Adenoids and otitis media with effusion: nasopharyngeal flora

In order to clarify the role of the microflora of the nasopharynx and adenoids as causative factors of otitis media with effusion (OME), bacteriologic species in middle ear effusions (MEEs), nasopharyngeal smears, and adenoid tissues of children with OME were cultured. The change in the microflora of the nasopharynx after adenoidectomy, and the degree of bacterial agreement between the microflora of the nasopharynx and adenoid tissue were investigated. Nasopharyngeal bacterial flora were investigated in 259 children with OME from November 1984 to November 1987. The patients were divided into two groups: group A (43 patients) underwent adenoidectomy, and group B (216 patients) had no adenoidectomy. Hemophilus influenzae, Streptococcus pneumoniae, Branhamella catarrhalis, and Staphylococcus aureus were cultured in 66.7% of nasopharyngeal smears from group B, and in 46.5% from group A. Adenoid specimens for bacteriologic investigation were obtained from 38 adenoidectomy patients at surgery. Of these, H influenzae were cultured from adenoid specimens taken from 16 of the 26 patients with OME (group C), while only three of the 12 adenoidectomy patients without OME (group D) were found to have H influenzae in their adenoid specimens. The findings of this study suggest that adenoid vegetation plays an important role in the etiology of OME.     

The nasopharyngeal bacterial flora in children with otitis media with effusion

A study was undertaken to evaluate the incidence of nasopharyngeal -streptococci with inhibitory activity against pathogens, as a defense mechanism of the normal bacterial flora against infection. Cultures were taken from the nasopharynges of 43 children with otitis media with effusion (OME). The detection rates of -streptococci with inhibitory activity against Haemophilus influenzae, Streptococcus pneumoniae, Staphylococus aureus and group A streptococci were significantly lower in the nasopharynx than those isolated from the tonsils of the same patients. Moreover, the detection rates of -streptococci with inhibitory activity against all of these pathogens derived from the nasopharynx were lower than those in healthy children, streptococcal strains with activity against H. influenzae and Strep. pneumoniae were also lower than that in patients with tonsillitis. These findings suggest that low nasopharyngeal levels of -streptococci with inhibitory activity against respiratory pathogens may render children susceptible to OME. Further studies are needed to investigate the relationships between the prevalence of pathogens in the nasopharynx and the inhibitory activities of -streptococci against them in order to devise and select optimal treatment for patients with OME.     

Extension of nasopharyngeal carcinoma and otitis media with effusion

In 35 patients with nasopharyngeal carcinoma that occupied the fossa of Rosenmüller, the relationship of the tumor, assessed by computed tomographic scans, to otitis media with effusion and ventilatory function of the eustachian tube was examined. Incidence of otitis media with effusion was low when the tumor was limited to the fossa of Rosenmüller (stage I), and high when the tumor extended from the fossa to the parapharyngeal space (stage II). Passive opening of the eustachian tube remained normal until the tumor occupied the parapharyngeal space (stage III). However, active tubal opening was impaired in stage I and the impairment increased with the tumor stage. These results indicate that tumor extension from the fossa of Rosenmüller to the parapharyngeal space and resultant poor active tubal opening cause the development of otitis media with effusion in patients with nasopharyngeal carcinoma.     

A case of nasopharyngeal actinomycosis leading to otitis media with effusion

Nasopharyngeal actinomycosis is extremely rare, and to our knowledge, only seven cases have previously been reported. Diagnosis of actinomycosis is made by clinical finding, observation of the bacteria and histopathological examination. Treatment for actinomycosis is surgical debridement and administration of antibioticus, especially penicillin for several weeks with good prognosis. We report a case of nasopharyngeal actinomycosis, which lead to otitis media with effusion. Endoscopic surgery and prolonged penicillin administration for 2 months were effective for treatment of actinomycosis in the nasopharynx.     

Organic change of effusion in the mastoid in otitis media with effusion and its relation to attic retraction

To try to solve the pathogenesis of severe attic retraction viewed from mastoid condition, we examined the residual soft tissue density (RSTD) in the mastoid by computed tomography (CT) in 85 patients (107 ears) with otitis media with effusion (OME) 3 months after tympanostomy tube insertion or later. The incidence of RSTD in the mastoid was significantly higher in OME of adults (52.6%) than in children (24.1%). Ears with severe attic retraction had RSTD significantly more frequently (80%) than those with no or mild attic retraction, and many of the mastoids with severe attic retraction were occupied totally by RSTD. The area of the mastoid (mastoid pneumatization) was significantly smaller, and CT density of the mastoid (sclerotic tendency) was significantly higher in ears with RSTD than in those without. RSTD after tympanostomy tube insertion in the mastoid indicating organic change of effusion was considered one of the important factors relating to the pathogenesis of severe attic retraction.     

Squamous cell metaplasia of the nasopharyngeal epithelium and its association with adult-onset otitis media with effusion

CONCLUSION: The common association between adult-onset otitis media with effusion (AO-OME) and squamous cell metaplasia (SCM) of the epithelium of Rosenmüller's fossa, which is near the Eustachian tube orifice, implies the predictive role of metaplasia, which probably compromises the drainage function of the middle ear. OBJECTIVE: To determine the effects of nasopharyngeal epithelial changes (SCM) on AO-OME. AO-OME is a multifactorial and insidious disease that may necessitate detailed investigation, i.e. biopsy of the nasopharynx, because of possible underlying nasopharyngeal malignancy. MATERIAL AND METHODS: Fifty-two patients with AO-OME (study group) and 29 with a unilateral neck mass in the posterior triangle without AO-OME (control group) were enrolled. Nasopharyngeal biopsies taken from all subjects were evaluated with regard to surface epithelial changes of the nasopharynx. RESULTS: Nasopharyngeal biopsies revealed SCM in 34/52 patients (65%) in the study group and 9/29 (31%) in the control group (p<0.05). During the follow-up period, recurrence of effusion occurred in 56% of the group with SCM and 22% of the group without it.     

Squamous cell metaplasia of the nasopharyngeal epithelium and its association with adult-onset otitis media with effusion

Conclusion

The common association between adult-onset otitis media with effusion (AO-OME) and squamous cell metaplasia (SCM) of the epithelium of Rosenmüller's fossa, which is near the Eustachian tube orifice, implies the predictive role of metaplasia, which probably compromises the drainage function of the middle ear.

Objective

To determine the effects of nasopharyngeal epithelial changes (SCM) on AO-OME. AO-OME is a multifactorial and insidious disease that may necessitate detailed investigation, i.e. biopsy of the nasopharynx, because of possible underlying nasopharyngeal malignancy.

Material and methods

Fifty-two patients with AO-OME (study group) and 29 with a unilateral neck mass in the posterior triangle without AO-OME (control group) were enrolled. Nasopharyngeal biopsies taken from all subjects were evaluated with regard to surface epithelial changes of the nasopharynx.

Results

Nasopharyngeal biopsies revealed SCM in 34/52 patients (65%) in the study group and 9/29 (31%) in the control group (p<0.05). During the follow-up period, recurrence of effusion occurred in 56% of the group with SCM and 22% of the group without it.     

Age and adenoid size in relation to adenoidectomy in otitis media with effusion

A previously reported study showed that adenoidectomy resolved effusions in chronic bilateral otitis media with effusion in 36 to 46 per cent of 103 children. This work includes 52 additional cases and assesses the effect of age and adenoid size in relation to adenoidectomy. Pre-operative lateral cephalometric radiographs showed the adenoid size and postnasal space airway. Surgery was allocated randomly into three groups: adenotonsillectomy, adenoidectomy, and no surgery. In addition, in all cases a unilateral myringotomy and ventilating tube insertion were performed. The ear not operated upon was assessed for clearance of the effusion at 3, 6, 9, and 12 months postoperatively. Following adenoidectomy the effusion resolved in the ear not operated upon in 31 to 45 per cent of cases assessed after 1 year. Tonsillectomy conferred no additional benefit. There was a trend for improved clearance of effusions in children more than 6 years of age, compared with those less than 6 years of age. There was also a trend for improved clearance after removal of larger adenoids from children with smaller postnasal space airways, but this was only significant for 3 months postoperatively.     

Nasopharyngeal flora in otitis media with effusion. A comparative semiquantitative analysis

An inflammatory process in the middle ear caused by bacteria or bacterial products emanating from the nasopharynx is one etiological factor considered in the unknown pathogenesis of otitis media with effusion (OME). The nasopharyngeal prevalence of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis and Streptococcus pyogenes was studied in 191 children with defined OME and in 53 age-matched children without middle ear disease. Duplicate sampling and semiquantitative analysis were performed to assess even minor differences in the distribution of pathogens between the two groups of children. Pathogens were recovered in 91% of OME children. A significantly higher number of pathogen species/patient (1.66 vs. 1.15, p less than 0.01) as well as pathogen colonies/patient was found in OME children compared to control children. Chronic OME in children is associated with an increased pathogen load in the nasopharynx, suggesting a role of these pathogens in the etiology of OME.     

腺样体与咽鼓管圆枕的毗邻关系及其与分泌性中耳炎的相关性

目的　观察腺样体肥大儿童的腺样体与咽鼓管圆枕的毗邻关系,探讨其与分泌性中耳炎的相关性。方法 144例腺样体肥大（或同时扁桃体肥大）70°鼻内镜下行等离子消融术患儿,术中观察并记录腺样体与咽鼓管圆枕的毗邻关系,并将其分为Ⅰ、Ⅱ、Ⅲ共3型;比较3组患儿分泌性中耳炎发病率、腺样体重度肥大（A/N比值是否大于0.7） 的发生率并计算有无统计学差异。结果　本组患儿分泌性中耳炎发病率23.6%;腺样体与咽鼓管圆枕的毗邻关系及合并分泌性中耳炎,Ⅰ型3例（9.1%,3/33）、Ⅱ型10例（16.9%,10/59）、Ⅲ型21例（40.4%,21/52）,Ⅰ型与Ⅱ型分泌性中耳炎发生率无显著性差异（χ 2=1.077,P =0.299）,Ⅰ型与Ⅲ型有显著性差异（χ 2=9.757,P =0.002）,Ⅱ型与Ⅲ型有显著性差异（χ 2 =7.542,P =0.006）;Ⅰ型和Ⅱ型组腺样体A/N＞0.7之和为34.9%,三型组A/N＞0.7为82.2%,Ⅰ型及Ⅱ型腺样体重度肥大率之和与Ⅲ型有显著性差异（χ 2=30.556,P =0.000）。结论　腺样体与咽鼓管圆枕毗邻关系及腺样体的肥大程度与分泌性中耳炎有显著相关性。     

Immune-mediated otitis media with effusion

This study was designed to clarify the role of immune reaction in otitis media with effusion (OME). Immune-mediated OME was induced in chinchillas, and characteristics of the disease were evaluated biochemically, cytologically, and histologically. OME was induced by a single intratympanic inoculation of keyhole limpet hemocyanin (KLH) in animals which had a high serum anti-KLH IgG titer. In addition, OME was maintained for 3 weeks in seven of 17 chinchillas, boosted by intradermal and intratympanic injections at 1-week intervals. Cells in the middle ear effusion (MEE) consisted substantially of neutrophils, a few macrophages, and other cells. The mean histamine and prostaglandin E2 levels in the MEE significantly exceeded the levels in corresponding sera. The lining membrane of the bullae was edematous and thickened due to dilatation and rupture of blood capillaries and cell infiltration. Next, the animals were inoculated with immune complex into the tympanic cavity. MEE appeared in all treated ears within three days after injection. Biochemical, cytologic, and histologic findings of the immune complex-induced OME resembled those of immune-mediated OME. An immune peroxidase method demonstrated that neutrophils in MEE phagocytose immune complexes. Our findings suggest that a perpetual cycle of inflammatory substances may maintain an inflammatory condition in the middle ear.     

Balance and otitis media with effusion

Dizziness can be caused by a variety of peripheral vestibular, central, and systemic disease processes. Eustachian tube dysfunction with and without middle-ear effusion has been considered one of the most common causes of balance disturbances in young children. Several studies have indicated that during an episode of otitis media the child's balance deteriorates and the child may become clumsy and fall more often. Thus, not only the adverse effect on hearing should be considered in the management of a child with otitis media, but also the child's balance.     

Balance and otitis media with effusion

Dizziness can be caused by a variety of peripheral vestibular, central, and systemic disease processes. Eustachian tube dysfunction with and without middle-ear effusion has been considered one of the most common causes of balance disturbances in young children. Several studies have indicated that during an episode of otitis media the child's balance deteriorates and the child may become clumsy and fall more often. Thus, not only the adverse effect on hearing should be considered in the management of a child with otitis media, but also the child's balance.     

Hearing acuity in otitis media with effusion and adhesive otitis media

The relationship between findings established by the photograph of the tympanic membrane and hypacusia was determined by pure-tone audiometry. Subjects were 352 ears of 267 patients diagnosed as otitis media with effusion (OME) or adhesive otitis media (AdOM). These two diseases were evaluated on the basis of photographs of the tympanic membrane taken from 1983 to 1988. The results were as follows; 1) The effect of aging process on hearing acuity was noted in patients with these diseases, i.e., values of hearing acuity by air and bone conduction were, in descending order, early-, mature-, and advanced-age groups, with significant differences (p less than 0.01). 2) Greater loss of acuity by air conduction in the middle to high frequency ranges was found in patients with OME than with AdOM. In bone conduction, a decrease in low frequency range in the early--and mature--age groups was larger in patients with AdOM than with OME and a significant decrease in 2000-6000 Hz in the advanced-age group was more marked in patients with OME than with AdOM (p less than 0.05). 3) Among patients with AdOM, those with retained fluid in the middle ear showed a significant decrease in air conduction values and a significant increase in air-bone gap compared with those without fluid (p less than 0.05). 4) The degrees of adhesion correlated well with a decrease in hearing acuity. 5) Hearing acuity was not influenced by attic retraction, white plaque, scar and atrophy of their tympanic membranes.     

Histopathology of otitis media with effusion

Summary Ultrastructural studies of the middle ear mucosa appear to be of significant value in better understanding the pathology of otitis media with effusion (OME). Our present study was undertaken in order to take advantage of the use of electron microscopy in investigating all areas of the middle ear mucosa. Tissues studied were obtained from the fresh postmortem temporal bones of three patients with OME and terminal head and neck malignancies. In the mucoid type of effusion (cases 1 and 2), goblet cells were seen to proliferate and secretory activity was greatly enhanced. In contrast, there was no evidence of secretory cell proliferation in the serous type of effusion. It was noteworthy that accumulated fluid was not homogeneous in the same ear, as exemplified by case 1, in which both mucoid and serous effusions were present. This occurrence was possibly the result of topographic diversity involving the secretory activity of the middle ear.Presented at the Extraordinary International Symposium on Recent Advances in Otitis Media with Effusion, Kyoto, Japan, 12–15 January 1985     

Bacteriology of otitis media with effusion

A study was undertaken to evaluate the prevalence and antibiotic susceptibility of bacteria present in the middle ear of patients with otitis media with effusion. Middle ear effusions (MEE), nasopharyngeal and throat swabs were obtained at operation and cultured for aerobic and anaerobic bacteria. Two hundred and fifty-nine effusions were obtained from 152 subjects examined. Haemophilus influenzae was isolated from 32 (12.3 per cent) effusions, Streptococcus pneumoniae from seven (2.7 per cent), Staphylococcus aureus from seven (2.7 per cent), Branhamella catarrhalis from one (0.4 per cent)--Group A beta haemolytic streptococci from one (0.4 per cent) and Staphylococcus epidermidis from three (1.9 per cent). The occurrence of respiratory pathogens in MEE reflected their prevalence in the upper respiratory tract. Significantly fewer children who had received antibiotics prior to surgery had organisms present in the MEE. Eight and a half per cent of H. influenzae and 64 per cent of B. catarrhalis were resistant to ampicillin. The present study confirms that bacteria are present in the middle ear in a significant number of patients with otitis media with effusion.