Beeinflußt das chronische Sero-Mucotympanon die Innenohrhörschwelle?

Summary A collective of children suffering from sero-mucous otitis was treated with ventilating tubes. The audiologic function of this group was compared with the hearing capacity of those children who had a conductive hearing deficiency of other origin. It could be shown that long lasting sero-mucous otitis involves bone conduction, even if conductive hearing loss disappeared after intensive treatment with ventilating tubes. This was not observed in the compared collective. The possible causes of inner ear damage are discussed. We assume that the main reasons of inner ear disturbance are diffusion of toxic products, reduced penetration of oxygene from the middle ear to the inner ear or irritation of the collateral vascular system.     

Ergebnisse der Behandlung des sekretorischen Mittelohrkatarrhs durch Adenotomie und Paukenröhrchen — eine Zehn-Jahres-Übersicht

Summary 1208 patients with secretory otitis media were treated and followed over a ten year period. The treatment consisted of adenoidectomy in 630 children and 1473 middle ear ventilation tubes in 578 patients in whom adenoidectomy and conservative measurements proved not to be successful. Conductive hearing loss in children with enlarged adenoids is caused by accumulation of fluid in the middle ear in more than 90%. Adenoidectomy per se improves hearing in 75%. In the remaining 25%, where ventilating tubes are indicated, recurrency rates of more than 30% are observed with prolonged follow up. Therefore a control-period of 2 years is necessary. Complications may include infection (10%), seldom, however, persistant perforations and very rarely secondary cholesteatoma.     

Diagnosis and incidence of recurrence of chronic tubal secretory otitis media in childhood

In a comparison of two groups of children undergoing adenoidectomy, the introduction of routine hearing tests revealed 30.8% more patients with secretory otitis media than in a control group in which tests were carried out only if profound hearing loss was suspected. The history and ear examination were insufficient for detection of secretory otitis media. Evaluation of patients not suspected of hearing loss revealed 24.5% more cases of secretory otitis media than by routine hearing tests. In 25.8% the secretory media recurred, requiring paracentesis or insertion of drainage tubes.     

Tympanoplasty decision making in a child with HIV contamination--case report

Otologic problems are infrequent in HIV patients. Authors present the case of chronic otitis media in the HIV infected child. The patient with significant hearing loss, and prolonged aural discharge, resistant to local and systemic antibiotic treatment was treated surgically. Mastoidectomy with myringoplasty was performed. The substantial hearing improvement has been obtained, ear discharge never returned. However due to episodes of chronic otitis media with effusion ear drainage with tympanostomy tubes, after initial surgery have been performed two times. The controversies regarding surgery decision-making in this group of patients are discussed.     

Quality of life outcomes after ventilating tube insertion for otitis media in an Australian population

OBJECTIVE: To assess the change in quality of life in a group of Australian children with recurrent acute otitis media (AOM) and/or otitis media with effusion (OME) who were treated with ventilating tube (VT) insertion. METHODS: Prospective pre- and post-intervention outcome study at the Women's and Children's Hospital, North Adelaide, South Australia. The Otitis Media 6-item (OM-6) survey was used as a measure of disease-specific quality of life prior to surgery and then again at 6 weeks post-operatively. Any patients who were listed for any additional ear, nose or throat (ENT) procedures at the same time were excluded. RESULTS: Complete responses for both pre- and post-surgery questionnaires were obtained from the parents of 53 patients. The age range was 11 months to 15.4 years (average 5.1 years), and 39.6% (n=21) were suffering from recurrent AOM whilst the remaining 60.4% (n=32) were suffering from OME. Overall ear-related quality of life was found to improve significantly following insertion of ventilating tubes (p<0.001), as was the mean OM-6 score (p<0.001). Furthermore, statistically significant improvements were noted in each individual domain making up the OM-6 survey (physical suffering, hearing loss, speech impairment, emotional distress, activity limitations and caregiver concerns). CONCLUSIONS: The disease-specific quality of life of a group of Australian pediatric patients with otitis media was found to significantly improve following insertion of ventilating tubes as measured by the OM-6 survey. Improvements were found in global ear-related quality of life, in the mean OM-6 score, as well as in all individual domains of the OM-6 survey.     

Management of chronic otitis media in the only hearing ear

OBJECTIVE: Chronic ear surgery is difficult. The management of such a disease either with or without cholesteatoma and in an only hearing ear is particularly challenging. Consequences of disease or unintended outcomes of therapy can both result in patient lifestyle alterations of major proportion. This report offers a diagnostic and treatment plan for chronic otitis media with and without cholesteatoma in the only hearing ear. METHODS: More than 10,000 charts of patients with chronic otitis media were retrospectively reviewed. Twenty-seven charts of patients with chronic otitis media in an only hearing ear who underwent surgical treatment were identified. The patients were followed for an average time of 43 months. RESULTS: Overall, the chronic otitis media was well controlled, and there was no change in the average discrimination or hearing thresholds when comparing preoperative and postoperative results. CONCLUSIONS: Chronic otitis media with and without cholesteatoma in an only hearing ear can be treated successfully with hearing preservation. Canal wall down tympanomastoidectomy is performed in most cases. Manipulation of the ossicular chain is avoided, and cholesteatoma that lies over a potential fistula is exteriorized.     

Otological and audiological outcomes five years after tympanostomy in early childhood

OBJECTIVE: Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long-term follow-up studies have included even a minority of patients under 1 year old. We investigated long-term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes. STUDY DESIGN: Prospective follow-up. METHODS: Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyv?skyl?, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure-tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds). RESULTS: Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively. CONCLUSIONS: Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow-up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.     

Pro or contra drainage of the tympanum

Ventilation tubes ("grommets") appear to be the logical treatment of chronic secretory otitis media, based on the theory of its pathogenesis. Usually they have an impressive immediate effect, and enjoy great popularity. However, there are critics who restrict the indications, for two reasons: it has been observed repeatedly that the spontaneous healing rate in secretory otitis media is about 80%, and follow up studies over several years suggest that persistent lesions of the middle ear (scars and defects of the tympanic membrane, conductive hearing loss, cholesteatoma etc.) occur somewhat more often in grommet-treated ears than in ears without ventilation tubes. A therapeutic advantage of ventilation tubes in the resolution of chronic secretory otitis media has not been proved. Therefore, according to our present knowledge the only treatment effect of ventilation tubes is the immediate elimination of conductive hearing loss. As development studies in children suggest that a conductive hearing loss does not become a handicap for speech and mental development unless it has persisted for several months, ventilation tubes seem to be indicated only when a bilateral middle ear effusion of greater than 25 dB persists for more than 3 months. However, in children with delayed speech development one should not wait such a long time, because they particularly depend upon normal hearing ability.     

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.     

Sinusitis,Otitis And Adenotonsillitis In Children: A Retrospective Study

A retrospective study of 93 cases in which ventilating tubes were required in the therapy of persistent otitis media. Paranasal sinus radiographs, antral washes and cultures of positive washes were used to demonstrate active sinusitis associated with persistent otitis media. Other factors are also of importance, such as allergic or other immune-related disease processes. However, active sinusitis was demonstrated in 25–49% of the cases studied, depending on criteria used.     

Treatment of chronic otitis media with effusion: results of tympanostomy tubes

Insertion of tympanostomy tubes to provide prolonged aeration and drainage of the tympanum in cases of chronic secretory otitis media has become the most commonly performed operation in children. To investigate the therapeutic efficacy of current treatments of chronic secretory otitis media, the authors undertook a randomized clinical trial with four treatment arms: myringotomy alone, tympanostomy tubes, adenoidectomy and myringotomy, and the combination of adenoidectomy and tympanostomy tubes. This report describes the preliminary (one-year) outcome in the group of children who were treated with tympanostomy tubes. The observed average differences between the myringotomy and tympanostomy tube groups were small, with the exception of one variable (time to first recurrence). Although the clinical importance of these differences remains to be established, the authors believe they are substantial enough to justify continued use of tympanostomy tubes in the primary surgical therapy of chronic secretory otitis media, when medical therapy and observation indicate the need for drainage to improve hearing or correct anatomic deformities of the tympanum.     

Otological findings in adults with isolated cleft palate or cleft lip, jaw, and palate]

BACKGROUND: Children with cleft palate often develop middle ear ventilation disorders due to chronic Eustachian tube dysfunction. This may lead to hearing loss. The insertion of ventilation tubes is a widely accepted measure to avoid sequelae of middle ear ventilation disorders and hearing loss. On the other hand, long-term therapy with ventilation tubes may inflict iatrogenic complications. The objective of the study was the evaluation of otoscopic and audiometric long-term findings in adult cleft patients who had been treated with ventilation tubes since childhood when chronic otitis media with effusion had been observed. PATIENTS AND METHODS: Ninety-two cleft palate patients had been followed up otoscopically and audiometrically for years. The average age was 19.3 years (minimum: 14, maximum: 39 years) at the time the last status was taken. RESULTS: Otoscopy revealed a perforation of the tympanic membrane in 3.8% of the 184 ears. 12% of the patients developed cholesteatoma, however three quarters of these occurred after age 11. 86.4% of the 92 patients had normal hearing in pure tone audiometry. CONCLUSION: Compared with adult cleft patients who did not receive ventilation tubes, our patients had a similar low incidence of eardrum perforations but a higher incidence of cholesteatomas while hearing loss occurred less often. Whether the higher incidence of cholesteatomas is caused iatrogenically or due to a longer follow-up period remains unclear. Whether the use of long-lasting ventilation tubes affects the incidence of cholesteatomas must be proved in further studies.     

Sensorineural hearing loss in patients with chronic otitis media

Chronic otitis media is generally associated with some degree of hearing loss, which is often the patient’s chief complaint. This hearing loss is usually conductive, resulting from tympanic membrane rupture and/or changes in the ossicular chain due to fixation or erosion caused by the chronic inflammatory process. When cholesteatoma or granulation tissue is present in the middle ear cleft, the degree of ossicular destruction is even greater. An issue that has recently gained attention is additional sensorineural hearing loss due to chronic otitis media. While the conductive loss can be minimized through surgery, sensorineural hearing loss constitutes a permanent after effect, attenuated only through the use of a hearing aid. However, a few groups have reported a decrease in sensorineural function in these patients as well. This survey study performed at a referral center evaluates the occurrence of sensorineural hearing loss in ambulatory patients with this disease. We reviewed the files of patients with unilateral chronic otitis media. One hundred and fifty patients met the inclusion criteria: normal otoscopy and normal hearing in the contralateral ear. Main outcome measure: bone-conduction threshold averages were calculated for frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hz, with comparison between the normal ear and the ear with chronic otitis media. Thresholds were examined separately for each frequency. The bone-conduction threshold averages for the normal side were lower than those for the ear with chronic otitis media. The threshold shift was statistically significant for each frequency (P < 0.0001, Student’s t test). There were differences between the groups when analyzed for age (500 and 1,000 Hz) or the presence of cholesteatoma (1,000 Hz). This study shows that chronic otitis media is associated with a decrease in cochlear function.     

Etiology of otitis media with effusion: Antihistamines—decongestsnts

In an attempt to find a causative factor for the increased incidence of otitis media with effusion, a detailed study of 50 cases was conducted. This study included 50 cases of non-purulent otitis media with effusion requiring ventilating tubes without tonsilloadenoid pathology. A study of these cases revealed an interesting pattern which suggests that antihistamines and decongestants may be causative or precipitating factors in the etiology of otitis media with effusion. A pilot study on the effects of these drugs on mucociliary activity was conducted and revealed further evidence that antihistamines and decongestants interfere with normal mucociliary activity which probably is a factor in abnormal Eustachian tube physiology.     

Outcomes of tympanostomy tube placement in children with Down syndrome—A retrospective review

Objectives

Tympanostomy tubes are commonly used for treatment of chronic otitis media with effusion (COME) or recurrent acute otitis media (RAOM) in patients with Down syndrome, but hearing outcomes in this population have been mixed, and complications appear to be common. We aim to characterize outcomes and complications associated with tympanostomy tube placement in this population.

Methods

Retrospective review. All patients with Down syndrome presenting to a tertiary academic pediatric otolaryngology practice over a ten year period from 2002 to 2012 who received tympanostomy tubes for COME, RAOM, or hearing loss were reviewed.

Results

Long term follow up data was obtained in 102 patients, with average follow up 4.7 years. COME was the primary indication for tube placement in 100/102 (98%). Less than half of these patients (44%) initially failed their newborn hearing screen. Post operative hearing was found to be normal or near normal for the better hearing ear in 85/99 (85.9%), and normal to near normal in bilateral ears in 71/99 (71%). A majority (63.7%) of patients required two or more sets of tubes during the follow up period. Long term complications were common and were significantly increased if the patient required three or more sets of tubes, including chronic perforation (36.6% vs 8.2%, p < 0.001), atelectasis (29.3% vs 1.6%, p < 0.0001), and cholesteatoma (14.6% vs 0%, p = 0.003).

Conclusions

COME is a frequent problem in Down syndrome, and the majority of patients will require two or more sets of tubes during their childhood and achieve normal postoperative hearing. Long term complications of otitis media appear to be more common in this population and appear to correlate with increasing number of tubes placed. More investigation is required to determine optimal treatment strategies for COME in patients with Down syndrome.     

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.     

Hearing loss in young adults who had ventilation tube insertion in childhood

It is known that insertion of ventilation tubes can cause damage to the tympanic membrane and hearing deterioration in the long-term. To investigate long-term effects of recurrent otitis media and of ventilation tube insertion, we used a study group (n = 358 subjects), with or without a history of otitis media and/or ventilation tube insertion, derived from a birth cohort that had been followed for 16 years. At 18 years of age, a standardized audiometric and otoscopic examination was performed. We found that ventilation tube insertion in childhood was associated with a mean persistent hearing loss in young adults of about 5 to 10 dB at the group level with a sensorineural component of 3 to 4 dB. This hearing loss could not be explained by the disease load of otitis media in childhood. Repeated insertions of ventilation tubes caused a greater deterioration of hearing than did a single insertion. Structural changes of the tympanic membrane were a mediating factor in the causal relationship between ventilation tube insertion and hearing loss. We conclude that ventilation tube insertion in childhood may induce hearing deterioration in the long-term.     

The long-term results of the treatment with transtympanic ventilation tubes in children with chronic secretory otitis media

In the present report we discuss the short-term and long-term results of treatment with transtympanic ventilation tubes in 140 children with chronic secretory otitis media. Important findings are: after 6 months only 40% and after 12 months only 5% of the inserted grommets are still draining. A good clinical result is obtained in 72% after 6 months, and in 52% after 12 months. With a long follow-up, up to 10 years, 71% of the children suffering from chronic secretory otitis media and treated with grommets, can be considered as cured, with or without a small complication. The poorest results are obtained after a follow-up of 2-3 years. Children under 7 years have a better prognosis than older children. There is also a better prognosis in children with serous effusions than in those with a glue ear. We noticed very few complications in our treatment with grommets: no sensorineural hearing loss and a persisting perforation in 2% of the treated ears.     

Silent otitis media

There is a traditional view that chronic otitis media and chronic mastoiditis must exist in the presence of a tympanic membrane perforation. Based on a human histopathological study of 123 temporal bones with chronic otitis media out of 333 temporal bones with all forms of otitis media pathology, only 24 patients (36 ears) had symptoms of otological disease recorded on their charts and only 19.5% of these had an associated tympanic membrane perforation. Unsuspected findings of chronic otitis media (active or inactive) are occasionally confirmed at exploratory tympanotomy. Such quiet chronic pathological findings in the middle ear have occurred in association with endolymphatic hydrops and cochlear end organ lesions suggesting the possibility that silent chronic otitis media may help explain sensorineural hearing loss, vertigo, and tinnitus for certain patients. We put forth the hypothesis that clinically undetectable silent otitis media in neonates and infants might help explain why certain children are otitis media prone. Our otopathology laboratory includes 111 ears harvested from neonates and infants (average age 8 months). Histological analysis revealed normal findings in some, whereas significant numbers of others show all forms of otitis media, including purulent otitis media, chronic otitis media, serous otitis media, and mucoid otitis media, with occasional overlap of types. Clinical implications will be discussed wth emphasis on silent otitis media and its relationship to the pathogenesis of otitis media and silent chronic otitis media and its possible role in causing insidious labyrinthine changes. A significant outcome of this study was the marked degree of unresolved mesenchyme in the clinically manifest otitis media group or silent otitis media group as compared to a control group. This association and role of mesenchyme is discussed relative to the pathogenesis of infantile otitis media.