Risk factors for chronicity in childhood otitis media with effusion.

One hundred and ninety-one children who presented to the author's clinic with otitis media with effusion (OME) over a 2-year period (1986-1988) have been studied prospectively. Resolution of their OME was considered to have occurred when they had normal findings on pneumatic otoscopy, tympanometry and audiometry on at least two occasions 6 months apart and had subjectively normal hearing in between. The number of operations performed during the course of the disease was used as a surrogate for chronicity. Children with a history of previous aural discharge at presentation were significantly more likely to have chronic OME (P = < 0.02).     

Ciliary activity on adenoids of patients with otitis media with effusion

Ciliary activity of the adenoidal surface in patients with otitis media with effusion (OME) was evaluated by a photoelectric method. Three groups of patients were compared: a non-OME group whose members had experienced no episode of OME; a middle ear effusion (MEE)-negative OME group whose members had an episode of recurrent OME but no MEE during the month preceding the operation; and an MEE-positive OME group whose members were experiencing an episode of recurrent OME with MEEs when tissue was taken for examination. To serve as a comparison, the ciliary activity in the central pharynx of normal guinea pigs was evaluated using the same technique. The ciliary activity in all patients was significantly lower than that in normal guinea pigs. No significant difference in ciliary activity was apparent between the non-OME group and the MEE-negative OME group. However, both were significantly higher than the ciliary activity of the MEE-positive OME patients. The following findings are drawn from our data: ciliary activity on the surface of hypertrophic adenoids is depressed, and patients with OME have reduced ciliary activity compared with those who have no otitis media or those who have otitis media without effusion.     

The frequency of otitis media with effusion in British pre‐school children: a guide for treatment

Data on the prevalence of otitis media with effusion (OME) as shown by serial tympanometry is presented for young children during the first 5 years of life. The children were participants in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC); a randomly selected 10% (n = 1400) of whom were selected for examination at ages 8, 12, 18, 25, 31, 37, 43, 49 and 61 months. Whilst sex had no effect, there was a decrease in prevalence of OME with increasing age. There was a marked seasonal effect on the prevalence of OME. Bilateral and unilateral OME were significantly more prevalent in the winter than in the summer months (36.6% in February in children aged 8 months compared with 16% at 61 months and 16.4% in August in children aged 8 months compared with 3.1% at 61 months). The results form an important background against which to assess both the results of screening and also the indications for surgical treatment.     

Prevalence rates of otitis media with effusion from 0 to 2 years of age: healthy-born versus high-risk-born infants.

In a prospective-longitudinal study, prevalence rates of otitis media with effusion (OME) were analysed in 150 healthy-born and 100 high-risk-born infants, aged 0-2 years. In order to determine OME, otoscopy and tympanometry were performed at 3-monthly intervals beginning at term date. The Maastricht Otitis Media with Effusion Study (MOMES) algorithm was used to standardize the diagnosis. The distribution of relevant background characteristics was similar in both groups except for gestational age and birth weight, which were significantly lower (P < 0.001) in the high-risk-born group. The ratio of unilateral:bilateral OME was 2:3. Prevalence rates of OME were strongly associated with age (P < 0.001). During the first months of life, OME prevalence rates increased rapidly in both groups, but did not differ significantly. However, from the age of 6 months on, OME prevalence rates of the high-risk group became significantly higher compared with the normal group (P < 0.05). The peak prevalence of OME (59% in the high-risk group versus 49% in the normal group) was observed around the age of 10 months. Although gradually decreasing prevalence rates were noted in both groups with aging, the differences between high-risk and normal infants remained, at least up to 24 months. In conclusion, OME is a very prevalent, age-dependent disorder during infancy, especially in high-risk infants. Peak prevalence of OME was found in the second half of the first year of life.     

Otitis media with effusion in children with congenital or early-onset hearing impairment

OBJECTIVE: The purpose of this study was to examine the incidence of otitis media with effusion (OME) among children with bilateral congenital or early-onset hearing impairment (CEHI) and to assess whether the diagnosis of OME had any effect on the detection of CEHI. METHODS: The study population consisted of all patients diagnosed in a Finnish university hospital between 1976 and 1995 as having CEHI (> 25 dB, 0.5-4 kHz, in the better hearing ear). Early-onset hearing impairments were defined as losses attributed to perinatal or neonatal complications. Otitis media with effusion was assigned when asymptomatic middle ear effusion had lasted at least 2 months and tympanocentesis had yielded mucous effusion. RESULTS: A total of 184 child patients with CEHI were identified. Of these, OME was diagnosed and treated in 28 (15%) patients. Of the patients with OME, diagnosis of CEHI was made before the occurrence of OME in 7 (25%) and at the same time in 10 (36%) but was delayed at least 6 months after the treatment of OME in 11 (39%) patients. CONCLUSION: It is suggested that all children undergoing ventilation tube placement should have age-appropriate hearing examination to exclude coexisting sensorineural hearing loss.     

Effects of otitis media with effusion on auditory temporal resolution

OBJECTIVE: There is mounting evidence to suggest that otitis media with effusion (OME) is associated with auditory processing deficits that persist beyond the resolution of the peripheral hearing loss. This study investigated the residual effects of OME on auditory temporal resolution. EXPERIMENT 1: METHODS: Experiment 1 measured detection thresholds for a brief tone presented either before (backward masking) or during (simultaneous masking) a masking noise, in 6- and 8-year-old children. Six-year-olds were selected from a prospectively studied group with a lifetime known history of OME. Eight-year-old children, with a retrospectively determined history of OME, were also recruited. All children were free of OME at the time of testing. RESULTS: Regardless of OME history, 6-year-old children had similar tone thresholds on all masking tasks. In contrast, 8-year-olds with a history of recurrent OME had 18 and 4dB higher mean thresholds for the backward and simultaneous masking conditions, respectively, compared with age-matched controls. Possible explanations for these results included (i) recruitment bias, rather than OME, contributed to differences in auditory processing abilities amongst 8-year-old children, or (ii) OME impaired performance at both ages, but this was not seen in 6-year-olds due to 'ceiling' effects. EXPERIMENT 2: METHODS: To distinguish between these possibilities, Experiment 2 measured temporal resolution, using backward masking and amplitude modulation detection, in the prospectively studied group of children when they were 8 years old. RESULTS: Regardless of OME history, these 8-year-olds had similar auditory temporal processing abilities. Results from Experiment 2 suggested that recruitment bias was the most likely explanation for the difference in auditory processing abilities between 8-year-old children with and without a history of OME found in Experiment 1. Consistent with previous data, associations were found between backward masking, age and cognitive ability. CONCLUSION: There is no evidence to suggest that OME effects temporal resolution after the recovery of normal pure-tone thresholds.     

Effects of otitis media with effusion (OME) on central auditory function

Conductive hearing loss attenuates and delays sound passing through the middle ear. This impairs binaural hearing and other central auditory functions dependent on high fidelity sound transmission. Persistent conductive loss leads to central impairments that persist after the peripheral loss has resolved. For example, children who have had multiple episodes of otitis media with effusion (OME) in the first few years of life may have poor detection of sounds in noisy environments, evidenced by reduced binaural unmasking (BU). Recent research shows that a 'threshold' level of OME is required to produce impaired BU. Children who had OME in one or both ears for more than about 50% of the first 5 years had reduced BU. Animal research, using long-term ear plugging, suggests that total OME duration, rather than age at the time of having the disease, determines its effect on BU. Animals reared with bilateral (but not unilateral) ear plugs also have poor auditory temporal resolution, and reduced sensitivity to short tones in the presence of background noise, after plug removal. However, given time (6-24 months) and training, all animals regained normal temporal resolution.     

Disease severity in patients referred to pediatric otolaryngologists with a diagnosis of otitis media

OBJECTIVE: This study evaluated disease severity of children referred to a pediatric otolaryngology practice with a diagnosis of otitis media (OM) before and after tympanostomy tube (TT) placement. METHODS: A retrospective review was conducted of patients referred to a pediatric otolaryngology practice from January 2000 to April 2004, with the chief complaint of middle ear effusion (MEE) and/or OM. Patients who underwent TT placement had pre- and post-operative hearing levels (HL) and bilaterality of disease analyzed. RESULTS: A total of 286 patients who underwent TT placement were included. Recurrent OM (ROM) was the most common diagnosis (42.6%), followed by OM with effusion (OME) plus ROM (ROM + OME) (31.7%) and then OME (25.7%) alone. The mean improvement in the pure tone average (PTA) hearing level was 14.8 dB in patients with OME, 9.5 dB in patients with ROM + OME and 6.3 dB in patients with ROM alone. The hearing improvements in OME and ROM + OME were statistically larger than the ROM group (P < or =0.0004). Hearing levels at 500, 1000, 2000 Hz and PTA showed statistically significant improvements in HL after tube placement in each group (P < 0.0001). Of the patients presenting with OME or ROM + OME, 70% had pre-operative findings demonstrating bilateral MEE. CONCLUSION: Most children referred for consideration of surgical management of OM have a diagnosis of ROM, or ROM in conjunction with OME, with only a small percentage having the diagnosis of OME alone. In addition, the majority of children have bilateral disease, suggesting a more severely affected patient population treated by the pediatric otolaryngologist. The results also demonstrate a significant improvement in hearing after the placement of TT. However, the long-term impact of this hearing improvement on a child's development is not known and an additional prospective study of children in this population group is warranted.     

Behavioral trends in young children with conductive hearing loss: a case–control study

Otitis media with effusion (OME) is a common condition affecting children and a well-known cause of conductive hearing loss that can potentially lead to speech development disorders. Recent studies, however, have demonstrated the influence of OME on development of attention disorders or social adaptation and acceptance. Hence, this study aimed to investigate the behavioral trends of children with OME based on the Achenbach test. A group of 117 patients with episodes of OME at the age of 4–5 was compared with a control group according to the Achenbach system of evaluation, by application of the Child Behavior Checklist questionnaire (CBCL). Patients suffering from OME had more anxiety/depression related disorders and attention disorders as compared with the control group. The psychological effect of OME in children of ages 6–8 is evident with anxiety and depression disorders being especially prominent among these patients.     

Auditory processing abilities in children with chronic otitis media with effusion

Conclusion The study results indicate that children with a history of otitis media with effusion (OME) suffer from auditory processing disorder to some degree. The findings support the hypothesis that fluctuating hearing loss may affect central auditory processing during critical periods.

Objectives Evidence suggests that prolonged OME in children can result in an auditory processing disorder, presumably because hearing has been disrupted during an important developmental period. A lack of auditory stimulation leads to the abnormal development of the hearing pathways in the brain. The aim of the present study was to determine the effects of OME on binaural auditory function and auditory temporal processing.

Method In the present study, the dichotic digit test (DDT) was used for binaural hearing, and the gap in noise (GIN) test was used to evaluate temporal hearing processing.

Results The average values of GIN differed significantly between children with a history of OME and normal controls (p?p?=?0.002).     

Eustachian tube insufflation with thermal water: Effectiveness in the treatment of pediatric otitis media with effusion

PurposeOtitis media with effusion (OME) is the most common ear disease in childhood. The hearing loss associated with OME impacts on children's language development and behavior. Eustachian tube insufflation are among possible treatments for OME, but data regarding their effectiveness are scarce. The aim of this investigation was to analyze the effect of inhalatory thermal therapy and Eustachian tube insufflation in a consecutive cohort of pediatric patients with OME.Materials and methodsSeventy-four pediatric patients referred for OME to the thermal medical center “La Contea” (Battaglia Terme, Padova, Italy) were considered. Data from tympanometry and pure tone audiometry performed immediately before (T0), at the end of treatment (T1) and at a follow-up control (T2) were analyzed.ResultsData from 148 ears were available. The pressure values of tympanometry significantly improved from T0 to T1 (p = 0.0001), and further improvement was recorded at T2, when 60.8% of patients had normal tympanograms. A significant gain of the air-conduction threshold in the T0-T2 interval was observed (p = 0.0001). At otoscopy, a significant reduction of tympanic membranes with fluid or air-fluid levels presence (p < 0.00001) and a significant increase of normal tympanic membranes (p = 0.0001) were found.ConclusionEustachian tube insufflation represented a well-tolerated and effective treatment in children with OME. Further investigations should deepen these results in randomized, double-blind settings, possibly with long-term follow-up periods. A quality-of-life and cost-effectiveness evaluation of this treatment approach for pediatric OME could be helpful for public health decision-making.     

Long-term result of management of otitis media with effusion in patients with post-irradiated nasopharyngeal carcinoma

The treatment of post-irradiated otitis media with effusion (OME) remains controversial. Hence the aim of this study was to understand the long-term result of management of post-irradiated OME. Eighty-five nasopharyngeal carcinoma patients with post-irradiated OME were prospectively enrolled. All were followed up with close observation and a hearing aid was advised for those with hearing loss. If patients were still bothered by aural fullness, tinnitus or hearing impairment and did not want to continue conservative treatment, tympanostomy plus aspiration was performed. Only those who had persistent OME and failed repeated tympanostomy for at least 3 months were suggested to undergo grommet insertion. After a mean follow-up of 842.1 ± 49.0 days from the completion of radiotherapy, OME was present in 45 patients (52.9%). Another 16 (18.8%) had chronic discharging ears with or without perforated eardrums. Grommets remained on the eardrums in eight patients. Among them, five were without otorrhea but discharge came from grommet tubes intermittently in three patients. Only 15 (17.6%) were free of OME, and one patient had a dry perforated eardrum. Our results showed current methods did not result in long-term resolution of some recalcitrant post-irradiated OME.     

Measurement of angle and length of the eustachian tube on computed tomography using the multiplanar reconstruction technique

OBJECTIVE: To compare the anatomic features of the eustachian tube (ET) between children with and without otitis media with effusion (OME) and with adults. METHODS: The angle and length of the ET in children with OME (54 ears, OME children) and without OME (50 ears, normal children), as well as those of normal adults (90 ears), were measured on computed tomography using the multiplanar reconstruction technique. RESULTS: The angles of ET in the OME children group, the normal children group, and the normal adult group were 20.4 +/- 3.5 degrees and 21.2 +/- 4.8 degrees , 19.9 +/- 3.4 degrees and 20.0 +/- 3.6 degrees , and 27.3 +/- 2.7 degrees and 27.3 +/- 2.8 degrees on the right and the left sides, respectively. There was no significant difference between the right and the left side in any group (P = .541, P = .952, P = .978). The lengths of ET in the OME children group, the normal children group, and the normal adult group were 37.2 +/- 3.0 mm (mean +/- SD) and 37.6 +/- 3.2 mm, 37.5 +/- 3.3 mm and 38.0 +/- 3.2 mm, and 42.5 +/- 2.8 mm and 42.9 +/- 2.9 mm on the right and the left sides, respectively. There was no significant difference between the right and left sides in any group (P = .670, P = .597, and P = .545). Both the angles and lengths were significantly greater in the normal adult group than in either the OME children group or the normal children group (one-way analysis of variance and Fisher's protected least significant difference tests, P < .05), but there was no significant difference in either the angle or length of the ET between the OME and normal children groups (P > .05). In the OME and normal children groups, the angle was observed to constantly increase with age, and the values were found to be within the range of the adult size in all the patients older than 7.5 years and 7.7 years in the OME children group and the normal children group, respectively. As well as the angle, the lengths were observed to constantly increase with age, but the increase appeared to be greater at a younger age (until approximately 3 to 4 years) than at an older age, and the values were found to be within the range of the adult size in all the patients older than 6.8 years and 7.7 years in the OME children group and the normal children group, respectively. CONCLUSION: The angle and length of the ET are more horizontal and shorter in infants than in adults. However, there is no statistical difference between the angle and length of the ET in infants with and without OME. These results lead us to believe that a short and horizontal ET may not be a main etiologic factor related to high susceptibility to OME in infants and children.     

Adult-onset otitis media with effusion: results following ventilation tube insertion.

The outcome of otitis media with effusion (OME) in children is generally good. However, it is less clear in adults. All adult patients who had a ventilation tube inserted for OME at the Ipswich Hospital between 1996 and 1997 were studied. Of 53 patients studied, 28 had had a previous history of ventilation tube insertion. Furthermore, at 15-27 months following ventilation tube insertion, the ventilation tube had already extruded in 31 patients and the OME had already recurred in 19 of these. Endoscopic examination revealed that many patients still had evidence of inflammation at the lateral nasal wall (26.4 per cent) and at the eustachian tube orifice (51 per cent). There is also a strong history of atopy in the studied group and the skin prick test was positive in 57 per cent of the patients. This study shows that many patients with adult-onset OME have underlying pathology that could lead to recurrence of OME following ventilation tube extrusion.     

The necessity and effect of prophylactic quinolone ear drops after ventilation tube insertion for otitis media with effusion

BackgroundOtitis media with effusion (OME) is a condition where non-infective fluid builds up in the middle ear. Long-term OME can cause damage to the middle ear and hearing impairment. Ventilation tube insertion (VTI) is an efficient procedure to drain persistent OME. However, the effect of prophylactic ear drops after VTI remains controversial because no infection is present. This study investigated the need for and effect of quinolone ear drops in patients with OME after VTI.MethodsBetween July 2018 and July 2021, 272 patients (436 ears with OME) who underwent VTI were enrolled. Prophylactic quinolone ear drops (ofloxacin) were used in 271 OME ears and not used in 165. The clinical findings and effect of the ear drops were assessed.ResultsThe group with postoperative ofloxacin had less postoperative otorrhea (p < 0.001). In univariate analysis, age ≥ 13 years (odds ratio [OR] = 1.499, 95% confidence interval [CI]: 1.003–2.238, p = 0.046) was significantly associated with recovery to normal middle ear functioning (type A on postoperative tympanometry). No adenoid hypertrophy (OR = 1.692, 95% CI: 1.108–2.585, p = 0.014) and no postoperative otorrhea (OR = 2.816, 95% CI: 1.869–4.237, p < 0.001) were significant independent factors associated with middle ear recovery in both univariate and multivariate analysis. After VTI, 65% of tympanic membranes in the group with postoperative ofloxacin recovered to normal, while in 67% of tympanic membranes in the group without ofloxacin scarring remained.ConclusionsPatients who received prophylactic postoperative ofloxacin had less postoperative otorrhea. No adenoid hypertrophy and no postoperative otorrhea were significant independent predictors of middle ear recovery to normal function in both univariate analysis and multivariate analysis. However, prophylactic ofloxacin was not an independent predictor of normal middle ear functioning after VTI. After VTI, most OME patients who had used ofloxacin postoperatively had eardrums that were in better condition than those of patients who had not used ofloxacin. In this study, we confirmed the advantages and limitations of OME after VTI with prophylactic ofloxacin, thus providing clinicians with some guidance regarding the decision to administer prophylactic ofloxacin.     

The point prevalence of otitis media with effusion among primary school children in Western Sicily

The objective of this study is to identify the prevalence of otitis media with effusion (OME) in primary school children and to value the possible predisposing factors focusing on relationship between allergy and OME in Western Sicily. 2,097 children attending primary school were screened from September 2006 to June 2007 in Sciacca. Children underwent pneumatic otoscopy, skin tests, tympanogram and acoustic reflex tests. Audiogram was performed if the child had a type B or a type C tympanogram. The criteria for diagnosis of OME were: documented persistent middle ear effusion by otoscopic examination for a minimum of 3 months, presence of B or C tympanogram, absence of ipsilateral acoustic reflex and a conductive hearing loss greater than 25 dB at any one of the frequencies from 250 Hz to 4 kHz. OME was identified in 143 children, in 61 of whom OME was unilateral and in 82 of whom it was bilateral. The overall prevalence of OME was 6.8%, with a maximum prevalence of 12.9% between 5 and 6 years of age. By increasing age, the prevalence of OME decreased. Also, we found a higher prevalence rate of OME in children with positive skin tests (62.9%) than those with negative skin tests (37.1%). The present study evidences the high social impact of OME, whose prevalence is directly correlated to age and atopy. Moreover, our finding supports the literature data that climatic and environmental factors may also have a role in the occurrence of OME.     

Compliance of the eustachian tube in patients with otitis media with effusion

To analyze the compliance of the eustachian tube, we measured the decrease in tubal resistance (pressure/air flow) with increasing air flow rate through the eustachian tubal lumen. When the eustachian tube is compliant, the tubal resistance decreases greatly because of the high distensibility of the tube. The tubal compliance index (TCI), which is the ratio of the tubal resistance between two different air flow rates, was compared among three groups: 36 ears of children with otitis media with effusion (OME), 26 ears of adult OME patients, and 10 otherwise normal ears with traumatic perforations of the eardrum. Compared with normal subjects, OME children had a significantly higher TCI (P less than .005), whereas OME adults had a significantly lower TCI (P less than .05). From these results, we concluded that eustachian tubes are compliant in children with OME but rigid in adults with OME.     

Relationships between otitis media sequelae and age

Objectives: To explore relationships between age and sequelae in two groups of children treated with tympanostomy tubes for chronic otitis media with effusion (OME). Study Design: Cross-sectional study of sequelae among children, adolescents, and adults at 4 years and 9 to 23 years after tympanostomy tube treatment. Methods: Group I was examined with otomicroscopy, tympanometry, and audiometry two to four times a year as part of a prospective study, and they were evaluated 4 years after initial tube treatment for this study. Group II received tubes while participating in a chronic OME study, but participants were not followed prospectively after treatment. Nine to 23 years after tube treatment, they were examined with otomicroscopy, tympanometry, and hearing screening. Results: Among the 5? to 28? year-old subjects, cholesteatoma (?1%) and perforation (?2%) were rare. In Group I, tympanosclerosis increased with age (P < .01), and OME (flat tympanograms) decreased with age in Group II (P < .01). The older cohort was more likely to have severe retractions (18% vs. 4%, P = .02), hearing loss (21% vs. 10%, P < .01), and severe atrophy (24% vs. 0%, P < .01) than the younger cohort, but they were less likely to have flat tympanograms (2% vs. 12%, P < .01). Conclusions: Although OME became less prevalent with age, important sequelae (severe atrophy, severe tympanic membrane retraction, hearing loss, cholesteatoma, and chronic perforation) may develop in children with chronic OME as they become adolescents and young adults. Long-term prospective studies are important in defining the progression of sequelae in these children.