Transtympanic endoscopic findings in patients with otitis media with effusion

Using a fine, rigid endoscope (Olympus, SES-1711K), we examined the middle ear, including the tympanic orifice of the eustachian tube, of children with otitis media with effusion (OME) in its active stage (26 ears), in the convalescent stage (13 ears), and during treatment with ventilation tubes for 10 days to 6 months (five ears) through myringotomy with the patients under general anesthesia. Several color photographs of representative ears are shown. In the active stage of OME, edema (73.1%) and hyperemia (23.1%) were characteristic features of the middle ear mucosa, and normal mucosa was seen in only one ear (3.1%). The tympanic orifice of the eustachian tube, which could be examined in 12 ears, were stenosed with edema in four ears (33.3%) or plugged with effusion in three ears (25.0%) in this group. In the convalescent stage of OME, dilated vessels were most often seen (69.2%), but the rest of the patients had normal mucosa (30.8%) in the middle ear, and none of them had edema nor hyperemia. The tympanic orifice of the eustachian tube, which could be examined in five ears, was clearly patent in all the patients in this group. One ear that was treated with a ventilation tube for 1 month showed dilated vessels and less severe inflammation than did ears that were in the active stage of OME, and three ears that were treated for more than 3 months showed almost normal middle ear mucosa.     

27例鼻咽癌患者合并分泌性中耳炎的临床分析

目的探讨鼻咽癌患者放疗前后分泌性中耳炎的临床特点及治疗措施。方法回顾性分析2003年一2006年我院经治的27例鼻咽癌患者,将其放疗前、放疗后的情况进行回顾分析。21例（32耳）中耳炎患者被分为鼓膜穿刺组与鼓膜置管组。结果27例患者放疗前有14例（17耳）并发分泌性中耳炎,放疗后分泌性中耳炎的患者增至21例（32耳）,双耳发病11例,6例未发生分泌性中耳炎。鼓膜穿刺组12例（19耳）,显效率为78.9％（15／19）,1例患者发展为慢性化脓性中耳炎;置管组9例（13耳）,有5例（7耳）疗效显著,显效率为54％（7／13）,有2例患者鼓膜穿孔。MRI检查显示,21例分泌性中耳炎患者中,19例有明显咽鼓管挤压和腭帆张肌肿胀。结论MRI检查有助于鼻咽癌患者放疗前后并发分泌性中耳炎的评估;鼓膜穿刺抽吸是治疗鼻咽癌并发分泌性中耳炎的有效和实用的措施。     

Microbiology of chronic and recurrent otitis media with effusion in young infants

Chronic otitis media with effusion (OME) has been assumed to be sterile, since several reports in the literature have described unsuccessful attempts to culture bacteria from it. However, several recent studies have confirmed an earlier report that there is a significant frequency of bacteria in the middle ears of children with chronic and/or recurrent OME. Similar studies in young infants with chronic and/or recurrent OME have not been previously reported. In this study, cultures were obtained at the time of myringotomy and tympanostomy tube insertion from 50 infants aged 1–12 months who had chronic and/or recurrent OME. From the 80 ears of 40 infants without cleft palate, 32% had bacteria isolated from their middle ears; 22% had Streptococcus pneumoniae or Haemophilus influenzae. In 21 of these ears, no effusion was apparent at myringotomy, but in 28% bacteria were isolated from middle ear washings. From the 20 ears of 10 infants with an unrepaired cleft palate, 55% had bacteria present in their middle ear aspirates; 50% had S. pneumoniae or H. influenzae. Even though the significance of bacteria in chronic OME in children, and now in young infants, is unclear at present, a therapeutic trial with an antimicrobial agent prior to surgical intervention would appear to be reasonable until such therapy is tested in a randomized, clinical trial.     

Ventilation time of the middle ear in otitis media with effusion (OME) after CO2 laser myringotomy

OBJECTIVE: The aim of this study was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications, and the recurrence rate of otitis media with effusion (OME) within 6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan. STUDY DESIGN: Prospective clinical study. MATERIALS AND METHODS: In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12 to 15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter. RESULTS: None of the children showed postoperative impairment of cochleovestibular function such as sensorineural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later, the condition of the tympanic membrane of 129 ears (81.1%) could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry and tympanometry. The CO2 laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% of the ears with serous secretion (n = 37; P <.05). CONCLUSION: The most important principle in treating OME is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this through a self-healing perforation in which its diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media.     

Does the use of radiofrequency myringotomy for insertion of a ventilation tube reduce the incidence of myringosclerosis?

The aim of the present study was to determine the rate of myringosclerosis after radiofrequency (RF) myringotomy and ventilation tube (VT) insertion and compare it with that after the incisional myringotomy and VT insertion. Thirty children (60 ears), 2–16 years old (mean age 7.06 ± 2.77 years) who were planned to undergo surgical intervention for bilateral otitis media with effusion (OME), were included in this study. The children were treated by RF myringotomy of the right ear, incisional myringotomy of the left ear, and insertion of VTs into both ears. Both ears were examined intraoperatively for bleeding, and patients were evaluated for myringosclerosis formation with otomicroscopy at the end of the ninth month. Myringosclerosis was observed in 22 of the 60 ears. The overall incidence was 36.6 %. Fifteen (50 %) left ears showed myringosclerosis by otomicroscopy, and seven (23.3 %) right ears showed myringosclerosis. The rate of myringosclerosis of the right ear was significantly lower than that of the left ear (p < 0.05). In addition, intraoperative tympanic membrane bleeding was observed in 24 (40 %) of the 60 ears: 21 (70 %) left ears and three (10 %) right ears were perforated by RF. The tympanic membrane bleeding rate of the right ear was significantly lower than that of the left ear (p < 0.01). The present study is the first to determine the myringosclerosis rate after RF myringotomy and VT insertion. Our results indicate that VT insertion with RF myringotomy decreased the incidence of myringosclerosis.     

Laser myringotomy versus ventilation tubes in children with otitis media with effusion: a randomized trial

OBJECTIVES: Insertion of ventilation tubes in children with otitis media with effusion (OME) is an accepted and common treatment procedure. The majority of patients require general anesthesia. Although laser myringotomy can be performed in local anesthesia, evidence is lacking that this treatment modality is an alternative for tubes, and outcome predictors for laser myringotomy are not available. STUDY DESIGN: Prospective randomized trial. METHODS: We screened 1,403 children with chronic OME that were indicated for placement of ventilation tubes. In the eligible patients, we performed laser myringotomy in one ear and placed a tube in the other ear, both within the same patient. Follow-up was scheduled each month for 6 months. Success was defined as absence of effusion or aural discharge. A logistic regression model was used with success of the therapy as binary outcome. This model was based on base-line variables, asked for in a parent's questionnaire. RESULTS: Two hundred eight children received the allocated intervention, and no complications occurred. The mean closure time of the laser perforation was 2.4 weeks, and the mean patency time of the ventilation tube was 4.0 months. The mean success rate was 40% for laser and 78% for tubes. Ten known variables were found to predict middle ear status after therapy. CONCLUSION: Laser myringotomy is a safe but less-effective procedure than insertion of a ventilation tube in the treatment of chronic OME. The prognostic model enables the otolaryngologist to choose the surgical treatment for the child that benefits most: laser myringotomy or ventilation tube.     

儿童分泌性中耳炎鼓膜置管前后听性脑干反应的特征

目的：评价儿童分泌性中耳炎鼓膜置管前后听性脑干反应（ABR）的特征及变化。方法：回顾性分析行鼓膜置管的37例分泌性中耳炎患儿（研究组）手术前后的ABR资料,并与30例健康儿童（对照组）的ABR资料相对比;将研究组再按波形分化程度分为波形分化不良组和波形分化较好组,对两组的病程及波Ⅴ反应阈等进行比较。结果：①儿童分泌性中耳炎可以影响ABR的波形分化和各波出现率,手术后有改善;术前波形分化不良组的波Ⅴ反应阈及病程与波形分化较好组相比,差异有统计学意义（P〈0．01或P〈0．05）。②Ⅰ、Ⅲ、Ⅴ波潜伏期术后较术前明显缩短且差异有统计学意义（P〈0．05）,但手术前后波间期的改变无统计学意义。③与对照组相比,手术前后均存在部分波潜伏期及波间期的异常,且有统计学意义。结论：儿童分泌性中耳炎的ABR表现为：波形分化及出现率的改变、波间期及波潜伏期的改变、波Ⅴ反应阈的改变,鼓膜置管术可以改善这些变化,但仍未达到对照组水平。     

Development of tympanosclerosis in children with otitis media with effusion and ventilation tubes

Ventilation tube (VT) insertion is an accepted treatment for chronic otitis media with effusion (OME) in children. One hundred and eighty five children with bilateral OME were treated by unilateral myringotomy and VT insertion with no treatment to the contralateral ear. During a 5 year follow-up 95 of the children required only one VT but the remainer required more than one but always treatment was carried out to the same ear. The rate of development of tympanosclerosis was measured and scored. After 2-3 years the extent of the sclerotic changes stabilised and the rate of development reached 37-39 per cent in ears receiving only one VT, compared with 47-49 per cent in ears treated by more than one tube. The extent of the changes was no different whether or not one or more than one tube had been inserted. There was no overall evidence of resolution of sclerotic change with time.     

探讨儿童分泌性中耳炎的诊断程序

目的 将鼓室导抗图、纯音听阈与耳CT结果比较,并经鼓膜切开所见验证,分析鼓室导抗图、纯音听阈和耳CT在判断中耳积液的敏感度.方法 分析2007年1月至2008年6月临床诊断分泌性中耳炎住院治疗的患者,将其病史、平均听阈、CT结果进行Logistic分析.结果 40例(75耳)患者中男28例(53耳),女12例(22耳).年龄最小3岁6个月,最大11岁10个月,平均6岁6个月.鼓膜切开证实中耳有分泌物62耳(82.7%),无明显分泌物13耳(17.3%).鼓膜置管23耳.统计学分析结果显示,听力损失程度、CT结果与中耳积液有相关性(r值分别为1.392、1.355;P值均＜0.05).结论 通过鼓膜情况、鼓室导抗图和平均听阈综合判断中耳积液有较高的敏感度.特别以传导性听力损失程度判断有无中耳积液有较高特异性.分泌性中耳炎的患儿,除常规耳科检查,应首先进行声导抗,纯音测听检查.尽管耳CT具有较高的敏感度但是由于其副作用的局限,不建议作为分泌性中耳炎的常规检查.     

The role of ventilation tube status in the hearing levels in children managed for bilateral persistent otitis media with effusion

The study determined the effects on hearing of the status of ventilation tubes, using a combination of otoscopy and tympanometry to determine function, in children managed for bilateral persistent otitis media with effusion (OME). The subjects were aged between 3.5 and 7 years and had a documented history of bilateral OME over a 12-week watchful waiting period associated with a hearing impairment in both ears of >or= 20 dB HL. The children reported are those randomized to the two surgical arms, both of which had bilateral myringotomy, aspiration of middle ear fluid and insertion of Shepard ventilation tubes. One arm furthermore received adenoidectomy. The data were analysed 'as treated' to document therapeutic progress. Tubes confirmed to be functioning on otoscopy and tympanometry only partially alleviate the conductive impairment associated with childhood OME (AC mean 12 dB HL, SD 4; ABG 13 dB, SD 7, 3 months post operation). Thus, children with a functioning ventilation tube cannot be considered to have 'normal' hearing. Once the tube has extruded, ears that no longer have OME still have a small conductive hearing impairment (at 12 months AC 14 dB HL, SD 6; ABG 16 dB, SD 9) but this improves with time. In children with bilateral tubes, both remain functioning for a median duration of 21 weeks (IQR 10-40) and at least one for a median of 40 weeks (IQR 24-61). Tube blockage significantly (P = 0.001) increases the risk of extrusion (84% versus 44%). When inserted in children between 3.5 and 7 years for OME, the otoscopic incidence of tube infection is low (1%).     

Eustachian tube function before recurrence of otitis media with effusion

OBJECTIVE: To study the role of eustachian tube function in the development of recurrent otitis media with effusion (OME) in children treated with tympanostomy tubes for OME. DESIGN: Prospective cohort study. SETTING: Three academic and general hospitals. PATIENTS: Children aged 2 to 7 years with a first clinical episode of OME that persisted for at least 3 months; 136 (81%) of 168 eligible children participated. All children received tympanostomy tubes for bilateral OME at study entry. MAIN OUTCOME MEASURE: Recurrence of OME within 6 months of tube extrusion. RESULTS: No statistically significant differences were present in eustachian tube function test results between ears that developed recurrent OME and those that did not. The difference in passive ventilatory function between ears with and without OME recurrence was 10 daPa (95% confidence interval, -24 to 43 daPa) for opening pressure and -3 daPa (95% confidence interval, -18 to 11 daPa) for closing pressure. The overall difference in the proportion of ears with and without OME recurrence that could not equilibrate positive and negative applied pressures was 12% (95% confidence interval, -2% to 26%). The proportions of ears with and without OME recurrence that induced negative pressure in the middle ear by forcefully sniffing were 22% and 31%, respectively (P = .75). CONCLUSION: Measurement of ventilatory and protective eustachian tube function using the forced response test, the pressure equilibration test, and the sniff test has no value in predicting whether children have an increased risk of OME recurrence.     

Otitis media with effusion in children shows a progressive resolution with time

The course of chronic otitis media with effusion (OME) was studied in 117 children (207 ears). Diagnosis was based on otoscopy and a flat (type B) tympanogram. This was compared with the presence or absence of middle ear effusion at myringotomy carried out 0-3, 3-6, 6-9 and more than 9 months after diagnosis. There was a highly significant reduction in the number of effusions diagnosed at myringotomy in those patients who had waited longer for operation. The effects of previous ventilation tube insertion, adenoidectomy, medical treatment between diagnosis and operation, month of diagnosis and month of admission on the results were examined. Tympanosclerosis and atelectasis occurred in 7.3 and 6.3% of ears respectively and in most cases were associated with previous grommet insertion.     

Detection of Helicobacter pylori in children with otitis media with effusion: a preliminary report

OBJECTIVE: To determine the presence of Helicobacter pylori in the middle ear effusion of patients with otitis media with effusion (OME) by polymerase chain reaction (PCR). STUDY DESIGN: A prospective study in patients with OME. METHODS: The study was performed in 38 patients with OME who were admitted to the ENT Clinic, Firat University from June 2003 to April 2004. In all cases, a myringotomy operation (with or without placement of a ventilation tube) was carried out. The effusion samples aspirated from the middle ear were analyzed with PCR assay. RESULTS: A total of 55 aspiration samples collected from 38 children ranging in age from 2 to 12 were included in the study. Fifteen of the subjects were girls, and 23 were boys. In 17 patients, both ears demonstrated effusions, whereas in 21 patients, only one ear had effusions. Nine (16.3%) of 55 the middle ear effusion samples were shown to be H. pylori positive by PCR. CONCLUSIONS: H. pylori was detected in the middle ear effusion of some patients with OME. These results may have interesting implications for a possible role of H. pylori in OME. In addition, these results suggest that further studies are needed to investigate the role of H. pylori in the etiology of OME.     

Diode laser myringotomy for chronic otitis media with effusion in adults.

OBJECTIVE: To analyze the closure time of diode laser-assisted myringotomies, the incidence of complications, and the hearing results in comparison with the "cold" procedure in adults with otitis media with effusion (OME). STUDY DESIGN: Prospective case-control study. SETTING: Tertiary referral center, university hospital. PATIENTS: Twenty-eight adult patients (39 ears), 13 men and 15 women, age 13 to 76 years (mean, 51.9). Inclusion criteria included 3 months (or more) history of OME resistant to medical therapy. Twenty-two control patients (34 ears) underwent cold myringotomies with knife and ventilation tubes (VT). INTERVENTION: Diode laser myringotomy performed in an office setting under local anesthesia with topical EMLA ointment. MAIN OUTCOME MEASURES: Timing of closure of the myringotomy, hearing results, incidence of complications, recurrence of OME. RESULTS: No intra- or postoperative pain nor complications were observed. Otomicroscopic daily monitoring documented the healing patterns of the tympanostomies, which remained patent for 7 to 25 days (average, 15.6 +/- 4.8 days). Immediate improvement of hearing was achieved in every patient. Recurrence of OME was observed in 36 ears (92.3%) within 1 month from healing. In the control group with VTs, healing of the eardrum was observed between 126 and 301 days (average, 183.2 +/- 44.8 days), and recurrence of OME was observed in 8 ears (23.5%) (p < 0.001). One month after healing, the air-bone gap was retained within 10 dB in 10.3% (4/39) of the diode laser group and in 50% (17/34) of the standard procedure group (p=0.0001). CONCLUSIONS: Diode laser myringotomy is a straightforward, painless procedure simplified by the thin fiberoptic cables available. Functional benefit is comparable to conventional tympanostomies plus VTs, but the duration of patency is too short to achieve long-term clearance of the effusion in "glue" ears of adult patients. Selected indications could be acute or recurrent otitis media or the prevention of barotraumas in tubal dysfunction.     

Does Helicobacter pylori have role in development of otitis media with effusion?

OBJECTIVE: Recently, it was suggested that tonsil and adenoid tissues may act as a reservoir for Helicobacter pylori (HP). A connection between chronic tubotympanal disorders and gastroesophageal reflux is well recognized, but the mechanism underlying this relationship is unclear. In this study, we investigated possible presence of HP in adenoid tissue and middle ear effusions in patients with chronic otitis media with effusion (OME) and we compared the data with the results of the children who had adenoid hypertrophy without OME. METHODS: The study was comprised of 38 consecutive children with adenoid hypertrophy and/or chronic OME. The patients were divided into two groups. The first group included 18 subjects having OME+adenoid hypertrophy and the second group included 20 subjects having solely adenoid hypertrophy. Each patient underwent the appropriate surgical procedure; myringotomy, placement of tympanostomy tubes and/or adenoidectomy. After myringotomy, the middle ear effusions were collected in a suction and collection device and a core biopsy specimen was taken from each adenoid tissue following adenoidectomy. DNA extracted from these samples was used for the amplification of 23S ribosomal RNA gene of HP by real-time polymerase chain reaction (RT-PCR). RESULTS: In the first group 34 effusion samples were obtained from ears of 18 patients (two had unilateral OME). HP was found to be positive in 12 children (67%) and 16 of 34 ears (47%) with RT-PCR. In eight children HP was positive in only one ear and in four children in both ears. No positive reaction was seen in tissue samples obtained from adenoids of these patients. In the second group a positive reaction was seen in adenoid tissue of only one patient. CONCLUSIONS: This study showed that there is HP presence in middle ears of the children with chronic OME, indicating HP having a possible role in OME pathogenesis. In addition, we demonstrated HP presence in only 1 of 38 adenoid specimens supporting the idea that adenoid tissue does not act as a reservoir for HP.     

CO2 laser myringotomy in children with otitis media with effusion

BACKGROUND: The study aimed to evaluate the clinical application of CO2 laser myringotomy in children with otitis media with effusion (OME) under topical anaesthesia in an office setting. METHODS: Laser myringotomy was performed with the CO2 laser Otoscan (OtoLAM) in 54 children (73 ears) with OME. The procedure on the tympanic membrane was performed under topical anaesthesia using Bonain's solution or 10 per cent Xylocaine (lidocaine) solution for 30 minutes before surgery. A circular perforation was created with a power of 15 W, single pulse duration of 200 msec and a scanned area of 1.9 mm in diameter. RESULTS: The mean healing time was 2.51 weeks (range 1-5 weeks). Effusion content was not a predictive prognostic factor for perforation healing time. Perforation location over anterior inferior or posterior inferior quadrants was not a predictive factor for perforation healing time. Xylocaine was the more effective anaesthestic. The OME resolution rate was 73 per cent. CONCLUSION: Laser myringotomy provides intermediate duration middle-ear ventilation. It could be beneficial in selected children with OME.     

Ultrasonic detection of middle ear effusion: a preliminary study

OBJECTIVE: To assess the ability to detect and characterize middle ear effusion in children using A-mode ultrasonography. DESIGN: Prospective nonblinded comparison study. SETTING: Tertiary children's hospital. PATIENTS: Forty children (74 ears) scheduled to undergo bilateral myringotomy with pressure equalization tube placement. INTERVENTIONS: Before myringotomy, ultrasound examination of the tympanic membrane and middle ear space was performed on each ear. Afterward, myringotomy was performed and the type of effusion (serous, mucoid, or purulent) was recorded. Pressure equalization tubes were then placed. MAIN OUTCOME MEASURE: Comparison of ultrasound findings with the visual assessment of the type of middle ear effusion present. RESULTS: Of the 74 ears tested, 45 (61%) had effusion on direct inspection. The effusion was purulent in 8 ears (18%), serous in 9 ears (20%), and mucoid in 28 ears (62%). Ultrasound identified the presence or absence of effusion in 71 cases (96%) (P = .04). Ultrasound distinguished between serous and mucoid effusion with 100% accuracy (P = .04). The probe did not distinguish between mucoid and purulent effusion. CONCLUSIONS: Ultrasonography is an accurate method of diagnosing middle ear effusion in children. Moreover, it can distinguish thin from mucoid fluid. Further refinements in probe design may further improve the sensitivity of fluid detection and allow differentiation of sterile vs infectious effusion.     

儿童分泌性中耳炎相关骨导听力下降的临床分析

目的：分析儿童分泌性中耳炎相关的骨导听力下降的病因、诊断和治疗方法。方法：回顾性分析150例（225耳）分泌性中耳炎儿童中35例（37耳）骨导听力下降的临床资料。结果：35例患儿均给予鼓膜切开置管或（和）鼻内镜下腺样体切除术,术后给予药物治疗。34例患儿骨导听阈恢复正常,1例患儿随访6个月改善不明显。结论：35例（23．3％）患儿的暂时性听阈移位或永久性听阈移位的发病机制与分泌性中耳炎有关。儿童分泌性中耳炎的发病病程中有发展成骨导听力下降的可能,应引起高度重视,及早干预避免病情发展。     

Chronic otitis media with effusion and Helicobacter pylori

OBJECTIVE: The aim of this study is to investigate the presence of Helicobacter pylori (HP) in the middle ear effusion by Campylobacter-like organism (CLO) test and whether it has a role in the ethiopathogenesis of chronic otitis media with effusion (OME). STUDY DESIGN: A prospective randomized and controlled study. METHODS: This study was performed with 45 patients with the diagnosis of chronic OME and adenoid hypertrophy, between the ages 3 and 13 (median 6). Thirty patients constituted the study group (18 male (60%) and 12 (40%) female). Adenoidectomy with myringotomy with ventilation tube insertion were performed to this group. Middle ear effusion and adenoid tissue pieces were collected and H. pylori presence was investigated by "CLO" testing. Fifteen patients of the matching age group (9 male (66.7%) and 6 (33.3%) female) constituted the control group to whom adenoidectomy with myringotomy were performed but no middle ear effusion could be determined (empty myringotomy patients). The wash out liquid of middle ear and pieces of adenoid tissue samples were also collected from the control group. By using CLO testing, the presence of H. pylori was investigated in the adenoid tissues and middle ear of the empty myringotomy patients. RESULTS: In 20 (66.6%) patients of the study group, CLO testing was positive in the middle ear effusions. None of the patients demonstrated positive CLO test in the wash out liquid of middle ear. There was significant difference of positive CLO testing in the middle ear effusions of two groups (p<0.001). CONCLUSIONS: These findings showed us that presence of HP in the middle ear effusion using CLO testing and this may be responsible for the ethiopathogenesis of chronic OME.     

Carhart's notch: a finding in otitis media with effusion

INTRODUCTION: Carhart's notch (CN) is a false depression of bone conduction (BC) thresholds at 2-4 kHz initially described in cases of stapes fixation. This study was designed to estimate the incidence and assess the clinical significance of CN in cases of otitis media with effusion (OME) in children. PATIENTS AND METHODS: Clinical records of 50 patients of OME that showed CN were analysed, retrospectively. First 24 were identified as seen in outpatients and 26 were found out of 100 consecutive cases of OME. The criteria of CN were a minimum 10 dB depression in BC at any frequency 500-4000 Hz. RESULTS: Fifty patients showed CN, with mean age of 8.8 years. All had myringotomies with or without insertion of grommets. The CN ranged from 10 to 20 dB in the majority and up to 30 dB in few cases. In 85 ears studied, the affected frequencies comprised of 2000 Hz in 80 (94%), 4000 Hz in 4 and 1000 Hz in one ear. Pre-operative tympanograms were of type B in 68 (80%), type C in 16 (18.8%) and type A in one ear. Middle ear fluid was thick glue in 57 (67%), serous in 5 (5.8%), and no fluid found in 23 (27%) cases. Oedematous, granular or polypoidal appearances of middle ear mucosa were noted in 57 (67%) of the ears. A normal mucosa was seen in 17 (20%), and no details were available in 11 (13%) ears. Post-operative audiograms showed improvements of BC thresholds in 72 (84.7%) of the ears. CONCLUSION: Our results show 26% incidence of CN in paediatric cases of OME, with evidence of thick fluid and abnormal middle ear mucosa in about two-thirds of cases. This suggests that CN may be of prognostic value for myringotomy outcomes. Statistically there is a significant correlation between presence of fluid on myringotomy and CN, and type of tympanogram and post-operative BC threshold improvement. There is no predictive value of CN in terms of character of the middle ear fluid. Studies with larger numbers may be required to determine this with more certainty. It can help clinically, however, in pre-operative assessment of these cases. It is our opinion that BC should be an essential part of routine audiometry in all cases of OME.