Risk of acute otitis media in relation to acute bronchiolitis in children

Objective

A prospective study was carried out to evaluate the prevalence and the etiology of acute otitis media (AOM) in children with acute bronchiolitis. Also to determine whether AOM occurring with acute bronchiolitis is accompanied with another pathogens or not.

Subjects and methods

One hundred and eighty children with acute bronchiolitis aged 3-18 months who were admitted to pediatrics department, Minia University hospital, were included in the study done in the winter and spring of 2009. In patients with AOM at entry or developed AOM within 14 days, Gram-stained smears, bacterial cultures, and enzyme-linked immunosorbent assay (ELISA) were performed on middle-ear aspirates to detect the presence of bacterial pathogens and RSV respectively.

Results

One hundred children (55.6%) with acute bronchiolitis had AOM at entry or developed AOM within 14 days, 45 patients (25%) had developed otitis media with effusion, and only 35 patients (19.4%) remained free throughout the 2-week observation period. Of 135 middle-ear aspirates (65 unilateral and 35 bilateral), bacterial pathogens were isolated in 86 patients (86%) [37 bacteria alone “37%” and 49 mixed bacteria and RSV “49%”], RSV was identified in 56 patients (56%) of middle ear aspirates [mixed with bacteria in 49 patients and RSV alone in 7 cases (7%).

Conclusion

We concluded that bacterial AOM is a complication in most children with acute bronchiolitis. Streptococcus pneumonia and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in 56% of acute otitis media with bronchiolitis.     

Intratemporal and intracranial complications of acute otitis media in a pediatric population

ObjectiveTo review all cases intratemporal and intracranial complications of acute otitis media (AOM) in infants and children from 1998 to 2013.MethodsRetrospective chart review of 109 consecutive patients admitted for complications of AOM during a 15-year period at a tertiary-care children's hospital. The main outcomes are: (1) complications of AOM, (2) bacteriology, (3) management strategies.ResultsIn our population, complications included mastoiditis (86.1%), subperiosteal abscess (38%), facial nerve palsy (16.7%), sigmoid sinus thrombosis (8.3%) and epidural abscess (7.4%). Other complications included post-auricular cellulitis, otic hydrocephalus and elevated intracranial pressure, internal jugular thrombosis, cranial nerve VI palsy and Gradenigo's syndrome, labyrinthine fistula, sensorineural hearing loss, and cerebellar infarct. Sixty-one patients (56%) received antibiotics prior to presentation. Cultures revealed Streptococcus pneumoniae in 36 patients (33.3%), other bacteria in 30 patients (27.8%), and “no growth” in 33 patients (30.5%). Nine patients (8.3%) did not undergo culture. Of the patients with S. pneumoniae, 20 cultures (55%) were found to be multidrug-resistant. Eleven patients (10.2%) were treated non-surgically, 31 (31%) were treated with myringotomy and intravenous antibiotics. Forty patients (97.5%) presenting with subperiosteal abscess required mastoid surgery. Thirteen of 18 (72.2%) patients with facial paralysis had full recovery. Eight of 10 (80%) patients with epidural abscess empyema required mastoid surgery and incision and drainage of the abscess.ConclusionComplications of AOM are uncommon, yet continue to have potentially serious consequences. The bacteriology in this population reveals an increasing trend of multi-drug resistant S. pneumoniae as the causative organism.     

252例儿童急性化脓性中耳炎菌群分布及药敏结果

目的分析儿童急性化脓性中耳炎菌群分布及药敏结果,寻找有效的抗生素进行治疗。方法对252例0-12岁(252耳)经临床诊断为急性化脓性中耳炎患儿的耳道分泌物及鼓膜穿孔前期经鼓膜刺激取分泌物进行细菌培养,同时对培养阳性菌株的种类及药物敏感试验结果进行统计。结果252份分泌物共分离出病原菌260株,总阳性率为95.9%,8例检出2种菌株。其中G 球菌188株(占72.3%);G-杆菌19株(占23.5%);真菌11株(占4.2%)。结论:G 球菌是本地区儿童急性化脓性中耳炎的主要致病菌,对青霉素及红霉素均有较高的耐药性。提示,临床用药不能仅凭经验,而应根据细菌培养结果和药敏结果用药,以获得理想疗效,减少转化为慢性病程的可能。     

Treatment of secretory otitis media with Kampo medicine

Summary Kampo medicine is a traditional Japanese herbal medicine that is known as Sairei-to and has been used to treat otitis media. This preparation was given orally for 4 weeks to 35 children with secretory otitis media (SOM). Four of 46 ears (8.7%) completely resolved while 32 ears (69.6%) showed a partial improvement without serious adverse reaction. Our findings indicate that Kampo medicine may resolve the inflammation and immune response associated with SOM. Further studies in its mechanism of action are warranted.     

中西医结合治疗分泌性中耳炎

目的 观察中西医结合治疗分泌性中耳炎的疗效。方法 对80例分泌性中耳炎患者采用中西医结合治疗。同时，另外80例患者单纯使用西药治疗作为对照组。结果 中西医结合治疗组的痊愈率及总有效率均明显提高。结论 中西医结合治疗分泌性中耳炎是一种值得推广的方法。     

P物质及组胺受体拮抗剂对分泌性中耳炎中耳积液的影响

采用免疫组化ＡＢＣ－ＧＤＮ及图象分析技术研究分泌性中耳炎中耳粘膜Ｐ物质含量的变化与中耳积液的关系，并观察ＳＰ受体拮抗剂ｓｐａｎｔｉｄｅ及组胺Ｈ２受体阻滞剂ｃｉｍｅ－ｔｉｄｉｎ对ＭＥＥ的影响，探讨ＳＰ在ＳＯＭ中的作用。结果发现，在ＳＯＭ条件下，中耳粘膜ＳＰ含量有逐渐增多趋势，并和ＭＥＥ量呈正相关。     

Clinical and audiological findings in children with acute otitis media

Conclusion: It is recommended to perform follow-up tympanometry and if necessary tonal audiometry in children who have normal plain otoscopy findings after recovering from acute otitis media (AOM). Children with Type B tympanogram, 3 months following the onset of AOM, are very likely to have a conductive hearing loss. Type B tympanogram is a much better indicator of effusion in the middle ear compared to plain otoscopy. Objective: This study was undertaken to investigate the frequency and duration of middle ear effusion in children following an episode of acute otitis media, to track changes in tonal audiometry and tympanometry findings in the post-AOM period, and recognize the optimal timing for performing both tests. Methods: In this study, 125 children aged 5–7 years with bilateral AOM were randomly selected and separately followed up for 3 months. The children underwent six ear, nose, and throat (ENT 1–6) examinations, six tympanometries (TM 1–6), and three tonal audiometries (TA 1–3). Evaluation of nasopharynx was done at the ENT 1 examination. Children who received ventilation tubes were followed for 21 month altogether. Results: At the first otoscopy, pathological findings were recorded in 250 ears/125 children (100.0%). The number of pathological otoscopy findings decreased at each subsequent examination. At ENT 6 all children had normal otoscopy findings. Type B tympanogram was detected in 49/250 (19.6%) ears at TM 6, performed 3 months following the onset of the disease. At the TA 1 conductive hearing impairment was recorded in 158/250 (63.2%) ears, at TA 2 in 66/250 (26.4%), and at TA 3 in 39/250 (15.6%). Most of them were associated with Type B tympanogram.     

Prognostic evaluation of secretory otitis media as a function of mastoidal pneumatisation

Summary Fifty-two secretory otitis media (S.O.M.) ears with a protracted course were compared roentgenologically (Schuller projection) with 52 S.O.M. ears which recovered after insertion of a single ventilating tube. Measurements were done first by comparing the pneumatised area millimetrically and later semi-quantitatively according to the size of the mastoid cells — grading the mastoid cells from 1 (eburnize) to 10 (very big mastoid cells).S.O.M. ears with protracted chronic course showed an average mastoid area of 312 mm², their cell size showing on the average a diploic or small-diploic cells —corresponding to grade 3.5. On the other hand, S.O.M. ears which recovered promptly had an average mastoid area of 440 mm², and their mastoid cells began to show as actual cells (small up to medium cells), corresponding to grade 5.7. The difference, both millimetrically and grade-wise, between the two groups was found to be very significant (P0.01). We may conclude that the prognosis of S.O.M. is related to the size of their mastoid cells or alternatively to the amount of air in the middle ear cleft as a whole.     

鼓膜激光打孔治疗分泌性中耳炎20例

目的 评价鼓膜激光打孔治疗分泌性中耳炎的疗效。 方法 分泌型中耳炎患者20例(25耳),行鼓膜激光打孔,并配合口服抗生素、激素及黏液促排剂等药物综合治疗。 结果 20例(25耳)中17耳鼓膜激光打孔1次痊愈,4耳激光打孔2次痊愈,4耳打孔失败后行鼓膜置管痊愈,打孔有效率为84%(21/25)。 结论 鼓膜激光打孔治疗分泌性中耳炎疗效确切,操作简单,可反复操作,是一种较好的治疗方式。     

儿童分泌性中耳炎的临床经验介绍

分泌性中耳炎是耳鼻喉科常见疾病之一,也是儿童的常见病及多发病之一,且儿童发病率明显高于成人,是引起儿童听力下降的重要原因之一,多有感冒病史,早期症状不明显,很容易延误病情。孙海波教授善于从中医角度治疗一些疑难病症,临床经验丰富,治疗儿童分泌性中耳炎更是有其独到见解,孙教授从"疏风宣肺,健脾利湿通窍"论治,随证加减,综合疗法治疗儿童分泌性中耳炎,疗效显著。     

分泌性中耳炎中耳积液的Epstein-Barr病毒测定

目的：探讨在分泌性中耳炎（ＳＯＭ）中的发病过程中是否有Ｅｐｓｔｅｉｎ－Ｂａｒｒ病毒（ＥＢＶ）参与。方法：应用聚合酶链反应（ＰＣＲ）技术对３４例ＳＯＭ患者（ＳＯＭ组）的血清、口腔含濑液和中耳积液（ＭＥＥ）进行ＥＢＶ检测,并与２０例正常人进行比较。结果：ＳＯＭ组血清和口腔含漱液标本中ＥＢＶ的检出率明显高于对照组,ＳＯＭ组ＭＥＥ中的ＥＢＶ检出率高于其血液标本。结论：在ＳＯＭ的发病过程中有ＥＢＶ的参与。     

Comparison of study designs for acute otitis media trials

BACKGROUND: A framework for evaluating the efficacy of antibiotics in development as well as those currently approved for acute otitis media (AOM) is needed. OBJECTIVE: Review strengths and limitations of various antibiotic trial designs and their outcome measures. METHODS: A review of 157 published trials involving 36,710 subjects for the treatment of AOM. RESULTS: AOM trials have three designs: (1) clinical, clinical diagnosis and assessment of outcomes; (2) single tympanocentesis, microbiologic diagnosis (by middle ear fluid culture) and clinical assessment of outcomes; and (3) double tympanocentesis, microbiologic diagnosis and microbiologic outcome assessment. Identifiable strengths and limitations of each design are reviewed. Case definitions for entry of children in trials of AOM vary widely. The lack of stringent diagnostic criteria in a clinical design allows for inclusion of a significant proportion of children with a non-bacterial etiology (i.e., viral AOM or otitis media with effusion). Tympanocentesis increases diagnostic accuracy at study entry; however, the procedure is confounding because of its potentially therapeutic benefit and the procedure is not performed in a uniform manner. A second tympanocentesis allows a high sensitivity to detect microbiologic eradication, but it does not correlate with clinical outcomes in half of the cases. The timing of outcome assessment also varies widely among trials. CONCLUSIONS: Improved clinical diagnosis criteria for AOM are needed to enhance specificity; emphasis on a bulging tympanic membrane has the best evidence base. Tympanocentesis within study designs has merits. At study entry it assures diagnostic accuracy but may alter outcomes and it is useful to document microbiologic outcomes but lacks specificity for clinical outcomes. For all designs, test of cure assessment 2-7 days after completion of therapy seems most appropriate.     

The efficacy of hesperidin for treatment of acute otitis media

Objectives

In this experimental study, the effect of hesperidin on the treatment of acute otitis media (AOM) was investigated in an AOM-induced rat model.

Expression of Toll-like receptors on peripheral blood white cells in acute otitis media

Objective

From 10 to 15% of children suffer from recurrent acute otitis media (AOM). An association between polymorphism in TLRs and their co-receptor CD14 with otitis media proneness has been described in children. Moreover, the experiments on animal models have shown that TLRs and their signaling molecules are critical for timely resolution of bacterial otitis.

Aim

The aim of this study was to determine the expression of TLR1, TLR2 and TLR4 on lymphocytes, monocytes and granulocytes in peripheral blood in children with recurrent or persistent AOM.

Methods

The study was performed on a group of 25 children hospitalized for recurrent AOM, failures of previous treatments and/or acute mastoiditis. The results were compared to the control group of healthy children at the same age. The expression of TLRs on peripheral blood white cells was measured by flow cytometric analysis. The results were expressed as mean fluorescence intensity (MFI). The statistical analysis was performed using the Mann–Whitney U test.

Results

The highest expression of TLR was found on monocytes, the lowest on lymphocytes in both groups of children (AOM and the control one). The expression of TLR1 was the lowest and expression of TLR4 was the highest on all examined cells. The expression of all examined TLRs on monocytes was significantly higher in the AOM group.

Conclusions

Peripheral blood monocytes are characterized by increased expression of TLRs in the course of recurrent AOM.     

分泌性中耳炎中耳积液成分研究进展

分泌性中耳炎(SOM)是指以传导性聋及鼓室积液为主要特征的不伴有急性炎性表现的中耳积液的非化脓性中耳炎。其病因与生理机制复杂,以耳闷、耳鸣、耳痛等耳部症状为主,各年龄段均可发生,而学龄前儿童是高发人群。目前,SOM病因及发病机制尚未完全阐明,对SOM中耳积液的成分分析是研究SOM病因及发病机制的常见方法,也是指导临床治疗的重要途径,本文通过查阅国内外发表的相关文献,对SOM中耳积液的成分研究进展进行比较总结,以提高临床医师对该病的认识。     

盐酸氨溴索治疗分泌性中耳炎疗效的Meta分析

目的 系统评价盐酸氨溴索治疗分泌性中耳炎的效果。方法 通过检索Pubmed、CNKI和万方数据库,以 “分泌性中耳炎”和 “盐酸氨溴索”为主题词检索盐酸氨溴索治疗分泌性中耳炎的随机对照试验研究(RCT),并辅以手工检索进行文献追索。以常规治疗为对照组,盐酸氨溴索治疗分泌性中耳炎为治疗组,提取纳入研究文献原始数据,并进行Meta分析。结果 14篇文献被纳入本次研究,共1412例分泌性中耳炎患者,其中治疗组743例,对照组669例。Meta分析结果显示,盐酸氨溴索治疗分泌性中耳炎效果优于常规治疗(P<0.05),总有效率合并OR及其95%CI为2.74(2.10,3.57)。结论 盐酸氨溴索能提高治疗分泌性中耳炎疗效,仍需对药物的不良反应通过大样本、多中心研究。     

Efficacy of vitamin A in experimentally induced acute otitis media

OBJECTIVE: Vitamin A plays a role in the prevention of oxidative tissue damage. In the present study we investigated therapeutic role of this substance on healing of middle ear mucosa in experimental acute otitis media (AOM). MATERIALS AND METHODS: Otitis media was induced by inoculating Streptococcus pneumoniae via transtympanic injection. Thirty rats were divided into two groups. Group I treated with parenteral ampiciline-sulbactam. Group II received same antibiotic regimen and parenteral single dose of 100,000 IU vitamin A in palmitate form. At tenth day post-inoculation, animals were sacrificed and mucosal samples were excised from the infected tympanic cavities for histpathological examination and blood samples were obtained for measurements of activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and evaluation of levels of malondialdehyde (MDA) and nitric oxide (NO). RESULTS: All the infected middle ear mucosas displayed various degrees of the inflammation, but there was no meaningful difference between two groups. However, epithelial integrity was significantly better in group II than group I (p<0.01). While serum NO and MDA levels decreased in the group receiving both antibiotic and vitamin A, serum SOD and GSH activity were found to increased. All of the statistical differences are significant. CONCLUSIONS: Pretreatment with vitamin A increases antioxidant enzyme activities and reduces formation of NO and MDA. Vitamin A may be considered as an additional medicament for the medical treatment of AOM.     

流式细胞术微球阵列法检测多种细胞因子在分泌性中耳炎患者中的表达

目的检测急性分泌性中耳炎(acute secretory otitis media,SOM)患者外周血及中耳积液中IL-2、IL-4、IL-6、IL-10、TNF、IFN-γ的表达水平,以期综合分析免疫因素在其发病中的作用。方法采用BD CBA Flex SetIL-2、IL-4、IL-6、IL-10、TNF、γ-干扰素试剂盒,利用流式细胞术微球阵列法检测37例急性上呼吸道感染诱发急性分泌性中耳炎外周血、耳积液,8例鼻咽癌患者放疗后分泌性中耳炎耳积液和10例正常人血清样本中6种细胞因子水平。结果急性上呼吸道感染诱发的中耳积液中的IL-2、IL-4、IL-6、IL-10、TNF、IFN-γ表达水平显著高于外周血(P<0.05);其中IL-6、IL-10、TNF、IFN-γ水平明显高于放疗后耳积液水平(P<0.05)。急性分泌性中耳炎外周血上述六种因子较正常对照组外周血差异无统计学意义(P>0.05)。结论中耳粘膜参与了急性分泌性中耳炎患者局部的免疫反应,在其发病中可能起到一定作用。     

翳风穴穴位注射治疗急性卡他性中耳炎临床疗效观察

目的客观评定翳风穴穴位注射治疗急性卡他性中耳炎临床疗效,并分析其临床治疗优势。方法将128例(即128耳)急性卡他性中耳炎患者随机分为对照组和治疗组,各64例,即64耳。对照组运用西医常规治疗,治疗组在对照组基础上加用翳风穴穴位注射治疗,两组均观察至病情痊愈,比较治疗效果。结果治疗组64耳均治愈,治愈率100%,其平均治愈天数为5.75±0.92天,其中58耳仅1次穴位注射后痊愈,4耳经注射2次痊愈,2耳注射3次后痊愈;对照组64耳在一疗程后49耳痊愈,治愈率70.11%,其平均治愈天数为8.32±2.25天。两组患者治愈天数有显著性差异(P<0.05)。两组患者治疗3天后500Hz和1000Hz状况下的听阈水平均明显下降(P<0.05),且观察组更低(P<0.05)。结论翳风穴穴位注射治疗急性卡他性中耳炎的疗效确切。     

儿童腺样体肥大与分泌性中耳炎的关系研究

目的探讨腺样体肥大儿童中分泌性中耳炎发病情况及其影响因素。方法258例住院手术治疗的腺样体肥大的儿童,均常规进行病史采集、鼻咽侧位片、声导抗检查;对部分患儿进行鼻内镜检查录像,单盲评估腺样体肥大程度及其与咽鼓管咽口的关系。统计分析分泌性中耳炎发生率及其影响因素。结果在258病例中经声导抗检查证实合并分泌性中耳炎者108例（41.9％）,而病史中有明确听力减退主诉者仅27例（10.5％）;对合并和未合并分泌性中耳炎病例的相关影响因素统计分析发现,患儿性别、病程长短、腭扁桃体大小等因素对分泌性中耳炎发病无明显影响,低龄患儿、腺样体过度肥大、腺样体与咽鼓管园枕或咽口关系密切者发生分泌性中耳炎可能性大,多元回归分析证明其中影响最显著的因素是腺样体与咽鼓管园枕或咽口关系密切程度。结论有必要对所有腺样体肥大患儿常规进行听力学检查,以确认或除外分泌性中耳炎诊断。低龄患儿、腺样体过度肥大或与咽鼓管园枕及咽口关系密切是分泌性中耳炎的促发因素。