The effects of childhood otitis media on the acoustic reflex threshold at age 15

Previous research has found that childhood otitis media leads to elevated adulthood acoustic reflex thresholds because of worsened audiometric thresholds in the stimulation ear, and abnormality of the tympanic membrane in the ear from which acoustic reflexes were measured. To confirm and expand this finding, our research utilized longitudinal data from 631 general-population-sampled children assessed between ages 5 and 15. Otitis media was assessed to age 9, audiometric thresholds were measured at age 11, and otoscopy and acoustic reflex thresholds testing were performed at age 15. Our findings support the earlier research, in that acoustic reflex threshold was higher in those with the worst experience of childhood otitis media. However, this was directly mediated not by audiometric threshold in the ear to which the stimulus was delivered, but by the amount of tympanic membrane abnormality in both the stimulus and probe ears. This appeared to have an effect independent of audiometric threshold. Furthermore, only those who suffered the worst, persistent, binaural childhood otitis media showed raised acoustic reflex thresholds.     

中耳炎区域性病理差异现象的研究及临床意义

目的　研究中耳炎病理过程中 ,中耳腔系统各不同区域病变特点、严重程度的差异及其原因和临床意义。方法　以 2 90耳各型伴炎性渗出液的中耳炎颞骨连续切片作为研究材料 ,将中耳腔系统分为咽鼓管区、前半 后下中鼓室区、听骨链区 (包括后上中鼓室、上鼓室区 )、鼓窦 乳突区分区进行组织病理学比较观察研究。结合 2 5 6耳各型慢性中耳炎薄层CT检查和其中 189耳手术中分区观察结果 ,对各分区病变特点和严重程度差异进行分析。结果　中耳炎时咽鼓管区几乎没有炎性病理变化 ;前半 后下中鼓室区病变轻 ,且多为可逆性病变 ;而听骨链区和鼓窦 乳突区病变明显比前两区严重 ,且多为顽固性或不可逆性病变。结论　这种“中耳炎区域性病理差异现象”是中耳腔系统前、后区域解剖结构、组织的特殊性引起中耳炎时内通风系统病理性阻塞 ,后部区域炎性渗出液易于积存并形成肉芽组织所造成的     

The pathology of silent otitis media: A predecessor to tympanogenic meningitis in infants

Objective

To determine the association of bacteria embedded within a fibrous matrix in the middle and inner ear in infants with tympanogenic meningitis.

Methods

Thirty-one cases with meningitis from the human temporal bone collection at the University of Minnesota were screened to select those with tympanogenic meningitis. Inclusion criteria for tympanogenic meningitis were acute meningitis with histopathological evidence of chronic otitis media, and no other source of infection. The presence of labyrinthitis and pathologic changes such as granulation tissue, fibrosis, cholesterol granuloma, cholesteatoma, tympanic membrane perforation, tympanosclerosis, and the type of effusion were noted. The extent and location of bacteria embedded in a fibrous matrix were also explored.

Results

Seventeen temporal bones, from nine cases that included two females and seven males, ranging in age from five to twenty-three months, met our criteria of tympanogenic meningitis. Eighty two percent of these temporal bones had bacteria within the fibrous matrices (BFM). BFM were located in one anatomical region in one temporal bone and multiple anatomic regions in sixteen temporal bones. The most common locations were the areas near the oval and round windows. They were also commonly seen in the epitympanum, facial recess, and supratubal recess. BFM within the inner ear were observed in the scala tympani and modiolus in the middle and basal turns of the cochleae of nine temporal bones. In one of these temporal bones, BFM were seen in the internal auditory canal. Labyrinthitis was seen in all ears. The tympanic membrane was intact in all cases. BFM were not seen in three temporal bones from two patients. In one case only one side was available for study.

Conclusions

Our findings show an association between the presence of BFM in the ear with chronic pathologic changes and tympanogenic meningitis. Potential pathways of bacteria from the middle ear include hematogeous spread and/or direct spread to dura through the tympanic tegmen, and/or to the inner ear through the oval and round windows, and from there to the modiolus and the meninges. Chronic pathologic changes in the middle ear behind an intact tympanic membrane and the lack of ear symptoms may result in potentially serious sequelae and complications in infant age groups. There should be a heightened awareness of this condition.     

Comb-filtered speech as a tool to demonstrate difficulties of speech perception and the importance of auditory training in cochlear implant users

Abstract

There are parallels between speech recognition by users of cochlear implants (CIs) and recognition of comb-filtered speech by normal hearing persons. We have found it possible to train inexperienced subjects to recognize spectrally deprived speech and we routinely demonstrate this process to relatives of implanted children to help them understand the complexities of CI auditory perception and training.

We tested the understanding of filtered speech by 38 normally hearing listeners, before and after a 15-minute training period. The original speech recording was comb filtered to retain only three spectral bands of 50 Hz width spaced over the range of 200–6250 Hz. Standard speech audiometry word lists were presented through headphones to one ear at the most comfortable level.

The mean score on the initial (baseline) test was 17% (range 0–37%). Training involved presenting each of the original test words after first informing the subject of the word's identity. The same word lists were then re-presented after the training period and produced a mean score of 57% (37–73%). A third test was then performed using a different word list, producing a mean score of 52% (37–70%).

The variability of results on the first test is analogous to speech recognition differences among newly implanted patients. The high results of the second and third test can be used to show parents that it is possible to learn new skills and improve speech recognition with CIs through training. Parents experiencing the process described here are better able to understand the initially unclear auditory experience of CI users and how this can be improved through training.     

Role of grommet in otitis media with effusion: A necessity or nuisance? A comparative study

Otitis media with effusion is one of the commonest otological problems in paediatric age group. The condition occurs in childhood as overt or covert hearing loss presenting as an educational or behavioural problem. As there is widespread controversy regarding its precise aetiology, natural history and pathogenesis a treatment dilemma still persists. The main goal of this study is to compare the efficacy of different modalities of medical and surgical treatment designed for this condition and analysis of the results statistical.     

Electric-acoustic stimulation in adults: localization and speech perception

Abstract

This paper reports findings from a study that was aimed at investigating how best to prescribe devices that provide electric-acoustic stimulation. The localization and speech perception of adults who use electric-acoustic stimulation in one ear and acoustic amplification in the opposite ear were evaluated. Results indicated localization benefits when acoustic amplification was used in both ears. Systematic adjustments of the relative output and cross-over frequencies were implemented to determine the settings that optimized outcomes. Results from a case study indicated benefits for localization and speech perception when electric–acoustic stimulation in one ear was combined with a hearing aid in the opposite ear, after acoustic-to-electric levels and cross-over frequencies were optimized.     

胆脂瘤型和骨疡型中耳炎Ⅰ期鼓室成形术的疗效观察

目的：探讨胆脂瘤型和骨疡型中耳炎Ⅰ期鼓室成形术的可行性及疗效影响因素。方法：52例(52耳)慢性化脓性中耳炎(胆脂瘤型30耳，骨疡型22耳)患者在清除病变的同时行鼓室成形术，其中单纯鼓室成形术12耳，乳突根治加鼓室成形术40耳。结果：全部病例均干耳，无一例胆脂瘤复发。语频段听力提高30dB以上者5耳，提高20～29dB者9耳，提高10～19dB者31耳，小于10dB者7耳，无听力下降者。结论：胆脂瘤型和骨疡型中耳炎可行Ⅰ期鼓室成形术，鼓膜有效振动面积、镫骨及镫骨底板的活动度是影响听力的重要因素，咽鼓管功能不良是手术失败的主要原因。     

中耳积液中纤维蛋白原含量与分泌性中耳炎疗效的关系

目的探讨中耳积液中纤维蛋白原含量与分泌性中耳炎病情迁延的关系及巴曲酶治疗分泌性中耳炎的可能机制。方法用凝固法对156例分泌性中耳炎患者治疗过程中的中耳积液中纤维蛋白原含量进行动态检测。鼓室抽液2次（间隔1周），积液复发者随机分成巴曲酶组及地塞米松组，穿刺后分别用0．5ml巴曲酶（2BU／ml）或0．5ml地塞米松（2mg／ml）行鼓室内注射治疗，观察治疗效果。结果积液复发组第1、2次复发中耳积液中纤维蛋白原含量均明显高于痊愈组，且第2次复发者的中耳积液纤维蛋白原含量更高（P〈0．01）。巴曲酶组治疗有效率为91．6％，较地塞米松组（有效率为62．5％）差异有统计学意义（P〈0．001）。治疗后6个月巴曲酶组平均气导听阈值（0．5、1．0、2．0kHz）变化与地塞米松组比较，治疗1周后2组中耳积液中纤维蛋白原含量差异，均有统计学意义（P〈0．01）。结论纤维蛋白原可能在分泌性中耳炎发生发展中起重要作用；鼓室内注射巴曲酶比注射地塞米松治疗分泌性中耳炎，疗效差异有统计学意义，其机制可能是通过降解纤维蛋白原以解除其对咽鼓管表面活性物质的抑制作用或（和）阻止其转变成不溶性纤维蛋白聚合体。     

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.     

Differential expression of cytokine genes and iNOS induced by nonviable nontypeable Haemophilus influenzae or its LOS mutants during acute otitis media in the rat

OBJECTIVE: We have previously demonstrated that the disruptions of nontypeable Haemophilus influenzae (NTHi) lipooligosaccharide (LOS) htrB and rfaD genes may play a role in the pathogenesis of otitis media (OM). The purpose of this study was to determine whether NTHi LOS gene disruptions influence the induction of gene expression for proinflammatory mediators in vivo using the rat model of acute OM. METHODS: At 3, 6, 12, 24, 48 and 72 h after transbullar inoculation with nonviable NTHi, expression of genes for the cytokines and chemolines; tumor necrosis factor alpha (TNF-alpha), interleukin-lbeta (IL-1beta), and IL-6, IL-1alpha, IL-8, IL-10, and inducible nitric oxide synthase (iNOS) were quantitated by real-time PCR. Enzyme-linked immunosorbent assay was performed to confirm the gene expression data as determined by real-time PCR. The middle ear inflammatory responses were also evaluated. RESULTS: The NTHi 2019 parent and its isogenic LOS htrB (B29) and rfaD (DK-1) mutant strains induced a significant up-regulation in gene expression for the cytokines examined compared to the sham-inoculated controls at 3, 6 and 12 h post-inoculation (P<0.05 in all cases). However, the NTHi 2019 cohort demonstrated a significant increase in gene expression for TNF-alpha (up to 6 h), IL-1alpha and IL-8 (up to 24 h), IL-1beta and IL-6 (up to 48 h), and IL-10 and iNOS (up to 72 h) relative to the animals inoculated with NTHi B29 (P<0.05, in all cases), Moreover, the concentrations of inflammatory cells in the middle ear lavage fluid samples from the NTHi 2019 cohort were 2.8-5.3-fold higher than those of the B29 cohort. There were no significant differences in mRNA expression of the cytokines between the NTHi 2019 and the DK-1-treated groups. CONCLUSIONS: Data from this study indicate that the disruption of the NTHi htrB gene may impact the temporal mRNA expression of inflammatory mediators and inflammation within the middle ear.     

Chorda tympani nerve function in children: relationship to otitis media and body mass index

Objective/hypothesis

A relationship between acute otitis media and elevated body mass index has recently been reported. Intriguingly, it was postulated that this relationship may result from altered chorda tympani nerve function impacting taste sensation and eating habits. We sought to test this directly by measuring chorda tympani nerve function in children with and without a previous history of acute otitis media and to determine the relationship to body mass index.

Study design

Retrospective cohort study.

Methods

Institutional research ethics board approval was obtained. Study participants included 142 children (5-18 years of age) who were recruited from an otolaryngology outpatient clinic at a tertiary academic pediatric hospital between May and August 2009. Children were excluded if they were not able to communicate effectively, younger than age 5, or had developmental disabilities. Body mass index was calculated and the history of previous otologic disease carefully elicited from the caregivers. Electrogustometric threshold, a validated measure of chorda tympani function, was obtained bilaterally in each child. Children were divided into cohorts based on the number of acute otitis media episodes, and electrogustometry thresholds were compared between cohorts.

Results

Electrogustometric thresholds were successfully obtained in all children. There was no significant relationship between chorda tympani nerve function and history of acute otitis media. Similarly, there was no significant association between the history of otitis media and body mass index.

Conclusion

This study did not demonstrate any effect of previous acute otitis media history on chorda tympani nerve function. Furthermore, it did not demonstrate a relationship between acute otitis media and elevated body mass index. This is counter-evidence to the previous hypothesis that increasing acute otitis media is responsible for increasing childhood obesity through alteration in chorda tympani nerve function.     

语言障碍儿童与分泌性中耳炎的关系(附1 108例分析)

目的:探讨儿童语言障碍与分泌性中耳炎(SOM)的关系。方法:对1108例语言障碍儿童进行听性脑干诱发电位(ABR)和声导抗检测,并按ABR反应阈将1108例患儿分为反应阈正常组、轻度听力障碍组、中度听力障碍组、重度听力障碍组。结果:所有受检耳中,听力障碍者占59.97%,SOM占12.64%;语言障碍患儿中B型图在各组中所占百分率由高到低依次为:轻度听力障碍组、中度听力障碍组、重度听力障碍组、正常反应阈组,两两比较,差异有统计学意义(P<0.01);部分SOM患儿ABR反应阈治疗后的均值较治疗前下降(P<0.01),但在重度听力障碍组,治疗后ABR反应阈仍表现为重度听力障碍。结论:听力障碍是儿童语言障碍的主要原因;伴轻、中度听力障碍的SOM患儿随着SOM的好转,部分语言障碍可随之改善,但伴重度听力障碍的SOM患儿的语言障碍并不随SOM的好转而好转。     

The point prevalence of otitis media with effusion in secondary school children in Pokhara,Nepal: A cross-sectional study

Objective

Otitis media with effusion (OME) is a condition of uncertain aetiology seen in paediatric practice. It has important sequelae that can result in significant morbidity. Worldwide documentation of OME prevalence in older children is poor as OME is traditionally seen in children below the age of 6 years. Available research in Nepal reports a prevalence of OME in children between the ages of 3 and 8 years as high as 27%. This study aims to establish a reliable prevalence of OME in children between the ages of 9 and 16 years in order to inform public health policy and target limited resources.

Methods

This cross-sectional study was undertaken in Pokhara, Nepal. Two different school populations were examined, government and non-government. Children in these schools between 9 and 16 years underwent clinical assessment for OME with otoscopy and tympanometry. Demographic data were also collected to identify potential OME risk factors. For each school population the prevalence of unilateral, bilateral and all case OME was calculated as percentages with 95% confidence intervals.

Results

A total of 494 children were recruited in this study (government = 187, non-government = 307). Fourteen were excluded due to impacted cerumen or other ENT pathology making it very difficult to conduct a clinical assessment. In the combined school populations the point prevalence of OME was 12.9%. The peak prevalence of OME was found in children aged 10 years (23.1%). A higher point prevalence of OME was found in the non-government school population than the government school (government = 9.3%, non-government = 15.0%). This difference was not statistically significant (χ² = 3.209, df = 1, p = 0.073). Age was found to be significant predictor of OME.

Conclusions

Contrary to its established natural history OME has been found to be widespread in older children in Nepal. No significant predictors of OME were established and rates did not vary significantly between school types. Studies need to be conducted in a larger population to investigate this further. To fully assess disease burden of OME amongst children in Nepal, prevalence in children not regularly attending schools also needs investigation.     

A study of knowledge,attitude and practices about otitis media in parents in Navi-Mumbai

Although otitis media poses a serious health risk in developing countries,being a frequent occurrence in children below five years of age,parental awareness and practices about otitis media have not been adequately researched.Present cross-sectional study was undertaken in Navi Mumbai schools,from October 2019 to December 2019,wherein parents with children<5 years of age answered a questionnaire which gathered data on their knowledge,attitude and practices about otitis media in their wards.Chi-square tests,Cramer’s V were used to study association between gender,age-group and education of parents with their knowledge,practice and attitude about otitis media.Out of 425 valid responses,overall most parents displayed adequate knowledge(77%),positive attitude(61%)and good care-seeking practices(70%).There was a positive correlation of knowledge and practice with level of education.This study shows acceptable levels of knowledge,attitude and practices in parents about otitis media.Parents who did not seek treatment from health centre attributed the behaviour to poverty,ignorance and lack of health insurance.The positive correlation of knowledge and practices with level of education highlights the importance of role of education in modifying parental awareness and care seeking behaviour.Our findings call for a need to further strengthen community-based healthcare and improve parental confidence in healthcare services for early detection and adequate treatment of otitis media.     

Challenges in reducing the burden of otitis media disease: An ENT perspective on improving management and prospects for prevention

Acute otitis media (AOM) is a major public health concern. This frequent disease of childhood is a leading cause of physician visits, a major component of paediatric healthcare burden, and a key contributor to antibiotic resistance. An international expert group comprising mainly ear, nose, and throat physicians met in June 2008 to discuss the optimal management of AOM, particularly with regards to unmet needs in diagnosis and management. Current guidelines do not help identify which patients are most at risk for severe or complicated AOM. Diagnosis of AOM is also complicated by a lack of correlation between clinical signs and symptoms and responsible pathogens. Consequently, treatment of AOM is not always appropriate, and the long-term overuse of antibiotics in AOM reduces the effectiveness of treatment and places children at risk for drug-resistant infections. There is a need for educational and research initiatives to improve diagnostic accuracy and management of AOM. Because there is currently no ideal treatment, vaccination is an attractive additional approach for managing AOM and reducing its burden.     

Management of otitis media with effusion in children with primary ciliary dyskinesia: A literature review

Objective

Primary ciliary dyskinesia is an autosomal recessively inherited group of disorders of ciliary ultrastructure. Otolaryngologists are frequently involved in the management of some of the most common symptoms of primary ciliary dyskinesia including chronic rhinitis, sinusitis and otitis media with effusion. A dilemma for otorhinolaryngologists is whether ventilation tubes are of benefit in children with primary ciliary dyskinesia and otitis media with effusion and what effective alternatives exist. This paper aims to address this issue via a literature review and case presentation.

Methods

An extensive review of the literature was undertaken and a discussion of the advantages and disadvantages of ventilation tubes in the management of otitis media with effusion in these children is presented and compared with that of the general population. We present a case of a 9 months old boy with Kartagener's Syndrome and chronic bilateral otitis media with effusion to illustrate our findings.

Results

Eight papers were identified, all with small study numbers. The main outcome measures were hearing, otorrhoea and tympanic membrane structural changes. The natural history of otitis media with effusion and hearing loss in primary ciliary dyskinesia appears to be fluctuant into adulthood. Therefore, otitis media with effusion in primary ciliary dyskinesia does not resolve by the age of 9 years, regardless of treatment, as previously assumed. Ventilation tube insertion improves hearing in primary ciliary dyskinesia, but may lead to a higher rate of otorrhoea when compared to the general population. Tympanic membrane changes were clinically insignificant.Our patient eventually underwent successful insertion of bilateral ventilation tubes with a marked improvement in hearing and language with minimal otorrhoea.

Conclusion/Discussion

The highest level of evidence found for the management of otitis media with effusion in children with primary ciliary dyskinesia was level IV. Currently, the evidence is inconclusive and conflicting. Whilst our results are promising, clearly higher quality research on a larger number of patients is required to definitively evaluate the management options for otitis media with effusion in these children.     

A visual analog scale can assess the effect of surgical treatment in children with chronic otitis media with effusion

BACKGROUND: The OM-6 survey is a validated and multinationally accepted instrument to measure the treatment effect of otitis media in children. Routine use of the OM-6 in a busy general practice is not always possible and can lead to incomplete returned surveys. A simplified method is favoured when the aim is a continuous process of complete treatment-outcome-data collection. This study tests if a VAS can quantify how much a child suffers from chronic otitis media and how much this changes due to surgical treatment. The change in overall OM-6 scores due to surgical treatment, functions as the gold reference standard. Furthermore, this study tests if the VAS is faster to use than the OM-6 and if it leads to an improvement in complete data collection. METHODS: Prospective cohort follow-up study of 175 consecutive children with chronic otitis media in a paediatric otolaryngology practice in a metropolitan area. Data collected included patient's age, gender, clinical presentation, type of surgical procedure performed, overall OM-6 score and VAS score (at initial presentation and at follow-up), time needed to complete an OM-6 survey and VAS separately and number of incorrect OM-6 surveys and VAS questions returned. RESULTS: The VAS scores and overall OM-6 scores show a good, positive correlation at baseline (Spearman's rho=0.71). This correlation improves at follow-up, one and 6 months after intervention (rho=0.73 and rho=0.80, respectively). The change in VAS scores and overall OM-6 scores, interpreted as change due to surgical intervention, show a good positive correlation at follow-up (rho=0.70 and rho=0.77, respectively). The VAS is almost three times faster than the OM-6 (28s versus 81s). More than 13% of OM-6 surveys were returned incomplete. All VAS questions were returned correct. CONCLUSIONS: The VAS can be used as a simplified method for routine surgical treatment effect analysis in children with chronic otitis media.