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.     

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.     

Platelet-activating factor (PAF) induced cytokine production and otitis media with effusion (OME) in the rat middle ear

OBJECTIVES: We examined the effect of platelet-activating factor (PAF) on IL-8 production in cultured rat middle ear epithelial cells (RMECs), and the concentrations of cytokine, PAF, and PAF-acetylhydrolase (PAF-AH) were also examined in the PAF-induced experimental OME (otitis media with effusion) of rats. METHODS: Using an enzyme-linked immunospecific assay, we measured the levels of cytokines in the cultured RMECs and the PAF-induced OME of rats. The PAF was quantitated by the platelet-aggregating activity and the PAF-AH was measured by radioimmunoassay. RESULTS: Both PAF and C-PAF, which is a stable analogue of PAF, significantly induced production of IL-8 in the RMECs in a dose-dependent manner. The PAF-induced IL-8 production was abolished by co-incubation with WEB2170, a specific PAF receptor antagonist. The concentrations of the cytokines and PAF in the PAF-induced OME of rats were higher on day 1 and the PAF and cytokine levels seemed to correspond well with the persistence of OME. CONCLUSION: PAF may stimulate the local production of cytokines and may induce OME in the middle ear.     

Erythromycin in the treatment of otitis media with effusion (OME)

Previous studies have shown erythromycin to penetrate into both the middle-ear effusion and the adenoid tissue in children with Otitis Media with Effusion (OME). The levels obtained were similar to the plasma levels. Cultures in long-standing cases of OME have yielded respiratory pathogens--Haemophilus influenzae, Streptococcus pneumoniae and Branhamella catarrhalis--in the nasopharynx in 79 per cent and in the middle-ear effusion in 18 per cent. In the present investigation a group of children with OME of more than three months' duration were given erythromycin (Abboticin) in standard dosage for the last 10 days prior to scheduled operation (paracentesis or tympanostomy). Resolution was determined as normalization of the middle ear status, and this led to cancellation of surgery. The rate of resolution--12/26 (45 per cent)--was significantly higher than in a similar group of children not treated with erythromycin--11/72 (15 per cent). There are thus rational reasons for using erythromycin in OME, in many cases as an alternative to tympanostomy.     

5-Fluorouracil ointment for the treatment of otitis media with effusion

OBJECTIVES/HYPOTHESIS: Our aim was to evaluate the combined effect of 5-fluorouracil (5-FU) and myringotomy for the treatment of otitis media with effusion (OME). OME is usually treated with medication, myringotomy, or insertion of a ventilation tube (VT). Except for VT insertion, however, treatment effects are short-lived. VT insertion has numerous sequelae: increased susceptibility to infection, large perforation of the tympanic membrane, cholesteatoma, and eventual hearing deterioration. We estimated the depressant action of 5-FU on normal cell proliferation in vitro. In addition, clinically, we assessed whether 5-FU has the potential to prolong the effect of myringotomy. STUDY DESIGN: An in vitro study and a clinical study were conducted. MATERIALS AND METHODS: In study I, fibroblasts harvested from the peritoneum of three green fluorescent protein transgenic mice were cultured with different doses of 5-FU. After 2 weeks, their proliferation rates were compared. In study II, patients (54 males, 47 females) were selected randomly from a group of patients with intractable OME. Myringotomy with or without a single dose of 5-FU ointment (approximately 0.10-0.30 mg) was performed in group I (n = 64) and group II (n = 37), respectively. The natural closure rates of the tympanic membrane were assessed in both groups. RESULTS: In vitro, 5-FU inhibited the growth of fibroblasts in a dose-dependent manner. The average time to tympanic membrane closure was 20.5 days in group I and 8.1 days in group II. No adverse events were observed in either group. CONCLUSIONS: Topical application of 5-FU ointment is useful in prolonging the effect of myringotomy. 5-FU ointment therapy is easy, safe, and cost-effective and may be of wide application.     

CO(2) laser treatment in 244 patients with respiratory papillomas

OBJECTIVE: Respiratory papillomas (RP) tend to recur and the difficulty in eradicating the disease makes their treatment frustrating. Meticulous CO(2) laser excisions every 2 months has been the most effective treatment to date. This article analyzes the results of this plan in 244 patients with RP in the nose, nasopharynx, pharynx, hypopharynx, larynx, trachea, lung parenchyma, and skin. METHODS: Two hundred forty-four patients with recurrent RP were treated by the senior author with CO(2) laser excisions and, in some cases, podophyllum and alpha interferon. Demographics, initial distribution of papillomas, number of operations performed on each patient, and current results were evaluated. RESULTS: Careful laser excisions of RPs every 2 months achieved "remission" of disease (no visible RP on indirect or often direct laryngoscopy 2 mo after last removal) in 37% of patients, "clearance" of the disease process (no RP clinically apparent for 3 y after last removal) in 6%, and "cure" (no clinical recurrence for 5 y after last removal) in 17%. Juvenile-onset RP tends to follow a more aggressive course than adult-onset RP. Four patients (1.6%) developed malignant transformation of their papillomas. Except for ones in lung parenchyma, RP in areas other than the true vocal cords tend to be cleared faster because aggressive removal does not cause hoarseness. Lung parenchyma RPs are eventually fatal because of pulmonary failure from abscesses and cysts resulting from a lack of effective treatment. CONCLUSION: Frequent and meticulously performed CO(2) laser excisions can achieve significant voice and airway improvement, and some clinical "cures." However, effective antiviral medicines and/or immunologic agents are needed to achieve true cures with elimination of all human papilloma virus 6 and 11 viruses.     

Vascular permeability of the middle ear mucosa in otitis media with effusion

Summary Vascular permeability (VP) of the middle ear mucosa (MEM) in chronic otitis media with effusion (OME) was estimated in both pediatric and adult patients by calculating the middle ear effusion (MEE) to serum concentration ratios of albumin and of four protease inhibitors: 1-antitrypsin (1-AT), 1-antichymotrypsin (1-X), inter--trypsin inhibitor (I--I) and 2-macroglobulin (2-M). The levels of albumin and 1-AT in MEE were higher while those of I--I and 2-M were lower than their serum levels in both adult serous and pediatric mucoid groups. There was a negative correlation between molecular weight and the mean value of the ratio (MEE/serum) of the four inhibitors in both serous (r=–0.989) and mucoid (r=–0.924) groups. Vascular permeability of the MEM seems to be variable in both serous and mucoid groups during middle ear inflammation. Selective leakage of proteins by molecular weight appears to occur in MEM. Our findings further indicate that a high level of the high-molecular-weight inhibitor 2-M in MEE may be a significant index reflecting the remarkably enhanced VP of the MEM.     

Vascular permeability of the middle ear mucosa in otitis media with effusion

Vascular permeability (VP) of the middle ear mucosa (MEM) in chronic otitis media with effusion (OME) was estimated in both pediatric and adult patients by calculating the middle ear effusion (MEE) to serum concentration ratios of albumin and of four protease inhibitors: alpha 1-antitrypsin (alpha 1-AT), alpha 1-antichymotrypsin (alpha 1-X), inter-alpha-trypsin inhibitor (I-alpha-I) and alpha 2-macroglobulin (alpha 2-M). The levels of albumin and alpha 1-AT in MEE were higher while those of I-alpha-I and alpha 2-M were lower than their serum levels in both adult serous and pediatric mucoid groups. There was a negative correlation between molecular weight and the mean value of the ratio (MEE/serum) of the four inhibitors in both serous (r = -0.989) and mucoid (r = -0.924) groups. Vascular permeability of the MEM seems to be variable in both serous and mucoid groups during middle ear inflammation. Selective leakage of proteins by molecular weight appears to occur in MEM. Our findings further indicate that a high level of the high-molecular-weight inhibitor alpha 2-M in MEE may be a significant index reflecting the remarkably enhanced VP of the MEM.     

The endothelial nitric oxide synthase (eNOS) polymorphism in otitis media with effusion (OME)

Objectives

Otitis media with effusion (OME) is the most common disease after viral infections of upper respiratory tract (URTI) in children. Studies indicate the important role of nitric oxide (NO) in the etiology of hearing loss. However, there is no study that focuses on the role of nitric oxide synthase (eNOS) polymorphisms in the cases with OME. The aim of the present study is to evaluate the eNOS polymorphisms in the pediatric patients with OME.

Gas exchange function of the middle ear in patients with otitis media with effusion

Gas exchange function through the middle ear mucosa was assessed using nitrous oxide (N₂O) in patients with otitis media with effusion (OME), as well as in normal ears during elective surgery for unrelated disorders. In all normal ears except one (n = 43), an increase in pressure was observed after N₂O inhalation. In 42 of 84 ears with OME, a pressure increase was observed, but not in the remaining 42 ears (50%), indicating that the gas exchange function in these latter ears was impaired. In 21 of the 42 ears showing no middle ear pressure increase following N₂O inhalation, the middle ear pressure was again monitored after myringotomy and aspiration of the effusion A pressure increase was found in 16 ears, indicating that the impairment in gas exchange function in ears with OME may be reversible in most cases. Computed tomography of the mastoid was examined preoperatively in 66 ears, with the presence or absence of a middle ear pressure change well correlated in 57 ears with the presence or absence of mastoid aeration.     

Viscosity of effusion in the middle ear and eustachian tube in patients with otitis media with effusion

The viscosity of middle ear effusion (MEE) in the tympanic cavity and in the bony portion of the eustachian tube (ET) was compared in 11 specimens (10 patients) with otitis media with effusion (OME). Twenty microliters of effusion from the bony portion of the ET was sampled through myringotomy on the anterosuperior quadrant of the tympanic membrane with a micro-syringe with a curved needle. MEE in the hypotympanum was also sampled by separately puncturing the posteroinferior quadrant of the tympanic membrane. Using the microviscometer developed by one of the authors, the relative viscosity of these effusions were measured, and their natural logarithmic values were compared between the two sites mentioned above in each patient by obtaining their ratios (ET/ME). Effusion was found to have a significantly higher viscosity in the bony portion of the ET than in the hypotympanum (paired t-test: t = 3.859, p less than 0.01). In two patients with OME (serous mastoiditis) due to radiation to the temporal region, the ratios of the viscosity were comparatively small. On the other hand, excluding these two patients with serous mastoiditis mentioned above, the ratios were highest in two patients with a history of more than 60 days of hearing loss. These results were considered to be a clue to the possibility that viscous effusion aggravates ET function as a result of OME.     

Conservative treatment of otitis media with effusion by autoinflation of the middle ear

A total of 85 children on the waiting list for grommet insertion aged between 3 and 10 years with bilateral chronic otitis media with effusion (OME) were assigned at random to an observation or treatment group. Those in the treatment group were given the Otovent® device to use three times a day for the duration of the study and both groups were then seen at monthly intervals for 3 months for pneumatic otoscopy and tympanometry. Statistically significant improvement was seen in those using the treatment with a compliance of more than 70%. This was detected on the outcome measures of tympanometry and pneumatic otoscopy after 1, 2 and 3 months. No side effects were demonstrated. We conclude that autoinflation is an effective short-term treatment for children with OME when used regularly under supervision.     

Lymphangioma of the middle ear and mastoid simulating chronic otitis media with effusion

Lymphangiomas are benign congenital malformations of the lymphatic system. Middle ear lymphangioma is extremely rare entity. A 14-year-old male patient with otitis media with effusion, which was previously diagnosed to be middle ear and mastoid lymphangioma, was treated. There were no cerebrospinal fluid fistula, solitary mass, and meningitis findings. All properties of chronic otitis media with effusion were present in that case. This case is unique with these clinical properties. Middle ear and/or mastoid lymphangioma should be remembered in the differential diagnosis of chronic middle ear effusions.     

The site of abnormality in otitis media with effusion (OME) as determined by immunological markers

Theories of pathogenesis have evolved through several stages. Currently, the 17 k Dalton polypeptide, Tumour Necrosis Factor (NF) and the other inflammatory mediators of the cytokine cascade are recognized to be central to the production of the effusion. These mediators have been found in effusions and have been shown to stimulate mucin production. The question is whether each ear undergoes pathological change independently. Existing biochemical and rheological results suggest that paired ears are significantly different. This project aimed to clarify the site of the abnormalities by comparing the concentrations of inflammatory mediators in each ear, for if the concentrations are different a central cause is unlikely. Glue was collected from 40 consecutive children with bilateral effusions at the time of insertion of their grommets. The concentration of TNF IL-1 and IL-8 (interleukin 1 and 8) was measured using a quantitative enzyme immunoassay technique with purified E. coli-expressed recombinant human IL-1, IL-8 and TNF as standards. The results for TNF concentration (0–67 pg/mg protein) and the interleukins were comparable with previously published data. The concentrations in the two ears were compared using the ANOVA test and a difference was established for IL-8 (P < 0.01) but not for TNF or IL-1. This may be expected as TNF and IL-1 are early phase immune mediators and promoters of the maintenance cytokine IL-8. Results demonstrate the two ears have a significantly different inflammatory response supporting the hypothesis of a separate evolution in each ear. This has implications for using the opposite ear as a control.     

儿童分泌性中耳炎耳积液中免疫相关指标表达分析

目的 探讨儿童分泌性中耳炎患者中耳积液中的免疫相关指标变化情况。 方法 选取2016年12月至2017年12月收治的30例分泌性中耳炎患儿设为研究组,选取同期体检的健康儿童30例设为对照组。比较两组外周血中CD4⁺T、CD8⁺T细胞百分数及CD4⁺ /CD8⁺比值。比较研究组中耳积液及血浆中IL-2、IL-4、IL-6水平。将研究组外周血CD4⁺,CD8⁺T细胞值与中耳积液中IL-2、IL-4、IL-6值进行相关性分析。 结果 研究组外周血中CD4⁺T、CD8⁺T细胞百分数均明显高于对照组,CD4⁺ /CD8⁺比值明显低于对照组,差异有统计学意义(P<0.01)。研究组中耳积液中IL-2、IL-4、IL-6水平均明显高于血浆,差异有统计学意义(P<0.01)。研究组血浆中IL-2、IL-4、IL-6水平均明显高于对照组,差异有统计学意义(P<0.01)。Pearson直线相关分析结果显示,研究组中耳积液中IL-2、IL-4、IL-6水平与外周血CD4⁺T、CD8⁺T含量均呈显著正相关(P<0.01)。 结论 分泌性中耳炎与强烈的免疫反应密切相关,存在CD4⁺T、CD8⁺T细胞亚群显著升高的现象,IL-2、IL-4、IL-6对于儿童分泌性中耳炎的诊断具有一定的临床意义。     

分泌性中耳炎中耳积液嗜酸细胞阳离子蛋白与IgE测定

目的：通过测量分泌性中耳炎（OME）患者中耳积液中嗜酸细胞阳离子蛋白（MECP）、中耳积液IgE（MIgE）及血ECP（SECP）的含量,进一步探讨OME发病机制与变态反应的关系。方法：对31例OME患者,用Uni-CAP-100型变应原体外检测系统分别测量MECP、MIgE及SECP含量,得出结果并统计学处理。结果：31例OME患者检测到MECP均值为56．88μg／L,明显升高9例,占28．1％;MIgE均值为27．2ku／L,明显升高3例,占9．7％。MECP与MIgE呈正相关（P〈0．05）;SECP均值为5．6μg／L。结论：ECP存在于OME的鼓室积液中,部分OME是中耳的局限性变态反应炎性过程。OME发病过程中存在着复杂的变态反应机制。