep apnea (OSA) on the negative pressure and acoustic compliance of middle ear cavity in children. METHODS The clinical data of 258 children with suspected OSA, who complained of mouth breathing or snoring at night in the Department of Otolaryngology Head and neck surgery of the Second Affiliated Hospital of Xi'an Jiao Tong University from August 2020 to March 2022, were enrolled and analyzed retrospectively. The OSA and otitis media with effusion (OME) were determined by polysomnography (PSG) and acoustic immittance examination, respectively. Then, the parameters of tympanometry were compared between OSA and non-OSA children or among the children with various severity of OSA. RESULTS There was no significant difference in the incidence of OME between children with OSA and those with non-OSA (15.80% vs 11.80%, P = 0.422). Compared with non-OSA children, OSA children had lower negative pressure (-56.42 vs -12.38, P < 0.001) and higher acoustic compliance (0.45 vs 0.38, P = 0.030) in middle ear cavity. There were also significant differences in negative pressure and acoustic compliance among children with mild, moderate and severe OSA (P < 0.001; P = 0.001). However, only the absolute value of negative pressure was markedly decreased after surgical therapy accompanied with transformation from OSA to non-OSA (-156.67 vs -45.67, P < 0.05), while this was not observed for acoustic compliance (0.48 vs 0.40, P > 0.05). CONCLUSION OSA may have an adverse influence on the negative pressure and acoustic compliance of middle ear cavity in children.
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Affiliation(s)
- QingQing Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China
| | - Yin Qiang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China
| | - Meng Xie
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China
| | - XiaoHong Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China
| | - RuiXin Guo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China
| | - Yao Shi
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China
| | - SiJing Ma
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China
| | - Long Cheng
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China
| | - HaiQin Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China.
| | - HuaNan Luo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, 710004, China.
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Yılmaz Topçuoğlu MS, Hornberger C, Lucena-Porcel C, Baumann I. [The complex pediatric middle ear hemangioma]. HNO 2023; 71:270-273. [PMID: 36635394 PMCID: PMC10066088 DOI: 10.1007/s00106-022-01261-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/14/2023]
Abstract
Hemangiomas in the pediatric middle ear are a rare occurrence. We present the case of a 3-year-old boy with unilateral hearing impairment and recurrent otitis media with effusion due to a hemangioma in the middle ear. This caused a venous sinus thrombosis, osteomyelitis, and mastoiditis. Interdisciplinary treatment was performed. This case shows that even benign lesions in the middle ear can cause severe, life-threatening complications due to the close proximity of important anatomic structures in the middle ear. Every case of asymmetric hearing loss should thus be examined in detail.
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Affiliation(s)
- Miray-Su Yılmaz Topçuoğlu
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Cornelia Hornberger
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Carlota Lucena-Porcel
- Pathologisches Institut, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland
| | - Ingo Baumann
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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24
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Cleere EF, Crotty TJ, Lang J, Young O, Keogh IJ. Clinical decision making in paediatric otitis media: A pilot quality improvement study. Int J Pediatr Otorhinolaryngol 2023; 164:111395. [PMID: 36434883 DOI: 10.1016/j.ijporl.2022.111395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/06/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to improve local management of paediatric otitis media using the 2022 American-Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) Clinical Practice Guideline for Tympanostomy Tubes in Children. METHODS A SQUIRE 2.0 compliant quality improvement study was carried out within the outpatient department of our otolaryngology tertiary referral centre. Local outpatient management of paediatric otitis media was compared to the AAO-HNS guidelines, specifically focussing on the decision to offer tympanostomy tubes. Following initial audit of practice, an educational session was performed within the otolaryngology department and local practice was subsequently re-evaluated. RESULTS Overall, 88 children were included (46 pre-intervention and 42 post-intervention) with a mean age of 7.6 years (range 1-12 years). Sixty-four (72.7%) children presented with suspected otitis media with effusion. The remainder presented with recurrent or persistent acute otitis media (24/88, 27.3%). Twenty-six children were offered tympanostomy tubes (29.5%). Initial evaluation of practice identified that the decision to offer tympanostomy tubes was guideline appropriate in 76.1% of children (35/46). This significantly improved following an educational session (40/42, 95.2%, p = 0.02). The reasons for non-guideline compliance included: otitis media with effusion <3 months, no evidence of middle ear fluid and patients meeting criteria for tympanostomy tube insertion not being offered. CONCLUSIONS A focussed educational intervention may improve local adherence to guidelines in the management of paediatric otitis media. Continued re-evaluation of local practice is essential in order to ensure children are managed in accordance with the guidelines.
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Motamed S, Amizadeh M, Dabiri S. Langerhans cell histiocytosis presented as bilateral otitis media with effusion, a rare case report. Caspian J Intern Med 2023; 14:401-405. [PMID: 37223299 PMCID: PMC10201119 DOI: 10.22088/cjim.14.2.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/16/2022] [Accepted: 08/10/2022] [Indexed: 05/25/2023]
Abstract
Background Langerhans cell histiocytosis (LCH) or histiocytosis X is considered as a rare disease that may have effect on multiple organs. The initial presentation of LCH is varied. The signs and symptoms of otologic histiocytosis can be the same as the acute or chronic infectious ear diseases. Definitive diagnosis of LCH is confirmed by biopsy and immunohistochemically staining of S-100 protein and CD1a antigen. Chemotherapy is the main mode of treatment. Case presentation In this report, we explained the clinical manifestation, diagnosis and treatment of a case of 15 month-old girl with diagnosed of LCH that initially presented with otitis media with effusion (OME). Conclusion LCH is a rare disease that presented with variable sign and symptoms and have an effect on multiple organs. LCH should be regarded in cases with recurrent ear infection without response to medical treatments. Moreover, biopsy with IHC is the gold standard of diagnosis and chemotherapy is the main form of treatment.
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Affiliation(s)
- Soheil Motamed
- Department of Otorhinolaryngology, Afzalipour faculty of medicine, Kerman University of Medical Sciences, Kerman, Iran
- Student research committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Amizadeh
- Department of Otorhinolaryngology, Afzalipour faculty of medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahriar Dabiri
- Department of Pathology, Afzalipour faculty of medicine, Kerman University of Medical Sciences, Kerman, Iran
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26
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Kanotra S, Purbi S, Bashir S, Sharma P. Endoscopic Treatment of Otitis Media with Effusion. Indian J Otolaryngol Head Neck Surg 2022; 74:4356-4359. [PMID: 36742874 PMCID: PMC9895635 DOI: 10.1007/s12070-021-03012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023] Open
Abstract
Myringotomy with grommet insertion is considered the standard of care for patients with unresolved otitis media with effusion and is traditionally performed under the operating microscope. The introduction of endoscopic ear surgery has provided otologists a tool for minimally invasive ear surgery with a panoramic view. We have described the use of endoscope for myringotomy and grommet insertion. The technique was found to be safe and effective and has the added advantage of being an excellent tool for teaching. The advantages and disadvantages of this technique vis a vis the traditional otomicroscopic technique have been discussed.
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Affiliation(s)
- Sonika Kanotra
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Shweta Purbi
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Seerat Bashir
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Preeti Sharma
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
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27
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McKenna Benoit M, Henry KS, Orlando M, Wong S, Allen P. Tone in Noise Detection in Children with a History of Temporary Conductive Hearing Loss. J Assoc Res Otolaryngol 2022; 23:751-758. [PMID: 36280641 PMCID: PMC9789224 DOI: 10.1007/s10162-022-00871-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/25/2022] [Indexed: 01/06/2023] Open
Abstract
Children with a history of temporary conductive hearing loss (CHL) during early development may show long-term impairments in auditory processes that persist after restoration of normal audiometric hearing thresholds. Tones in noise provide a simplified paradigm for studying hearing in noise. Prior research has shown that adults with sensorineural hearing loss may alter their listening strategy to use single-channel energy cues for tone-in-noise (TIN) detection rather than rove-resistant envelope or spectral profile cues. Our objective was to determine the effect of early CHL on TIN detection in healthy children compared to controls. Children ages 4-7 years, with and without a history of CHL due to otitis media with effusion (OME) before age 3 years, participated in a two-alternative forced choice TIN detection task. Audiometric thresholds were normal at the time of testing. Thresholds for detection of a 1000 Hz tone were measured in fixed-level noise and in roving-level noise that made single-channel energy cues unreliable. Participants included 23 controls and 23 with a history of OME-related CHL. TIN thresholds decreased with increasing age across participants. Children in both groups showed similar TIN sensitivity and little or no threshold elevation in the roving-level condition compared to fixed-level tracks, consistent with use of rove-resistant cues. In contrast to older listeners with sensorineural hearing loss, there was no detectable change in TIN sensitivity with roving level for children with a history of OME-related CHL.
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Affiliation(s)
- Margo McKenna Benoit
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA.
| | - Kenneth S Henry
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
| | - Mark Orlando
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
| | - Stephanie Wong
- Department of Otolaryngology, Virginia Commonwealth University, Virginia, USA
| | - Paul Allen
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
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Dange PS, Bhat VK, Yadav M. Adenoid Morphology and Other Prognostic Factors for Otitis Media with Effusion in School Children. Indian J Otolaryngol Head Neck Surg 2022; 74:3649-3653. [PMID: 36742487 PMCID: PMC9895436 DOI: 10.1007/s12070-020-02332-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction This study aimed to compare the children having enlarged adenoids with and without otitis media with effusion (OME) concerning clinical features like mouth breathing, snoring, recurrent episodes of cold, hearing impairment and specific morphology of adenoid. Further, the flora of adenoid tissue and middle ear fluid were also compared. Methods One hundred and twenty children having clinical features suggestive of enlarged adenoids with [Group A (n = 60)] or without [Group B (n = 60)] OME were included in this cross-sectional study. All patients underwent clinical examination, diagnostic nasal endoscopy, radiography of the nasopharynx, blood absolute eosinophil count and immittance. Core adenoid tissue was subjected to microbiological culture after adenoidectomy. OME fluid was subjected to microbial analysis after myringotomy. Results In group A patients, snoring was present in 90% (p = 0.011), adenoid facies in 76.6% (p < 0.001) and tubal tonsil enlargement in 86.7% (p < 0.001). The parts related to the development of OME were: behind the posterior cushion in 86%, touching the posterior end of septum in 76.7%, inside nasal cavity in 70% and completely covering the Eustachian tube orifices in 95% (p < 0.001 in all of them). Conclusion Specific morphology of adenoid enlargement and tubal tonsil enlargement was more critical in predicting the risk of developing OME and not just the grade of adenoid hypertrophy. The microbial flora in the adenoid core was similar in children with and without OME.
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Affiliation(s)
- Prajwal Shrirang Dange
- Department of Otolaryngology, Head and Neck Surgery, Mysore Medical College, Mysore, India
| | - Vikram Kemmannu Bhat
- Department of Otolaryngology, Head and Neck Surgery, Karnataka Institute of Medical Sciences, Hubli, India
| | - Mona Yadav
- Department of Otolaryngology, Head and Neck Surgery, Karnataka Institute of Medical Sciences, Hubli, India
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Araújo ES, Jacob LCB, Oliveira MTDD, Chaves JN, Oliveira EB, Saters TL, Alvarenga KDF. Wideband absorbance for the assessment of pressure equalizing tubes patency in children. Int J Pediatr Otorhinolaryngol 2022; 162:111309. [PMID: 36099781 DOI: 10.1016/j.ijporl.2022.111309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/27/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze the feasibility of using wideband absorbance to verify the patency of pressure equalizing tubes (PETs) in clinical practice and to present the response pattern of this measure for ears with patent PET. METHODS This observational case-control type study evaluated 48 ears of 30 children with severe or profound hearing loss, aged 10-44 months, of both sexes. The subjects were subdivided into two groups: 24 ears with Sheppard type PET (experimental group - EG) and 24 ears with normal middle ear (control group - CG), paired with the EG, according to age, sex, and ear evaluated. To obtain the wideband absorbance, a Middle-Ear Power Analyzer, version 5.0 (Mimosa Acoustics), was used, and absorbance values for pure tone and chirp stimuli were analyzed. RESULTS There was no influence of ear (right or left) on the measurements obtained. The EG showed higher absorbance values at low frequencies. Although the two stimuli made it possible to identify the difference in acoustic transfer function between the groups studied, compared to pure tone, the chirp stimulus allowed identification of differences in a higher number of frequencies. CONCLUSIONS Ears with a patent PET present an acoustic transfer pattern that differs from that obtained for normal middle ears, with a higher absorbance at low frequencies. Both pure tone and chirp stimuli can be used to identify such differences, nevertheless, the use of chirp stimulus is recommended, since it allows differentiation over a wider frequency range.
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Affiliation(s)
- Eliene Silva Araújo
- Department of Speech-Language Pathology and Audiology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Lilian Cassia Bornia Jacob
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry / University of São Paulo, FOB / USP, Bauru, São Paulo, Brazil
| | - Maria Taiany Duarte de Oliveira
- Graduate Program in Speech, Language and Hearing Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Juliana Nogueira Chaves
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - Eduardo Boaventura Oliveira
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - Thais Lenharo Saters
- Graduate Program in Speech, Language and Hearing Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Kátia de Freitas Alvarenga
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry / University of São Paulo, FOB / USP, Bauru, São Paulo, Brazil
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Zhang QQ, Guo RX, Xie M, Qiang Y, Shi Y, Liu XH, Cheng L, Liu HQ, Luo HN. Hypoxia in non-rapid eye movement sleep in children with otitis media with effusion. J Int Med Res 2022; 50:3000605221133659. [PMID: 36310499 PMCID: PMC9619286 DOI: 10.1177/03000605221133659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective This study aimed to analyze the status of hypoxia in non-rapid eye movement (NREM) sleep in children with otitis media with effusion (OME). Methods A total of 232 children with OME and/or adenotonsillar hypertrophy were enrolled in this retrospective study between August 2020 and November 2021. Polysomnographic monitoring was carried out, and the differences in polysomnographic results between the experimental group (children with OME and adenotonsillar hypertrophy) and control group (children with adenotonsillar hypertrophy only) were compared. Results The lowest oxygen saturation level during sleep was significantly lower in the experimental group (n = 36) than in the control group (n = 196). However, the apnea-hypopnea index, respiratory disorder index, apnea index, obstructive apnea index, obstructive apnea-hypopnea index, and mixed apnea-hypopnea index were significantly higher in the experimental group than in the control group. More importantly, the apnea-hypopnea index, the oxygen desaturation index, oxygen desaturation events, the average heart rate during NREM sleep, and the NREM stage in total sleep time were also significantly higher in the experimental group than in the control group. Conclusions Hypoxia during NREM sleep may affect the severity of OME in children.
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Affiliation(s)
- Qing-Qing Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Rui-Xin Guo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Meng Xie
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Yin Qiang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Yao Shi
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Xiao-Hong Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Long Cheng
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Hai-Qin Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Hua-Nan Luo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
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Mirashrafi F, Emami H, Bagheri Z, Rahavi-Ezabadi S. Middle Ear Status in Cleft Lip and Palate Patients: A Five-Year Follow-Up. Iran J Otorhinolaryngol 2022; 34:247-251. [PMID: 36246200 PMCID: PMC9515997 DOI: 10.22038/ijorl.2022.62094.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/30/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION The best strategy to treat otitis media with effusion in cleft lip/palate patients is still under debate. This research aimed to evaluate the otologic outcomes in children at least five years post-repair. MATERIALS AND METHODS A retrospective study was conducted on 40 children who underwent palatoplasty between January 1, 2012, and January 1, 2014, at Children's Medical Center (Tehran, Iran). Patients had intervelar veloplasty under magnification (Sommerlad's Technique). Based on patients' charts, their age, gender, cleft type, date of palatoplasty, as well as the date and the frequency of ventilation tube (VT) insertion, were recorded. Furthermore, otomicroscopy, middle ear status, and tympanometry were assessed five years postoperatively. RESULTS There was no significant difference in middle ear status between children with complete and incomplete cleft palates. The mean age at the time of study and the mean follow-up duration were significantly higher in the normal middle ear group, compared to the abnormal middle ear group (7.7±1.6 vs. 6.8±0.9, P=0.03 and 6±1.15 vs. 5.42±0.9, P=0.04, respectively). Middle ear status was not significantly different between early or late palatoplasty patients. In addition, the frequency and timing of VT insertion were not significantly different between the two groups. CONCLUSIONS Middle ear status improved as patients grew older; however, the age of palatoplasty and the frequency of VT insertion were not significant prognostic factors in patients who underwent intervelar veloplasty under magnification.
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Affiliation(s)
- Fatemeh Mirashrafi
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamed Emami
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zeinab Bagheri
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sara Rahavi-Ezabadi
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Qarib Street, Keshavarz Blvd, 14194, Tehran, Iran. E-mail:
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Urban MJ, Wojcik C, Losenegger T, Hammond R, Barry S, Jagasia A, Filpo W, Jagasia AJ. Incorporating hearing screening to an otolaryngology surgical mission in the rural Dominican Republic. Int J Pediatr Otorhinolaryngol 2022; 160:111222. [PMID: 35839652 DOI: 10.1016/j.ijporl.2022.111222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/20/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Hearing loss disproportionately affects low- and middle-income countries. Children with undiagnosed hearing loss may have difficulty with learning, language development, and behavior. The aim of this study was to understand the extent of hearing loss and common otologic disorders among school-age children in the rural western region of the Dominican Republic and to chronical the early stages of a limited-resource, locally-sustained hearing screening program in tandem with a bi-annual surgical mission. METHODS Hearing screenings were performed for 528 school-age children (1056 ears, age 5-17 years old) over 5 days in a village hospital in Peralta, DR. Testing initially included otoscopy and screening audiometry. Children who referred or could not be conditioned underwent distortion product otoacoustic emissions (OAEs), and tympanometry. Children who referred following both screening audiometry and OAEs were considered to have hearing loss. Those with normal tympanograms were considered potential hearing aid candidates. RESULTS Abnormal ear examination/otoscopic results were present in 43 children (8.1%) and included: microtia/atresia, impacted cerumen, ear canal foreign body, serous otitis media, otitis externa, and tympanosclerosis. 55 of 528 school-age children referred following screening audiometry and 7 were unable to condition. Of these 62 children, 56 tolerated OAEs and 20 referred following OAEs (3.8%). Fourteen children had type B or C tympanogram and 6 school-age children who were determined to have chronic otitis media with effusion (COME) underwent myringotomy and pressure equalization tube placement. Ten of 528 children (1.9%) had normal tympanometry and otoscopy, and referred following screening audiometry and OAEs suggesting the patients may be potential hearing aid candidates. CONCLUSIONS The prevalence of hearing loss in this cohort of children in the rural, western Dominican Republic was high at roughly 4% with roughly 2% of children being potential hearing aid candidates. Nearly 10% of children screened had an abnormal otologic examination; sometimes easily remedied by otolaryngologic intervention. With the support of local leadership, it is feasible to incorporate hearing services into otolaryngology outreach and build locally sustainable programs.
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Affiliation(s)
- Matthew J Urban
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, 60612, USA.
| | - Christopher Wojcik
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, 60515, USA
| | - Tasher Losenegger
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Rachel Hammond
- Department of Communication Disorders and Sciences, Rush University, Chicago, IL, 60612, USA
| | - Shannon Barry
- Department of Communication Disorders and Sciences, Rush University, Chicago, IL, 60612, USA
| | | | | | - Ashok J Jagasia
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
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Toizumi M, Satoh C, Quilty BJ, Nguyen HAT, Madaniyazi L, Le LT, Ng CFS, Hara M, Iwasaki C, Takegata M, Kitamura N, Nation ML, Satzke C, Kumai Y, Do HT, Bui MX, Mulholland K, Flasche S, Dang DA, Kaneko K, Yoshida LM. Effect of pneumococcal conjugate vaccine on prevalence of otitis media with effusion among children in Vietnam. Vaccine 2022; 40:5366-5375. [PMID: 35934579 DOI: 10.1016/j.vaccine.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/28/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Otitis media with effusion (OME) is common in young children and is associated with Streptococcus pneumoniae infection. We aimed to determine the impact of pneumococcal conjugate vaccine (PCV) introduction on the prevalence of OME and OME associated with vaccine-type (VT) or non-VT. METHODS Population-based cross-sectional surveys were conducted in pre- (2016) and post-PCV periods (2017, 2018, and 2019) at selected communes in Nha Trang, Vietnam. For each survey, we randomly selected 60 children aged 4-11 months and 60 aged 14-23 months from each commune. Nasopharyngeal sample collection and tympanic membrane examination by digital otoscope were performed. S. pneumoniae was detected and serotyped by lytA qPCR and microarray. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using Firth's logistic regression, stratified by age group. RESULTS Over the four surveys, 2089 children had a bilateral ear examination. Compared to pre-PCV, the prevalence of OME reduced in 2018 (OR 0.51, 95 %CI 0.28-0.93) and in 2019 (OR 0.53, 95 %CI 0.29-0.97) among the <12-month-olds, but no significant reduction among the 12-23-month-olds. The prevalence of OME associated with VT pneumococcus decreased in 2018 and 2019 (2018: OR 0.14, 95 %CI 0.03-0.55; 2019: OR 0.20, 95 %CI 0.05-0.69 in the <12-months-olds, 2018: OR 0.05, 95 %CI 0.00-0.44, 2019: OR 0.41, 95 %CI 0.10-1.61 in the 12-23-months-olds). The prevalence of OME associated with non-VT pneumococcus increased in the 12-23-month-olds in 2017 (OR 3.09, 95 %CI 1.47-7.45) and returned to the pre-PCV level of prevalence in 2018 and 2019 (OR 0.94, 95 %CI 0.40-2.43 and 1.40, 95 %CI 0.63-3.49). CONCLUSION PCV10 introduction was associated with a reduction of OME prevalence in infants but not in older children.
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Affiliation(s)
- Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chisei Satoh
- Department of Otorhinolaryngology, Nagasaki University Hospital, Nagasaki, Japan
| | - Billy J Quilty
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lina Madaniyazi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Lien Thuy Le
- Department of Bacteriology, the Pasteur Institute in Nha Trang, Nha Trang, Viet Nam
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minoru Hara
- Department of Otorhinolaryngology, Kamio Memorial Hospital, Tokyo, Japan
| | - Chihiro Iwasaki
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Noriko Kitamura
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Yoshihiko Kumai
- Department of Otorhinolaryngology, Nagasaki University Hospital, Nagasaki, Japan
| | - Hung Thai Do
- Department of Bacteriology, the Pasteur Institute in Nha Trang, Nha Trang, Viet Nam
| | | | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Kenichi Kaneko
- Department of Otorhinolaryngology, Nagasaki University Hospital, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
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Yoshida S, Seki S, Sugiyama T, Kikuchi S, Iino Y. Clinical characteristics of atelectatic eardrums and adhesive otitis media in children. Int J Pediatr Otorhinolaryngol 2022; 159:111188. [PMID: 35653949 DOI: 10.1016/j.ijporl.2022.111188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/26/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Atelectatic eardrum and adhesive otitis media in children are related to persistent otitis media with effusion (OME) and eustachian tube dysfunction in infancy. However, the pathogenesis of these diseases is not fully understood, and some cases even progress to pars tensa cholesteatoma. This study analyzed the clinical characteristics of children with atelectatic eardrum and adhesive otitis media to clarify associated causes of and risk factors for progression of these middle ear pathologies in children. PATIENTS AND METHODS This retroactive study included 38 ears of 31 children with atelectatic eardrums (atelectasis group), and 19 ears of 17 children with adhesive otitis media (adhesive OM group). Thirty-two contralateral non-cholesteatoma ears of 32 children with congenital cholesteatoma were also examined as a control group. Participants were aged 15 or younger. Life history (obtained via questionnaire), associated diseases, hearing acuity, aeration and development of the temporal bone were investigated. RESULTS All children in the atelectasis and adhesive OM groups had a history of recurrent acute otitis media (rAOM) and/or OME. The prevalence of perennial allergic rhinitis was 18 cases (58%) in the atelectasis group and 16 cases (94%) in the adhesive OM group. The prevalence of perennial allergic rhinitis was significantly higher in the adhesive OM group compared to the control group (P < 0.01). The development of mastoid air cells, categorized by MC classification, showed MC0 + MC1 (poor pneumatization) in 19 ears (50.0%) with atelectatic eardrums and 12 ears (63.2%) with adhesive OM. Poor pneumatized mastoid was more frequently observed in the ears of the atelectasis and adhesive OM groups compared to the control group (P < 0.01). No significant difference was found in regards to aeration of the middle ear between the two groups; however, aeration was significantly poorer in both groups compared to the control group (P < 0.01). Three characteristics were analyzed using multivariate logistic regression: perennial allergic rhinitis (odds ratio [OR] 4.319, P = 0.013), poor mastoid pneumatization (OR 8.457, P = 0.012), and pars flaccida retraction pocket (OR 20.897, P = 0.006). These characteristics were shown to be significant risk factors for atelectatic eardrums and adhesive OM. In addition, the predisposition to perennial allergic rhinitis was shown to be the most important factor in the progression from atelectatic eardrum to adhesive otitis media (OR 16.615, P = 0.012). CONCLUSION Children with perennial allergic rhinitis, poor development of mastoid air cells, poor aeration of the temporal bone, and with pars flaccida retraction pocket were at an increased risk of developing an atelectatic eardrum and adhesive OM. In particular, perennial allergic rhinitis was shown to be a significant risk factor in the progression from atelectatic eardrum to adhesive otitis media. Allergic inflammation may affect not only the nasal passages but also the eustachian tube, resulting in persistent middle ear dysfunction. Therefore, children with rAOM/OME who have these risk factors should be carefully monitored and treat over time in effort to prevent progression of pathology.
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Affiliation(s)
- Saeko Yoshida
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan.
| | - Saori Seki
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
| | - Tomonori Sugiyama
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
| | - Saori Kikuchi
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
| | - Yukiko Iino
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
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Otsuka S, Imai R, Kamakura T, Nishimura H, Osaki Y, Furukawa M, Yasui T, Yamashita M, Nakamura M, Iwamoto Y, Kanazu K, Yonei S, Okazaki S, Hirose M. How long do tympanostomy ventilation tubes last in pediatric patients with otitis media with effusion or adhesion? A study using Kaplan-Meier survival analysis. Int J Pediatr Otorhinolaryngol 2022; 159:111210. [PMID: 35724491 DOI: 10.1016/j.ijporl.2022.111210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the functional duration and survival rate of tympanostomy ventilation tubes and the complications associated with their use in pediatric patients who underwent tube insertion for otitis media with effusion (OME). Complications were analyzed including recurrence and tympanic membrane perforation after the tube removal or extrusion. METHODS Altogether, 447 ears from 234 pediatric patients younger than 15 years of age were studied retrospectively. All patients had undergone long-term tympanostomy ventilation tube: the Goode T-tube insertion for OME at the Osaka Women's and Children's Hospital, which is the pediatrics specialty hospital between April 2014 and March 2016. They were typically followed up every 3-4 months or more frequently if necessary due to otorrhea or tube infection. Subsequently, the tube duration, survival rates of the tube especially at 22 months after insertion defined as "full-term placement", and the rates of recurrence and perforation were calculated and statistically evaluated. RESULTS Of 447 ears, 335 ears from 184 patients underwent their first tube insertion, and 112 ears from 64 patients underwent their second or subsequent tube insertion within the targeted period. Two hundred ears from 106 patients were associated with a cleft palate. The survival rate at full-term placement was 51.7%. The recurrence rate was 56.3%, and the rate of the tympanic perforation was 8.5%. CONCLUSIONS Approximately half of the tubes survived for 22 months. The perforation rate was relatively low; however, recurrence of OME was seen in more than half the ears.
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Affiliation(s)
- Shintaro Otsuka
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology, Nara City Hospital, 1-50-1 Higashikideracho, Nara, Nara, 630-8305, Japan
| | - Ryusuke Imai
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroshi Nishimura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Yasuhiro Osaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masashi Furukawa
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Furukawa ENT Clinic, 5-1 Oharacho, Ashiya, Hyogo, 659-0092, Japan
| | - Toshimichi Yasui
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Yasui ENT Clinic, 1294-1 Minaminakayasumatsu, Izumisano, Osaka, 598-0033, Japan
| | - Maki Yamashita
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Megumi Nakamura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Yoriko Iwamoto
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Kimi Kanazu
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Shinichi Yonei
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Suzuyo Okazaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Masayuki Hirose
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
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Moniri AB, Lino J, Aziz L, Rosenfeld RM. Autoinflation compared to ventilation tubes for treating chronic otitis media with effusion. Acta Otolaryngol 2022; 142:476-483. [PMID: 35787134 DOI: 10.1080/00016489.2022.2088855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Otitis media with effusion (OME) is the most common cause of acquired hearing loss and surgery in children. Autoinflation has been suggested as an alternative treatment for OME. OBJECTIVES The aim of the study was to compare treatment outcome with a new autoinflation device versus ventilation tube (VT) surgery or watchful waiting in children with chronic bilateral OME from the waiting list for surgery. METHODS Forty-five children performed autoinflation during four weeks, forty-five were submitted to VT surgery, and twenty-three were enrolled as control group. Tympanometry was performed in the autoinflation and the control groups and audiometry in all groups. RESULTS An equivalent hearing improvement was achieved in the autoinflation and the VT group at one (p=.19), six (p=.23) and twelve (p=.31) months with no significant alteration in the control group. In the autoinflation group 80% of the children avoided surgery and no complications were reported compared to 34% complication rate in the VT group. CONCLUSION Autoinflation achieved an equivalent improvement in hearing thresholds compared to VT surgery for treating OME. SIGNIFICANCE Autoinflation may be a reasonable first-line treatment for children with OME to potentially avoid surgery.Article Summary: The Moniri autoinflation device is well tolerated and an effective alternative to ventilation tubes for treatment of chronic otitis media with effusion in young children.What's known on this subject: Previous studies have shown that autoinflation may reduce effusion in children with otitis media with effusion; however limited compliance to treatment, lack of adequate hearing evaluation, short follow-up time and also lack of comparative data to ventilation tube surgery have been reported.What this study adds: A new device was developed to allow for the performance of autoinflation in young children. The effect is compared to ventilation tube surgery and equivalent improvement in hearing is achieved in the short and the long-term follow-up.
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Affiliation(s)
- Armin B Moniri
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.,Regenerative Medicine Program, Department of Biomedical Sciences and Medicine, University of Algarve, Campus da Penha, Faro, Portugal.,Algarve Biomedical Center (ABC), Campus de Gambelas, Faro, Portugal
| | - João Lino
- Department of Otorhinolaryngology, Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Médicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Luaay Aziz
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Kourelis K, Angelopoulou M, Goulioumis A, Fouzas S, Kourelis T. Surgery for adenotonsillar hypertrophy and otitis media in children is less demanded in quarantine times. Int J Pediatr Otorhinolaryngol 2022; 158:111169. [PMID: 35552162 DOI: 10.1016/j.ijporl.2022.111169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/21/2022] [Accepted: 04/30/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In the COVID-19 era, extreme measures of social distancing have contained the spread of common viral respiratory infections, which are involved in the pathogenesis of Adenotonsillar Hypertrophy (ATH), and Chronic Otitis Media with Effusion (COME), the two commonest chronic ENT diseases of childhood. This study examines the lockdown effect on the number of procedures performed for these two conditions. METHODS The consecutive charts of 650 and 195 children being operated respectively for ATH and COME during the quarantine (05/2020-02/2021) and unrestrained (05/2019-02/2020) periods were retrospectively reviewed. Surgical treatment of ankyloglossia, performed in 103 patients during the same periods was employed as a control procedure. RESULTS Adenotonsillectomies and tympanostomies significantly decreased in the lockdown phase by 52% (P < 0.001) and 74% (P < 0.001), respectively, whereas control procedure counts increased by 25%. In terms of seasonal variation, ATH-related surgeries were significantly reduced during the winter season of the pandemic by 73% (P < 0.001), in comparison with the corresponding months of the unrestrained period. School-aged children received significantly fewer operations for ATH (-59%) than preschoolers (-42%), as a result of the lockdown (P = 0.044). CONCLUSION When the child's exposure to respiratory pathogens is minimal, as in the case of lockdown, a noticeable decline occurs in the incidence of ATH and COME indicated for surgical treatment. Chronic low-grade inflammation, boosted by repetitive viral infections seems to underlie both conditions. Timely, effective isolation measures might reverse the disease process and keep the child away from the Operating Room.
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Affiliation(s)
- Konstantinos Kourelis
- Department of Otolaryngology, Children's Hospital of Patras "Karamandaneio", 26331, Patras, Greece.
| | - Maria Angelopoulou
- Department of Otolaryngology, Children's Hospital of Patras "Karamandaneio", 26331, Patras, Greece
| | - Anastasios Goulioumis
- Department of Otolaryngology, Children's Hospital of Patras "Karamandaneio", 26331, Patras, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, University Hospital of Patras, 26504, Patras, Greece
| | - Theodoros Kourelis
- Department of Medical Oncology, "Olympian" General Hospital, 26443, Patras, Greece
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Bamaraki K, Namwagala J, Hidour R, Bambi EN. Otitis media with effusion in children aged 2-12 years attending the paediatric clinic at Mulago National Referral Hospital, a Ugandan tertiary hospital: a cross-sectional study. BMC Pediatr 2022; 22:357. [PMID: 35733177 PMCID: PMC9214977 DOI: 10.1186/s12887-022-03408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Otitis media with effusion (OME) is common in children aged between 6 months to 4 years, and it is one of the causes of hearing loss (HL) in children worldwide. OME is a type of inflammation of the middle ear in which there is a collection of fluid. The latter causes HL which interferes with speech and language development, communication skills, school performance, psychosocial skills, and quality of life of children. Methods This was a prospective cross-sectional study on 246 children aged 2 -12 years, attending the Mulago National Referral Hospital (MNRH). A consecutive sampling procedure was used to reach each participant under ethical considerations until the sample size was reached. All children aged 2–12 years who meet inclusion criteria were examined first by the Pediatrician and then by the Principal Investigator. Patients with tympanogram type B (flat curve) were diagnosed to have OME. The prevalence of OME was summarized as a proportion and multivariate analysis was used to determine the factors associated with OME. Data were analyzed using the STATA version 13.0. Results A total of 246 children were recruited for the study. Of the 246 children, 60% were male. The median age of the participants was 4.8 ± 2.8 years. The prevalence of OME was found to be 11%. Upper respiratory tract infections (URTI), recurrent AOM (p = 0.005, OR:5.14, 95% CI: 1.66–15.96), and snoring (p = 0.000, OR: 6.32, 95% CI: 2.32–17.26) were found to be strongly associated with OME in children aged 2–12 years attending the Mulago National Referral Hospital. Conclusions The prevalence of OME among children aged 2–12 years attending MNRH was found to be 11%. There is an association between OME and URTI, recurrent AOM, and snoring in children aged 2–12 years attending MNRH.
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Affiliation(s)
- Kabagambe Bamaraki
- Department of Ear, Nose, and Throat, Makerere University, College of Health Sciences, Kampala, Uganda.
| | - Justine Namwagala
- Department of Ear, Nose, and Throat, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Rym Hidour
- Department of Ear, Nose, and Throat, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Emma Nsalazi Bambi
- Department of Pediatrics and Child Health, Makerere University, College of Health Sciences Kampala, Kampala, Uganda
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Kouhi A, Xia A, Khomtchouk K, Santa Maria PL. Minimally invasive trans-tympanic eustachian tube occlusion animal model. Int J Pediatr Otorhinolaryngol 2022; 156:111070. [PMID: 35228098 DOI: 10.1016/j.ijporl.2022.111070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/27/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Eustachian tube dysfunction is believed to be involved in the pathogenesis of many middle ear diseases including chronic suppurative otitis media. We aimed to describe a simple and reliable animal model of Eustachian Tube obstruction to further research into middle ear disorders. STUDY DESIGN Prospective cohort study in animals. SETTING University laboratory. SUBJECTS AND METHODS 30 mice C57Bl/6J (n = 15) and CBA/CaJ (n = 15) aged 6-8 weeks received transtympanic Eustachian tube occlusion on left ear trough an acute tympanic membrane perforation using thermoplastic latex used in dental procedures (gutta percha). Control mice (n = 6) received tympanic membrane perforation only. At two and four weeks, the mice were observed for signs of Eustachian tube dysfunction and compared to control ears. ET dysfunction was defined as presence of effusion in the middle ear. RESULTS 100% (n = 30) of the treated ears had otoscopic signs of Eustachian tube dysfunction at two weeks and the endpoint time of four weeks, compared to 0% in control mice (0/6). Temporary head tilt lasting up to 2 days were observed in 3 mice (10%). No other potential adverse events were recorded. No bacterial growth was determined in the middle ear fluid. CONCLUSION We describe a technically easy and reliable method for Eustachian tube occlusion in mice with an excellent success rate and minimal morbidity.
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Affiliation(s)
- Ali Kouhi
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, USA; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anping Xia
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, USA
| | - Kelly Khomtchouk
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, USA
| | - Peter Luke Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, USA.
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Sait S, Alamoudi S, Zawawi F. Management outcomes of otitis media with effusion in children with down syndrome: A systematic review. Int J Pediatr Otorhinolaryngol 2022; 156:111092. [PMID: 35290945 DOI: 10.1016/j.ijporl.2022.111092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/24/2021] [Accepted: 02/26/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assesses the current state of uncertainty concerning the management options used for otitis media with effusion (OME) in children with trisomy 21. REVIEW METHODS A systematic review of adhering to the PRISMA statement of studies evaluating the management of OME in trisomy 21 children prior to September 2021 was conducted. Studies were identified using the following medical databases: PubMed, Google Scholar, CINAHL, Scopus and Medline. Data extraction was performed by screening of titles and abstracts based on eligibility criteria, followed by full-article analysis of selected records. RESULTS Twenty articles were included in this review. Studies showed conflicting outcomes regarding the different interventions used for OME in children with trisomy 21. Of those evaluating pressure equalizing tubes (PET), some studies report pronounced complication rates and recommend using a conservative approach unless complications arise and/or hearing loss is severe. In contrast, other studies reported significantly reduced complication rates and improved hearing with earlier intervention and adaptations to PETs. Hearing aids may be provided after multiple failed PETs. CONCLUSION Clinical equipoise still persists regarding the best method to manage children with trisomy 21 who have OME. Although PETs exhibited the lowest complication rates and highest improvement rates, further prospective trials are warranted to assess the various treatment modalities and determine which of them would provide the best outcome while reducing complications as well as the age of treatment.
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Affiliation(s)
- Salam Sait
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sarah Alamoudi
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Faisal Zawawi
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
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Walsh R, Reath J, Gunasekera H, Leach A, Kong K, Askew D, Girosi F, Hu W, Usherwood T, Lujic S, Spurling G, Morris P, Watego C, Harkus S, Woodall C, Tyson C, Campbell L, Hussey S, Abbott P. INFLATE: a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children. Trials 2022; 23:309. [PMID: 35421984 PMCID: PMC9009496 DOI: 10.1186/s13063-022-06145-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 03/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children. METHODS/DESIGN This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3-16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken. DISCUSSION INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12617001652369 . Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration.
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Affiliation(s)
- Robyn Walsh
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Amanda Leach
- Menzies School of Health Research, Darwin, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Deborah Askew
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Federico Girosi
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Timothy Usherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sanja Lujic
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Geoffrey Spurling
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service) Queensland Health, Brisbane, Australia
| | - Peter Morris
- Menzies School of Health Research, Darwin, Australia
| | - Chelsea Watego
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | | | - Claudette Tyson
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Sylvia Hussey
- Townsville Aboriginal and Islander Health Service, Townsville, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Sydney, Australia.
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Wynings EM, Jaffal H, St John R, Johnson RF, Chorney SR. Mechanical ventilation and middle ear effusions among tracheostomy-dependent children. Int J Pediatr Otorhinolaryngol 2022; 155:111062. [PMID: 35202901 DOI: 10.1016/j.ijporl.2022.111062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/28/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the cumulative 24-month incidence of middle ear effusion (MEE) among tracheostomy-dependent children requiring ventilatory support. METHODS A prospective longitudinal cohort study included all children under 2 years of age with a tracheostomy placed at a tertiary care children's hospital between 2015 and 2020 that obtained at least one tympanometry exam. The development of MEE, defined as a flat tympanogram with normal external canal volume, and mechanical ventilation requirement at examination were recorded. RESULTS Ninety-four children with a mean age at tracheostomy of 5.4 months (SD: 3.7) were included. During a mean follow-up of 18.3 months (SD: 14.6) (median: 14.1 months, interquartile range: 6.6-27.8), 192 tympanometry examinations were obtained with 59% (114/192) while requiring mechanical ventilation. Within 24 months after tracheostomy, 56.5% (95% CI: 48.9-64.4%) of children developed at least one MEE. Among those on mechanical ventilation, 74.0% (95% CI: 65.6-82.5%) developed MEE compared to 31.2% (95% CI: 21.4-44.0%) not on mechanical ventilation (HR: 2.97, 95% CI: 1.46-6.05, P = .003). A persistent MEE on two consecutive exams was not statistically more common for children on a ventilator (OR: 0.64, 95% CI: 0.01-6.95, P = .70). When controlling for age at exam, craniofacial syndrome, and newborn hearing test results on logistic regression, ventilator-dependence significantly predicted the presence of MEE (OR: 2.34, 95% CI: 1.18-4.68, P = .02). CONCLUSION Children with a tracheostomy were more likely to develop MEE when requiring mechanical ventilation. Clinicians should recognize this risk factor and appropriately assess for development of MEE to mitigate adverse speech and language development outcomes in this vulnerable population.
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Affiliation(s)
- Erin M Wynings
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hussein Jaffal
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Rachel St John
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA.
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Iemura-Kashiwagi M, Okano T, Iwai N, Taniguchi M, Omori K. Prognosis of otitis media with effusion in pediatric patients with cleft palate during language-acquisition period treated by simultaneous tympanostomy tube placement with palatoplasty. Int J Pediatr Otorhinolaryngol 2022; 155:111071. [PMID: 35217270 DOI: 10.1016/j.ijporl.2022.111071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 01/30/2022] [Accepted: 02/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cleft palate (CP) in children is frequently complicated by otitis media with effusion (OME) due to Eustachian tube dysfunction. Although tympanostomy tube (TT) placement can be beneficial in the treatment of OME to prevent short-term hearing loss, there is no consensus regarding the indications for and timing of TT insertion. The present study was performed to define the safety and effectiveness of simultaneous TT placement with palatoplasty during the language-acquisition period. METHODS We retrospectively reviewed the medical charts of pediatric patients who underwent palatoplasty for CP in a tertiary medical center, Kyoto University Hospital, from June 2010 to October 2018. The TT retention time was estimated using the Kaplan-Meier method. The incidence of OME recurrence was compared among four Veau classification groups based on the patients' sex, type of CP, median TT retention time, and type of fluid. RESULTS Seventy-six subjects (150 ears) were enrolled in the study. The median follow-up duration was 48.7 months (range, 18.2-108.0 months) after the first TT placement. A first TT retention time of <20.1 months was a significant risk factor for OME recurrence. Subjects with maxillofacial anomaly complex and subjects with cleft lip and palate and an alveolar cleft showed a significantly higher OME recurrence rate than subjects with clefts only in the hard and/or soft palate. There was no significant difference in the occurrence of sequelae between subjects with only a single TT placement and subjects with more than one TT placement. CONCLUSIONS Based on the findings of the present study, it is reasonable to perform TT insertion at the same time as palatoplasty on patients who meet the indications. This technique may reduce the number of times the patient requires general anesthesia and maintain good middle ear condition during the period of language acquisition between 1 and 3 years of age.
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Affiliation(s)
- Maho Iemura-Kashiwagi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Otolaryngology-Head and Neck Surgery, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Takayuki Okano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Noriko Iwai
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Iwai Clinic, Hirakata, Japan
| | - Mirei Taniguchi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ikeda R, Hidaka H, Ito M, Kamide Y, Kuroki H, Nakano A, Yoshida H, Takahashi H, Iino Y, Harabuchi Y, Kobayashi H. Pharmacotherapy focusing on for the management of otitis media with effusion in children: Systematic review and meta-analysis. Auris Nasus Larynx 2022:S0385-8146(22)00072-4. [PMID: 35341623 DOI: 10.1016/j.anl.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/15/2022] [Accepted: 03/13/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the evidence for treating children with otitis media with effusion with pharmacotherapy. DATA SOURCES For the systematic review, data were retrieved from PubMed, Cochrane database, and the Japan Medical Abstracts Society Database (1st January 1995 through 31th May 2019). STUDY SELECTION Articles addressing pharmacotherapy for the management of otitis media with effusion in children were selected in English. DATA EXTRACTION The database was searched using the keywords "Otitis Media with effusion or secretory otitis media" and the following medical agents: carbocysteine, antihistamines, leukotriene receptor antagonist, and steroid nasal spray. DATA SYNTHESIS After a critical review of 18 studies, studies addressing steroid nasal spray were eligible for quantitative synthesis. Intranasal steroids for OME showed no benefit with OR 1.155 (95% CI 0.834-1.598) within one month. Conversely, intranasal steroids have effects for OME with OR 1.858 (95% CI 1.240-2.786) for more than one month. CONCLUSIONS We found evidence of benefit from treatment of OME in children with intranasal steroids and S-carboxymethylcysteine at longer-term follow-up.
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Yunaiyama D, Aoki A, Kobayashi H, Someya M, Okubo M, Saito K. Eustachian tube involvement in a patient with relapsing polychondritis detected by magnetic resonance imaging: A case report. World J Clin Cases 2022; 10:1441-1446. [PMID: 35211581 PMCID: PMC8855176 DOI: 10.12998/wjcc.v10.i4.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/28/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Relapsing polychondritis (RP) is a rare inflammatory disease involving the systemic cartilage, such as the auricle, trachea, and bronchiole, among others. A patient with RP shows variable symptoms based on the involved cartilage.
CASE SUMMARY A 72-year-old Japanese woman with a history of redness of the bilateral auricles for 3 d was referred to a clinician. The clinician prescribed antibiotics to the patient; however, the symptoms worsened; thus, she was referred to our hospital. Head and neck magnetic resonance imaging (MRI) showed edematous auricle with remarkable contrast, fluid collection in the bilateral mastoid cells, suggesting otitis media. The eustachian tube (ET) on the right side was also edematous with contrast enhancement. The patient was suspected of RP according to the diagnostic criteria. A biopsy of the auricular cartilage was performed by an otorhinolaryngologist, confirming pathological proof of RP. Treatments with steroids were immediately administered thereafter.
CONCLUSION We highlight a rare case of RP with radiologically confirmed involvement of ET in the MRI.
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Affiliation(s)
- Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Tokyo, Japan
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Hachioji-shi 193-0998, Japan
| | - Akiko Aoki
- Department of Rheumatology, Tokyo Medical University Hachioji Medical Center, Hachioji-shi 193-0998, Japan
| | - Hiroshi Kobayashi
- Department of Rheumatology, Tokyo Medical University Hachioji Medical Center, Hachioji-shi 193-0998, Japan
| | - Miwako Someya
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji-shi 193-0998, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, Hachioji-shi 193-0998, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Tokyo, Japan
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Abstract
Otitis media with effusion (OME) is amongst the most common pediatric diseases and the most common cause of hearing loss in children. It is accepted that adenoid hypertrophy (AH) is related to OME incidence. Better understanding of the correlation between the relative size of AH and the incidence of persistent OME may provide evidence to support a more standardized approach to the diagnosis and treatment of OME. A retrospective study carried out between April 2016 and April 2018 collected data on 65 children aged 2-12 years, diagnosed with chronic OME and symptoms of AH, where conservative therapy failed. Pre-diagnostic data were collected from patient history, otoscopy, rhinoscopy, and oropharyngoscopy findings. Diagnostic workup included tympanometry, audiometry, and flexible nasal fiberoptic endoscopy. Adenoid grading was performed according to Cassano method after endoscopic visualization. Of the 65 patients, 37 were male and 28 were female. There was no statistically significant difference according to gender or average age. The highest incidence of persistent OME with AH was recorded in the youngest age groups (2-5 and 6-9 years). The most frequent AH grades were grade II (35.38%) and grade III (50.77%), yielding a statistically significant result. The most common presenting symptoms were hearing impairment, snoring, and nasal obstruction (100%, 64.62% and 60%, respectively). Higher AH grades are critical for persistence of OME and may cause conservative therapy failure.
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Affiliation(s)
- Marta Zrinka Galić
- Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Marisa Klančnik
- Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
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Rohde M, Korsholm M, Lüscher M, Fast S, Godballe C. Diagnosis of possible nasopharyngeal malignancy in adults with isolated serous otitis media; a systematic review and proposal of a management algorithm. Eur Arch Otorhinolaryngol 2022; 279:3229-3235. [PMID: 35099596 DOI: 10.1007/s00405-022-07279-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/19/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The objective of this study was (1) to systematically review the evidence of routine post-nasal space blind biopsies and/or imaging of adults with isolated serous otitis media (SOM) of unknown cause for detection nasopharyngeal malignancy (NPM), and (2) to design a clinical management algorithm for these patients. METHODS A systematic search was conducted in the databases PubMed, Embase and Cochrane Library guided by the study question "Should adults with isolated SOM of unknown cause undergo routine biopsies of the post-nasal space and/or diagnostic imaging for detection of NPM?". All retrieved studies were reviewed and quantitatively analyzed. RESULTS The systematic literature search identified 552 publications accessible for title-abstract screening. This yielded 23 studies for full text assessment, of which 6 were found eligible for inclusion. All six studies dealt with nasopharyngeal blind biopsies, whereas no studies on cross-sectional imaging were identified. The derived summarized results of the included studies showed that 5.5% (31/568) of patients with isolated SOM of unknown cause were diagnosed with NPM. Of these, 6.5% (2/31) had normal nasopharyngeal endoscopy (i.e., malignancy was discovered by blind biopsies). Finally, 0.35% (2/568) of patients with isolated SOM of unknown cause diagnosed with NPM had normal nasopharyngeal endoscopy findings (i.e., nasopharyngeal endoscopy ruled-out malignancy in 99.65% of patients). CONCLUSIONS We found no evidence supporting routine use of blind biopsies or cross-sectional imaging in adults with isolated serous otitis media of unknown cause. We propose a pragmatic management algorithm for workup of adults with persistent secretory otitis media.
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Affiliation(s)
- Max Rohde
- Research Unit for ORL-Head and Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 1st Floor, 5000, Odense C, Denmark.
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense C, Denmark.
| | - Malene Korsholm
- Research Unit for ORL-Head and Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 1st Floor, 5000, Odense C, Denmark
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense C, Denmark
| | | | - Søren Fast
- Private ENT Specialist, Teglgårdsparken 15, 5500, Middelfart, Denmark
| | - Christian Godballe
- Research Unit for ORL-Head and Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 1st Floor, 5000, Odense C, Denmark
- Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense C, Denmark
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Ho CY, Chin SC, Hu CY, Chen SL. The necessity and effect of prophylactic quinolone ear drops after ventilation tube insertion for otitis media with effusion. Am J Otolaryngol 2022; 43:103266. [PMID: 34757314 DOI: 10.1016/j.amjoto.2021.103266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Otitis media with effusion (OME) is a condition where non-infective fluid builds up in the middle ear. Long-term OME can cause damage to the middle ear and hearing impairment. Ventilation tube insertion (VTI) is an efficient procedure to drain persistent OME. However, the effect of prophylactic ear drops after VTI remains controversial because no infection is present. This study investigated the need for and effect of quinolone ear drops in patients with OME after VTI. METHODS Between July 2018 and July 2021, 272 patients (436 ears with OME) who underwent VTI were enrolled. Prophylactic quinolone ear drops (ofloxacin) were used in 271 OME ears and not used in 165. The clinical findings and effect of the ear drops were assessed. RESULTS The group with postoperative ofloxacin had less postoperative otorrhea (p < 0.001). In univariate analysis, age ≥ 13 years (odds ratio [OR] = 1.499, 95% confidence interval [CI]: 1.003-2.238, p = 0.046) was significantly associated with recovery to normal middle ear functioning (type A on postoperative tympanometry). No adenoid hypertrophy (OR = 1.692, 95% CI: 1.108-2.585, p = 0.014) and no postoperative otorrhea (OR = 2.816, 95% CI: 1.869-4.237, p < 0.001) were significant independent factors associated with middle ear recovery in both univariate and multivariate analysis. After VTI, 65% of tympanic membranes in the group with postoperative ofloxacin recovered to normal, while in 67% of tympanic membranes in the group without ofloxacin scarring remained. CONCLUSIONS Patients who received prophylactic postoperative ofloxacin had less postoperative otorrhea. No adenoid hypertrophy and no postoperative otorrhea were significant independent predictors of middle ear recovery to normal function in both univariate analysis and multivariate analysis. However, prophylactic ofloxacin was not an independent predictor of normal middle ear functioning after VTI. After VTI, most OME patients who had used ofloxacin postoperatively had eardrums that were in better condition than those of patients who had not used ofloxacin. In this study, we confirmed the advantages and limitations of OME after VTI with prophylactic ofloxacin, thus providing clinicians with some guidance regarding the decision to administer prophylactic ofloxacin.
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Wang LC, Phyland D, Giddings CE. A randomised trial of single or extended dosing ciprofloxacin versus no intervention for Prevention of Ventilation Tube Otorrhoea and Obstruction (PreVenTO2). Clin Otolaryngol 2021; 47:287-294. [PMID: 34758186 DOI: 10.1111/coa.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the effectiveness of ciprofloxacin 0.3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children. DESIGN 3-arm parallel assessor-blinded randomised controlled trial. Randomisation in 1:1:1 ratio to single intraoperative application of ciprofloxacin drops, extended 5-day postoperative application and no drops. Patients were assessed by blinded assessors at 6 weeks postoperatively. SETTING The study was conducted in a large tertiary health network in Melbourne, Australia. PARTICIPANTS All children, 17 years and under, undergoing bilateral MEVT surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached. MAIN OUTCOME MEASURES Presence of postoperative otorrhoea and ventilation tube obstruction at 6 weeks postoperatively. RESULTS 256 paediatric patients completed the study with a median age of 4.02 years. 153 participants were male. By ear-analysis (n=512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR=0.341, 95%CI 0.158-0.738, NNT= 11.25, p=.006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR=0.424, 95%CI 0.193 to 0.930, NNT=14.7 p=.032). CONCLUSION Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost-effectiveness.
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Affiliation(s)
- Luke Chenkan Wang
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| | - Debra Phyland
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| | - Charles Edward Giddings
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
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Hu Y, Dong H, Huang J, Huang J, Tao D, Huang C, Hu L, Xu H, Sun Y. Long non-coding RNA (lncRNA) nuclear enriched abundant transcript 1 (NEAT1) promotes the inflammation and apoptosis of otitis media with effusion through targeting microRNA (miR)-495 and activation of p38 MAPK signaling pathway. Bioengineered 2021; 12:8080-8088. [PMID: 34723778 PMCID: PMC8806769 DOI: 10.1080/21655979.2021.1982842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Long non-coding RNA (lncRNA) plays a vital role in human inflammatory diseases. Our study aimed to investigate the function of lncRNA nuclear-enriched abundant transcript 1 (NEAT1) in otitis media with effusion (OME). The mRNA levels of NEAT1 and miR-495 were measured by RT-qPCR. The protein levels of p38 MAPK were detected by western blot. The levels of inflammatory cytokines were examined by ELISA. CCK-8 and flow cytometry assays were used to evaluate the cell viability and apoptosis, respectively. The interaction between NEAT1 and miR-495 was determined by luciferase reporter and RIP assays. NEAT1 was highly expressed in OME, and silencing of NEAT1 facilitated the cell proliferation and suppressed levels of inflammatory cytokines and cell apoptosis in LPS-induced HMEECs. Moreover, miR-495 was confirmed as a downstream target of NEAT1. Functional assays revealed that NEAT1 promoted the OME by targeting miR-495. It was further demonstrated that NEAT1 could activate the p38 MAPK signaling pathway by regulating miR-495, and the p38 MAPK inhibitor restored the effects of NEAT1 overexpression on the inflammation levels, cell proliferation, and apoptosis. Our study revealed that lncRNA NEAT1 served as a ceRNA to activate p38 MAPK signaling by targeting miR-495 in OME, which may offer a new target for OME treatment.
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Affiliation(s)
- Yajuan Hu
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Hongjun Dong
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jingjing Huang
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jie Huang
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Dandan Tao
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Chao Huang
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Lei Hu
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Hao Xu
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Yan Sun
- Department of Otorhinolaryngology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
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