Hearing loss after "refractory" secretory otitis media

CONCLUSIONS: The results indicate that SOM of extreme duration, and maybe also the treatment of SOM, are risk factors for developing permanent hearing loss, both conductive and sensorineural. OBJECTIVE: Fluctuating or persisting hearing loss of varying degrees is known to accompany secretory otitis media (SOM). The aim of this study was to detect possible hearing sequelae in young adults who had suffered from "refractory" SOM during childhood. MATERIAL AND MEDTHODS: A total of 33 subjects (age 16-25 years) with previous SOM that had persisted for a mean of 11 years (range 6-19 years) were retrospectively examined at a mean of 18 years after their first myringotomy or tube insertion and compared to 15 healthy controls. The follow-up included audiometric examinations (pure-tone audiometry, distorted speech and impedance audiometry), otomicroscopy and scrutiny of medical records. RESULTS: The SOM group had poorer hearing at all frequencies with the exception of 1.5 kHz in the range 0.125-16 kHz. Those with the greatest number of myringotomies and tube insertions and those with the longest duration of SOM had significantly poorer hearing at high frequencies (8-16 kHz) than those with fewer tube insertions and a shorter duration of SOM. The SOM group scored lower on distorted speech tests than the controls.     

Hearing loss as a sequel of lumbar puncture.

Only a few case reports have been published about hearing impairment following lumbar puncture, and not all were thoroughly documented by audiograms. We present nine cases of hearing loss following myelography, lumbar puncture, and spinal anesthesia. We speculate that this rare complication arises only in persons with a wholly or partially patent cochlear aqueduct, and occurs via the release of perilymphatic fluid in the cerebrospinal space. Hearing loss was seen in eight of the nine patients in the lower frequencies, and in six of the nine patients on both sides. Recovery to normal hearing was noticed in six of the nine patients. Transient hearing loss may occur more often than it is generally assumed, and the symptom can remain unnoticed. Since not all of these hearing losses proved to be fully reversible, we suggest informing patients about this complication for medicolegal reasons.     

Air conduction thresholds and secretory otitis media: a conventional and extra-high frequency audiometric comparison

A comparison has been made of air conduction threshold changes up to 1 year after myringotomy, aspiration of middle ear fluid, and insertion of ventilation tubes in ten patients with bilateral and 12 with unilateral secretory otitis media (SOM). Pure tone air conduction thresholds have been analyzed in three frequency groups: low frequency (LF; 0.25 0.5, and 1 kHz), high frequency (HF; 2, 4, and 8 kHz), and extra-high frequency (EHF; 10, 12, 14 and 16 kHz). In the LF and HF ranges, significant improvement came during the first 24 hours after intubation, while in the EHF range, threshold lowering occurred gradually over the following 2 months. Possible explanations for these findings are discussed.     

Hearing loss and otitis media in velo-cardio-facial syndrome.

There is an increased prevalence of otitis media and associated hearing loss in patients with isolated cleft or submucous cleft palates, palatal abnormalities which are well known components of velo-cardio-facial syndrome (VCFS). The records of 166 VCFS patients were reviewed for the purpose of documenting the prevalence of middle ear disease and associated conductive hearing loss in patients with VCFS. Patients were divided according to age, type of palatal abnormality and presence or absence of chromosomal deletion using fluorescence hybridization test. Results indicated that the prevalence of middle ear disease in patients with VCFS was 47% and the prevalence of hearing loss was 44%, the majority of which was conductive and due to middle ear disease (74%) and 11% of which was sensorineural. There was no statistical difference between groups using the chi2-test with regard to age, type of palatal abnormality and presence of chromosomal deletion. The prevalence of conductive hearing loss secondary to middle ear disease in VCFS is comparable to the prevalence found in isolated cases of cleft palate.     

Incidence of coexisting sensorineural hearing loss and secretory otitis media

There are currently no standard guidelines for assessing hearing in children who are evaluated for tympanostomy tubes. We describe the results of audiologic testing on 587 children, age 2 months to 17 years admitted to Pediatric Otolaryngology Department Bia?ystok for treatment of secretory otitis media. Ten children (1.7%) were found to have previously unrecognized sensorineural hearing loss. In four cases total unilateral deafness, in six others moderate to severe sensorineural bilateral hearing loss was diagnosed. Three other children referred to our clinic as sensorineural hearing loss were found to have secretory otitis media as the only or coexisting cause of deafness. Results of our study show the importance of age--appropriate hearing assessment as part of diagnostic procedure for secretory otitis media.     

仙璐贝治疗急性分泌性中耳炎的临床观察

目的 观察仙璐贝（Sinupret）治疗急性分泌性中耳炎的临床疗效。方法 急性分泌性中耳炎患者148例（155耳）分为仙璐贝治疗组89耳和对照组66耳。结果 治疗组显效75耳，有效9耳，总有效率94．38％；对照组显效41耳，有效15耳。总有效率84．85％，两组差异有显著性（P〈0．05）。结论 仙璐见辅助治疗急性分泌性中耳炎有效，可减少鼓膜穿刺几率，缩短疗程。     

Screening for secretory otitis media: evaluation of some impedance screening programs for long-lasting secretory otitis media in 7-year-old children

In an unselected cohort of 387 seven-year-old children 90% had all 9 planned impedance audiometries during their first year at school. The results from these 348 children were analyzed in different impedance screening programs, as 3 consecutive screening series, each comprising two or 3 tests at an interval of 4-8 weeks. The specificity of the ASHA and Nashville programs was too low in finding long-lasting secretory otitis media, namely about 70%, so that there were too many false positive cases. Therefore, a new impedance screening program was designed. It had about the same sensitivity (80%) but a far better specificity (95%) than the ASHA and Nashville programs. The predictive value of a positive test was 15% in the ASHA and Nashville programs, but 3 times better (48%) in the designed Hirtshals program. The Hirtshals program had a referral rate of 9% compared with the 32-36% in the ASHA and Nashville programs. The frequencies of retesting were 31% in the ASHA program, 52% in the Nashville Program and 45% in the Hirtshals program. Before general screening for long-lasting secretory otitis media can be recommended, additional information is needed.     

急性分泌性中耳炎调节性T细胞及T淋巴细胞亚群的分析

目的 检测急性分泌性中耳炎(SOM)患者外周血调节性T细胞及淋巴细胞亚群的变化,综合分析免疫因素在其发病中的作用.方法 以流式细胞术检测38例上感后诱发急性SOM患者,30例健康献血者外周血中CD3+、CD4+、CD8+、NK细胞、B淋巴细胞百分比,CD4 +/CD8+比值,CD4+ CD25+调节性T细胞百分比以及T淋巴细胞亚群的计数.结果 患者组CD3+ CD8+、NK细胞的百分比明显低于正常对照组(P＜0.05);CD4+/CD8+、B淋巴细胞比例明显高于正常对照组(P＜0.05);正常对照组Tregs占CD4 +T淋巴细胞的比例为(6.695±1.09)％,患者组占CD4 +T淋巴细胞的比例为(12.82±4.56)％,与正常对照组比较差异有统计学意义(P＜0.05);两组间CD3+、CD4+细胞比例,差异无统计学意义(P＞0.05);正常对照组及患者组外周血CD3+、CD3+ CD4+、CD3+ CD8+T淋巴细胞计数,两组之间差异无显著性(P＞0.05).结论 急性分泌性中耳炎患者存在着免疫失调,CD4+/CD8+下降,Tregs比例异常增高,说明免疫异常在SOM的发病中起一定的作用.     

Hearing and hearing loss in 5-year-old children. Pure-tone thresholds and the effect of acute otitis media

Air and bone conduction pure-tone thresholds of 420 unselected urban children were measured with standard clinical audiometry. The mean of air conduction pure-tone averages (average threshold at 0.5, 1 and 2 kHz) was 8.6 dB HL in girls and 8.3 dB HL in boys. In only 5 ears (0.6%), was this average greater than or equal to 35 dB HL. The threshold greater than or equal to 35 dB HL at 4 kHz was found in 1.4% of the ears and at 8 kHz in 4.1%. The bone conduction threshold greater than 20 dB HL at any of the frequencies from 0.5 to 4 kHz was very rare, and only once, at 4 kHz, was it greater than 35 dB HL. Earlier attacks of acute otitis media seemed to have only a marginal long-term effect on air conduction hearing, and an almost negligible effect on bone conduction hearing.     

感音神经性聋与分泌性中耳炎的相关性研究

目的：探讨感音神经性聋与分泌性中耳炎的关系。方法：对治疗后骨导听力下降仍未恢复的38例分泌性中耳炎患者进行分析，观察健耳和患耳在不同频率的骨导听阈情况，并分别就其发病年龄、病程、积液性质和积液量与骨导听阈的关系进行观察。结果：患耳在不同频率的骨导听阈均大于健耳（均P＜0．01）；年龄愈大、病程愈长，感音神经性聋发生率愈高；积液为黏液者发生率高于浆液者；但与积液量无明显关系。结论：分泌性中耳炎可导致感音神经性聋，其发病原因和机制是多方面的，年龄大、病程长、积液为黏液者更易导致感音神经性聋的发生；应提高认识，早诊断，早治疗。     

Sensorineural hearing loss and acute otitis media in children

Sensorineural hearing of 359 otoscopically and tympanometrically normal 5-year-old children with known otitis-history was studied under ideal conditions. In the subgroups of children with a different number (0, 1-2, 3-7, greater than or equal to 8) of attacks of acute otitis media (AOM) in their history, the mean bone conduction thresholds unregularly varied from 0.1 dB to 7.4 dB, depending on the frequency and the subgroup studied. The proportion of the ears with a bone conduction threshold greater than 10 dB at 0.5, 1, 2 or kHz ranged, also unregularly, from 10.8% to 0.5%, the greatest percentages being found at 0.5 and 1 kHz in the children without a history of AOM. Thus, neither AOM nor its treatment, even if frequently occurring, seem to cause permanent sensorineural hearing loss in children.     

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.     

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

Fifty-two secretory otitis media (S.O.M.) ears with 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 semiquantitatively 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 (P greater than or equal to 0.01). 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.     

A history of acute suppurative otitis media and allergic symptomatology in children with chronic secretory otitis media and controls

The parents of children with secretory otitis media and the parents of healthy children attending for routine school or community medical examinations have been questioned about previous acute otitis media, aural discharge, chronic nasal symptoms and allergic disorders. Eighty-nine pairs of children, matched for age and sex, were available for analysis. There was a significantly higher incidence of acute otitis media, aural discharge and chronic nasal symptoms in the secretory otitis group (P = less than 0.001). Amongst the allergic symptoms and disorders, the only significant differences demonstrated were for drug allergy, eye itching and eye running (P = less than 0.05). The results confirm that a relationship exists between acute otitis media and secretory otitis media and also support the conventional image of the child with secretory otitis as a mouth breather with nasal symptoms. They do not lend support to the view that allergy is an important factor in the pathogenesis of secretory otitis.     

Hearing in children with a history of acute otitis media. Use of paracentesis

The examination of 103 children aged 1 year to 5 years had acute otitis media purulenta. They were treated with paracentesis which had a positive effect on recovery of the acoustic function. It is shown that children with previous acute otitis media should be followed up to control recovery of hearing.     

Diagnosis and treatment of secretory otitis media

The majority of patients with secretory otitis media present with signs and symptoms characteristic of an inflammatory condition. The authors describe the use of various techniques to detect secretory otitis media. They then present options for treatment.