Increased adenoid mast cells in patients with otitis media with effusion.

OBJECTIVE: Previous studies have been suggested the possible role of adenoid mast cells in the pathogenesis of otitis media with effusion (OME). The aim of the present study was to evaluate the possible relationship of adenoid mast cells and hearing loss in patients with chronic OME. METHODS: Twenty patients with combined chronic OME and chronic adenoiditis (OME-A) and 20 patients with isolated chronic adenoiditis were studied. Hearing thresholds were determined by pure tone audiometry in both groups. All subjects underwent adenoidectomy and adenoid mast cells were counted in each specimen. Number of adenoid mast cells were determined in both groups. Possible relationship of adenoid mast cells and hearing thresholds in OME-A patients was evaluated by comparing the hearing thresholds of OME-A patients with mast cell count above the mean of OME-A group and hearing thresholds of OME-A patients with mast cell count below the mean of OME-A group. RESULTS: All isolated chronic adenoiditis patients had normal hearing thresholds. OME-A patients had hearing thresholds ranging from 12-52 dB. The number of adenoid mast cells in OME-A group (median: 80) was significantly greater than isolated chronic adenoiditis group (median: 38) (P < 0.05). OME-A patients with adenoid mast cell count above the mean of OME-A group had significantly higher hearing thresholds compared to OME-A patients with mast cell count below the mean of OME-A group (P < 0.05). CONCLUSIONS: Patients with OME-A have greater number of adenoid mast cells than patients with isolated chronic adenoiditis. OME-A patients with adenoid mast cell count above the mean of the OME-A group had higher hearing thresholds than OME-A patients with adenoid mast cell count below the mean of the OME-A group. Increased number of adenoid mast cells may contribute to the pathogenesis of higher hearing thresholds in some OME-A patients.     

Chosen factors of T and B cell apoptosis in hypertrophic adenoid in children with otitis media with effusion

Evaluation of lymphocyte homeostasis within the chronically inflamed adenoid, closely related to the functioning of the immune system, may have a role in qualifying children for adenoidectomy. Apoptosis is a major process maintaining balance between tonsillar lymphocytes. The Fas receptor and Bcl-2 protein family which show pro-apoptotic and anti-apoptotic actions are of particular significance in apoptosis induction. Adenoid excised due to hypertrophy with or without chronic otitis media with effusion was used as study material. Flow cytometry was used to assess the percentages of apoptotic lymphocytes and CD4⁺, CD8⁺, CD19⁺ cells with CD95⁺ antigen and Bcl-2 protein in the group of children who underwent adenoidectomy due to adenoid hypertrophy and accompanying otitis media with effusion. The percentages of CD4⁺Bcl-2⁺, CD8⁺Bcl-2⁺ and CD19⁺Bcl-2⁺ lymphocytes in the group of children with adenoid hypertrophy and acute otitis media were lower as compared to the reference group. However, the percentages of CD4⁺, CD8⁺ and CD19⁺ cells with CD95⁺ antigen were higher in the study group comparing to the reference group. The tendency of reduced percentages of T and B lymphocytes with Bcl-2 expression and elevated percentages of these cells with CD95⁺ expression within the adenoid may reflect local immunity disorders.     

Resistant bacteria in the adenoid tissues of children with otitis media with effusion

OBJECTIVE: To investigate the relationship between the resistant bacteria in the adenoid tissue and the middle ear effusion of children who underwent myringotomy and adenoidectomy with the diagnosis of otitis media with effusion (OME). METHODS: This study was performed in the ENT Clinic, Firat University between January 2001 and June 2001. Forty-one subjects who were enrolled in the study were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a myringotomy together with an adenoidectomy because of adenoid hyperthrophy. Bacteriological cultures were performed on the samples obtained from adenoid tissues and middle ear fluids, in the bacteria that were cultured; the resistance to oxacilline sodium and beta-lactamase were investigated. The resistance of penicillin was confirmed by MIC test. The control group composed of individuals who did not have OME but who underwent adenotonsillectomy due to adenotonsillary hyperthrophy. RESULTS: In the adenoid tissue cultures; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the 70% (29/41) of the study group and 40% (20/41) of the control group (P<0.01). In the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were found to be 48% (20/41) in the study group and 16% (4/25) in the control group (P<0.05). We observed that bacterial growth in 29% (9/31) of the middle ear cultures of the study group and resistant bacteria were isolated in 77% (7/9) of them. The same pathogens which have grown in the middle ear cultures were also present in the adenoid tissue cultures. CONCLUSION: The isolation of resistant bacteria in most of the adenoid tissue samples of the children with OME, makes us to consider the possible role of these bacteria in the development of OME.     

Role of adenoid biofilm in chronic otitis media with effusion in children

To study the extent of surface adenoid biofilm and to evaluate its role in the pathogenesis of chronic otitis media with effusion (COME) in children. The study was carried out on 100 children between 3 and 14 years of age, who were divided into two groups. The first group (50 children) had otitis media with effusion associated with adenoid hypertrophy, whereas the second group (50 children) had adenoid hypertrophy without middle ear effusion. Adenoidectomy with ventilation tube insertion was done for group 1 cases, whereas, only Adenoidectomy was done for group 2 cases. Microbiological study, Scanning electron microscope and multiplex- PCR were done for suspected adenoid biofilms and specimens from middle ear effusion. Adenoids removed from children with COME had higher grade biofilm formation (74 %) than the second group (42 %). No correlation was found between adenoid size and biofilm formation. Culture of adenoid tissue in group 1 patients was positive in 52 % of cases compared to 96 % by PCR, while in group 2 culture of adenoid tissue was positive in 38 % compared to 48 % by PCR. Culture of middle ear fluid was positive in 32 % of cases only compared to 80 % by PCR. A positive correlation was found between results of bacterial biofilm visualized by SEM and bacteria detected and identified by PCR technique. On the other hand, no correlation was found between results of bacterial biofilm visualized by SEM and bacteria detected by culture. The size of the adenoid is not the main determinant factor in OME pathogenesis but the degree of bacterial colonization is much more important. Adenoids in COME may act as a reservoir of chronic infection rather than causing mechanical Eustachian obstruction. Higher grade biofilm formation was found in cases with middle ear effusion than those with adenoid hypertrophy only. These findings support the hypothesis that there would be an association between adenoidal biofilm formation and COME. This study focused on the value of PCR in detecting pathogens in the adenoid and middle ear specimens although the bacterial culture would be negative.     

Relation between adenoid size and otitis media with effusion

AimsThis study compares the efficacy of adenoidectomy on otitis media with effusion (OME) in patients with different size of adenoids and the connection between differently sized adenoids and middle ear effusion.Material and methodsChildren with a history of at least 3 months’ OME underwent adenoidectomy and myringotomy without the insertion of a tympanostomy tube. Treatment assignment was stratified by adenoids’ size causing choanal obstruction (grade I-III) and according to Eustachian tube ostium obstruction (grade A–C). The subjects were followed for 12 months.ResultsAdenoidectomy was significantly more effective in children with adenoids in contact with torus tubarius (grade B, C) compared to those with small adenoids without contact (P < 0.001). The volume of the adenoids was irrelevant (P = 0.146). The size of adenoids did not affect the viscosity of the middle ear secretion. The distribution of mucous and serous secretion was not dependent on the size of adenoids; the efficacy of adenoidectomy was 82% in mucous as well as serous secretion.ConclusionThe relation between adenoids and torus tubarius is more important than the volume of the adenoids. The viscosity of middle ear fluids (serous or mucous) did not influence the rate of treatment efficacy.     

儿童腺样体肥大合并慢性鼻窦炎对分泌性中耳炎发生率的影响

目的探讨儿童腺样体肥大(AH)合并慢性鼻窦炎(CRS)对分泌性中耳炎(OME)发生率的影响。方法对我院2017年至2018年行腺样体切除术或腺样体扁桃体切除术的腺样体肥大患者的临床资料进行统计和分析,包括病史和体征,电子鼻咽镜检查,声阻抗测试以评估腺样体肥大患者分泌性中耳炎和慢性鼻窦炎的患病情况。并使用统计软件SPSS 24.0进行统计分析。结果在208例AH儿童中,有分泌性中耳炎的50例(24%),在学龄儿童(6~12岁)腺样体肥大患者中分泌性中耳炎的发生率最高。腺样体肥大组和腺样体肥大合并慢性鼻窦炎组之间分泌性中耳炎的发生率在统计学上有差异(P=0.001)。结论患有慢性鼻窦炎的腺样体肥大儿童患分泌性中耳炎的风险相应增加,而学龄期的腺样体肥大儿童分泌性中耳炎发生率最高。     

内镜手术治疗腺样体肥大致儿童分泌性中耳炎

目的：探讨腺样体肥大致儿童分泌性中耳炎的诊治方法和手术效果。方法：对37例患儿行内镜下腺样体切除＋鼓膜置管术。结果：患儿术后听力均提高,拔管后随访13～17个月未见复发。结论：内镜下腺样体切除＋鼓膜置管术对腺样体肥大致儿童分泌性中耳炎有确切疗效。     

Evaluation of adenoid mast cells in children with secretory otitis media

Mast cells may play a role in pathogenesis of the otitis media with effusion (OME) in children. The study involved 72 children with no history of allergic diseases. The analysed material were adenoids removed on the grounds of hypertrophy. Immunohistochemical analyses were carried out using antibodies (Dako, M 7052) directed against mast cell tryptase. The slides evaluation was performed by means of optic microscope. The presence of mast cells within adenoidal tissue were scored. There were no statistically significant difference between the numbers of mast cells in each examined adenoid as well as age groups. Our results correspond with those obtained by other authors according to mast cells distribution in adenoid tissue and do not indicate any particular role of mast cells in pathogenesis of OME in children.     

Dendritic cells and lymphocyte subpopulations of the adenoid in the pathogenesis of otitis media with effusion

Objective

To assess dendritic cells and lymphocyte subpopulations of adenoid and peripheral blood in patients with adenoid hypertrophy and otitis media with effusion (OME). To explain the influence of immunological status of adenoid on the development of OME.

Methods

The examined group covered 123 surgically treated patients due to adenoid hypertrophy (39 children with coexisting OME). Preoperative clinical examination included anamnesis and otorhinolaryngological examination with nasofiberoscopy, videootoscopy and assessment of the hearing organ. The material of the study were surgically removed adenoids and peripheral blood samples prepared and then analyzed by the means of tri-colour flow cytometry. The obtained results were statistically analyzed.

Results

Significant differences between patients with adenoid hypertrophy with coexisting OME and children without OME concerning CD19+CD69+, CD3+CD69+, CD4+CD69+CD8+CD69+ and CD19+CD25+ cells were observed. No statistical differences were revealed in the blood of patients with and without OME. Several statistical differences were noted between the adenoid and peripheral blood in patients with otitis media with effusion concerning BDCA-2+/CD123+ cells, CD3+ and CD19+ lymphocytes with the markers of their activation.

Conclusions

The adenoid is involved in local immune response regardless of constitutional immunological mechanisms in patients with OME coexisting with adenoid hypertrophy. Significantly lower percentage of CD3+CD69+, CD4+CD69+, CD8+CD69+ and CD19+CD69+ cells of adenoid in patients with OME attests to reduced T-cells activation of the adenoid in relation to patients without OME.     

分泌性中耳炎患儿腺样体与中耳积液中IgE相关性的研究

目的:探讨反复发作的分泌性中耳炎(OME)患儿腺样体和中耳积液中的IgE是否存在相关性.方法:选取35例OME患儿为实验组,31例腺样体肥大患儿为对照组,实验组取中耳积液和腺样体标本,对照组取腺样体标本,其中腺样体标本制成组织匀浆,用酶联免疫分析技术测定腺样体和中耳积液中IgE的含量.运用SPSS 18.0统计软件对所有相关数据进行处理分析.结果:实验组腺样体和中耳积液中IgE的含量比对照组明显增高(P<0.05).实验组中耳积液和腺样体中IgE的含量呈直线正相关(r=0.580,P<0.05).结论:OME的发生与免疫因素有关,肥大腺样体内的Ⅰ型免疫反应增强,可能与OME的反复发作、迁延不愈有关.     

Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy

ObjectiveClinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy.Material and MethodsIn a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss.ResultsThe study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB.ConclusionAn objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.     

Cytokines in children with otitis media with effusion

We assayed 38 middle ear effusions from 23 children aged 4–13 years (mean 7) undergoing tympanostomy tube placements. All fluid was assayed for tumor necrosis factor (TNF) α, interleukin (IL) 1β, IL-8, and IL-10. Cytokine concentrations were measured by means of an enzyme-linked immunosorbent assay. Detectable levels of IL-1β, IL-8, and IL-10 were found in all of the effusions. TNF-α was detected in 18 of the middle ear effusions (47.4%). The mean concentration of TNF-α, IL-1β, IL-8, and IL-10 was, respectively, 0.423 ± 1.39, 30.58 ± 68.7, 7001.9 ± 6743, and 56 ± 58.7 pg/ml. There was a strong, statistically significant correlation between the concentrations of TNF-α and IL-1β (r = 0.87, P = 0.001) and between IL-1β and IL-8 (r = 0.53, P = 0.001). There was no correlation between the concentrations of IL-10 and other cytokines examined or between tympanic membrane pathology and the concentrations of TNF-α, IL-1β, IL-8, or IL-10. The presence of IL-10 in middle ear effusions may be one of the causes of a lack of clinical features of acute inflammation and may lead to a chronic inflammatory state. Received: 25 August 1999 / Accepted: 5 January 2000     

Increased IL-17 and 22 mRNA expression in pediatric patients with otitis media with effusion

ObjectivesMiddle ear effusion has been reported to be associated with immune responses in patients with otitis media with effusion (OME). Although various cytokines are involved in immunologic responses in patients with OME, no study to date has assessed the involvement of the pro-inflammatory cytokines interleukin (IL)-17 and IL-22. This study analyzed the levels of expression of IL-17 and IL-22 in the middle ear effusion of patients with OME.MethodsPatients aged <11 years who were diagnosed with chronic OME and underwent ventilation tube insertion from May 2013 to August 2015 were enrolled. Effusion fluid samples were obtained during surgery and levels of IL-17 and IL-22 mRNAs assessed by real-time PCR. IL-17 and IL-22 mRNA levels were compared in patients with effusion fluid positive and negative for bacteria; in patients with and without accompanying diseases, recurrent disease, and re-operation; and relative to fluid characteristics.ResultsThe study cohort included 70 pediatric patients, 46 boys and 24 girls, of mean age 4.31 ± 2.11 years. The levels of IL-17 and IL-22 mRNA were higher in patients with than without sinusitis, but only IL-22 mRNA levels differed significantly (p < 0.05). The level of IL-17 mRNA was significantly higher in patients who did than did not undergo T&A (p < 0.05). The level of IL-22 expression was significantly higher in mucoid and purulent middle ear fluid samples than in serous fluid samples (p < 0.05).ConclusionIL-17 and IL-22 mRNAs are involved in the pathophysiology of OME and are significantly higher in subjects with than without accompanying diseases.     

小儿分泌性中耳炎与腺样体肥大

目的探讨小儿分泌性中耳炎与腺样体肥大的关系.方法回顾性分析1988～2001年我院施行扁桃体及腺样体联合切除术患儿116例,其中患分泌性中耳炎37例(31.9%),共52侧.结果术后37例分泌性中耳炎均治愈,随访期间仅2例复发.结论分泌性中耳炎伴扁桃体及腺样体肥大者,应考虑联合切除术,以利咽鼓管功能恢复.     

Age and adenoid size in relation to adenoidectomy in otitis media with effusion

A previously reported study showed that adenoidectomy resolved effusions in chronic bilateral otitis media with effusion in 36 to 46 per cent of 103 children. This work includes 52 additional cases and assesses the effect of age and adenoid size in relation to adenoidectomy. Pre-operative lateral cephalometric radiographs showed the adenoid size and postnasal space airway. Surgery was allocated randomly into three groups: adenotonsillectomy, adenoidectomy, and no surgery. In addition, in all cases a unilateral myringotomy and ventilating tube insertion were performed. The ear not operated upon was assessed for clearance of the effusion at 3, 6, 9, and 12 months postoperatively. Following adenoidectomy the effusion resolved in the ear not operated upon in 31 to 45 per cent of cases assessed after 1 year. Tonsillectomy conferred no additional benefit. There was a trend for improved clearance of effusions in children more than 6 years of age, compared with those less than 6 years of age. There was also a trend for improved clearance after removal of larger adenoids from children with smaller postnasal space airways, but this was only significant for 3 months postoperatively.