Expression of C-type lectin receptor mRNA in otitis media with effusion and chronic otitis media with and without cholesteatoma

Background & objectivesC-type lectin receptors (CLRs) are a family of pattern recognition receptors (PRPs). The expression of CLRs has been analyzed in other diseases but has not yet been compared in patients with otitis media with effusion (OME), chronic otitis media (COM) and COM with cholesteatoma (Chole OM). This study therefore evaluated the levels of expression of mRNAs encoding Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1, and DAP-12 in patients with OME, COM, and Chole OM.MethodsCLR mRNA levels in patients with OME, COM, and Chole OM were assessed by real-time polymerase chain reaction. The level of expression of each mRNA was compared in patients with and without bacteria, and in patients with conductive hearing loss (CHL) and sensorineural hearing loss (SNHL).ResultsThe patterns of expression of CLRs differed in patients with OME, COM, and Chole OM. Galectin-1 mRNA level was significantly higher in the COM than in the Chole OM group (p < 0.05), and MR1 and Galectin-1 mRNA levels among patients with CHL were significantly higher in those with COM than with Chole OM (p < 0.05). Galectin-1 mRNA level among patients with SNHL was also significantly higher in the COM than in the Chole OM group (p < 0.05).ConclusionsThe levels of expression of mRNAs encoding the CLRs Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1 and DAP-12 differ among patients with OME, COM, and Chole OM.     

Increased IL-17 and 22 mRNA expression in pediatric patients with otitis media with effusion

ObjectivesMiddle ear effusion has been reported to be associated with immune responses in patients with otitis media with effusion (OME). Although various cytokines are involved in immunologic responses in patients with OME, no study to date has assessed the involvement of the pro-inflammatory cytokines interleukin (IL)-17 and IL-22. This study analyzed the levels of expression of IL-17 and IL-22 in the middle ear effusion of patients with OME.MethodsPatients aged <11 years who were diagnosed with chronic OME and underwent ventilation tube insertion from May 2013 to August 2015 were enrolled. Effusion fluid samples were obtained during surgery and levels of IL-17 and IL-22 mRNAs assessed by real-time PCR. IL-17 and IL-22 mRNA levels were compared in patients with effusion fluid positive and negative for bacteria; in patients with and without accompanying diseases, recurrent disease, and re-operation; and relative to fluid characteristics.ResultsThe study cohort included 70 pediatric patients, 46 boys and 24 girls, of mean age 4.31 ± 2.11 years. The levels of IL-17 and IL-22 mRNA were higher in patients with than without sinusitis, but only IL-22 mRNA levels differed significantly (p < 0.05). The level of IL-17 mRNA was significantly higher in patients who did than did not undergo T&A (p < 0.05). The level of IL-22 expression was significantly higher in mucoid and purulent middle ear fluid samples than in serous fluid samples (p < 0.05).ConclusionIL-17 and IL-22 mRNAs are involved in the pathophysiology of OME and are significantly higher in subjects with than without accompanying diseases.     

Bacterial biofilm in adenoids of children with chronic otitis media. Part I: a case control study of prevalence of biofilms in adenoids,risk factors and middle ear biofilms

Background: Biofilms are communities of bacteria embedded in a self-produced glycocalyx matrix. Adenoids have been shown to harbor bacterial biofilms.

Aim/objectives: To compare the prevalence of biofilms in adenoid of children with chronic otitis media (COM) (group1) versus a control group without any COM (group 2) having adenoids removed because of hypertrophy.

Material and methods: One hundred and three children were prospectively enrolled in this case-control study, group 1 (n?=?52) and group 2 (n?=?51). The main outcome measurement was the prevalence of biofilm in adenoidectomy specimens analyzed using confocal laser scanning microscopy. Children in group 1 who had middle ear (ME) effusion and requiring the insertion of a tympanostomy tube underwent biopsy of the ME mucosa and effusion sampling.

Results: Biofilms were found in adenoids’ specimens of both groups and in the ME biopsy and effusion. The biofilm prevalence in adenoids was 63.5% (33/52) in group 1 and 47.1% (24/51) in group 2. Day nursery and previous antibiotics intake were significantly more frequent in group 1 than in group 2.

Conclusions and significance: This case-control study demonstrates that adenoid tissue in children with COM contains more mucosal biofilms than adenoid tissue removed for hypertrophy. Biofilm was seen in ME biopsies and effusion.     

Auditory processing abilities in children with chronic otitis media with effusion

Conclusion The study results indicate that children with a history of otitis media with effusion (OME) suffer from auditory processing disorder to some degree. The findings support the hypothesis that fluctuating hearing loss may affect central auditory processing during critical periods.

Objectives Evidence suggests that prolonged OME in children can result in an auditory processing disorder, presumably because hearing has been disrupted during an important developmental period. A lack of auditory stimulation leads to the abnormal development of the hearing pathways in the brain. The aim of the present study was to determine the effects of OME on binaural auditory function and auditory temporal processing.

Method In the present study, the dichotic digit test (DDT) was used for binaural hearing, and the gap in noise (GIN) test was used to evaluate temporal hearing processing.

Results The average values of GIN differed significantly between children with a history of OME and normal controls (p?p?=?0.002).     

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.     

C-type lectin receptors mRNA expression in patients with otitis media with effusion

ObjectiveThe role of C-type lectin receptor, a type of pattern recognition receptor, in otitis media with effusion (OME) is unclear. We assayed the levels of expression of C-type lectin receptor mRNA in children with OME and evaluated its relationship to the presence of bacteria, accompanying diseases, and characteristics of exudates.Subjects and MethodsThe study population consisted of 73 children with OME who had undergone ventilating tube insertion. The levels of expression of Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, Dec-205, Galectin-1, Tim-3, Trem-1, and DAP-12 mRNA in middle ear effusion were determined by real-time PCR. The level of expression of each mRNA was correlated with the presence of bacteria, accompanying diseases, and exudates characteristics.ResultsThe levels of expression of C-type lectin receptor mRNAs were not associated with bacterial presence or exudates characteristics (p > 0.05 each). Levels of expression, however, were significantly higher in patients with sinusitis, adenoid vegetation or adenoiditis, and allergic rhinitis (p < 0.05 each).ConclusionsLevels of expression of C-type lectin receptor mRNA may be associated with the pathogenesis of OME, being significantly higher in patients with than without accompanying sinusitis, adenoid vegetation or adenoiditis, and allergic rhinitis.     

Expression of CXCL4 and aquaporin 3 and 10 mRNAs in patients with otitis media with effusion

PurposeBacterial infections in children with underdeveloped Eustachian tubes are a major cause of otitis media with effusion (OEM), and persistent effusion in the middle ear in these patients is a major cause of surgical intervention. CXCL4 is associated with bacterial infection, and aquaporins 3 and 10 are associated with water metabolism. This study assessed the expression of mRNAs encoding CXCL-4 and aquaporins 3 and 10 in the effusion of pediatric OME patients, and the association of this expression with clinical manifestations.MethodsLevels of CXCL4 and aquaporin 3 and 10 mRNA were assayed by real-time RT-PCR in the middle ear effusion of 38 pediatric patients with OME requiring ventilation tube insertion. The relationships of these mRNA levels with the presence of bacteria; concomitant diseases such as allergic rhinitis, sinusitis, and adenoid disease; recurrence of OME; and number of ventilation tube insertions were evaluated.ResultsCXCL4 and aquaporin 3 and 10 mRNAs were expressed in middle ear effusion of all OME patients. CXCL-4 mRNA levels were significantly lower when bacteria were present and in patients with concomitant diseases (p < 0.05 each). Levels of all three mRNAs were unrelated to OME recurrence or number of ventilation tube insertions (p > 0.05 each). The levels of CXCL4 and aquaporin 10 mRNAs were significantly correlated (p < 0.05).ConclusionExpression of CXCL4 and aquaporin 3 and 10 mRNAs in middle ear effusion is associated with the pathophysiology of OME. CXCL4 mRNA levels are significantly lower in patients with than without concomitant diseases or bacterial infections.     

PERSISTENCE OF MIDDLE EAR DYSFUNCTION AFTER RECURRENT ACUTE OTITIS MEDIA

The presence of otitis media with effusion (OME) and high negative pressure (-200 to -400 mm H₂O)₃ were investigated in follow-up of a randomized double-blind placebo-blind placebo-controlled trial on the efficacyu of amoxicilin/clavulanic acid in the treatment of acute otitis media. All children in this study were recruited from a general practice population. Tympanometry results 1 month from the start of an episode of acute otitis media were taken as outcome criteria. Bilateral middle ear dysfunction was defined as bilateral OME, unilateral OME and contralateral or bilateral high negative pressure. Bilateral middle ear dyusfunction was present in 47.9% of the patients. Of all teh investigated factors of possible influence (age, sex, season, laterality of acute otitis media, therapy, and clinical course of acute otitis media), only season showed a statistically significant influence on the persistence of OME/high negative pressure (P = 0.001). Bilateral middle ear dysfunction was shown to be of prognostic value for the risk of a recurrence of acute otitis media (odds ratio 3.75). shown to be of prognostic value for the risk of a recurence of acute otitis media (odds ratio 3.75).     

Pharyngeal reflux in children with chronic otitis media with effusion

Objective—To investigate whether there is an association between chronic otitis media (COM) with effusion and pharyngeal reflux in children by using 24-h pH monitoring with a dual probe.

Material and Methods—This was a prospective study. The study group consisted of 25 children with COM with effusion and the control group comprised 12 healthy children. All children underwent 24-h esophageal pH monitoring with a dual probe (distal and proximal esophageal pH monitoring).

Results—In the study group, the frequencies of pharyngeal and gastroesophageal reflux (GER) were 48% and 64%, respectively, and the corresponding values in the control group were 8.3% and 25%. Both of these differences were significant (p<0.05). In the study group, 28% of patients were positive for at least 1 symptom of GER; 72% of the patients did not have any symptoms but 56% of these patients had silent GER.

Conclusions—These findings indicate that pharyngeal reflux may play an important role in the etiology of COM with effusion. If patients have typical symptoms of GER, such as pyrosis, regurgitation, dysphagia and emesis, the presence of GER should be considered. The presence of silent GER and pharyngeal reflux should also be considered.     

Serum IgA and IgG functional antibodies and their subclasses to Streptococcus pneumoniae capsular antigen found in two aged‐matched cohorts of children with and without otitis media with effusion

Serum IgA and IgG functional antibodies and their subclasses to Streptococcus pneumoniae capsular antigen found in two aged‐matched cohorts of children with and without otitis media with effusion The relationship between acute otitis media and otitis media with effusion (OME) is uncertain and the aetiology of OME is multifactorial. Otitis media with effusion may be an inflammatory condition; both bacteria and viral infections could play a part in this inflammation. The four bacteria Streptococcus pneumoniae, Haemophilus influenza, Staphylococcus aureus and Branhamella catarrhalis cause 60% of the infections whereas S. pneumoniae accounts for up to 35%. IgA provides the dominant surface response to polysaccharide and lipopolysaccharide antigens, of which IgA₂ is the main subclass. Once the mucosa has been breached, most protection is provided by IgG. IgG₂ acts mainly against bacterial capsular antigens. This study looked at two groups of 50 children with and without OME who were aged between 3 and 10 years. The aims were to determine if, firstly, the levels of the serum immunoglobulins were different in the two groups, secondly whether these children made the appropriate antibody response to the capsular antigen to S. pneumoniae (PCP), and finally if there was a delay in the maturity of the IgA response. The total IgG, IgA and all subclass levels were measured using radial immunodiffusion. Levels of functional IgA and IgG were measured using ELISAs (25 patients in each group). The results were analysed with non‐parametric tests. The immunoglobulin levels were within the normal levels for both groups. There were very good correlations between the IgG total anti‐PCP and the IgG₂ anti‐PCP (R > 0.9, p = 0.001). There was a good correlation between the levels of both IgG total and IgG₂ anti‐PCP against IgA total anti‐PCP in both groups (R > 0.85, p > 0.01). This confirms a normal antibody response between both groups of patients. The ages of the controls and patients (50 samples) were correlated with increasing titres of circulating functional antibodies (P = 0.001). This is highly suggestive of a normal age‐related response. In conclusion, the findings were contradictory to our original hypothesis that there is a subtle difference in surface protection between children with and without OME. We believe that a previous history of recurrent acute otitis media is unrelated to the development of OME after 3 years of age.     

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.     

Findings at initial surgery for childhood otitis media with effusion and subsequent outcome

The outcome of initial surgical treatment in children with otitis media with effusion (OME) was analysed in a prospective study involving 225 new patients. The presence or absence of effusion in each ear and type of effusion present were recorded at surgery. The outcome measure studied was resolution or recurrence of middle ear effusions necessitating further surgical intervention. The outcome was significantly more favourable in children with unilateral effusions at surgery as opposed to bilateral effusions (P> 0.03) but was unrelated to the type of effusion (serous or mucoid). Patients with unilateral effusions at surgery appear to have a fluctuating form of OME in which effusions are present in either or both ears at different times.     

Clinical outcomes of otitis media with effusion following palatoplasty in patients with incomplete cleft palate

Background: Diagnosis and treatment strategies for CP with OME and the timing of ear tube insertion remain controversial.

Objectives: To analyze the clinical outcomes of otitis media with effusion in children with incomplete cleft palate after palatoplasty prospectively.

Methods: A total of 30 children (10 months–2 years old) with incomplete CP were enrolled in this study and received at least 6 months of follow-up evaluations after palatoplasty.

Results: The overall improvement rate of OME was as high as 26% in this group. Average air conduction hearing threshold was significantly better than that before surgery in the 8 patients with improved OME (p?<?.05). Among the 8 children with improved OME, 7 (87.5%) were found to have middle ear effusion that improved within 6 months after CP repair. There was no significant difference in the improvement rate between the severe degree II group and the mild group.

Conclusion: A 6-month follow-up period is recommended. The severity of incomplete CP is not fully related to the function of the eustachian tube.

Significance: The overall improvement rate was as high as 26%, and effusion in the tympanic cavity subsided in 7 out of 8 cases within 6 months after the CP repair.     

Analysis of risk factors for childhood persistent middle ear effusion

Conclusions

Although exposure to infectious agents and parental smoking are known to influence the overall risk of otitis media, these risk factors do not appear to be linked with the tendency to develop chronic otitis media with effusion (COME) instead of recurrent acute otitis media (RAOM). The genetic inflammatory response type of the child appears to influence the risk of persistent middle ear effusion in COME.

Objective

Two different clinical presentations of childhood otitis media are encountered: RAOM; and COME, which is associated with persistent effusion in the middle ear. The objective of this study was to assess putative factors that may regulate the development of persistent middle ear effusion in COME.

Material and methods

In total, 159 children with RAOM and their parents (n=304), and 55 children with COME and their parents (n=110) were evaluated. All the children with COME or RAOM were aged <4 years.

Results

There was no difference in the frequency of attendance at day care outside the home, number of siblings or parental smoking between children with RAOM and those with COME. The frequency of parental allergy and asthma was lower among children with COME than those with RAOM.     

Risk factors for chronicity in childhood otitis media with effusion

One hundred and ninety-one children who presented to the author’s clinic with otitis media with effusion (OME) over a 2-year period (1986–1988) have been studied prospectively. Resolution of their OME was considered to have occurred when they had normal findings on pneumatic otoscopy, tympanometry and audiometry on at least two occasions 6 months apart and had subjectively normal hearing in between. The number of operations performed during the course of the disease was used as a surrogate for chronicity. Children with a history of previous aural discharge at presentation were significantly more likely to have chronic OME (P = < 0.02).     

Pediatric otitis media in Fiji: Survey findings 2015

ObjectiveOtitis media (OM), as a common infectious disease, is a major cause of hearing impairment among the general population. OM remains a major public health threat in the Pacific islands, but the risks of OM have not been thoroughly explored in this region. The objective of this study is to investigate the prevalence, clinical features, and quality-of-life impacts of OM in Fiji.MethodsIn the medical service trip entitled “Healing and Hope – Taiwan Cathay Heart and Hearing Medical Mission to Fiji” (TCHHMMF), we conducted a cross-sectional OM survey study in Suva and Sigatoka areas (Korolevu, Cuvu, and Lomawai) in the summer of 2015. The otitis media – 6 (OM-6) was used to survey the OM-related quality of life.ResultsIn the 467 pediatric patients (aged 0–18 years old) screened, 13 (2.78%) have acute otitis media (AOM), 37 (7.92%) have otitis media with effusion (OME), and 19 (4.1%) have chronic otitis media (COM). Age (OR 0.53, 95% CI: 0.36–0.77) is a significant predictor of AOM, whereas male gender (OR 2.46, 95% CI: 1.13–5.37), smoke exposure (OR 2.81, 95% CI: 1.01–7.82), and concomitant chronic sinusitis (OR 6.05, 95% CI: 2.31–15.88) are significant predictors of OME. The mean OM-6 item scores are highest in caregiver concerns (3.8), physical suffering (3.7), and hearing loss (3.4) domains.ConclusionOM is an important primary care disease in Fiji that remains under-served. It is critical to educate professionals, parents, and patients to detect and to improve care for OM.     

Adaptation and validation of the chronic otitis media questionnaire 12 (COMQ-12) in the Mexican Spanish language (COMQ-12-Mx)

Abstract

Background: Chronic otitis media (COM) questionnaire 12 (COMQ-12) is a specific-disease tool that evaluates COM patients.

Objective: To validate COMQ-12 in the Mexican Spanish language (COMQ-12-Mx).

Materials and methods: Mexican Spanish-speaking healthy volunteers and COM patients who attended a Secondary Care Center from May 2019 to October 2019. The COMQ-12 in Mexican Spanish was obtained by translation and back translation from an English-Spanish translator. All participants completed the COMQ-12-Mx questionnaire. COM patients were included regardless of their COM status. Control group completed the questionnaire twice. Participants were categorized into three groups: group 1 (COM), group 2 (volunteers first test) and group 3 (volunteers retest). Cronbach’s alpha was used for internal consistency, Spearman’s rank correlation coefficient was used for test-retest reliability and Mann–Whitney U test compared groups.

Results: We included 78 Mexican Spanish-speaking participants (COM n?=?37, healthy volunteers n?=?41), 51 females and 27 males, mean age was 39.67 years (SD ± 18.32). Group 1 COMQ-12-Mx score was 22.108?±?11.79, group 2 score was 3.561?±?4.399 (p?≤?.001) and group 3 score was 3.683?±?4.435. Cronbach’s alpha was 0.828 and test-retest reliability achieved a 0.928 outcome.

Conclusions: COMQ-12-Mx is a valid and reliable tool to evaluate quality life in Mexican Spanish-speaking patients with COM.     

Grommets in otitis media: a 25-year follow up

Abstract

Background: This study is unique as it is the first study which can describe the long term sequelae of treatment of otitis media with effusion (OME) with insertion of grommets in the Primary Health Sector in Denmark.

Objectives: Eardrum pathology and hearing acuity 25 years after treatment of OME by insertion of grommets, in a private ear-, nose-, and throat practice.

Material and methods: 262 children with OME were treated from 1975 to 1978. The patients were re-examined by otomicroscopy, tympanometry and pure tone audiometry after 7.5, 12, and 25 years.

Results: Hearing level, flaccida retraction and incudo pexi was equivalent. For atrophy and myringosclerosis no equivalence was shown using 95% confidence intervals. Tympanometry was fairly unchanged.

Conclusion and significance: The insertion of a grommet in treating OME has no influence on hearing acuity in the long term. The prevalence of myringosclerosis and atrophy was unchanged in 70–80% of the eardrums. Most important is that the small increase in myringosclerosis and atrophy does not seem to influence the hearing acuity. We show that long term sequelae from the Primary Health Sector are similar to those from the Secondary Health sector.