Does auditory tube angle really affect childhood otitis media and size of the mastoid?

Objective

To assess the cross-sectional area of mastoid air cells and auditory tube angles (ATA), which were defined as the angles between the longitudinal line bisecting the transverse length of the external auditory canal and the longitudinal axis of the auditory tube (AT), both in healthy ears and diseased ears in patients with unilateral chronic otitis media (COM).

Methods

25 patients who had unilateral COM were included in the study. Assessment was performed using a quantitative digital image processing computer tomography (CT) program.

Study design

Prospective study with institutional review board approval including adult patients who had otological symptoms since their childhood period.

Results

Mastoid areas were greater on the healthy side than on the diseased side (p < 0.05). ATA were not significantly different among groups (p > 0.05). When we compared ATA with mastoid area in each group; there were no significant correlations in both healthy group and COM group (p > 0.05). Mastoid size in COM group was smaller than in the healthy group.

Conclusion

We suggest that middle ear inflammations in childhood may affect mastoid size but, the anatomic relationships of the auditory tube, mastoid and middle ear that form a functional unit may not be significantly important in chronic ear disease.     

Eustachian tube diameter: Is it associated with chronic otitis media development?

Objective

To evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis.

Cochlear implantation and management of chronic suppurative otitis media: single stage procedure?

In a series of 360 patients who underwent cochlear implantation at our center, four patients (five procedures) had cochlear implantation with obliteration of the mastoid cavity and management of cholesteatoma as a single-staged procedure. Three patients were bilaterally deaf secondary to CSOM and had bilateral mastoid cavities, and in one patient congenital cholesteatoma was identified during cochlear implantation. A mastoidectomy or revision mastoidectomy with obliteration of the mastoid cavity and cochlear implantation was performed as a single stage procedure. Cholesteatoma reoccurred in one patient 9 years after cochlear implantation. Surgical procedures, complications, follow-up and outcomes are discussed.This article was prepared in the academic interests of the authors and was not funded by any company or organizations. This paper was presented at the British Society of Neuro-otology Conference in September 2003 at Imperial College, London.     

Are the hearing and eustachian tube functions of the hot air balloon pilots disturbed?

ObjectiveTo evaluate the hearing and Eustachian tube functions (ETF) of hot air balloon (HAB) pilots, who are exposed to high altitude occupationally.Materials and methodsThe study was designed as a cross-sectional controlled study. Thirty HAB pilots and 30 healthy volunteers were included. Pure tone audiometry and speech discrimination scores (SDS) were used to assess the hearing function. Pure tone average (PTA) was calculated using the hearing thresholds (HT) at the frequencies 500, 1000, 2000, and 4000 Hz. Tympanometry and automatic Williams test (ETF1) were conducted to assess the ETF of the participants. Eustachian Tube Dysfunction (ETD) was defined as the change of tympanometric peak pressure (TPP) at rest (P1) less than in 10 decapascals (daPa) with Valsalva (P2) and Toynbee (P3) maneuvers. Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) was also administrated.ResultsMean ages of the participants were 32.03±8.12 and 32.33±9.47 years in the HAB and control groups, respectively (p = 0.865). HTs, PTAs, SDSs, P1, P2, P2-P1 and P1-P3 values were similar in the groups (p > 0.05). P3 values ??in both ears were significantly higher in the HAB group compared to the control group (p = 0.018, p = 0.002). Positive correlations were detected between the duration of the experience of HAB pilots and their HTs at 4 kHz and 8 kHz (p < 0.05) The prevalence of ETD in at least one ear was 83.7% and in both ears was 43.3% in the HAB group, both of which were significantly higher than the control group (p = 0.001, p = 0.049). The ETDQ-7 scores were also higher in the HAB group compared to the control group (p < 0.001).ConclusionBoth the subjective and objective measures of ETF indicate that ETD is common among the HAB pilots. However, the hearing functions of those seem to be unaffected.     

Obstruction of the eustachian tube orifice and pressure changes in the middle ear: are they correlated?

OBJECTIVES: We performed a cross-sectional study to investigate whether the obstruction of the eustachian tube orifice due to adenoid hyperplasia changes the pressures in the middle ear. METHOD: Fifty consecutive children 2 to 12 years of age with nasal obstruction were examined from May to October 2005. Adenoid size and status of the eustachian tube orifice were assessed with nasal flexible fiberoptic endoscopy. Tympanometry was used to evaluate the middle ear. RESULTS: In children with occlusion of the eustachian tube orifice by adenoid tissue, 87% had abnormal pressure in the middle ear according to tympanograms. When orifices were not occluded, 86% of the tympanograms were normal (p < .001). CONCLUSIONS: Obstruction of the eustachian tube orifice by adenoid tissue was associated with tympanograms suggestive of abnormal pressure in the middle ear. Future studies with a larger sample size are necessary to clarify this association.     

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.     

Is surgery of the inner nose indicated before tympanoplasty? Effects of nasal obstruction and reconstruction on the eustachian tube

BACKGROUND: When tympanoplasty is to be done in a patient suffering from chronic otitis media, usually potential interactions between middle ear mucosa, Eustachian tube function, and the nose and nasopharynx are considered. Poor tubal function goes along with a diminished success rate of tympanoplasty. On the other hand, pathological findings in the nose or the nasopharynx are often said to be responsible for inadaequate tubal function. Consequently, many authors feel that surgery of the nose should be performed before tympanoplasty if septal deviation or hypertrophy of the conchae is seen in a patient with chronic otitis media. PATIENTS AND METHODS: In order to better understand interactions between nasal pathology and Eustachian tube function, we utilized a pressure chamber to examine 50 patients undergoing septoplasty and conchotomy. Besides insufflation tests (Toynbee, Valsalva), we performed dynamic tubal examination with the dual-impedance method. Active parameters (positive and negative residual pressure) and passive parameters (tubal opening and tubal closing pressure) were recorded as the chamber pressure was varied. The aim of our investigation was to test if surgery of the nasal septum and the conchae really improves tubal function, thus evaluating indications for septoplasty before tympanoplasty. In addition, we explored the early and the late consequences of nasal surgery on tubal function. This was done to find out the optimal postoperative period during which tympanoplasty could be performed following septoplasty. RESULTS: In many of the patients, insufflation tests were negative and dynamic tubal parameters were outside normal value range before surgery of the nose. One week after surgery, active and passive parameters and insufflation tests even deteriorated in the majority of our patients. Six to 8 weeks after surgery, we observed a tendency towards normalization of tubal parameters. This was significant for tubal closing pressure, but not for the other parameters. Whereas passive tubal parameters showed considerable improvement in many patients, there was no real improvement of active tubal parameters in most patients. This tendency was observed several months after surgery of the nose as well. Despite this improvement of passive tubal function, we did not observe a complete normalization of mean values even after 4 to 6 months. In several patients (who were satisfied with functional results of septoplasty) tubal parameters were even worse some weeks or months after nasal surgery, but this was not subjectively registered by our patients. DISCUSSION: We conclude from our data that dysfunction of the Eustachian tube frequently occurs in patients with deviation of the nasal septum and the conchae. Septoplasty and conchotomy worsen tubal function during the early postoperative period, lasting for at least one week. In a later period, improvement of tubal function may occur but in many patients no effects of nasal surgery on Eustachian tube can be measured. Thus, septoplasty before tympanoplasty cannot be generally recommended in all patients with septal deviation. We suggest that it may be useful in cases with severe nasal pathology or chronic infection of the nose or the nasopharynx, if this is accompanied by poor tubal function. We recommend analysis of Eustachian tube function before deciding on therapeutic management. Individual findings in the specific patient should be the leading criteria in all cases. If septoplasty and conchotomia are done, tympanoplasty should not be performed in the same session or in the early postoperative period, but several months after nasal surgery.     

Can chronic nasal obstruction cause dysfunction of the paratubal muscles and otitis media? An experimental study in developing Wistar rats

OBJECTIVE: To quantitatively analyze modifications of the paratubal muscles in developing Wistar rats following nasal obstruction. MATERIAL AND METHODS: Twenty-four Wistar rats were used. Twelve were examined at 6, 8 and 12 weeks after birth and were considered normal controls. The nostrils of the remaining 12 rats were bilaterally obstructed by means of a synthetic resin 28 days after birth. The animals were sacrificed at either 2, 4 or 8 weeks after nostril occlusion. Serial sections were made in the dorsoventral plane and stained with hematoxylin-eosin. Four 5 x 5 microm2 areas, selected within the paratubal muscles, were histologically analyzed and the number of muscular fibers was counted manually. RESULTS: The number of tensor veli palatini muscle fibers progressively decreased in the obstructed rats compared with age-matched normal controls and in those that had been obstructed for 4 and 8 weeks these reductions were statistically significant. CONCLUSION: The correct development of the paratubal muscles seems to be linked to physiological nasal breathing and is negatively affected by oral breathing.     

What is the effectiveness of beta-glucan for treatment of acute otitis media?

IntroductionAs a supplement, beta–glucan has various therapeutic healing effects generated by the immune cells. It has been scientifically approved and proven to be a biological defense modifier. The aim of this study was to investigate the effects of beta–glucan on treatments administered in an acute otitis media modelObjectivesThis study investigated the effect of beta–glucan on the treatment of acute otitis media in an acute otitis media -induced animal model. Efficacy was evaluated both immunologically and histologically.MethodsThe study sample comprised 35 adult rats, randomly separated into 5 groups of 7: Group 1 (control), Group 2 (acute otitis media, no treatment), Group 3 (acute otitis media + antibiotic), Group 4 (acute otitis media + beta–glucan) and Group 5 (acute otitis media + beta–glucan + antibiotic). Analyses were made of the histopathology and immunology examination results in respect of thickening of the tympanic membrane, epithelium damage, inflammation, and sclerosis. In all groups the serum levels of TNF-α, IL-4, IL-6 and IL-1β were evaluated.ResultsAll serum cytokine levels were significantly lower in the beta–glucan and antibiotic-treated groups compared to the acute otitis media Group. Significant differences in tympanic membrane thickness, inflammation, epithelium damage, and sclerosis values were observed between the acute otitis media + antibiotic and acute otitis media + beta–glucan Groups. According to these parameters, the values in aute otitis media + antibiotic + beta–glucan Group were markedly lower than those of the other groups. There was a significant difference in the acute otitis media + antibiotic + beta–glucan Groups compared to acute otitis media Group (p < 0.001).ConclusionsBoth antibiotic and beta–glucan treatment reduced acute otitis media signs of inflammations in an acute otitis media-induced rat model, decreasing histological damage and cytokine levels. Co-administration of antibiotic and beta–glucan led to a significant reduction in tympanic membrane thickness, inflammation, and epithelium damage. Antibiotic + beta–glucan treatment resulted in a greater decrease in tympanic membrane thickness, inflammation, and epithelium damage than in the other groups. From these results, it can be suggested that beta–glucan, in combination with antibiotics may provide an alternative for the treatment of acute otitis media.     

Do Staphylococcus aureus superantigens play a role in the pathogenesis of otitis media with effusion in children?

ObjectivesStaphylococcal enterotoxins (SEs), acting as superantigens, have been reported to be involved in the pathogenesis of chronic inflammatory diseases of the upper and lower airway. There has been no previous study investigating the role of SEs in otitis media with effusion (OME). Therefore, this study was designed to analyze middle ear aspirates from children with and without OME for the presence of SEs.MethodsMiddle ear aspirates were obtained from 24 patients and 24 controls. All samples were processed for bacterial culture and detection of five staphylococcal SEs (SEA, SEB, SEC and SED) and toxic shock syndrome toxin-1 using the Rapid Latex Agglutination Test.ResultsIn bacterial culture assays, six samples (25%) of the study group and five samples (20.8%) of the control group showed bacterial growth. At least one SE was demonstrated in 6 of 24 patients and in 3 of 24 controls. There was no statistically significant difference between the two groups with respect to the presence of SEs.ConclusionAlthough there is evidence that SEs have a potential role in the pathogenesis of chronic inflammatory diseases, there is no evidence that the inflammation process is initiated by SEs in patients with OME.     

Do biofilms contribute to the initiation and recalcitrance of chronic rhinosinusitis?

Chronic rhinosinusitis is a common disease whose underlying aetiopathogenesis has not been completely understood. Amongst a range of other potential environmental triggers in this disease, a role has recently been proposed for bacterial biofilms. Adopting the biofilm paradigm to explain the initiation and maintenance of this disease may help to clarify previous inconsistencies in this disease that have resulted in the role of bacteria being questioned. Of particular interest is the association of bacterial biofilms with recalcitrant disease states. Over the last five years, research has progressed rapidly since biofilms were first identified on the surface of diseased sinonasal mucosa. Their presence there has now been associated with more severe disease that is often recalcitrant to current management paradigms. Technological advances are allowing accurate characterization of the bacterial and fungal species within these biofilms, which would appear to be an important step in improving our understanding of how these bacterial communities might interact with the host to cause disease. This is an unanswered, yet highly important, question in this field of research that will undoubtedly be an area of investigation in the near future. As the body of evidence suggesting biofilms may be involved in this disease grows, research interest has switched to the development of antibiofilm therapies. Given the unique properties of bacteria existing in this form, biofilm eradication strategies will need to incorporate novel medical therapies into established surgical practices as we attempt to improve the outcomes of our most difficult patients.     

Why are NICU infants at risk for chronic otitis media with effusion?

Newborns in a Neonatal Intensive Care Unit (NICU) and even later have a high incidence of otitis media with effusion (OME). It is unclear which aspects play a role in the incidence of chronic OME during infancy. In order to investigate the effect of nasally-placed tubes, cranial growth, immune system, and neuromotor function on the occurrence of chronic OME, 83 NICU patients were observed prospectively for middle ear status. Duration and type of treatment with nasal tubes were obtained from the NICU notes. At the NICU, and 1 and 2 years of age the cranial circumference and neuromotor function were assessed. As a proxy for disturbed local immune system parental reports of snoring, mouth breathing and common cold were used. Multivariate analysis revealed that infants treated with nasotracheal and nasopharyngeal tubes showed a marginally significant increased risk for chronic OME (OR=3.2 [95% CI 0.5--21.2]). Treatment with nasogastric tubes appeared to have a lower risk for chronic OME (OR=1.5 [95% CI 0.1--25.1]). No significant effect was found for cranial circumference. Signs of disturbed local immunity during the first 6 months of life (OR=1.4 [95% CI 0.4--4.7]), as well as impaired neuromotor function (OR=1.9 [95% CI 0.5--6.8]), showed also a marginally significant increased risk for chronic OME. The cohort of NICU patients might be relatively too small in order to find significant effects. Although the results of this study should be interpreted cautiously, it is suggested that nasally-placed tubes for ventilatory assistance, disturbed local immunity and impaired neuromotor function are associated with chronic OME.     

Is there fungal infestation in paediatric chronic otitis media – Mucosal disease?

ObjectivesTo determine the prevalence of fungal infestation in paediatric chronic otitis media (COM)-mucosal disease and to study the various factors that might influence the said infestation.MethodsA cross-sectional study was done on the cited subject in a sample size of 66 paediatric patients [Age group: 1–18 years] suffering from active COM-mucosal disease. In all we had 75 ears from which swab samples were taken as some patients had bilateral disease. Clinical record was documented in each case. Three sample swabs were analysed for aerobic, anaerobic and fungal infection respectively from the discharging ear. Fungal infection was diagnosed by culture. The data was tabulated and statistically analysed for any correlation of fungal infestation with age, sex, background, duration of COM, previous antibiotic/steroid usage and intractable otorrhoea.ResultsWe recorded a prevalence of 32% for fungal colonization of COM-mucosal disease in paediatric population i.e., 24 out of 75 ears. There was no association observed between fungal infestation and specific paediatric age group, sex, background or duration of the disease. However, a distinct statistical correlation was present between fungal infestation and previous antibiotic/steroid usage and intractable otorrhoea.ConclusionFindings of this study lead us to conclude that all cases of paediatric COM-mucosal disease should be analysed for fungal colonization, especially those with intractable otorrhoea and there should be judicious use of antibiotics and steroid ear drops in COM-mucosal disease.