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Pöyhönen L, Silvola J, Poe D, Rautiainen M, Kivekäs I. Balloon dilation improves both the hearing level and the quality of life in patients suffering from obstructive Eustachian tube dysfunction. Eur Arch Otorhinolaryngol 2024; 281:1259-1265. [PMID: 37725135 PMCID: PMC10858106 DOI: 10.1007/s00405-023-08231-2] [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] [Received: 06/20/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Chronic obstructive Eustachian tube dysfunction (OETD) can lead to tympanic membrane (TM) retraction and middle ear effusion (MEE) which can cause conductive hearing impairment, which among other ear symptoms can lower the quality of life (QoL). In this prospective study we assess hearing results and subjective changes in QoL following balloon Eustachian tuboplasty (BET) in treatment of OETD. METHODS Totally 25 ears with TM retraction and 18 ears with MEE due to chronic OETD underwent BET as the sole intervention. Outcomes including otoscopy, ability to perform the Valsalva maneuver, tympanometry, audiometry, Eustachian tube inflammation scale and the Glasgow Benefit Inventory questionnaire (GBI) were obtained on all patients preoperatively and 6 months postoperatively. RESULTS Hearing thresholds improved statistically significantly (p < 0.05) with means of 3 dB in the TM retraction group and 9 dB in the MEE group. Total GBI results indicated a positive influence on patients' QoL. Valsalva success rate was 80% in patients with TM retraction and 67% in patients with MEE. Tympanometry results improved in 50% of TM retraction patients and in 33% of MEE patients. CONCLUSIONS Here we demonstrated that the BET has a positive impact on patients' conductive hearing loss and QoL in patients with TM retraction or MEE. Results were better in TM retraction group than in MEE group.
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Affiliation(s)
- Leena Pöyhönen
- Department of Ear and Oral Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
| | - Juha Silvola
- Department of Otorhinolaryngology, Faculty of Medicine, Akershus University Hospital, Akershus and University of Oslo, Campus AHUS, Oslo, Norway
| | - Dennis Poe
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA
| | - Markus Rautiainen
- Department of Ear and Oral Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Ear and Oral Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland.
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.
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Merchant GR, Al-Salim S, Skretta D, Tempero RM. Limited Audiological Assessment Results in Children With Otitis Media With Effusion. Ear Hear 2024; 45:505-510. [PMID: 37759362 PMCID: PMC10922150 DOI: 10.1097/aud.0000000000001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Clinical practice guidelines predicate the need for evaluation of hearing in children with otitis media with effusion (OME). The objective of this work was to characterize the completeness of hearing assessment results in children with OME. DESIGN Forty participants with OME completed two full audiological assessments, one in a clinical setting and a second in a research setting. An additional 14 participants without OME completed a single audiological assessment in the research setting as a control group. The success of various behavioral and objective audiometric tests in each setting was quantified and evaluated. RESULTS Findings indicate that ear-specific behavioral audiometric information is substantially limited in children with OME, particularly in clinical settings. In contrast, objective testing including tympanometry and otoacoustic emission testing was largely successful. CONCLUSIONS Ear-specific behavioral audiometric information is limited in children with OME and, consequently, consideration of these data for use as part of clinical decision making is also limited. Objective tests were more successful but are not direct measures of hearing.
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Affiliation(s)
| | - Sarah Al-Salim
- Department of Research, Boys Town National Research Hospital, Omaha, NE
| | - Delaney Skretta
- Department of Research, Boys Town National Research Hospital, Omaha, NE
| | - Richard M. Tempero
- Department of Otolaryngology, Boys Town National Research Hospital, Omaha, NE
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Lechien JR, Maniaci A, Gengler IM, Al Barajraji M, Mayo-Yanez M. Laryngopharyngeal reflux in otitis media with effusion. Am J Otolaryngol 2024; 45:104152. [PMID: 38134846 DOI: 10.1016/j.amjoto.2023.104152] [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: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Jerome R Lechien
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Antonino Maniaci
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Catania 95123, Italy
| | - Isabelle M Gengler
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Mejdeddine Al Barajraji
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France
| | - Miguel Mayo-Yanez
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
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Araújo ALPKD, Cordeiro FP, da Costa Monsanto R, Penido NDO. Audiometric evaluation in different clinical presentations of otitis media. Braz J Otorhinolaryngol 2024; 90:101359. [PMID: 38070239 PMCID: PMC10755540 DOI: 10.1016/j.bjorl.2023.101359] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 01/01/2024] Open
Abstract
OBJECTIVES To assess the hearing thresholds in acute otitis media, otitis media with effusion and chronic otitis media (non-suppurative, non-cholesteatomatous suppurative and cholesteatomatous) and to compare the hearing outcomes with non-diseased ears (in bilateral cases) or contralateral healthy ears (in unilateral cases), since hearing loss is the most frequent sequel of otitis media and there is no previous study comparing the audiometric thresholds among the different forms of otitis media. METHODS Cross sectional, controlled study. We performed conventional audiometry (500-8000Hz) and tympanometry in patients with otitis media and healthy individuals (control group). Hearing loss was considered when the hearing thresholds were > 25 dBHL. RESULTS Of the 112 patients diagnosed with otitis media (151 ears), 48 were men (42.86%) and 64 were women (57.14%). The average age was 42.72 years. Of those, 25 (22.32%) were diagnosed as AOM, 15 (13.39%) were diagnosed with OME and the remaining 72 (63.28%) were diagnosed with COM (non-suppurative COM, n=31; suppurative COM, n=18; cholesteatomatous COM, n=23). As compared with controls, all forms of otitis media had significantly higher bone-conduction thresholds (500-4000Hz). Conductive hearing loss was the most frequent type of hearing loss (58.94%). However, the number of patients with mixed hearing loss was also relevant (39.07%). We noted that the presence of sensorioneural component occurred more frequently in 1) Higher frequencies; and 2) In groups of otitis media that were more active or severe in the inflammatory/infective standpoint (AOM, suppurative COM and cholesteatomatous COM). CONCLUSION All types of otitis media, even those with infrequent episodes of inflammation and otorrhea, had worse bone conduction thresholds as compared with nondiseased ears (p<0.01). We observed worse hearing outcomes in ears with recurrent episodes of otorrhea and in ears with AOM, especially in high frequencies.
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Affiliation(s)
| | | | - Rafael da Costa Monsanto
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP), São Paulo, SP, Brazil; Otopathology Laboratory - University of Minnesota, Minneapolis, MN, USA
| | - Norma de Oliveira Penido
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP), São Paulo, SP, Brazil
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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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Zhang J, Chen R, Chen S, Yu D, Elkamchouchi DH, Alqahtani MS, Assilzadeh H, Huang Z, Huang Y. Application of lipid and polymeric-based nanoparticles for treatment of inner ear infections via XGBoost. Environ Res 2023; 239:117115. [PMID: 37717809 DOI: 10.1016/j.envres.2023.117115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/26/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
Taking hearing loss as a prevalent sensory disorder, the restricted permeability of blood flow and the blood-labyrinth barrier in the inner ear pose significant challenges to transporting drugs to the inner ear tissues. The current options for hear loss consist of cochlear surgery, medication, and hearing devices. There are some restrictions to the conventional drug delivery methods to treat inner ear illnesses, however, different smart nanoparticles, including inorganic-based nanoparticles, have been presented to regulate drug administration, enhance the targeting of particular cells, and decrease systemic adverse effects. Zinc oxide nanoparticles possess distinct characteristics that facilitate accurate drug delivery, improved targeting of specific cells, and minimized systemic adverse effects. Zinc oxide nanoparticles was studied for targeted delivery and controlled release of therapeutic drugs within specific cells. XGBoost model is used on the Wideband Absorbance Immittance (WAI) measuring test after cochlear surgery. There were 90 middle ear effusion samples (ages = 1-10 years, mean = 34.9 months) had chronic middle ear effusion for four months and verified effusion for seven weeks. In this research, 400 sets underwent wideband absorbance imaging (WAI) to assess inner ear performance after surgery. Among them, 60 patients had effusion Otitis Media with Effusion (OME), while 30 ones had normal ears (control). OME ears showed significantly lower absorbance at 250, 500, and 1000 Hz than controls (p < 0.001). Absorbance thresholds >0.252 (1000 Hz) and >0.330 (2000 Hz) predicted a favorable prognosis (p < 0.05, odds ratio: 6). It means that cochlear surgery and WAI showed high function in diagnosis and treatment of inner ear infections. Regarding the R2 0.899 and RMSE 1.223, XGBoost shows excellent specificity and sensitivity for categorizing ears as having effusions absent or present or partial or complete flows present, with areas under the curve (1-0.944).
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Affiliation(s)
- Jie Zhang
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang,325000, China
| | - Ru Chen
- Department of Otolaryngology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Shuainan Chen
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang,325000, China
| | - Die Yu
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang,325000, China
| | - Dalia H Elkamchouchi
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Mohammed S Alqahtani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia; BioImaging Unit, Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH, UK
| | - Hamid Assilzadeh
- Faculty of Architecture and Urbanism, UTE University, Calle Rumipamba S/N and Bourgeois, Quito, Ecuador; Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam; School of Engineering & Technology, Duy Tan University, Da Nang, Viet Nam; Department of Biomaterials, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, India.
| | - Zhongguan Huang
- Department of Otolaryngology, Pingyang Affiliated Hospital of Wenzhou Medical University, Pingyang, Zhejiang, 325400, China.
| | - Yideng Huang
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang,325000, China.
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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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Schild SD, Mendelsohn MA, Plum A, Goldstein NA. Outcomes and Management of Infants Who Refer Newborn Hearing Screening. Ann Otol Rhinol Laryngol 2023; 132:1662-1668. [PMID: 37322843 DOI: 10.1177/00034894231180949] [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] [Indexed: 06/17/2023]
Abstract
OBJECTIVES With the implementation of Universal Newborn Hearing Screening, early diagnosis and referral has been expedited. Many patients who refer screening pass subsequent testing with otoacoustic emissions (OAE) or auditory brainstem response (ABR). The objective of our study was to identify the incidence and etiology of hearing loss in infants who refer initial testing in an urban, tertiary care pediatric otolaryngology practice. METHODS We performed a chart review of infants who were evaluated after referring newborn hearing screening from 2017 to 2021. Data collected included birth history, hospital screening results, subsequent audiology and otolaryngology visit findings, final hearing diagnoses, interventions, and outcomes. RESULTS Of the 450 patients, 83.8% (n = 377) had normal hearing bilaterally after repeat testing (OAE and/or ABR). Thirty five patients were diagnosed with otitis media with effusion (OME) (7.8%) and 17 patients (3.8%) were diagnosed with sensorineural hearing loss. Twenty seven patients (6.0%) were diagnosed with obstructing cerumen/vernix, many times in addition to another diagnosis. Of the 17 patients with sensorineural hearing loss, 2 had genetic syndromes and 2 had congenital cytomegalovirus. Sensorineural hearing loss was significantly associated with the presence of a deafness syndrome (P = .004) and in-utero infections (P = .04). About 11 (2.4%) underwent myringotomy with tube placement, 5 (1.1%) were fitted with hearing aids, 2 (0.4%) were referred for hearing aids, 4 (0.9%) had both myringotomy with tube placement and hearing aids, 1 child had a soft band/Bone Anchored Hearing Aid (BAHA) (0.2%), and 1 child (0.2%) had a cochlear implant. CONCLUSION Our incidence of sensorineural hearing loss was 3.8% (95% CI 2.0, 5.5), compared to rates of 0.44 to 68% in the published literature. Most patients had normal hearing, usually identified after only 1 repeat test. OME requiring myringotomy tube insertion was the most common pathology requiring intervention. Close observation for resolution and intervention, if warranted, is critical to prevent sequelae.
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Affiliation(s)
- Sam D Schild
- Department of Otolaryngology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew A Mendelsohn
- Department of Otolaryngology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ann Plum
- Department of Otolaryngology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Nira A Goldstein
- Department of Otolaryngology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
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Tamir SO, Bialasiewicz S, Brennan-Jones CG, Der C, Kariv L, Macharia I, Marsh RL, Seguya A, Thornton R. ISOM 2023 research Panel 4 - Diagnostics and microbiology of otitis media. Int J Pediatr Otorhinolaryngol 2023; 174:111741. [PMID: 37788516 DOI: 10.1016/j.ijporl.2023.111741] [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: 08/09/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES To identify and review key research advances from the literature published between 2019 and 2023 on the diagnosis and microbiology of otitis media (OM) including acute otitis media (AOM), recurrent AOM (rAOM), otitis media with effusion (OME), chronic suppurative otitis media (CSOM) and AOM complications (mastoiditis). DATA SOURCES PubMed database of the National Library of Medicine. REVIEW METHODS All relevant original articles published in Medline in English between July 2019 and February 2023 were identified. Studies that were reviews, case studies, relating to OM complications (other than mastoiditis), and studies focusing on guideline adherence, and consensus statements were excluded. Members of the panel drafted the report based on these search results. MAIN FINDINGS For the diagnosis section, 2294 unique records screened, 55 were eligible for inclusion. For the microbiology section 705 unique records were screened and 137 articles were eligible for inclusion. The main themes that arose in OM diagnosis were the need to incorporate multiple modalities including video-otoscopy, tympanometry, telemedicine and artificial intelligence for accurate diagnoses in all diagnostic settings. Further to this, was the use of new, cheap, readily available tools which may improve access in rural and lowmiddle income (LMIC) settings. For OM aetiology, PCR remains the most sensitive method for detecting middle ear pathogens with microbiome analysis still largely restricted to research use. The global pandemic response reduced rates of OM in children, but post-pandemic shifts should be monitored. IMPLICATION FOR PRACTICE AND FUTURE RESEARCH Cheap, easy to use multi-technique assessments combined with artificial intelligence and/or telemedicine should be integrated into future practice to improve diagnosis and treatment pathways in OM diagnosis. Longitudinal studies investigating the in-vivo process of OM development, timings and in-depth interactions between the triad of bacteria, viruses and the host immune response are still required. Standardized methods of collection and analysis for microbiome studies to enable inter-study comparisons are required. There is a need to target underlying biofilms if going to effectively prevent rAOM and OME and possibly enhance ventilation tube retention.
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Affiliation(s)
- Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Sasmon Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel.
| | - Seweryn Bialasiewicz
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Christopher G Brennan-Jones
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Carolina Der
- Facultad de Medicina, Universidad Del Desarrollo, Dr Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Liron Kariv
- Hearing, Speech and Language Institute, Sasmon Assuta Ashdod University Hospital, Israel
| | - Ian Macharia
- Kenyatta University Teaching, Referral & Research Hospital, Kenya
| | - Robyn L Marsh
- Menzies School of Health Research, Darwin, Australia; School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Amina Seguya
- Department of Otolaryngology - Head and Neck Surgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Ruth Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; Centre for Child Health Research, University of Western Australia, Perth, Australia
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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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12
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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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13
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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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14
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Zhang Y, Liu J, Yang F, He Y, Yan S, Bai Y, Zhang Z, Luan F. COVID-19-related secretory otitis media in the omicron era: a case series. Eur Arch Otorhinolaryngol 2023; 280:4697-4700. [PMID: 37341758 DOI: 10.1007/s00405-023-08075-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/14/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES Increased numbers of patients with secretory otitis media appeared in outpatient clinics after the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Omicron pandemic; however, the relationship between SARS-CoV-2 Omicron variant infection and secretory otitis media is uncertain. METHODS We performed tympanocentesis and used reverse transcription-polymerase chain reaction (RT-PCR) testing to examine middle ear effusion (MEE) and nasopharyngeal secretions from 30 patients with secretory otitis media associated with SARS-CoV-2 infection. RT-PCR was performed using the open reading frame 1ab and nucleocapsid protein gene kit from Shanghai Berger Medical Technology Co., Ltd., as the sole assay method, in accordance with the manufacturer's instructions. RESULTS MEEs from 5 of the 30 patients tested positive for SARS-CoV-2, including one patient with positive results for both the nasopharyngeal secretion and MEE. We report and discuss the medical records of six patients, including these five MEE-positive patients and a MEE-negative patient. CONCLUSION SARS-CoV-2 RNA can be detected in MEE caused by coronavirus disease 2019-related secretory otitis media even when a patient's nasopharyngeal secretion tests PCR-negative for SARS-CoV-2. The virus can remain in the MEE for a long time after SARS-CoV-2 infection.
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Affiliation(s)
- Yu Zhang
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Jingrui Liu
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Feifei Yang
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yanan He
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Sinan Yan
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yushuang Bai
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Zhanchi Zhang
- Department of Human Anatomy, Hebei Medical University, Shijiazhuang, 050017, China.
- Hebei Key Laboratory of Neurodegenerative Disease Mechanism, Hebei Medical University, Shijiazhuang, 050017, China.
| | - Feng Luan
- Department of Otolaryngology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
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15
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Partycka-Pietrzyk K, Niedzielski A, Kasprzyk A, Jabłońska J, Mielnik-Niedzielska G, Chmielik LP. Audiometric Outcomes of Ventilation Drainage Treatment for Otitis Media with Effusion in Children: Implications for Speech Development and Hearing Loss. Med Sci Monit 2023; 29:e941350. [PMID: 37752698 PMCID: PMC10543299 DOI: 10.12659/msm.941350] [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: 06/04/2023] [Accepted: 07/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Otitis media with effusion is the most commonly recognized condition in childhood. Chronic otitis media with accompanying hearing loss is particularly unfavorable in the first years of the child's life because it can not only permanently damage the structure of the middle ear, but also adversely affect speech development and intellectual abilities in the child. MATERIAL AND METHODS This study, from a single center in Poland, included 201 children (372 ears) requiring surgical treatment due to otitis media with effusion. The condition was diagnosed by an ear, nose, and throat specialist, and each patient had a hearing test performed. The control group consisted of 21 patients (42 ears) with negative outcomes following an audiological interview. RESULTS Among all of the patients enrolled in the study, a normal tympanometry result was found in 60.6% of ears, and otoemission occurred in 63.3% of ears. The average hearing threshold in the study group was 22.01 Hz in the 500 Hz frequency range, while they were 16.76 Hz, 12.72 kHz, and 14.78 kHz for the corresponding 1 kHz, 2 kHz, and 4 kHz ranges, respectively. CONCLUSIONS Ventilation drainage is an effective treatment for otitis media with effusion. The presence of genetic disease has the greatest impact on the course of otitis media. These patients most often require reinsertion of a ventilation tube.
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Affiliation(s)
- Kornela Partycka-Pietrzyk
- Department of Pediatric Otolaryngology, Audiology, and Phoniatrics, Medical University of Lublin, Lublin, Poland
| | - Artur Niedzielski
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Dziekanów Leśny, Poland
| | - Anna Kasprzyk
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Dziekanów Leśny, Poland
| | - Joanna Jabłońska
- Department of Pediatric Otolaryngology, Audiology, and Phoniatrics, Medical University of Lublin, Lublin, Poland
| | - Grażyna Mielnik-Niedzielska
- Department of Pediatric Otolaryngology, Audiology, and Phoniatrics, Medical University of Lublin, Lublin, Poland
| | - Lechosław P. Chmielik
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Dziekanów Leśny, Poland
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16
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Liu CB, Shi YH, Li XY, Fan ZT. Prevalence and risk factors of otitis media with effusion in children with obstructive sleep apnea. Eur Rev Med Pharmacol Sci 2023; 27:5445-5452. [PMID: 37401280 DOI: 10.26355/eurrev_202306_32780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the correlation between obstructive sleep apnea (OSA) and otitis media with effusion (OME) in Chinese children and identify risk factors for OME to support the development of standardized diagnostic and treatment methods. PATIENTS AND METHODS Clinical data of 1,021 children with OSA admitted to our hospital between January 2019 and December 2020 were collected. The prevalence of OME was assessed based on age groups and different grades of adenoid hypertrophy (AH). Multivariate logistic regression was performed to determine risk factors for OME in this population. RESULTS Among the patients, only 73 (6.15%) reported hearing loss as the main complaint, while 178 (17.43%) were diagnosed with OME after the examination. Acoustic immittance showed higher detection rates for OME compared to those of otoscopy and pure tone audiometry. In addition, the incidence of OME did not increase with AH grade but was higher in children with OSA with AH grade IV. Multivariate regression analysis showed that the younger age group (2-5 years), AH grade IV, nasal inflammatory disease, and passive smoking were significant risk factors for OSA and OME. However, sex, age of 6-12 years, and presence of chronic tonsillitis/tonsillar hypertrophy had no significant impact on the prevalence of OME. CONCLUSIONS OME is highly prevalent in children with OSA. Clinicians should be vigilant in diagnosing OME, should conduct routine audiological examinations, and actively screen for middle ear fluid in all children with OSA, especially in younger children (2-5 years) with nasal mucosa inflammation and a history of passive smoking. This will help improve the detection rate of OME, as early intervention is paramount for preventing complications.
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Affiliation(s)
- C-B Liu
- Department of Otorhinolaryngology, Hebei Eye Hospital, Hebei, China.
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17
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Wyly DR, DeSchepper A, Nedved A, Lee BR, El Feghaly RE. Appropriateness of Diagnosis and Management for Otitis Media With Effusion in Pediatric Urgent Care Clinics. Pediatr Emerg Care 2023; 39:390-392. [PMID: 37159334 DOI: 10.1097/pec.0000000000002954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Otitis media with effusion (OME)'s clinical presentation is often confused with acute otitis media (AOM) by clinicians. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. The aim of this study was to determine the clinician diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 urgent care clinics within a pediatric health care system. METHODS We retrospectively reviewed a random sample of encounters for children aged 0 to 18 years with a billing diagnosis of OME in 2019. We recorded clinical symptoms, antibiotic prescribed, and the clinicians' diagnosis. We used the American Academy of Pediatrics guidelines to assign an AOM diagnosis and compared those with the clinicians' final diagnoses using Pearson χ 2 . RESULTS Of the 912 eligible charts, clinicians' final diagnoses were as follows: AOM for 271 (29.7%) patients, OME for 638 (70.0%) patients, and no ear pathology for 3 (0.3%) patients. Antibiotics were prescribed for 519 (56.9%) patients; of those, only 242 (46.6%) had a final clinician diagnosis of AOM. Antibiotic prescribing rates were higher when a clinician diagnosed AOM compared with OME (89.3% vs 43.2%; P < 0.001). Per American Academy of Pediatrics guidelines, up to 273 (29.9%) patients qualified for an AOM diagnosis, but those were not the same as those diagnosed with AOM by clinicians ( P < 0.001). CONCLUSIONS When evaluating children with a billing diagnosis of OME, a third fit a diagnosis of AOM. Clinicians commonly misdiagnosed AOM, but also prescribed antibiotics to almost half of those they diagnose with OME.
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Affiliation(s)
- Donna R Wyly
- From the Division of Urgent Care, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO
| | - Ashley DeSchepper
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO
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18
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Kovalenko SL, Lazareva LA, Azamatova SA. [Efficacy of bioregulative drugs in the treatment of otitis media with effusion associated with rhinosinusitis and adenoiditis]. Vestn Otorinolaringol 2023; 88:13-20. [PMID: 37450385 DOI: 10.17116/otorino20228803113] [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] [Indexed: 07/18/2023]
Abstract
PURPOSE Improving of otitis media with effusion (OME) with rhinosinusitis (RS) and adenoiditis treatment effectiveness. MATERIALS AND METHODS The study included 112 patients 12-18 y.o. with otitis media with effusion, who were divided into 2 groups depending on the treatment scheme. The Group I (the main group) patients treatment included Traumeel S and Euphorbium compositum Nasentropfen S in addition to the standard treatment, and the Group II (comparison), children were prescribed standard therapy. Patients of both groups were divided into 3 subgroups depending on the upper respiratory tract inflammation symptoms: A - patients with adenoiditis; B - with rhinosinusitis and C - combination of adenoiditis and rhinosinusitis. The comparison group (groups IIB and IIC) treatment scheme (children with rhinosinusitis) included topical corticosteroids and the main group patients didn't receive corticosteroids. All patients went through complaints and anamnesis collection, routine otorhinolaryngological and instrumental examination before and after treatment. RESULTS Analysis of treatment results demonstrated high efficacy of multicomponent drugs with low doses of active ingredients in the therapy of patients with OME, regardless of comorbid pathology. Significantly better results were obtained in the patients treated with bioregulatory drugs when comparing the outcomes of OME therapy in combination with adenoiditis (groups IA and IIA). Comparable efficacy results were obtained in the treatment group of patients with OME associated with RS (in groups IB and IIB as well as in groups IC and IIC), where GCS was received in the comparison group. The high efficacy and safety of bioregulatory drugs makes the use of these agents a promising treatment for patients with OME, RS and adenoiditis.
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Affiliation(s)
- S L Kovalenko
- Kuban State Medical University of the Ministry of Health of Russian Federation, Krasnodar, Russia
- State Budget Medical Organization «Children's city polyclinic No. 1 of Krasnodar», Krasnodar, Russia
| | - L A Lazareva
- Kuban State Medical University of the Ministry of Health of Russian Federation, Krasnodar, Russia
| | - S A Azamatova
- Kuban State Medical University of the Ministry of Health of Russian Federation, Krasnodar, Russia
- Adyghe Republican Hearing Rehabilitation Center of State Budget Organization of Health of Republic of Adygea Adyghe Republican Clinical Hospital Adyghe Republican Center for Medical Rehabilitation, Maykop, Russia
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Thorsen J, Pedersen TM, Mora-Jensen ARC, Bjarnadóttir E, Bager SC, Bisgaard H, Stokholm J. Middle ear effusion, ventilation tubes and neurological development in childhood. PLoS One 2023; 18:e0280199. [PMID: 36638109 PMCID: PMC9838841 DOI: 10.1371/journal.pone.0280199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Otitis media with middle ear effusion (MEE) can be treated with ventilation tubes (VT) insertion, and it has been speculated that prolonged MEE in childhood can affect neurological development, which in turn may be important for later academic achievements. OBJECTIVE To investigate the association between middle ear effusion (MEE), treatment with ventilation tubes (VT) and childhood neurological development. STUDY DESIGN We examined 663 children from the Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010) unselected mother-child cohort study. Children were followed by study pediatricians with regular visits from pregnancy until 3 years of age. MEE was diagnosed using tympanometry at age 1, 2 and 3 years. Information regarding VT from age 0-3 years was obtained from national registries. We assessed age at achievement of gross motor milestones from birth, language scores at 1 and 2 years, cognitive score at 2.5 years and general development score at age 3 years using standardized quantitative tests. RESULTS Children with MEE had a lower 1-year word production vs. children with no disease: (median 2, IQR [0-6] vs. 4, IQR [1-7]; p = 0.017), and a lower 1-year word comprehension (median 36; IQR [21-63] vs. 47, IQR [27-84]; p = 0.03). Children with VT had a lower 2-5-year cognitive score vs. children with no disease; estimate -2.34; 95% CI [-4.56;-0.12]; p = 0.039. No differences were found between children with vs. without middle ear disease regarding age at achievement of gross motor milestones, word production at 2 years or the general developmental score at 3 years. CONCLUSION Our study supports the previous findings of an association between MEE and concurrent early language development, but not later neurological endpoints up to the age of 3. As VT can be a treatment of those with symptoms of delayed development, we cannot conclude whether treatment with VT had positive or negative effects on neurodevelopment.
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Affiliation(s)
- Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tine Marie Pedersen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Anna-Rosa Cecilie Mora-Jensen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Elín Bjarnadóttir
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Søren Christensen Bager
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
- * E-mail:
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20
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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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Tukur AR, Mahmud A, Jibril YN, Jalo RI, Salisu AD. Allergic rhinitis: An indicator of otitis media with effusion in children seen at aminu kano teaching hospital, Kano. Niger J Clin Pract 2022; 25:1725-1730. [PMID: 36308246 DOI: 10.4103/njcp.njcp_206_22] [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: 06/16/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is a multifocal IgE-mediated type I hypersensitivity reaction involving nasal mucosa characterized by excessive sneezing, watery rhinorrhea, nasal itching, nasal stuffiness, and eyes itching. Tympanometry is a simple, rapid, and objective test that can be easily carried out. The use of tympanometry in clinical setting can improve detection of middle ear effusion and other middle ear abnormalities. AR has been found to be one of the predisposing factors to developing Otitis Media with Effusion (OME) in children. PATIENTS AND METHODS A case-control study was used to determine the prevalence of OME among children with AR as cases and those without allergy as controls. The study participants were children aged 4-12 years with clinical diagnosis of AR attending ENT clinics of Aminu Kano Teaching Hospital, whereas controls were children age 4-12 years without history of AR, ear diseases, or other respiratory system related ailments attending general outpatient clinics in Aminu Kano Teaching Hospital. An interviewer-administered score for AR (SFAR) questionnaire was filled out for all the participants, those with score of 6 and above were selected as cases. The two groups had complete ENT examination and tympanometry done, findings were recorded, and analyzed using SPSS version 21. RESULTS The mean age of the cases was 6.8 ± 2.1 years, whereas it was 7.5 ± 2.6 years for the controls. The mean difference was 0.7 and was not statistically significant (t = 2.35, df = 258, P value = 0.20). Type B tympanogram suggesting OME was found in 7.3% of subjects and in 2.8% of controls. Type C tympanogram suggesting negative middle ear pressure was found in 15.5% of subjects and in 4.6% of controls. Type A tympanogram suggesting normal middle ear pressure was found in 75% of subjects and in 90% of controls. Acoustic reflex was found to be absent in 29.6% of subjects and in 15.4% of controls and this found to be statistically significant (χ2 = 7.77, df = 1, P value = 0.001). The difference between type A, B, and C tympanograms of subjects and that of controls was found to be statistically significant (Type A χ2 = 14.62, df = 4, P value = 0.01, Type B χ2 = 14.06, df = 4, P value = 0.01, Type C χ2 = 17.01, df = 6, P value = 0.01). Type B tympanogram was used as an indicator to suggest OME for the purpose of this study. CONCLUSION Participants with AR were found to have more abnormalities of tympanometric parameters and higher prevalence of type B tympanogram suggesting OME than controls.
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Affiliation(s)
- A R Tukur
- Department of ENT, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
| | - A Mahmud
- Department of ENT, Federal Medical Centre Yola, Adamawa, Kano, Nigeria
| | - Y N Jibril
- Department of Otolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - R I Jalo
- Department of Community Medicine, Aminu Kano Teaching Hospital/Bayero University Kano, Nigeria
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Restuti RD, Tamin S, Nugroho DA, Hutauruk SM, Mansyur M. Factors affecting the occurrence of otitis media with effusion in preschool and elementary school children: a comparative cross-sectional study. BMJ Open 2022; 12:e065291. [PMID: 36171035 PMCID: PMC9528613 DOI: 10.1136/bmjopen-2022-065291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Identify the risk factors for otitis media with effusion (OME), especially laryngopharyngeal reflux (LPR), adenoid hypertrophy and allergic rhinitis, that could be used to develop prevention strategies in children. DESIGN A comparative cross-sectional study was conducted to make sure the adequacy of proportions of OME and non-OME cases in finding the related factors. SETTING History taking, ear/nose/throat (ENT) examination, and tympanometry were performed in preschool and elementary schools. Flexible fibreoptic nasopharyngolaryngoscopy was performed in a bronchoesophagology outpatient clinic in a tertiary referral hospital in Jakarta, Indonesia. PARTICIPANTS Preschool and elementary children in East Jakarta, Indonesia were recruited for this study. A total of 2016 participants underwent history taking, ENT examination and tympanometry. The case group was 46 children with OME, and the control group was 46 children without OME. The number of subjects fulfilled the minimum sample size for two proportions comparison. MAIN OUTCOME MEASURES A type B tympanogram indicated OME. A Reflux Finding Score of more than 7 indicated LPR. Adenoid hypertrophy was diagnosed using flexible fibreoptic nasopharyngolaryngoscopy. Allergic rhinitis was diagnosed using a questionnaire based on the International Study of Asthma and Allergies in Childhood phase III that has been validated for Indonesians. RESULTS The proportion of LPR in the OME group was significantly higher than in the non-OME group, at 78.3% and 52.2%. The probability of OME occurrence in patients with LPR was 3.3 times higher than in patients without LPR (OR 3.3; 95% CI 1.33 to 8.189; p=0.01). There was no significant relationship between adenoid hypertrophy and OME (p=0.211; 95% CI 0.71 to 3.97), and also between allergic rhinitis and OME (p=0.463; 95% CI 0.61 to 4.28). CONCLUSION The probability of OME occurrence in patients with LPR was 3.3 times higher than in patients without LPR. LPR should be considered in patients with OME and vice versa.
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Affiliation(s)
- Ratna Dwi Restuti
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Susyana Tamin
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dwi Agustawan Nugroho
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Syahrial Marsinta Hutauruk
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Goldman RD. Acute otitis media in children 6 months to 2 years of age. Can Fam Physician 2022; 68:589-590. [PMID: 35961722 PMCID: PMC9374071 DOI: 10.46747/cfp.6808589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
QUESTION Acute otitis media (AOM) is one of the most common findings among children in our family medicine office, and we frequently see this illness during seasons with high rates of upper respiratory tract infections. With more widespread pneumococcal immunization, has the rate of AOM declined? What are the current recommendations for antibiotic treatment? ANSWER Although rates of the infection have declined over time with better uptake of vaccines against Streptococcus pneumoniae, AOM is still prevalent in the pediatric population and may be associated with serious complications that affect hearing and quality of life. Once a diagnosis has been made (based on a combination of acute onset of symptoms, signs of middle ear inflammation, and effusion), treatment of children 6 months to 2 years of age depends on physical examination findings. Children with perforated tympanic membranes and purulent discharge should receive 10 days of systemic antibiotics. For children with more mild symptoms or early AOM, primary care providers should consider either treatment or watchful waiting.
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Wang MC, Chu CH, Wang YP. Factors influencing surgeon decision-making by measuring waiting time for pediatric ventilation tube insertions. J Chin Med Assoc 2022; 85:699-703. [PMID: 35421868 DOI: 10.1097/jcma.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The surgeon and physician's decision-making may be influenced by many factors. The clinical practice guideline suggested that watchful waiting for 3 months should be the initial management for pediatric otitis media with effusion. The waiting time of ventilation tube insertion for pediatric patients is a proper measurement for physician decision-making. This study investigated factors influencing the waiting time for pediatric ventilation tube insertion and to explore factors influencing physician decision-making. METHODS Information associated with all patients under 18 years of age who received ventilation tube insertions from July 1, 2000 to December 31, 2009 were retrieved and analyzed from a nationwide, population-based administrative database. The waiting time before ventilation tube insertions from the time of diagnosis of otitis media with effusion was recorded. Certain factors that would influence the waiting time were identified. At the same time, how these factors influenced clinical decision-making were also identified. RESULTS The waiting time decreased as patient age increased (p < 0.001), and increased as the recent frequency of upper respiratory tract infection diagnosis increased (p < 0.001). Patients who received simultaneously bilateral ventilation tube insertions had shorter waiting time than those who had unilateral surgery (p < 0.01) and patients who had undergone ventilation tube insertions in a tertiary referral center generally had longer waiting times (p < 0.001). CONCLUSION The waiting time of ventilation tube insertions for pediatric otitis media with effusion can be influenced by many factors. Patients with older age and undergone simultaneously bilateral ventilation tube insertion had shorter waiting time. Patients who had more upper respiratory tract infection episodes and who received ventilation tube insertions in a tertiary referral center setting were subject to longer waiting times.
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Affiliation(s)
- Mao-Che Wang
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine and Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Huei Chu
- Department of Otolaryngology Head Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, New Taipei City, Taiwan, ROC
| | - Ying-Piao Wang
- Department of Otolaryngology Head Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, New Taipei City, Taiwan, ROC
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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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Sundgaard JV, Bray P, Laugesen S, Harte J, Kamide Y, Tanaka C, Christensen AN, Paulsen RR. A deep learning approach for detecting otitis media from wideband tympanometry measurements. IEEE J Biomed Health Inform 2022; 26:2974-2982. [PMID: 35290196 DOI: 10.1109/jbhi.2022.3159263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In this study, we propose an automatic diagnostic algorithm for detecting otitis media based on wideband tympanometry measurements. METHODS We develop a convolutional neural network for classification of otitis media based on the analysis of the wideband tympanogram. Saliency maps are computed to gain insight into the decision process of the convolutional neural network. Finally, we attempt to distinguish between otitis media with effusion and acute otitis media, a clinical subclassification important for the choice of treatment. RESULTS The approach shows high performance on the overall otitis media detection with an accuracy of 92.6%. However, the approach is not able to distinguish between specific types of otitis media. CONCLUSION Out approach can detect otitis media with high accuracy and the wideband tympanogram holds more diagnostic information than the commonly used techniques wideband absorbance measurements and simple tympanograms. SIGNIFICANCE This study shows how advanced deep learning methods enable automatic diagnosis of otitis media based on wideband tympanometry measurements, which could become a valuable diagnostic tool.
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Bonavia L, Jackson J. Gradenigo Syndrome in a 14-Year-old Girl as a Consequence of Otitis Media With Effusion. J Neuroophthalmol 2022; 42:e408-e409. [PMID: 34001731 PMCID: PMC8834142 DOI: 10.1097/wno.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Luke Bonavia
- Ballarat Health Services (LB), Ballarat Central, Victoria, Australia; Albury Base Hospital (JJ), Wodonga, Victoria, Australia; and University of NSW Medical School (JJ), Albury Campus, Albury, NSW, Australia
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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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Kim YJ, Jung HW, Choi YS, Chang HK, Kim SH, Yeo SG. Investigation of Bacterial Community Using 16s rRNA Amplicon Sequencing for Children with Otitis Media Effusion in Korea. Clin Lab 2022; 68. [PMID: 35023671 DOI: 10.7754/clin.lab.2021.210507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recently, microbiome of otitis media with effusion (OME) was investigated using high throughput sequencing (HTS) in children to discover unbiased causal bacteria and natural otitis media microbiomes. However, there are very few studies in the Asian population, and there are no studies in Koreans yet. METHODS We investigated bacterial community of OME from 27 Korean children. Routine bacterial culture, PCR targeting six frequent bacteria, and 16S rRNA amplicon sequencing were performed on effusion samples. Medical records of patients were reviewed. RESULTS The most common bacteria found in culture and PCR were coagulase negative Staphylococci and Hemophilus influenza, respectively. The most abundant taxon in 16S rRNA amplicon sequencing was Hemophilus. The bacteria that showed positive PCR were found to be the most abundant taxon in 16S rRNA amplicon sequencing. Alloiococcus was not found in all three methods. CONCLUSIONS Our findings will contribute to a better understanding of causative agents of otitis media in children. The technical advancement of HTS in the clinical field will help further understanding.
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AlSarhan H, Mohammed AA, T Yaseen E. Reliability of the otoscopic tympanic membrane findings in the diagnosis of middle ear effusion. J PAK MED ASSOC 2021; 71(Suppl 8):S110-S112. [PMID: 35130231] [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: 06/14/2023]
Abstract
OBJECTIVE To estimate the reliability of otoscopic findings to predict the presence of middle ear effusion. METHODS The cross-sectional study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from April 1, 2019, to January 1, 2020, and comprised patients of either gender aged 3-70 years complaining of ear problems. The patients were randomly assigned to two specialist otolaryngologists who checked the presence of retraction of the tympanic membrane and other features suggesting middle ear effusion. All the patients underwent tympanometric impedance measurement to compare the results with the otoscopic findings. Data was analysed using SPSS 25. RESULTS The study comprised 369 ears of 203 patients. There were 98(48.3%) male and 105(51.7%) female patients. The overall mean age was 19±17.45 years. In 141(38%) ears, middle ear effusion was confirmed by tympanometric finding type B flat impedance curve, while 187(51%) ears had impedance curve type C and 41(11%) ears had impedance curve type A. The positive predictive value of otoscopic appearance in the diagnosis of middle ear effusion was 38%. History of recent hearing loss or upper respiratory tract infection had no significant association with the condition (p>0.05). CONCLUSIONS Otoscopic tympanic membrane findings were found poor predictors of the existance of middle ear effusion.
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Affiliation(s)
- Haider AlSarhan
- Department of Surgery, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Ali Abed Mohammed
- Department of Surgery, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Ehab T Yaseen
- Department of Surgery, College of Medicine, Mustansiriyah University, Baghdad, Iraq
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Kotaška K, Hanousková L, Průša R, Borský J, Dytrych P, Jurovčík M. Hyaluronic acid concentration in the middle ear fluid as an indicator of severity of the secretory otitis in newborns with cleft palate. Acta Biochim Pol 2021; 68:795-797. [PMID: 34487433 DOI: 10.18388/abp.2020_5672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022]
Abstract
The aim of the study was to investigate the hyaluronic acid concentration in middle ear fluid of patients with cleft palate as an indicator of the severity of the disease. Hyaluronic acid was examined in the middle ear fluid of 65 children (48 boys and 17 girls) subjected to cleft lip surgery in neonatal period up to 10 days of age. Patients were divided into 3 groups according to the course of the disease. First group consists of 15 patients with favorable course, second group consist of 25 patients with moderate course, third group included 25 patients with an adverse course. Hyaluronic acid levels were determined by commercially available immunoassay. The concentrations of hyaluronic acid in the middle ear fluid were as follows (mean+SEM): favorable course: 14253+2393 µg/l, moderate course: 7503+1345 µg/l, adverse course: 5905+2393 µg/l. Patients with adverse course and moderate course had significantly decreased hyaluronic acid levels in middle ear fluid compared to the patients with favorable course (P=0.02 and P=0.0018). Hyaluronic acid concentration is related to the course of the disease and the lowest values are most frequent in patients with an adverse course.
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Affiliation(s)
- Karel Kotaška
- Department of Medical Chemistry and Clinical Biochemistry, 2nd Medical Faculty, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Lenka Hanousková
- Department of Medical Chemistry and Clinical Biochemistry, 2nd Medical Faculty, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Richard Průša
- Department of Medical Chemistry and Clinical Biochemistry, 2nd Medical Faculty, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Jiří Borský
- Department of ENT, 2nd Medical Faculty, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Petra Dytrych
- Department of ENT, 2nd Medical Faculty, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Michal Jurovčík
- Department of ENT, 2nd Medical Faculty, Charles University, University Hospital Motol, Prague, Czech Republic
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Merchant GR, Neely ST. The influence of otitis media with effusion on middle-ear impedance estimated from wideband acoustic immittance measurements. J Acoust Soc Am 2021; 150:969. [PMID: 34470321 PMCID: PMC8349246 DOI: 10.1121/10.0005822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
The goal of this work was to estimate the middle-ear input impedance ( Zme) from wideband acoustic immittance (WAI) measures and determine whether Zme improves the clinical utility of WAI. The data used in this study were from a previously reported set of WAI measurements in ears with otitis media with effusion [OME; Merchant, Al-Salim, Tempero, Fitzpatrick, and Neely (2021). Ear Hear., published online]. Ears with OME were grouped based on effusion volume, which was confirmed during tube surgery. Zme was estimated from the measured ear-canal impedance. An electrical-analog model of ear-canal acoustics and middle-ear mechanics was used to model the ear canal and Zme. The model results fit the measured responses well for all conditions. A regression approach was used to classify the responses of different variable types to effusion volume groups and determine the specificity and sensitivity of the binary classifications. The Zme magnitude increased with increasing effusion volume. The area under the receiver operating characteristic curve (AUC) was compared for binary decisions of the OME categories. The Zme estimate resulted in a clinically meaningful improvement in the AUC for distinguishing healthy ears from ears with OME. Overall, these results suggest that Zme estimation may provide useful information of potential clinical value to improve the diagnostic utility of WAI measurements for OME.
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Affiliation(s)
- Gabrielle R Merchant
- Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska, USA
| | - Stephen T Neely
- Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska, USA
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Yukkaldıran A, Erdoğan O, Kaplama ME. Neutrophil-lymphocyte and platelet-lymphocyte ratios in otitis media with effusion in children: Diagnostic role and audiologic correlations. Int J Clin Pract 2021; 75:e13805. [PMID: 33128315 DOI: 10.1111/ijcp.13805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
AIM To investigate the relationship between hearing loss and complete blood count parameters including neutrophil, lymphocyte, platelet (PLT), mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in children with otitis media with effusion (OME). MATERIALS-METHOD The study group was formed by 244 paediatric patients who underwent ventilation tube placement because of OME, and was split into two groups as serous and mucoid. The control group included 112 individuals who have no hearing problems. Hearing levels were determined with pure tone audiometry in the study group, preoperatively, and control group. The blood parameters were compared between the serous, mucoid and control groups. The correlation analysis was performed between the blood parameters and hearing levels in the study group. The blood parameters were compared between the groups identified by hearing loss classification. FINDINGS There were significant negative correlations between hearing levels and each of NLR, PLR and MPV. There were significant positive correlations between hearing levels and each of the lymphocyte and PLT. According to the receiver operating characteristic (ROC) curves, serous OME can be estimated with 68% sensitivity and 61% specificity by the NLR value more than 1.1, and 77% sensitivity and 77% specificity by the PLR value more than 102.4. The ROC curve revealed that slight hearing loss could be estimated with 70% sensitivity and 73% specificity by the NLR value more than 1.31, and 78% sensitivity and 77% specificity by the PLR value more than 102.4. CONCLUSION The present study revealed that NLR and PLR values were valuable parameters in the diagnosis of serous OME and predicting a hearing loss. These parameters may provide additional information to the audiogram that could influence the therapeutic decision.
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Affiliation(s)
- Ahmet Yukkaldıran
- Department of Otorhinolaryngology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Osman Erdoğan
- Department of Otorhinolaryngology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Mehmet Erkan Kaplama
- Department of Otorhinolaryngology, SBÜ Mehmet Akif İnan Training and Research Hospital, Sanliurfa, Turkey
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Mileshina NA, Volodkina VV, Kurbatova EV, Osipenkov SS, Polunin MM, Chernova OV. [The main steps in treatment of the children with otitis media with effusion]. Vestn Otorinolaringol 2021; 86:13-16. [PMID: 34499441 DOI: 10.17116/otorino20218604113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 06/13/2023]
Abstract
THE AIM Of the investigation was to establish the standard and improve the treatment of otitis media with effusion (OME) in children. 361 children at age from 11 months to 18 years were inspected after tympanostomy during 2013-2018 years. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, CT. MATERIAL AND METHODS Treatment takes into consideration the reveal of OME: surgical initially. The tympanostomy preferable place is anterior-inferior quadrant. RESULTS In cases with cleft palate or reccurence OME long-term tubes and balloonisation of ET are preferable. CONCLUSION Authors received normalization of the hearing thresholds in 97.6% cases, but after surgery the patients have to be followed-up during 12-24 months.
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Affiliation(s)
- N A Mileshina
- Russian Research Clinical Center for Audiology and Hearing Rehabilitation, Moscow, Russia
| | - V V Volodkina
- Russian Research Clinical Center for Audiology and Hearing Rehabilitation, Moscow, Russia
| | - E V Kurbatova
- Russian Research Clinical Center for Audiology and Hearing Rehabilitation, Moscow, Russia
| | - S S Osipenkov
- Russian Research Clinical Center for Audiology and Hearing Rehabilitation, Moscow, Russia
| | - M M Polunin
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - O V Chernova
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
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Tsunoda A, Suzuki M, Kishimoto S, Anzai T, Matsumoto F, Ikeda K, Terasaki O. Otitis Media With Effusion Caused by a Parapharyngeal Tumor Showing Normal Nasopharyngeal Findings. Ear Nose Throat J 2019; 100:543-545. [PMID: 31608684 DOI: 10.1177/0145561319881513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/15/2022] Open
Abstract
The objective of this study is to evaluate otitis media with effusion (OME) among patients with parapharyngeal tumor. We have experienced 82 parapharyngeal tumor cases and encountered 14 patients complaining of hearing loss due to OME as the initial symptom. These patients showed normal nasopharyngeal findings and the presence of tumor had been detected long time after the beginning of their hearing symptoms (4 months to 13 years: median 2.5 years). Six patients had undergone ventilation tube insertion on the affected ear, which may lead to delay in diagnosis. Pathological examination was performed in 76 of 82 patients. Among these 76 patients, 13 showed OME. Seven patients had malignant lesions, whereas 6 had benign lesions. Therefore, malignant lesions are prone to occur with OME and its relative risk was 2.26 (95% confidence intervals, 1.16-4.42). This difference was statistically significant (P = .044, Fisher test). Otitis media with effusion is a very common disease and is well-known as a primary symptom of nasopharyngeal carcinoma. Therefore, nasopharyngeal observation is necessary for patients with intractable middle ear effusion. However, present 14 patients with OME showed normal nasopharyngeal findings and finally found after an imaging study. From our data, OME is an important but go-by symptom of parapharyngeal tumors. Imaging studies are potently useful for such patients with intractable OME.
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Affiliation(s)
- Atsunobu Tsunoda
- Department of Otolaryngology, 220929Juntendo University Nerima Hospital, Tokyo, Japan
| | - Mayumi Suzuki
- Department of Anesthesiology, 13100Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiji Kishimoto
- Department of Otolaryngology, 117100Kameda Medical Center, Kamogawa, Japan
| | - Takashi Anzai
- Department of Otolaryngology, 220929Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Katsuhisa Ikeda
- Department of Otolaryngology, 220929Juntendo University, Tokyo, Japan
| | - Omi Terasaki
- Department of Otolaryngology, 220929Juntendo University Nerima Hospital, Tokyo, Japan
- Kurita Hospital, Kawasaki, Japan
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Chow AHC, Cai T, McPherson B, Yang F. Otitis media with effusion in children: Cross-frequency correlation in pure tone audiometry. PLoS One 2019; 14:e0221405. [PMID: 31437206 PMCID: PMC6705822 DOI: 10.1371/journal.pone.0221405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Different guidelines are adopted in clinics and countries to assess pure tone hearing sensitivity in children with otitis media with effusion (OME). Some guidelines specify a broad range of audiometric frequencies that must be tested and from which average thresholds determined, while others leave test frequencies unspecified. For guidelines that suggest specific frequencies there are various pure tone frequencies and frequency ranges given. The present study investigated whether (1) a full range of audiometric frequencies is required to evaluate hearing loss caused by OME in children, or if neighboring frequencies provide essentially the same threshold information, and (2) if different combinations of test frequency pure tone averaging calculations may affect decision criteria for surgical treatment. In a retrospective cohort study, right and left ear air conduction pure tone threshold data were obtained, from 125 Hz to 8 kHz, for 96 children with OME aged 4 to 12 years. Paired t-tests, correlation tests (Pearson’s r, Cronbach’s alpha, intraclass correlation) and absolute differences were used to examine the relationships among pure tone audiometric (PTA) frequencies for all ears with hearing loss. 168 ears were found to have OME-related hearing loss. Only the 125 Hz—250 Hz comparison showed no statistically significant difference between neighboring thresholds. However, only the 4 kHz and 8 kHz comparison showed a clinically significant mean difference of ≥ 10 dB. When viewing individual differences, comparison between 250 Hz and 500 Hz, 125 Hz and 500 Hz, and 4 kHz and 8 kHz, showed a large number of ears with clinically significant differences between test frequencies. Comparisons among low frequency 3 PTA average (500 Hz, 1 kHz, 2 kHz), high frequency 3 PTA average (1 kHz, 2 kHz, 4 kHz), and 4 frequency PTA average (500 Hz, 1 kHz, 2 kHz, 4 kHz) showed no statistically significant differences, with very strong correlations for all comparisons. In addition, for all the combinations of PTA averages, no clinically significant differences were found for the various comparisons or among individual results. Clinically, testing hearing sensitivity in the 125 Hz to 8 kHz range is worthwhile in evaluating hearing sensitivity in children with OME due to large individual variability across audiometric frequencies. However, frequencies tested for criterion averages for surgical treatments of children with OME may be restricted to 3 frequency PTA averages, either an average of 500 Hz, 1 kHz, 2 kHz or an average of 1 kHz, 2 kHz, 4 kHz, as no clinically significant differences were found using these or a 4 frequency averaging technique. For research purposes, 250 Hz can proxy for hearing thresholds at 125 Hz; and the low frequency 3 PTA average, high frequency 3 PTA average and 4 frequency PTA average may be used interchangeably, as no statistically significant differences were found among these measures.
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Affiliation(s)
- Ann Hiu Ching Chow
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Ting Cai
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Bradley McPherson
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Feng Yang
- Department of Speech Therapy, Shenzhen Children’s Hospital, Shenzhen, China
- * E-mail:
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Barry JG, Freigang C, Birchall JP, Daniel M. OMQ-14 and ECLiPS questionnaires: Potential adjuncts in the assessment of otitis media with effusion? Int J Pediatr Otorhinolaryngol 2019; 123:26-32. [PMID: 31055204 DOI: 10.1016/j.ijporl.2019.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/08/2019] [Accepted: 04/19/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the capacity of two parental report questionnaires, OMQ-14 and ECLiPS, to support clinical-decision making in children affected by Otitis Media with Effusion (OME). DESIGN OMQ-14 and ECLiPS were administered twice to 90 children aged 2-12 years, three months apart, or 3 months after surgery to insert ventilation tubes (VT). Children were subdivided according to clinical diagnosis into VT (n = 25) and Active Observation (AO; n = 20), and compared with healthy control children (n = 45). Data were analyzed at group level using repeated measures ANOVA, and at individual level using Receiver Operator Characteristics (ROC) curves and confusion matrices. RESULTS Both OMQ-14 and ECLiPS were sensitive to the presence of OME, and also to improvements in hearing post-surgery. Both were also good at classifying children into their clinically-established diagnostic groups based on score cut-offs determined using Receiver Operator Characteristics (ROC) curves. However, outputs from confusion matrices suggest only around 50% of children after VTs would be indistinguishable from controls following VT surgery. Differences were observed in which children were identified as still having problems according to the questionnaires. OMQ-14 is more sensitive to disease-related hearing loss, while the ECLiPS is more sensitive to developmental difficulties. CONCLUSIONS Despite being developed with different aims in mind, the OMQ-14 and ECLiPS were similarly sensitive both to symptoms of disease-related hearing difficulty and also to treatment-related improvements in hearing. A significant number of VT children continue to have poor OMQ-14 and ECLiPS scores relative to control children. ECLiPS scores do not always change in a way that hearing improvements would predict, suggesting the ECLiPS is sensitive to wider developmental difficulties. Parental report in the form of narrow or broad-based questionnaires may complement history-taking and audiometry to enhance the quality of discussion between carers and clinicians about OME management.
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Affiliation(s)
- Johanna G Barry
- The University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom; Otorhinolaryngology Head & Neck Surgery, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom.
| | - Claudia Freigang
- The University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - John P Birchall
- Otorhinolaryngology Head & Neck Surgery, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Mat Daniel
- Otorhinolaryngology Head & Neck Surgery, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom.
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Abbasi J. Smartphone-Based Detection of Middle Ear Fluid. JAMA 2019; 322:107. [PMID: 31287506 DOI: 10.1001/jama.2019.9395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Li YQ, Chen YB, Yin GD, Zeng XL. Effect of balloon dilation eustachian tuboplasty combined with tympanic tube insertion in the treatment of chronic recurrent secretory otitis media. Eur Arch Otorhinolaryngol 2019; 276:2715-2720. [PMID: 31197531 DOI: 10.1007/s00405-019-05512-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/15/2019] [Accepted: 06/08/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the long-term clinical effect of balloon dilation eustachian tuboplasty (BET) combined with tympanic tube insertion (TTI) in the treatment of chronic recurrent secretory otitis media (CRSOM). MATERIALS AND METHODS A retrospective study of 30 cases of CRSOM treated with BET combined with TTI under general anesthesia between August 2014 and September 2016. Thirty cases of CRSOM treated with TTI in the same period were taken as the control group. All cases were followed over 24 months. The scores of eustachian tube (ET) function preoperation, 1 month, 6 months, 12 months, and 24 months postoperation were collected and analyzed, respectively. A satisfaction questionnaire was used to evaluate the therapy at 24-months postoperation. RESULTS The symptoms were significantly improved and the ET score was obviously increased postsurgery in most cases treated with BET plus TTI compared with those treated with TTI alone. The highest ET score was obtained at 6 months post BET. Five (14%) cases (6 ears) of CRSOM recurred. The 24-month postoperation follow-up questionnaire showed that 84.6% of the patients were satisfied with the treatment, while ten cases (25%) in the TTI group recurred. CONCLUSION BET combined with TTI surgery is an effective therapy for patients with CRSOM.
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Affiliation(s)
- Yong-Qi Li
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
| | - Yu-Bin Chen
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Gen-di Yin
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xiang-Li Zeng
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
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Ye M, Li X. Effect of vascular endothelial growth factor and its receptors in adult otitis media with effusion. Eur Arch Otorhinolaryngol 2019; 276:1889-1895. [PMID: 30919059 DOI: 10.1007/s00405-019-05400-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/13/2019] [Accepted: 03/19/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Some studies have demonstrated that vascular endothelial growth factor (VEGF) plays a critical role in the pathogenesis of otitis media with effusion (OME) in animal models. However, the levels of VEGF and its receptors in adult OME have not been clarified. Our study was designed to detect the levels of VEGF and its receptors in adult OME and explore their relationship with effusion types, duration and prognosis of OME. METHODS 61 patients with secretory otitis media were enrolled including 21 males and 40 females, with an average age of 54.7 ± 17.5 years. The middle-ear effusions were collected by tympanocentesis or myringotomy. The protein concentrations were determined by enzyme-linked immunosorbent assay and messenger RNA by real-time quantitative PCR. RESULTS VEGF level was higher in AOME group, but not correlated with the recurrence of OME. VEGFR1 and VEGFR2 levels were lower in recurrent group compared with non-recurrent group. VEGFR2 level was higher in serous effusions than mucoid effusions. VEGF messenger RNA was positively correlated both with HIF-1α and MUC5B. CONCLUSIONS VEGF and its receptors function to induce the production of middle-ear effusions (MEEs) at acute stage of OME rather than chronic or recurrent stage, which is mainly mediated by HIF-1α pathway. The formation of mucoid effusions is associated with MUC5B and VEGFR2, but not with duration and recurrence of OME.
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Affiliation(s)
- Mengxiao Ye
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, People's Republic of China
| | - Xiping Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, People's Republic of China.
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Şimşek E, Bicer CK, Mazlumoğlu MR, Kara SS, Erel O, Çarlıoğlu A. Is otitis media with effusion associated with oxidative stress? Evaluation of thiol/disulfide homeostasis. Am J Otolaryngol 2019; 40:164-167. [PMID: 30621930 DOI: 10.1016/j.amjoto.2018.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/08/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND We evaluated the relationship between otitis media with effusion and thiol/disulfide homeostasis using a novel marker of oxidative stress. METHODS The study group consisted of 30 patients (mean age 8.33 ± 3.30 years) with bilateral otitis media with effusion admitted to our hospital. The control group consisted of 35 (mean age 7.40 ± 3.97 years) age-, sex-, and body mass index-matched healthy subjects. Thiol/disulfide homeostasis was measured using a newly developed method. RESULTS Native and total thiol levels were lower in the study than the control group (native thiols 421.37 ± 72 μmol/L vs. 464.46 ± 46.42 μmol/L, p < 0.05; total thiols 468.42 ± 77.89 μmol/L vs. 501.32 ± 50.30 μmol/L, respectively). Disulfide levels and the disulfide/native thiol and disulfide/total thiol ratios were higher in the study group (disulfides 23.56 ± 4.68 μmol/L vs. 18.43 ± 4.94 μmol/L; disulfide/native thiol ratio 5.65 ± 1.05 vs. 3.97 ± 1.03%; disulfide/total thiol ratio 5.06 ± 0.83 vs. 3.66 ± 0.88%, respectively). CONCLUSION Oxidative stress may be the major cause of the increase in oxidized thiols in patients with bilateral otitis media with effusion, however, this relationship requires further investigation.
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Affiliation(s)
- Eda Şimşek
- Clinic of Ear, Nose and Throat, University of Health Sciences, Kayseri Education and Research Hospital, Kayseri, Turkey.
| | - Cemile Koca Bicer
- Yildirim Beyazit University, Faculty of Medicine, Department of Clinical Biochemistry Ankara, Turkey
| | | | - Soner Sertan Kara
- Erzurum Regional Training and Research Hospital, Department of Pediatric Infectious Diseases, Erzurum, Turkey
| | - Ozcan Erel
- Yildirim Beyazit University, Faculty of Medicine, Department of Clinical Biochemistry Ankara, Turkey
| | - Ayşe Çarlıoğlu
- Erzurum Regional Training and Research Hospital, Department of Endocrinology, Erzurum, Turkey
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Abstract
Chronic ear disease is composed of a spectrum of otologic disorders intrinsically tied to Eustachian tube dysfunction. Presentation can range from asymptomatic findings on physical examination to critically ill patients with intracranial complications. Internists represent the first line in diagnosis of these conditions, making awareness of the common signs and symptoms essential. With surgical management often required, partnership between internal medicine and otolaryngology is fundamental in the management of patients with chronic ear disease.
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Affiliation(s)
- Susan D Emmett
- Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, DUMC Box 3805, Durham, NC 27710, USA.
| | - John Kokesh
- Department of Otolaryngology, Alaska Native Medical Center, 4315 Diplomacy Drive, Anchorage, AK 99508, USA
| | - David Kaylie
- Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, DUMC Box 3805, Durham, NC 27710, USA
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Weber BC, Whitlock SM, He K, Kimbrell BS, Derkay CS. An evidence based protocol for managing neonatal middle ear effusions in babies who fail newborn hearing screening. Am J Otolaryngol 2018; 39:609-612. [PMID: 29753496 DOI: 10.1016/j.amjoto.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 04/06/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the prevalence of middle ear disease in infants referred for failed newborn hearing screening (NBHS) and to review patient outcomes after intervention in order to propose an evidence-based protocol for management of newborns with otitis media with effusion (OME) who fail NBHS. METHODS 85 infants with suspected middle ear pathology were retrospectively reviewed after referral for failed NBHS. All subjects underwent a diagnostic microscopic exam with myringotomy with or without placement of a ventilation tube in the presence of a middle ear effusion and had intra-operative auditory brainstem response (ABR) testing or testing at a later date. RESULTS At the initial office visit, a normal middle ear space bilaterally was documented in 5 babies (6%), 29/85 (34%) had an equivocal exam while 51/85 (60%) had at least a unilateral OME. Myringotomy with or without tube placement due to presence of an effusion was performed on 65/85 (76%) neonates. Normal hearing was established in 17/85 (20%) after intervention, avoiding the need for any further audiologic workup. Bilateral or unilateral sensorineural hearing loss (SNHL) or mixed hearing loss was noted in 54/85 (64%) and these children were referred for amplification. Initially observation with follow up outpatient visits was initiated in 27/85 (32%) however, only 3/27 (11%) resolved with watchful waiting and 24/27 (89%) ultimately required at least unilateral tube placement due to OME and 14/24 (59%) were found to have at least a unilateral mixed or SNHL. CONCLUSIONS An effective initial management plan for children with suspected middle ear pathology and failed NBHS is diagnostic operative microscopy with placement of a ventilation tube in the presence of a MEE along with either intra-operative ABR or close follow-up ABR. This allows for the identification and treatment of babies with a conductive component due to OME, accurate diagnosing of an underlying SNHL component and for prompt aural rehabilitation.
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Affiliation(s)
- Brittany C Weber
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Scott M Whitlock
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kaidi He
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Blake S Kimbrell
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Craig S Derkay
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA
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Werker CL, van den Aardweg MTA, Coenraad S, Mink van der Molen AB, Breugem CC. Internationally adopted children with cleft lip and/or cleft palate: Middle ear findings and hearing during childhood. Int J Pediatr Otorhinolaryngol 2018; 111:47-53. [PMID: 29958613 DOI: 10.1016/j.ijporl.2018.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 03/09/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adopted children with cleft lip and/or cleft palate form a diverse group of patients. Due to increased age at palatal repair, adopted children have a higher risk of velopharyngeal insuffiency and poor speech outcome. Delayed palate repair may also lead to longer lasting Eustachian tube dysfunction. Decreased function of the Eustachian tube causes otitis media with effusion and recurrent acute otitis media, which can lead to other middle ear problems and hearing loss. METHODS One-hundred-and-thirty-two adopted children treated by the Cleft palate team in Wilhelmina Children's Hospital during January 1994 and December 2014 were included. Retrospectively, middle ear findings, the need for ventilation tube insertion and hearing during childhood were assessed. Findings were compared with 132 locally born children with cleft lip and/or cleft palate. RESULTS Adopted children had a mean age of 26.5 months old when they arrived in our country. After the age of two the total number of otitis media with effusion episodes and the need for ventilation tube placement did not significantly differ among adopted and non-adopted children. Adopted children had significantly more tympanic membrane perforations. Hearing threshold levels normalized with increasing age. Although within normal range, adopted children showed significantly higher pure tone averages than locally born children when they were eight to ten years old. CONCLUSION In general, adopted patients with cleft lip and/or cleft palate did not have more middle ear problems or ventilation tubes during childhood. However, theyhave more tympanic membrane perforations.
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Affiliation(s)
- C L Werker
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - M T A van den Aardweg
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - S Coenraad
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - C C Breugem
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
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Ohta N, Ueki S, Konno Y, Hirokawa M, Kubota T, Tomioka-Matsutani S, Suzuki T, Ishida Y, Kawano T, Miyasaka T, Takahashi T, Suzuki T, Ohno I, Kakehata S, Fujieda S. ETosis-derived DNA trap production in middle ear effusion is a common feature of eosinophilic otitis media. Allergol Int 2018; 67:414-416. [PMID: 29242145 DOI: 10.1016/j.alit.2017.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/06/2017] [Accepted: 11/19/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Nobuo Ohta
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Yamagata City Hospital Saiseikan, Yamagata, Japan.
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yasunori Konno
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Makoto Hirokawa
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshinori Kubota
- Yamagata City Hospital Saiseikan, Yamagata, Japan; Department of Otolaryngology Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | | | - Yusuke Ishida
- Division of Anatomy and Cell Biology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tasuku Kawano
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomomitsu Miyasaka
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoko Takahashi
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tatsutoshi Suzuki
- Department of Otolaryngology Head and Neck Surgery, Kitasato University Faculty of Medicine, Sagamihara, Japan
| | - Isao Ohno
- Center for Medical Education, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Seiji Kakehata
- Department of Otolaryngology Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Shigeharu Fujieda
- Division of Otorhinolaryngology - Head & Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
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Ozana N, Sagiv D, Lipschitz-Tayar N, Schwarz A, Shemer A, Wolf M, Zalevsky Z. Remote optical sensing in otolaryngology: middle ear effusion detection. Opt Express 2018; 26:16187-16199. [PMID: 30119454 DOI: 10.1364/oe.26.016187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
Otitis Media (OM) is related to a group of inflammatory diseases of the middle ear (ME) commonly encountered, worldwide. A method based on a simple device, which can be used by medical staff and non-experts to detect OM is presented. The method is based on detection of tympanic membrane (TM) vibrations. A laser beam is pointed on an infra-sonic stimulated TM with fast camera capturing the back scattered secondary speckle patterns. A camera enables inspection of the frequency and amplitude of the changes in TM characteristics obtained by analysis of the spatial-temporal statistics of the speckle patterns. The results may provide information that express ME effusion.
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Pandey R, Zhang C, Kang JW, Desai PM, Dasari RR, Barman I, Valdez TA. Differential diagnosis of otitis media with effusion using label-free Raman spectroscopy: A pilot study. J Biophotonics 2018; 11:e201700259. [PMID: 29232053 PMCID: PMC6423968 DOI: 10.1002/jbio.201700259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/07/2017] [Accepted: 12/10/2017] [Indexed: 05/08/2023]
Abstract
Otitis media with effusion (OME) is an important and common condition affecting hearing in pediatric patients characterized by the presence of fluid in the middle ear space. The fluid is normally described as serous or mucoid based on differences in the fluid viscosity. The differential diagnosis of two OMEs, namely serous and mucoid is of significant clinical value because while the former is self-limiting, surgical procedure is commonly required for the latter. However, accurate identification of fluid types remains a challenging target unattainable with current clinical modalities due to unavailability of nonperturbative molecular tools. Here, we report an emerging spectroscopy approach featuring Raman scattering and multivariate analysis of spectral patterns to discern serous and mucoid fluids, obtained from pediatric patients undergoing myringotomy and tube placement, by providing information of differentially expressed molecules with high specificity. We demonstrate the feasibility of Raman spectroscopy-based approach to categorize middle ear effusion based on the characteristic spectral markers, notably of mucin, with classification accuracy of 91% and 93% for serous and mucoid, respectively. Our findings pave the way for further development of such a tool for fully noninvasive application that will lead to objective and accurate diagnosis thereby reducing unnecessary visits and surgical procedures.
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Affiliation(s)
- Rishikesh Pandey
- Connecticut Children’s Innovation Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Chi Zhang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Jeon W. Kang
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Parind M. Desai
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Ramachandra R. Dasari
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Ishan Barman
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland
- Correspondence: Ishan Barman, Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218. , Tulio A. Valdez, Connecticut Children’s Innovation Center, University of Connecticut, School of Medicine, Farmington, CT 06032.
| | - Tulio A. Valdez
- Connecticut Children’s Innovation Center, University of Connecticut School of Medicine, Farmington, Connecticut
- Department of Otolaryngology, Stanford University, Palo Alto, California
- Correspondence: Ishan Barman, Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218. , Tulio A. Valdez, Connecticut Children’s Innovation Center, University of Connecticut, School of Medicine, Farmington, CT 06032.
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Karpova EP, Burlakova KY. [Possibilities of treatment of inflammatory pathology of the nasopharynx in children with chronic adenoiditis and otitis media with effusion]. Vestn Otorinolaringol 2018; 83:40-43. [PMID: 30721181 DOI: 10.17116/otorino20188306140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 06/09/2023]
Abstract
The purpose of observation is to increase the effectiveness of treatment of children with chronic adenoiditis and exudative medium otitis. MATERIAL AND METHODS: In the observation were included 102 children with exudative medium otitis and chronic adenoiditis at the age of 3 to 14 years. All patients passed clinical and anamnestic diagnostic, endoscopic study, study of the nasopharynx, and PCR diagnostics of the stroke of the mucous membrane of the nasopharynx. The treatment was conducted, taking into account the patient's age, in the design of a simple randomized follow-up. RESULTS: In a nasopharynx children with chronic adenoiditis and exudative medium otitis revealed a predominance of viral and bacterial associations; among viruses, rhinovirus and adenovirus occupy a leading place. Effective complex conservative treatment was developed with the use of the Lysobact, which helps to reduce the frequency of prescribing antibacterial therapy. The use of lysozyme is one of the promising areas of treatment of chronic adenoiditis and exudative medium otitis.
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Affiliation(s)
- E P Karpova
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 123242; Children's City Clinical Hospital Z.A. Bashlyaevoi, Moscow, Russia, 125373
| | - K Yu Burlakova
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 123242; Children's City Clinical Hospital Z.A. Bashlyaevoi, Moscow, Russia, 125373
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Shelton RL, Nolan RM, Monroy GL, Pande P, Novak MA, Porter RG, Boppart SA. Quantitative Pneumatic Otoscopy Using a Light-Based Ranging Technique. J Assoc Res Otolaryngol 2017; 18:555-568. [PMID: 28653118 DOI: 10.1007/s10162-017-0629-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 04/23/2016] [Accepted: 05/29/2017] [Indexed: 12/29/2022] Open
Abstract
Otitis media is the leading cause of hearing loss in children. It is commonly associated with fluid in the ear, which can result in up to 45 dB of hearing loss for extended periods of time during a child's most important developmental years. Accurate assessment of middle ear effusions is an important part of understanding otitis media. Current technologies used to diagnose otitis media with effusion are pneumatic otoscopy, tympanometry, and acoustic reflectometry. While all of these techniques can reasonably diagnose the presence of an effusion, they provide limited information about the infection present behind the tympanic membrane.We have developed a technique based on low-coherence interferometry-a non-invasive optical ranging technique capable of sensing depth-resolved microscopic scattering features through the eardrum-to quantify eardrum thickness and integrity, as well as detect any effusion, purulence, or biofilm behind the tympanic membrane. In this manuscript, the technique is coupled with a pneumatic otoscope to measure minute deflections of the tympanic membrane from insufflation pressure stimuli. This results in quantitative measurements of tympanic membrane mobility, which may be used to gain a better understanding of the impact of infection on the membrane dynamics. A small pilot study of 15 subjects demonstrates the ability of pneumatic low-coherence interferometry to quantitatively differentiate normal ears from ears with effusions present. Analysis of the strengths and weaknesses of the technique, as well as focus areas of future research, is also discussed.
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Affiliation(s)
- Ryan L Shelton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA
| | - Ryan M Nolan
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA
| | - Guillermo L Monroy
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Paritosh Pande
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA
| | - Michael A Novak
- Department of Otolaryngology-Head and Neck Surgery, Carle Foundation Hospital, Urbana, IL, USA
- Department of Surgery, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ryan G Porter
- Department of Otolaryngology-Head and Neck Surgery, Carle Foundation Hospital, Urbana, IL, USA
- Department of Surgery, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Stephen A Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N. Mathews Ave, Urbana, IL, 61801, USA.
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Internal Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Kim SH, Jeon EJ, Hong SM, Bae CH, Lee HY, Park MK, Byun JY, Kim MG, Yeo SG. Bacterial Species and Antibiotic Sensitivity in Korean Patients Diagnosed with Acute Otitis Media and Otitis Media with Effusion. J Korean Med Sci 2017; 32:672-678. [PMID: 28244296 PMCID: PMC5334168 DOI: 10.3346/jkms.2017.32.4.672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/07/2017] [Indexed: 11/20/2022] Open
Abstract
Changes over time in pathogens and their antibiotic sensitivity resulting from the recent overuse and misuse of antibiotics in otitis media (OM) have complicated treatment. This study evaluated changes over 5 years in principal pathogens and their antibiotic sensitivity in patients in Korea diagnosed with acute OM (AOM) and OM with effusion (OME). The study population consisted of 683 patients who visited the outpatient department of otorhinolaryngology in 7 tertiary hospitals in Korea between January 2010 and May 2015 and were diagnosed with acute AOM or OME. Aural discharge or middle ear fluid were collected from patients in the operating room or outpatient department and subjected to tests of bacterial identification and antibiotic sensitivity. The overall bacteria detection rate of AOM was 62.3% and OME was 40.9%. The most frequently isolated Gram-positive bacterial species was coagulase negative Staphylococcus aureus (CNS) followed by methicillin-susceptible S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), and Streptococcus pneumonia (SP), whereas the most frequently isolated Gram-negative bacterium was Pseudomonas aeruginosa (PA). Regardless of OM subtype, ≥ 80% of CNS and MRSA strains were resistant to penicillin (PC) and tetracycline (TC); isolated MRSA strains showed low sensitivity to other antibiotics, with 100% resistant to PC, TC, cefoxitin (CFT), and erythromycin (EM); and isolated PA showed low sensitivity to quinolone antibiotics, including ciprofloxacin (CIP) and levofloxacin (LFX), and to aminoglycosides. Bacterial species and antibiotic sensitivity did not change significantly over 5 years. The rate of detection of MRSA was higher in OME than in previous studies. As bacterial predominance and antibiotic sensitivity could change over time, continuous and periodic surveillance is necessary in guiding appropriate antibacterial therapy.
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Affiliation(s)
- Sang Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Ju Jeon
- Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea College of Medicine, Incheon St. Mary's Hospital, Incheon, Korea
| | - Seok Min Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Chang Hoon Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yong Byun
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Myung Gu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
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