Organic change of effusion in the mastoid in otitis media with effusion and its relation to attic retraction

To try to solve the pathogenesis of severe attic retraction viewed from mastoid condition, we examined the residual soft tissue density (RSTD) in the mastoid by computed tomography (CT) in 85 patients (107 ears) with otitis media with effusion (OME) 3 months after tympanostomy tube insertion or later. The incidence of RSTD in the mastoid was significantly higher in OME of adults (52.6%) than in children (24.1%). Ears with severe attic retraction had RSTD significantly more frequently (80%) than those with no or mild attic retraction, and many of the mastoids with severe attic retraction were occupied totally by RSTD. The area of the mastoid (mastoid pneumatization) was significantly smaller, and CT density of the mastoid (sclerotic tendency) was significantly higher in ears with RSTD than in those without. RSTD after tympanostomy tube insertion in the mastoid indicating organic change of effusion was considered one of the important factors relating to the pathogenesis of severe attic retraction.     

Tympanic membrane atrophy, scarring, atelectasis and attic retraction in persistent, untreated otitis media with effusion and following ventilation tube insertion

Two hundred and twenty two children with persistent bilateral otitis media with effusion (OME) were treated with unilateral ventilation tube insertion and no treatment to the contralateral ear. The tympanic membrane changes in the operated and unoperated ears were compared during a 12 year follow-up. Segmental atrophy resulted from tube insertion whereas minor scarring and thickening of the pars tensa was related to the middle ear condition. Eighty three percent of untreated ears and 85% of those treated with tubes did not develop atelectasis. Sixty percent of untreated ears and 64% of treated ears did not develop attic retraction. Very few cases (1.5 and 2%) in untreated and treated ears, respectively developed severe atelectasis. The overall duration of OME was assessed from the pre-operative history of hearing loss, the 3 month period of pre-operative observation and the post-operative time with effusion. There is a relationship between duration of the disease and development of both atelectasis and attic retraction.     

上鼓室内陷袋的临床特征分析

目的：探讨上鼓室内陷袋的临床特征。方法：分析92例（118耳）上鼓室内陷袋患者的临床资料、临床表现（常以耳闷胀感、听力下降及耳鸣为主诉）、耳内镜检查及分级、听力学、影像学检查及并发病变。结果：118耳中,TosⅠ～Ⅳ级分别为15耳（12．7％）,48耳（40．7％）,23耳（19．5％）及32耳（27．1％）。耳内镜下可见并发的分泌性中耳炎41耳（34．7％）、中耳膨胀不全16耳（13．6％）、粘连性中耳炎8耳（6．8％）及内陷袋胆脂瘤。纯音测听以传导性聋为主,少数还有以传导性聋为主的混合性聋。因并发中耳疾病及疾病性质的不同,而对听力的影响也不同,且差异也有统计学意义（P〈0．01）。Ⅰ～Ⅲ级各病变组与Ⅳ级病变对听力的影响有统计学意义（P〈0．01）,Ⅰ～Ⅲ级之间的听阈无统计学意义（P〉0．01）,声阻抗以平坦型及负压为主。其中97耳CT及X线摄片结果显示,乳突气化不良程度与对照组有差异（P〈0．01）。结论：上鼓室内陷袋反映中耳负压状态,其发病机制与咽鼓管功能、炎症、乳突气化程度相关;因其存在发展为内陷袋胆脂瘤的潜在危险,故临床上应加强早、中期病变的随访及干预。     

鼓膜置管治疗成人渗出性中耳炎的长期观察

目的探讨鼓膜置管术对成人渗出性中耳炎治疗的长期结果.方法总结分析1996年6月至1999年6月治疗的42例成人渗出性中耳炎患者.男24例,女18例,左耳17例,右耳19例,双耳6例,共计48耳;年龄20～70岁,平均37岁;病程1个月至1年.通气管常规置入加冲洗治疗,8个月内取管,随访4-8年.结果症状全部消失29例;耳鸣6例,伴听力下降4例;时有耳堵塞感发作5例;鼓室积液复发2耳.鼓膜正常者28耳,鼓膜瘢痕、钙化10耳,鼓膜内陷8耳,鼓膜变薄、松弛2耳,鼓膜穿孔2耳.结论成人渗出性中耳炎行鼓膜置管治疗的远期效果良好,其并发症及后期的鼓膜改变较儿童期少.     

Sequelae of otitis media with effusion among children with cleft lip and/or cleft palate

Otitis media with effusion (OME) is common among children with cleft palate, and may lead to such long-term consequences as hearing loss, tympanic membrane retraction, and chronic otitis media (COM). In total, 104 children with cleft lip and/or palate treated for OME at our institution were reviewed. Mean duration of follow-up was 6.9 years, and mean age at latest follow-up was 9.6 years. The incidence of COM was 19%, and the incidence of cholesteatoma was 1.9%. Ears showing such long-term sequelae of OME as hearing loss, tympanic membrane retraction, and chronic otitis media, were noted to have undergone a significantly greater number of ventilation tube insertions than ears not showing these sequalae. Our findings would suggest that a conservative approach to the management of OME in children with cleft palate is more likely to be beneficial in the long term.     

Otological and audiological outcomes five years after tympanostomy in early childhood

OBJECTIVE: Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long-term follow-up studies have included even a minority of patients under 1 year old. We investigated long-term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes. STUDY DESIGN: Prospective follow-up. METHODS: Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyv?skyl?, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure-tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds). RESULTS: Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively. CONCLUSIONS: Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow-up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.     

A 14-year prospective follow-up study of children treated early in life with tympanostomy tubes: Part 2: Hearing outcomes

OBJECTIVE: To determine hearing outcomes in young children receiving early and repeated tympanostomy tube insertion for recurrent acute otitis media or otitis media with effusion. DESIGN: Prospective 14-year follow-up. SETTING: Central Hospital of Central Finland, a tertiary care hospital.Patients Three hundred five consecutive infants and young children with otitis media received initial tympanostomy tube insertion at the age of 5 to 16 months. The final study group comprised 237 patients (77.7%) attending the 14-year checkups. MAIN OUTCOME MEASURES: At the 14-year checkups, children received clinical examinations and audiometric testing for the determination of bone and air conduction pure-tone thresholds. RESULTS: The mean pure-tone average of 177 healed ears was 4.3 dB. The mean pure-tone average of all ears was 5.8 dB, with significantly poorer results in ears with abnormal outcomes such as grade II or higher pars tensa retraction, otitis media with effusion, and tympanic membrane perforation. Thirteen (5.5%) of 237 ears had a hearing level worse than 15 dB, and the better ear hearing level was poorer than 15 dB in 3 patients. CONCLUSIONS: The hearing level of healed ears was comparable to that of age-matched normal ears. Hearing losses were infrequent, of slight grade, and, when present, almost exclusively conductive and related to unsuccessful otological outcomes. From the hearing point of view, repeated tympanostomy tube insertion for recurrent acute otitis media or otitis media with effusion early in life is a safe treatment.     

Sequelae of otitis media with effusion among children with cleft lip and/or cleft palate1

Otitis media with effusion (OME) is common among children with cleft palate, and may lead to such long‐term consequences as hearing loss, tympanic membrane retraction, and chronic otitis media (COM). In total, 104 children with cleft lip and/or palate treated for OME at our institution were reviewed. Mean duration of follow‐up was 6.9 years, and mean age at latest follow‐up was 9.6 years. The incidence of COM was 19%, and the incidence of cholesteatoma was 1.9%. Ears showing such long‐term sequelae of OME as hearing loss, tympanic membrane retraction, and chronic otitis media, were noted to have undergone a significantly greater number of ventilation tube insertions than ears not showing these sequalae. Our findings would suggest that a conservative approach to the management of OME in children with cleft palate is more likely to be beneficial in the long term.     

保留乳突的改良完壁式鼓室成形术的临床疗效观察

目的 探讨局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤行上鼓室径路保留乳突的改良完壁式鼓室成形术的长期临床疗效.方法 诊断慢性化脓性中耳炎、中耳胆脂瘤47例(47耳)患者,结合患者专科检查,依据手术方式不同分A、B两组,A组行上鼓室径路保留乳突的改良完壁式鼓室成形术,B组行完壁式乳突切开+鼓室成形术.术后随访5～7...     

Assessment of complications of the condition and of the treatment of otitis media with effusion

Persistent otitis media with effusion (OME) may cause long-term changes of the tympanic membrane and middle ear, resulting in some degree of hearing loss. One of the traditional aims of treatment with ventilation tubes is to prevent these complications from developing. Ventilation tubes themselves, however, are also known to induce changes of the tympanic membrane. Several recent studies have addressed the questions: what are the effects of the disease, and what are the result of its treatment? The object of this study was to present the state of the art, by literature review, regarding structural and functional complications of OME and treatment with ventilation tubes. In both observational and experimental studies tympanosclerosis is reported to occur in 39-65% of ears treated with ventilation tubes as opposed to 0-10% of untreated ears. For segmental atrophy these percentages are 16-73 and 5-31, respectively. Regarding the prevalence of atelectasis and attic retraction, the difference between ventilated and untreated ears is less: 10-37% as opposed to 1-20% for atelectasis, and 10-52% as opposed to 29-40% for attic retraction. The average hearing loss associated with these tympanic membrane abnormalities is less than 5 dB. Although ventilation tubes have proven very effective in improving hearing in the short term, they have not proven effective in preventing long-term changes of the tympanic membrane related to OME, nor in keeping some degree of hearing loss from developing.     

A comparison of outcomes following tympanostomy tube placement or conservative measures for management of otitis media with effusion

We obtained the charts of 183 patients (197 ears) who had undergone surgery for chronic otitis media (COM), and we reviewed their otic histories to analyze the series of events that ultimately culminated in surgery. All ears had originally been treated for otitis media with effusion (OME); 125 ears had been treated with tympanostomy tube placement, and 72 ears had been treated with conservative measures. Our goal was to compare the influence that these two strategies had on the subsequent development of COM and its sequelae (i.e., retraction pockets, tympanic membrane perforations, and cholesteatomas) and thereby determine which strategy is preferable. We found that although retraction pockets developed in a significantly higher proportion of the tympanostomy-treated ears than the conservatively treated ears (58 vs. 35%; p < 0.01), a significantly greater percentage of retractions in the tympanostomy-treated ears were mild and situated in the anterior part of the tympanic membrane (52 vs. 32%; p < 0.05). Moreover, severe retractions were significantly more common in the conservatively treated ears (40 vs. 16%; p < 0.02); the incidence of complete retractions in the two groups of ears was similar (tympanostomy: 32%; conservative treatment: 28%). Cholesteatomas developed in a significantly lower percentage of tympanostomy-treated ears (67 vs. 81%; p < 0.05), and the incidence of large cholesteatomas that involved the tympanic and mastoid cavities was likewise significantly lower in these ears (44 vs. 69%; p < 0.05). There was no significant difference in the incidence of tympanic membrane perforations. Finally, even though all of these ears eventually required surgery for COM, the tympanostomy-treated ears required significantly fewer repeat surgeries (16 vs. 28%; p < 0.05) and significantly fewer radical modified tympanomastoidectomies (30 vs. 44%; p < 0.05). Therefore, we conclude that myringotomy with insertion of tympanostomy tubes to treat OME is superior to conservative treatment.     

无明显耳漏症状的胆脂瘤型中耳炎17例临床分析

目的 探讨无明显耳漏症状的胆脂瘤型中耳炎临床特征，提高诊断水平。方法 回顾性分析17例(17耳)经手术及病理证实的本病临床资料。结果 17例中12例无耳漏史，3例幼年时及2例发病早期曾有短时耳漏。鼓膜看不到穿孔4例，松弛部及紧张部后上方有轻微体征13例，其中瘢痕及内陷囊袋各3例，上皮痂、耵聍覆盖5例，针尖样穿孔2例。听力下降以轻、中度传导性聋为主。鼓室导抗图为B型。CT诊断符合率为76．5％(13／17)。结论 无明显耳漏症状的胆脂型中耳炎常以无明显耳漏，轻、中度听力下降及鼓膜体征轻微为主要临床特征．易发生漏诊、误诊。轻、中度听力下降可为其唯一症状，也是诊断的重要线索。仔细检查鼓膜并结合影像学资料综合分析才可减少漏诊，防止耳源性并发症。     

Prussak''s space: chronological development and routes of aeration

Investigation of Prussak's space and its relationship to adjacent spaces is important in elucidating the cause of retraction pocket and cholesteatoma formation in this space. This study was designed to quantitatively characterize the chronological development of Prussak's space and its relationship to adjacent spaces in temporal bones. One-hundred and forty-nine human temporal bone slides (115 normal, 28 with otitis media with effusion, three with retraction pockets and three with attic type cholesteatoma) including specimens ranging from fetal to adult bones were studied. Prussak's space was formed and sufficient aeration routes established by 4 years of age in normal temporal bones. In temporal bones with otitis media with effusion, however, the growth of Prussak's space was suppressed and few routes for aeration established until 10 years of age. In normal temporal bones, Prussak's space developed with aeration routes sufficient to avert the negative pressure which can result in retraction pocket formation in the pars flaccida of the tympanic membrane.     

Experimental background for the use of tympanostomy tubes

Already within 24 h, splitting of the soft palate in rats caused production of effusion in the attic space. During the next couple of days the effusion material filled the meso- and hypotympanon. The production of a serous fluid in the attic space appeared concomitant with an elevated histamine content in the middle ear cavity, irrespective of whether the ears were ventilated or not. In the artificially ventilated middle ears no effusion appeared in the meso- and hypotympanon and the hypotympanal mucosal lining remained normal. The serous effusion filling the middle ear cavities with the intact tympanic membranes was replaced at about 7 days by a purulent effusion material containing mainly Gram-negative enteric rods. Thus it seems that a serous otitis media and a purulent otitis media occur in a continuum. The change to a purulent infection could be prevented by artificial ventilation, but as soon as the myringotomies were healed or the tympanostomy tubes got clogged a flocculent, pus-like effusion also appeared in these middle ear cavities.     

Influence of the Gas Exchange Function Through the Middle Ear Mucosa on the Development of Sniff-Induced Middle Ear Diseases

To investigate the influence of gas exchange function through the middle ear mucosa on the development of sniff-induced middle ear diseases, the authors examined the mastoid pneumatization among patients with sniffing habit using computed tomography, and also examined the change of negative middle ear pressure induced by sniffing using tympanogram. In 20 ears with cholesteatoma or adhesive otitis media, the areas of mastoid cavity measured at the level of the lateral semicircular canal were significantly smaller than those in 26 ears with otitis media with effusion (OME) or attic retraction and in eight normal ears with sniffing habit (P < .01 and P < .0001, respectively). In 26 ears with OME or attic retraction, the areas of mastoid cavity were significantly smaller than those in eight normal ears with sniffing habit (P < .0001). By contrast, in the four ears with sniff-induced middle ear disease, the recovery of negative middle ear pressure in 5 minutes without swallowing was less than 10 mm H₂O, whereas in all seven ears with normal eardrum, negative middle ear pressure recovered by more than 20 mm H₂O in 5 minutes. These findings suggested that impairment of gas exchange function through the middle ear mucosa, as well as eustachian tube dysfunction, might be closely related to the development of sniff-induced middle ear diseases.     

声反射在成人分泌性中耳炎中的诊断价值

目的提高耳科门诊成人分泌性中耳炎中耳积液的检出率,探讨声反射在协助诊断分泌性中耳炎是否伴有中耳积液中的临床价值。方法回顾性分析耳鼻咽喉科门诊169例确诊为分泌性中耳炎伴有中耳积液的成年患者的临床资料,并对听力正常与听力下降患者的鼓室图、同侧声反射及纯音测听等资料进行对比。结果169例(237耳)经鼓膜穿刺证实为中耳积液的患者中,223耳(94.1%)未引出声反射,14耳(5.9%)引出声反射;鼓室图异常200耳(84.4%),正常者37耳(15.6%);216耳(91.1%)有传导性听力下降,21耳(8.9%)听力正常。不论听力是否下降,同侧声反射的未引出率均高于异常鼓室图的概率(P<0.05);在不同听力及不同类型鼓室图中,声反射的未引出率没有差异(P>0.05),具有无创、快捷及客观等优点,能更好的帮助临床工作者评估分泌性中耳炎的疗效及预后。结论声反射能协助提高成人分泌性中耳炎伴中耳积液的检出率,具有无创、快速及客观等优点,能更好地帮助临床工作者评估分泌性中耳炎的疗效及预后。     

Hearing acuity in otitis media with effusion and adhesive otitis media

The relationship between findings established by the photograph of the tympanic membrane and hypacusia was determined by pure-tone audiometry. Subjects were 352 ears of 267 patients diagnosed as otitis media with effusion (OME) or adhesive otitis media (AdOM). These two diseases were evaluated on the basis of photographs of the tympanic membrane taken from 1983 to 1988. The results were as follows; 1) The effect of aging process on hearing acuity was noted in patients with these diseases, i.e., values of hearing acuity by air and bone conduction were, in descending order, early-, mature-, and advanced-age groups, with significant differences (p less than 0.01). 2) Greater loss of acuity by air conduction in the middle to high frequency ranges was found in patients with OME than with AdOM. In bone conduction, a decrease in low frequency range in the early--and mature--age groups was larger in patients with AdOM than with OME and a significant decrease in 2000-6000 Hz in the advanced-age group was more marked in patients with OME than with AdOM (p less than 0.05). 3) Among patients with AdOM, those with retained fluid in the middle ear showed a significant decrease in air conduction values and a significant increase in air-bone gap compared with those without fluid (p less than 0.05). 4) The degrees of adhesion correlated well with a decrease in hearing acuity. 5) Hearing acuity was not influenced by attic retraction, white plaque, scar and atrophy of their tympanic membranes.     

Pars flaccida displacement pattern in otitis media with effusion in the gerbil.

HYPOTHESIS: Our hypothesis is that otitis media with effusion causes stiffness loss in the pars flaccida of the tympanic membrane. This loss of stiffness may be persistent and may trigger the development of retraction pockets and cholesteatoma. BACKGROUND: Otitis media with effusion is a very common disease in childhood. It can cause minor to moderate hearing loss and delayed speech development. Otitis media with effusion is a risk factor for retraction pocket formation. METHODS: Otitis media with effusion was induced unilaterally in 15 gerbils by obstructing the eustachian tube with glue. The contralateral ears served as normal controls. As a measure of mechanical stiffness, pars flaccida peak displacement versus pressure was used. The displacement measurements were made with moire interferometry. This is a noncontacting optical technique with which the displacement of an object can be measured in real time. RESULTS: The mean peak displacement of the pars flaccida in the group with otitis media with effusion was increased threefold as compared with normal controls. This difference was statistically significant. CONCLUSION: There was a loss of mechanical stiffness in the pars flaccida caused by otitis media with effusion. This loss of stiffness may be persistent and may predispose for retraction pocket formation and cholesteatoma development.     

Clinical observation of acute otitis media in children

This report presents the results of the clinical observation of 96 children under ten years of age with acute otitis media (107 ears) who visited our out-patient clinic from May 1986 to August 1987. The patients were classified into the following three groups according to clinical course: Group 1: 25 cases (26.0%) in which acute inflammatory findings rapidly disappeared and otitis media was cured within two weeks with no evidence of effusion; Group 2: 62 cases (64.6%) in which acute inflammatory findings rapidly disappeared but obvious accumulation of effusion which resolved gradually was observed and in which otitis media was cured from two weeks to three months after onset; Group 3: 9 cases (9.4%) in which persistent accumulation of effusion for more than three months was observed and which required myringotomy and insertion of a ventilation tube and in which a diagnosis of otitis media with effusion was made. The presence or absence of allergic diseases, adenoid symptoms, and otorrhea, or history of tonsillitis had no affect on the prognosis of acute otitis media. However, patients with a history of acute otitis media were at a significantly higher risk of developing the disease chronically. At the time of the resolution of the tympanic redness, abnormal findings in the tympanic membrane and tympanogram (TG), suggestive of the presence of middle ear effusion, were observed in approximately 80% of the patients. Approximately 20% of the patients who showed Type Cs or B in TG at that time developed otitis media with effusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Practical use of MESNA in atelectatic ears and adhesive otitis media

OBJECTIVE: MESNA is a synthetic sulfur compound that produces mucolysis by disrupting disulfide bonds. This study aimed to address indications and technique of MESNA application in otologic surgery, especially in retraction pockets and adhesive otitis media. METHODS: MESNA application was performed in 42 ears of 39 patients. The diagnoses were retraction pockets fixed to incudostapedial joint, stapes or promontorium, and adhesive otitis media in 24 and 17 ears, respectively. Calculations were performed according to 24 ears of 23 patients with follow-up data. RESULTS: One or more of the following surgical interventions were performed: MESNA application alone and ventilation tube insertion, reinforcement or mastoidectomy in addition to MESNA application. Sensorineural hearing loss was not encountered after MESNA application. The operation was successful in 79.2%. Overall revision surgery was needed in 20.8% of the ears. In 71.4% of the ears treated with MESNA alone, revision surgery was needed. CONCLUSION: In the light of our experience, we advocate the use of MESNA in atelectatic ears, because it makes the operation easy and safe by allowing elevation of the tympanic membrane by its mechanical and chemical actions.