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.     

How we do it: the Farrior‐Olaizola mastoidectomy technique in the management of squamous chronic otitis media

? In the Farrior‐Olaizola mastoidectomy the connection between the antrum and attic is closed with a cartilage plate –‘the antrum exclusion and attic elimination on demand technique’. This prevents future tympanic membrane retraction and recurrent disease. ? It is a suitable treatment for most cases of cholesteatoma, including children. ? As a canal wall up technique residual disease occurred in 18% of adults and 22% of children in our series. These have been discrete encapsulated epithelial pearls easily removed at the second look stage. ? Recurrent disease was uncommon (3.5%).     

Reversibility of reduced ciliary activity on adenoids of patients with otitis media with effusion following culture

We have studied the ciliary activity of the pharyngeal epithelium on adenoids obtained from patients with recurrent otitis media with effusion to assess indirectly the ciliary activity in the Eustachian tube. In conclusion, the following has been speculated from the present study: (1) middle ear effusions depress the ciliary activity; and (2) recovery of the reduced ciliary activity can be achieved in an effusion-free environment inasmuch as the ciliated cells have not undergone organic changes. Prompt elimination of the effusion, if present, is of critical importance for the recuperation of tubotympanic drainage, because a positive therapeutic effect resulting from elimination of the effusion can only be possible in early phase of the disease, before irreversible morphological lesions have occurred.     

Laser myringotomy in otitis media with effusion: long-term follow-up

Otitis media with effusion is a leading cause of conductive hearing loss in children. Myringotomy and insertion of tympanostomy tubes is the accepted form of treatment. Recently, several studies utilizing laser myringotomy have been published, but few of them present late results. The objective of this study was to compare late results of the treatment with laser and classical myringotomy. A clinical effectiveness trial was conducted in three groups of children: (1) 37 children treated with laser myringotomy (ML), (2) 29 children treated with laser myringotomy and the insertion of tympanostomy tubes (ML+V) and (3) 43 children treated with classical myringotomy and the insertion of tympanostomy tubes (MC+V). All types of surgery were performed under general anesthesia because adenoidectomy and/or tonsillectomy was done at the same time. The results of treatment were assessed on the basis of the otoscopic examination (recurrences of effusion, condition of the tympanic membrane, and audiological examination (pure-tone audiometry, tympanometry and DPOAE). The minimum follow-up period was 1 year. The recurrence rate was lowest in the ML+V (11%) group, and highest in the ML group (36%). The difference between ML+V and MC+V was not significant. Permanent changes in the tympanic membrane were observed in 8% of the ears after ML, 19% after ML+V and 31% after MC+V. The difference was significant between the ML and MC+V groups. PTA was significantly higher in the MC+V group than in the control group of otologically healthy children. Mean amplitudes of DPOAE, measured in treated children with normal tympanometry results, were significantly lower than in the control group, but within the normal range. The use of CO₂ laser during myringotomy has no negative effect on the function of the cochlea. Healing of the tympanic membrane after laser myringotomy was uneventful with a low percentage of permanent sequelae.     

How we do it: Radiofrequency‐turbinectomy for nasal obstruction symptoms

? Radiofrequency energy has been reported to be effective to reduce nasal obstruction because of inferior turbinate hypertrophy. ? A total of 158 patients who had undergone such surgery are reported. ? Three to 30 months postoperatively 85% of the patients reported a marked decrease in nasal obstruction. This was irrespective of a short‐term or a long‐term follow‐up, and was applicable to patients that had septal deviations in addition. ? Radiofrequency‐turbinectomy is a simple and effective method for treatment of nasal obstruction as a result of hypertrophy of the inferior turbinates, even if combined with a moderate septal deviation.     

How we do it: Chemo‐electroporation in the head and neck for otherwise untreatable patients

? Chemo‐electroporation therapy with bleomycin is a locoregional treatment modality for head and neck and skin cancer, with the potential to preserve function. ? In our institution, chemo‐electroporation therapy is used for patients that can no longer be treated by surgery or radiotherapy, or for whom surgical treatment would be very extensive and thus declined by the patient. ? This paper describes in detail the technique of bleomycin‐electroporation therapy. The literature is reviewed and preliminary results of the clinical trial are presented. ? The main focus of the trial is to determine the safety, effectiveness, and burden of bleomycin‐electroporation therapy for the patient. ? All 17 tumours responded to therapy. Local tumour control was reached in 14 of the 17 (82.4 %) tumours. ? Based on the outcome of the clinical trial, bleomycin‐electroporation therapy has the potential to become a valuable addition to the late‐stage treatment options for patients with head and neck or skin tumours.     

How we do it: BAHA positioning in patients with microtia requiring auricular reconstruction

• ? Bilateral microtia is a challenging problem as these patients require both reconstruction of the auricle and rehabilitation of hearing.
• ? Our aim was to find the optimal position for bone‐anchored hearing aids (BAHA) in patients requiring reconstruction of the auricle on the same side.
• ? From an analysis of five such operated patients, it was found that siting a BAHA 6.5–7.0 cm from the position of the external auditory meatus is probably the correct distance to facilitate optimal auricular reconstruction.
• ? Using these criteria, a group of another five patients with BAHA awaiting auricular reconstruction were reviewed. Of these only three (60%) have been satisfactorily sited.

     

The relationship between chronic otitis media with effusion and surface and deep flora of hypertrophic adenoids

Objective

The relationship between bacterial flora of the adenoids and middle ear problems is unclear. In this study, superficial and deep aerobic and anaerobic bacterial flora of adenoid tissues were compared in children with and without chronic otitis media with effusion (cOME).

Patients and methods

Between 2004 and 2007, family members of children (ages 1-14 years) who were scheduled to undergo adenoidectomy were approached for participation in the study. Of the 180 patients who gave consent, 107 (59%) did not have cOME (Group I), whereas 73 (41%) had had a tympanostomy tube previously due to cOME (Group II). Prior to adenoidectomy, swabs were taken from the surface of the adenoids, and samples of deep tissue for culture were obtained from curetted tissue. All samples were cultured aerobically and anaerobically. Growth of 10 of the bacteria most commonly cultured were evaluated: 5 classified as normal flora (coagulase-negative staphylococci, α-hemolytic streptococci, Neisseria spp., Prevotella spp. ve Peptostreptococci) and 5 potential pathogens (S. aureus, S. pyogenes, S. pneumoniae, H. influenzae ve Moraxella spp.).

Results

Isolation rates of potential pathogens including S. pneumoniae,H. influenzae and Moraxella spp. from surface and deep cultures of adenoids were between 5 and 15% (no significant differences between those with and without cOME). While S. aureus was the most frequently isolated bacteria (26%) in children with cOME (Group II), the incidence of S. pyogenes as a potential pathogen was only 1% (p < 0.05) in Group II and the anaerobic Prevotella spp. were significantly less common (p < 0.05) in children with cOME (Group II).

Conclusion

Potential pathogens of middle ear colonized in adenoid tissue may not be significant factor for the etiopathogenesis of cOME. Bacterial interference mechanisms may play an important role in pathogenesis of cOME because of Prevotella spp. showed statistically significant decrease children with cOME.     

综合疗法治疗成人分泌性中耳炎分析

目的探究临床分泌性中耳炎的综合治疗疗效。方法选取就诊的56例成人分泌性中耳炎患者,随机分为对照组和治疗组,每组28例,对照组采用口服药物+咽鼓管注药+波氏法咽鼓管吹张,治疗组采用口服药物+鼓膜穿刺+波氏法咽鼓管吹张+鼓室药物灌注。结果治疗组有效率为89.7%(35/39),对照组有效率为80.0%(24/30),治疗组有效率显著高于对照组(<0.05)。结论"综合疗法"治疗分泌性中耳炎是较好的临床治疗选择。     

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.     

How we do it: Tympanoplasty: are different three‐ and four‐frequency averages comparable?

? The results of tympanoplasty may be reported in a variety of ways. Pure‐tone audiometry underpins reporting, yet there is no constancy in the pure‐tone threshold average used. We examine the relationship between the 0.5, 1, 2 kHz, 0.5, 1, 2, 3 kHz and 0.5, 1, 2, 4 kHz pure‐tone audiometry averages. ? Using audiometric data collected for 77 patients, we have compared hearing threshold using three different frequency averages derived from pure‐tone audiometry. ? The 0.5, 1, 2 kHz, 0.5, 1, 2, 3 kHz and 0.5, 1, 2, 4 kHz three‐ and four‐frequency averages are significantly different, this difference being primarily determined by the changes in the 4‐kHz threshold. Using an average including 4 kHz results in 8% few patients achieving an ABG closure to within either 10 dB or 20 dB. ? When comparing surgical results with others, surgeons should use reports employing comparable audiometric measures of analysis.     

分泌性中耳炎患儿腺样体组织中T淋巴细胞亚群分布

目的 探讨儿童肥大腺样体T淋巴细胞亚群免疫失衡与反复发作性分泌性中耳炎的关系.方法 106例分泌性中耳炎患儿腺样体组织(72例中耳炎发作次数大于3次,34例中耳炎发作次数少于等于3次)及30例单纯腺样体肥大患儿腺样体组织.采用免疫组化方法检测上述各组T淋巴细胞CD4 、CD8 的表达及CD4 /CD8 值,统计分析三组之间是否有差别.结果 反复发作性分泌性中耳炎(中耳炎发作次数大于3次)患儿腺样体组织中CD4 、CD8 细胞数及CD4 /CD8 分别为41.9±9.07,20.45±7.08,2.10±0.17;较非反复发作性分泌性中耳炎组(中耳炎发作次数少于等于3次)17.4±6.85,13.02±5.88,1.33±0.11及单纯腺样体肥大组(无中耳炎病史)16.3±8.21,11.15±5.71,1.39±0.1 5均有显著性差异(P＜0.05);其中CD4 细胞数明显多于CD8 细胞数;非反复发作性分泌性中耳炎组患儿腺样体组织中CD4 、CD8 的表达及CD4 /CD8 与单纯腺样体肥大组比较无明显差异(P＞0.05).结论 反复发作性分泌性中耳炎的形成与T淋巴细胞亚群免疫失衡有关.     

Effect of adenoidectomy on otitis media with effusion, tubal function, and sinusitis

Three clinical studies were performed to investigate the effects of adenoidectomy on otitis media with effusion (OME), especially with regard to eustachian tube (ET) disfunction and sinusitis, which often accompanies OME. In the first study, the audiograms, tympanograms, and ET ventilatory functions of 78 adenoidectomized patients (121 ears) and 54 non-adenoidectomized patients (63 ears) were compared over 6 months. The audiograms and tympanograms of the adenoidectomized group showed significant improvement; however, no difference in passive tubal opening pressure was noted despite an improvement in positive pressure equalizing function observed in the adenoidectomized group at 6 months after the operation. In the second study, tubal passive resistance (PR) and the ratio of passive resistance to active resistance (PR/AR) were compared before and 1 month after adenoidectomy using the forced response test (12 subjects, 12 ears). Neither PR nor PR/AR had significantly improved after the operation. In the third study, sinusitis improvement in 45 adenoidectomized patients 6 months after the operation was evaluated in comparison with 33 non-adenoidectomized patients. This condition was found to have improved significantly in the adenoidectomized group. Overall, adenoidectomy appeared effective in reducing the incidence of OME and sinusitis, and in improving the active ventilatory function of the ET without causing changes in the tubal passage. It is conceivable that tubal active ventilatory function was improved due to a reduction of inflammation and pollution around the nasopharynx by adenoidectomy, and that the effect of adenoid mass on the ET is minimal.     

How we do it: Diagrammatic recording of tympanomastoid procedures

? Accurate documentation of the operative findings of tympanomastoid procedures is essential for effective patient management and to satisfy the growing demands of clinical audit. ? Due to the three‐dimensional complexity of the middle ear, it is difficult to represent graphically. ? Consequently, most surgeons only describe subjectively their operative, otological findings. ?We present for the first time a simple middle ear template which provides an objective tool to improve the recording of tympanomastoid procedures.     

Expression of receptor CD23+ on B lymphocytes in hypertrophied adenoids of children with otitis media with effusion

Tonsil pharyngeal is stimulated chronic by pathogens can be causes this hypertrophied; whose often is companions to otitis media with effusion. Subpopulation dominates in tonsil pharyngeal are lymphocytes B, and their markers activation are expression of antigen CD23+. The aim of this study was finding dependence between otitis media with effusion and coexistent hypertrophy adenoids, and percentage of lymphocytes CD19+ with expression of antigen CD23+ in hypertrophy adenoids. In the study showed higher significant percentage of lymphocytes CD19+ CD23+ at children in otitis media with effusion (20.08+/-2.93) with reference to comparative group, which was only hypertrophy adenoid (18.16+/-2.25). Percentage lymphocytes B (CD23+) were the highest (20.01+/-5.81) in children subgroup above 5 years old with otitis media with effusion, and lowest (17.36+/-2.78) in children comparative subgroup above 5 years old. As regards on different functions of antigen CD23+ the assessment of percentage lymphocytes B with expression of CD23+ can be additional marker in course immunological and inflammatory processes to occur in hypertrophy adenoids at children are sick otitis media with effusion.     

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.