Association of otoscopic findings and hearing level in pediatric patients with otitis media with effusion

Objective

To find the association between the abnormalities of tympanic membrane characteristics and the hearing level in pediatric patients with otitis media with effusion.

Methods

Sixty-three pediatric patients with otitis media with effusion had undergone ear examinations by pneumatic otoscopy to assess the color, transparency, mobility, fluid level and retraction of the tympanic membrane. An audiogram was done in the same setting, average hearing threshold and air-bone gap were measured. Otoscopic findings and the result of the hearing test were analyzed to identify the association between the abnormalities of the tympanic membrane characteristics and elevated hearing threshold.

Results

Hearing loss was found in 92.1% of the patients. Mean hearing level was 31.7 ± 10.3 dB. From linear regression analysis, the patients with dull or opaque tympanic membrane had a significantly higher hearing threshold of 7.2 dB than the patient with translucent ear drum after adjusting for mobility and retraction. The patients with tympanic membrane retraction had a higher hearing threshold of 5.1 dB than the patient who had no retraction after adjusting for transparency and mobility. Mobility had a significant relationship to elevated hearing threshold in the univariate analysis but not in multivariable analysis.

Conclusion

Opacity and retraction were the two characteristics of abnormal tympanic membrane that were associated with elevated hearing threshold in the patients with otitis media with effusion. Hearing test is suggested if opacity or retraction of the tympanic membrane is found.     

腺样体切除对儿童分泌性中耳炎听力的影响

目的探讨腺样体切除术对分泌性中耳炎听力的影响。方法对72例确诊为腺样体肥大所致的分泌性中耳炎患儿随机分为非手术组和手术组，分别进行药物治疗和手术治疗。结果非手术组治疗后听阈≤20dB12耳，手术组治疗后听阈≤20dB36耳，两组治疗后听阈改变经x^2检验差异有显著性。结论腺样体切除术对分泌性中耳炎所致的听力下降的改善是非常有效的。     

Frequency-specific hearing results after surgery for chronic ear diseases

Objectives

To analyze frequency-specific hearing results after surgery for chronic ear diseases while considering pathological findings and various surgical factors.

Methods

Patients who underwent surgical management of chronic otitis media were reviewed retrospectively (n=559). Using pure tone audiometry, air conduction (AC), bone conduction (BC), and air bone gap (ABG) change between pre- and post-operative tests were calculated for the frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000 (AC and BC), and 6,000 Hz (AC). Frequency-specific results were investigated, considering various surgical factors, such as type of surgery, type of ossiculoplasty and pathological findings.

Results

AC results in the intact canal wall mastoidectomy showed improvement at each frequency except 4,000, 6,000 Hz. AC results in the tympanoplasty showed improvement at each frequency except 6,000 Hz. AC and ABG results in the open cavity mastoidectomy showed improvement only at the frequencies of 250, 500, 2,000 Hz. AC and ABG improved at low and mid frequencies but not in high frequencies above 3,000 Hz when ossicular reconstruction was conducted. AC and ABG results also improved at low and mid frequencies in the cholesteatoma, and ABG results improved at all frequencies except 3,000 Hz in the non-cholesteatoma.

Conclusion

After chronic ear surgery, AC and ABG changes improved, primarily in the low and mid frequencies. Further evaluation and studies for post-operative hearing loss at high frequencies are recommended for rehabilitation of hearing ability after surgery.     

听力障碍新生儿随访中听力恢复正常的原因分析

目的：分析新生儿普遍听力筛查中3个月内诊断为听力障碍婴儿其听力恢复正常的原因。方法：2001年11月～2005年6月在上海市出生并接受新生儿普遍听力筛查未通过者,转至上海市儿童听力障碍诊治中心接受听力学评估,均在出生3个月内诊断为听力障碍,并进行听力学跟踪随访至少6个月,对听力恢复正常者进行分析。结果：出生3个月内诊断为听力障碍者681例,随访6～24个月听力恢复正常者94例（115耳）,占13．8％。听力恢复正常者中发现有鼓室积液56例（64耳）,占59．6％;未发现有明确器质性原因者38例（51耳）,占40．4％。听力恢复正常115耳中听力障碍轻度105耳,占91．3％;中度8耳,占7．0％;中重度2耳,占1．7％;重度和极重度无恢复正常者。结论：出生3个月内诊断有听力障碍的患儿,随年龄增长其听力恢复正常的可能性以轻、中度聋为大。恢复原因主要是分泌性中耳炎自愈和听中枢生理性发育逐渐成熟。     

新生儿听力筛查的研究历史与现状

听力损失会影响儿童言语语言发育、心理发育、教育、就业和婚育,而且会影响家庭沟通、给家庭带来经济压力,给社会带来沉重负担。许多国家联系已有的保障、社会和教育系统,使用各种筛查方法和方案已成功地开展了早期听力检测和干预项目,认识到了新生儿听力筛查的重要性,并积极加强与国际的交流与合作,进行新生儿听力筛查项目的培训和实施。早期发现、早期诊断、早期治疗,旨在提高生活水平,提高人口素质,使新生儿听力筛查项目在曲折中不断向前发展。本文从新生儿概况、新生儿听力筛查的发展阶段、筛查技术以及面临的挑战回顾了新生儿听力筛查的发展现状,并提出展望。     

咽鼓管功能对行Ⅰ型鼓室成形术的慢性中耳炎患者短期听力影响分析

目的 通过对耳内镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎患者的临床资料分析,探讨咽鼓管功能对其听力影响。方法 收集诊断为慢性化脓性中耳炎患者42例,结合声导抗正负压平衡试验和咽鼓管功能障碍评分量表(ETDQ-7)将分为咽鼓管功能障碍患者作为研究组(25例),将咽鼓管功能正常患者作为对照组(17例),对比分析两组患者手术前后听力的变化。结果 研究组术前与术后气导平均听阈、骨导平均听阈均高于对照组,差异具有统计学意义(P <0.05);研究组术后气导平均听阈和骨导平均听阈的改善值均高于对照组,差异无统计学意义(P> 0.05);研究组术后4 k Hz气导听阈改善值低于对照组,差异无统计学意义(P> 0.05);研究组术后8 k Hz气导听阈改善值低于对照组,差异有统计学意义(P <0.05)。结论 良好的咽鼓管功能不会增加Ⅰ型鼓室成形术对慢性化脓性中耳炎患者平均听力的改善程度,但有利于患者术后高频听力的恢复。     

儿童分泌性中耳炎致骨导听力下降的临床特征分析

目的 探讨儿童分泌性中耳炎致骨导听力下降的特点、病因和预后.方法 回顾性分析75例(82耳)分泌性中耳炎患儿骨导听力下降的临床资料,并对其发病年龄、病程、积液性质和积液量与骨导听阈的关系进行观察.结果 75例患儿(82耳)骨导听力下降,平均骨导阈值在2.0 kHz和4.0kHz处增高最明显.骨导听阈与病程和积液性质显著相关(P＜0.01或P＜0.05),与年龄、积液量无关.75例患儿均采取鼓膜切开置管术和(或)腺样体切除术,术后给予药物治疗.随访6月,听力恢复正常者76耳,气导听阈下降但骨导听阈无改善者6耳.结论 分泌性中耳炎可导致儿童骨导阈值增高,是导致儿童耳聋的危险因素之一,及早干预可避免病情发展.     

分泌性中耳炎骨导听阈改变的临床观察

目的证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳炎,尤其是顽固的分泌性中耳炎提供依据.方法115例(164耳)分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0.5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数.分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组.结果在164耳中,出现骨导听阈提高的共94耳(57.3%).双侧组与单侧组骨导听力损失程度差异均无显著性(P>0.05);单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;不同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大.结论半数以上分泌性中耳炎可以导致感音神经性聋.在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势.     

手术治疗儿童腺样体肥大致反复发作的分泌性中耳炎

目的：探讨治疗儿童经手术切除肥大腺样体后致顽固性分泌性中耳炎的疗效。方法：对32例行腺样体切除后患儿进行听力、声阻抗、纯音测听方面的检查。结果：治愈28例,好转3例,无效1例,有效率96.9%。结论：切除腺样体可作为治疗儿童反复发作的分泌性中耳炎（otitis media with effusion OME）的手段之一。     

儿童分泌性中耳炎的外科手术干预

目的探讨儿童分泌性中耳炎的手术干预方式，为儿童听力筛查中分泌性中耳炎患儿的干预措施选择提供临床资料。方法总结2004-2008年我院90例儿童分泌性中耳炎接受手术治疗且资料完整者45例（82耳）的年龄特点、听力下降时间、手术方式、手术前后听力状况比较。结果术前平均纯音听阈FrrA（pure-tone threshold average，500Hz，1000Hz，2000Hz，4000Hz听阈均值）从8dBHL-61dBHL，平均（34.8&#177;12.09）dBHL。术后PTA从0dB HL-38dB HL，平均（15.9&#177;7.88）dB HL，3耳术后听闯提高，4耳无改善，75耳听阈降低，占91.5％，平均听阈降低18.9dBHL。手术方式：鼓膜置管术9例，腺样体切除＋鼓膜置管术29例，腺样体切除＋扁桃体切除＋鼓膜置管术7例。结论腺样体切除＋鼓膜置管术是我们治疗儿童分泌性中耳炎的基本术式；扁桃体切除术不作为治疗分泌性中耳炎常规选择；对儿童分泌性中耳炎的术式选择应该个体化。     

Hearing impairment in otitis media with effusion: a cross-sectional study based in Pokhara, Nepal

Objective

Otitis media with effusion (OME) is a major cause of childhood hearing impairment (HI) in the developing world, but its prevalence has never been quantified in Nepal. This study therefore set out to determine the proportion of cases of OME complicated by HI and to identify associated factors.

Methods

This was a cross-sectional prevalence survey carried out in rural, urban and Tibetan schools in and around Pokhara, Nepal. HI was the primary outcome, and was defined as a middle-frequency pure tone average >25 dB on audiological testing. The study population was defined as children aged four years and older, attending primary school and with a diagnosis of OME.

Results

One hundred and eleven schoolchildren with a combined total of 172 ears affected by OME underwent audiometric assessment. HI was most prevalent in the rural Nepali population; 27% (95%CIs 18–38%) had HI, with a mean hearing loss of 22 dB (15–25 dB). In the Tibetan population, 16% (8–29%) had HI, with a mean loss of 17 dB (12–22 dB). The urban Nepali population had the least HI; 4% (1–13%) were affected, with a mean loss of 16 dB (15–19 dB). The difference in prevalence between the urban and rural Nepali populations was statistically significant (p > 0.05). Logistic regression analysis did not identify any associated factors.

Conclusions

HI is a common complication of OME in Nepal. There is hitherto-unreported variation between populations in the number of cases of OME complicated by HI. This study identified higher rates of morbidity amongst rural populations but was unable to identify associated factors.     

新生儿听视同步筛查的临床模式

目的探索新生儿听力、眼病同步筛查的可行性和临床模式；了解新生儿听力下降及眼病的发病情况。方法在母婴同室应用瞬态诱发耳声发射，新生儿重症监护病房采用两阶段筛查技术进行新生儿听力筛查；同步进行新生儿眼病筛查。听力复筛未通过者，生后3个月进入诊断程序并进行跟踪随访和定期的听力学评估；眼病筛查疑似病例及时转诊到专业眼科进一步确诊。结果自2002年10月1日至2005年4月30日在济南市妇幼保健院共出生16800例新生儿，对其中的15398例（91．7％）新生儿进行了听力、眼病同步筛查。新生儿听力损失在同步筛查儿中的检出率：双耳0．312％（48／15398），单耳0．227％（35／15398）；有4例单耳或双耳先天性感音神经性聋伴发眼病或眼部阳性体征：1例极重度感音神经性聋（双）、听神经病伴双眼先天性完全性白内障，1例轻度感音神经性聋（双）伴发左眼永存瞳孔膜，1例轻度感音神经性聋（双）伴双眼底静脉扩张，1例右耳轻度感音神经性聋伴双眼永存玻璃体动脉。在15398例统计取样的新生儿中，共检出先天性眼病或眼部阳性体征13种2211例。结论新生儿期听力损失和眼病或眼部阳性体征在临床中并不少见。新生儿听视同步筛查在听力下降以及眼病监测和防治中是可行的，亦是有效的。     

Characteristics of hearing impairment in Yemeni children with chronic suppurative otitis media: A case-control study

Background

Chronic suppurative otitis media (CSOM) is a serious disorder particularly in low resource settings. It can lead to disabling hearing impairment and sometimes life-threatening infective complications.

Objective

The aim of the present study was to describe the characteristics of hearing impairment associated with CSOM in Yemeni children.

Methods

A case-control study of 75 children with CSOM and 74 healthy controls. Hearing was assessed by behavioural testing and audiometry.

Results

Cases had lower academic performance than controls (OR 15.31, 95% CI 1.99-322.14, p < 0.001). Disabling hearing impairment >30 dB was present in 51.5% (right ear) and 66.7% (left ear) of children with CSOM.

Conclusion

Disabling hearing impairment was identified as a major health problem in these Yemeni children with CSOM. There is a need for investment to reduce the burden of CSOM and its complications in these communities. Greater attention to the chronic disabling effects of CSOM in children is required in poor communities and low resource settings.     

湖州市新生儿听力和耳聋基因联合筛查结果分析

目的　探讨新生儿听力与耳聋基因联合筛查临床价值。方法　对2014年2月～2015年8月出生的1933例新生儿作为研究对象,进行听力及耳聋基因的联合筛查。结果　1933例新生儿中,听力初筛通过率71.34%（1379/1933）,未通过率28.66%（554/1933）,听力障碍率4.14‰（8/1933）。基因筛查突变率：GJB2突变率28.97‰ （56/1933）,SLC26A4突变率 13.97‰（27/1933）,GJB3突变率6.21‰（12/1933）,线粒体12 S rRNA 基因突变率1.03‰（2/1933）。1例235delC纯合突变,听力初筛双耳未通过,复筛失访;2例12 S rRNA1555A>G同质突变听力初筛通过。8例听力障碍者耳聋基因筛查均正常。结论　聋病基因同步筛查可以弥补单纯新生儿听力筛查的不足,两者应联合运用,互为补充,发挥最大作用。     

Postoperative change in wideband absorbance after tympanoplasty in chronic suppurative otitis media

ObjectiveTo identify the wideband absorbance (WBA) of reconstructed TM comparing with perforated and normal TM, and to investigate the efficacy of WBA to predict postoperative hearing outcome.MethodsNinety-eight adults (128 ears) with normal TM and 40 patients (40 ears) who were diagnosed with chronic suppurative otitis media (CSOM) and underwent tympanoplasty type 1 were enrolled. Pure tone audiometry and WBA were measured before and 6 and 12 months after surgery. Finally, only 29 patients in CSOM group completed all the tests.ResultsSignificant differences in WBA were observed between normal ears, CSOM, and reconstructed ears at middle to high frequencies. During follow-up, absorbance decreased at low frequencies and increased at middle to high. Significant positive correlation at low to middle frequency was observed between change in air-bone gaps (ABG) and absorbance at corresponding frequencies.ConclusionWBA in patients with CSOM was significantly different from normal TM, and a significant change in WBA was observed after tympanoplasty with improvement of ABG. WBA may be a useful tool for monitoring the postoperative change in absorbance of sound energy in the middle ear.     

Trends in otitis media surgery: a decrease in adenoidectomy

OBJECTIVE: Large variability in adenoidectomies and tympanostomy tube insertions between Norway and Finland has been suggested, but not yet confirmed. Objective is to compare trends in paediatric adenoidectomies and tympanostomy tube insertions for Norway and Finland from 1999 to 2005. METHODS: National Finnish and Norwegian databases (STAKES and NPR) provided information on children between 0 and 7 years operated in the years 1999-2005. Surgical rates were viewed in the light of child density, age and gender, and compared bi-nationally. RESULTS: Adenoidectomies were more common in Finland throughout the study period. Adenoidectomies in both countries decreased markedly from 1999 to 2005. The Finnish adenoidectomy rates were reduced from 212 to 133 per 10,000 children, equivalent Norwegian figures were 84 and 44 per 10,000 children. Tympanostomy tube insertions increased from 97 to 147 per 10,000 children in Finland in the same study period. In Norway the rates were more stable, 119 and 123 per 10,000 in 1999 and 2005, respectively. Peak-age for otitis media surgery was the second year of life in Finland, sixth in Norway. Boys were more frequently operated on in both countries. CONCLUSION: Our study confirmed differences in the approach to otitis media surgery and revealed a decreasing trend in adenoidectomies in both countries. Similar data from other countries is needed to confirm the latter.     

Revision surgery for chronic otitis media: Characteristics and outcomes in comparison with primary surgery

Objectives

To analyze the characteristics and outcomes of revision surgery for chronic otitis media (COM) with or without cholesteatoma, and to compare with those of primary surgery.

Methods

A retrospective chart review was performed on 208 patients who underwent revision surgery for COM over an 8-year period (1997–2004) and 51 patients who underwent a primary canal wall down mastoidectomy (CWDM), and were followed for more than 12 months.

Results

Recurrent or residual cholesteatoma was found in 49.5% of cases. The mastoid tip and perisinal air cells were the most frequent sites of residual air cells. As a result of revision surgery, a dry and safe ear was achieved in 88.5% of patients. A residual air–bone gap (ABG) of ≤30 dB was achieved in 70.1% of cases with a revision CWDM with ossiculoplasty. In comparison with 51 patients who underwent primary CWDM, the disease control rate was not different. However, postoperative hearing result after ossiculoplasty was worse and longer healing time was required after revision surgery.

Conclusion

The characteristics and surgical outcome of recurrent COM must be fully understood for complete control of the disease.     

Otitis media as a cause of significant hearing loss among Nigerians

Mild or worse hearing loss, defined as pure tone average >25 decibel, is seen commonly with preventable etiologies.

Settings

A tertiary care, urban referral hospital.

Methods

Retrospective analysis of prospectively collected data of individuals attending the hearing loss clinic of National Hospital, Abuja, between May 2005 and April 2007. Data matching the diagnosis of acute otitis media (AOM), otitis media with effusion (OME) and chronic suppurative otitis media (CSOM) were extracted from the database and analyzed.

Result

A total of 298 cases with primary presenting complaints of hard of hearing were seen. A total of 77 cases had hearing loss due to otitis media. 44 (57.1%) had OME, 26 (33.8%) had CSOM, while 7 (9.1%) had AOM. The observed distribution of the OME was left OME (18.1%, n = 14), right OME (9.1%, n = 7) and bilateral OME (29.9%, n = 23), while the CSOM is distributed into left CSOM (15.5%, n = 12), bilateral CSOM (11.7%, n = 9) and right CSOM (6.4%, n = 5), and AOM is distributed into right AOM (2.6%, n = 2), left AOM (3.9%, n = 3), and bilateral AOM (2.6%, n = 2). The mean pure tone averages for the three groups are AOM (30.5 dB), OME (41.5 dB) and CSOM (56.9 dB).

Conclusion

Otitis media is an important cause of preventable hearing loss in developing countries, and the predominance of unilateral otitis media in the left ear observed in this study deserves further studies.     

The treatment outcomes of rituximab for intractable otitis media with ANCA-associated vasculitis

Objective

To investigate treatment outcomes, hearing outcomes, and adverse effects of rituximab (RTX) for intractable otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV).