Long-term follow-up of children inserted with T-tubes as a primary procedure for otitis media with effusion

This study reviews 90 children who underwent T-tube insertion as a primary procedure for otitis media with effusion over a 3-year period and compares the long-term results with a similar group, matched in terms of age, treated with conventional Shepard gromments during the same period. Fifty-one patients (102 ears) in the T-tube group and 53 patients (106 ears) in the Shepherd grommet group attended for clinical review, a minimum of 6 years post-surgery. No significant difference was found between the two groups in terms of pre-operative symptoms (P= 0.95). operative findings (P= 0.84), hearing loss (P= 0.75), or degree of retraction or tympanosclerosis of the tympanic membrane (P= 0.80). A perforation rate of 24% in the T-tube group, compared with 2% in the Shepard grommet group (P= 0.001) is directly attributable to T-tube insertion. Furthermore, the risk of perforation was related to the duration of the ventilation tube in the typanic membrane.     

Long-term effects of ventilation tubes for persistent otitis media with effusion in children

The otological, auditory and developmental effects of treatment with ventilation tubes were studied in a sample of 7–8-year-old Dutch children screened for otitis media with effusion (OME) serially at preschool age. Children treated with ventilation tubes were matched retrospectively for OME history, sex, and age with children who were not treated surgically. At the age of 7–8, abnormalities of the tympanic membrane were more prevalent in treated than in untreated ears. No significant differences were found in middle ear function and hearing in both groups. Some positive effects of early surgical intervention on specific developmental measures were found.     

Persistent otitis media with effusion: A new experimental model

Objectives/Hypothesis: Numerous mechanical animal models for the creation of otitis media with effusion (OME) have been described since the 1920s. However, there are many problems associated with these models, including high infection rates, unreliability, and high resolution rates. The aim of the current study was to create a suitable mechanical animal model that would produce a sterile and long-lasting effusion. Study Design: A new technique using an external surgical approach on specific pathogen–free rats is described. Method: The eustachian tubes of 56 rats were obstructed in the mid portion along the skull base with gutta percha. Results: All animals developed an effusion within 1 week of the procedure. The resolution rate was 8%, with 80% maintaining sterile effusions for up to 1 year. Conclusions: This new procedure for an OME model has proved consistently reliable in creating a persistent and long-lasting effusion. It has a low infection rate and should benefit future studies on the prolonged effects of OME on the tympanic membrane and middle ear.     

根据鼓室积液物理特性处理伴腺样体肥大的分泌性中耳炎

目的 探讨根据鼓室积液物理特性区别处理伴发于腺样体肥大的分泌性中耳炎临床价值.方法 对2006年1月～2008年1月在我院手术的伴发于腺样体肥大的分泌性中耳炎患者按其鼓室积液物理特性进行区别处理.鼓室积液量多黏稠时,行鼓膜置管术;鼓室积液量少稀薄时,仅行鼓膜穿刺抽液.所有患者同时行腺样体切除术.结果 鼓膜置管组167例...     

分泌性中耳炎患者吸鼻试验检测结果分析

目的 观察分析分泌性中耳炎(otitis media with effusion,OME)患者吸鼻试验结果,探讨咽鼓管闭合功能在OME发病中的作用.方法 选择56例成人OME患者、16例儿童OME患者、66例健康成年人和20例健康儿童做为研究对象,对4组人群采用问卷调查及使用咽鼓管功能综合检查仪进行吸鼻试验检测,并对结果进行统计分析.结果 以外耳道压低于基线10 dapa(含10 dapa)定为吸鼻试验阳性.成人OME组吸鼻试验阳性率为64.86％(对照组为9.09％),儿童OME组吸鼻试验阳性率为70.83％(对照组为38.24％),均明显高于对照组(P值均＜0.05),而成人与儿童OME患者吸鼻试验阳性率差异无统计学意义(X2=0.289,P＞0.05).结论 OME患者吸鼻试验阳性率明显高于健康对照组,提示咽鼓管闭合功能不全参与了OME的发病.     

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.     

Prediction of upper respiratory tract bacteria in acute otitis media

Conclusions. Thorough otomicroscopical examination of the tympanic membrane in acute otitis media (AOM) might distinguish AOM episodes caused by different bacteria. It thus might be a way to select appropriate treatment for each patient without raising the number of dangerous complications. Objectives. The aim of this study was to see if it might be possible to predict the causative bacterium by judging the otomicroscopical appearance of the tympanic membrane in episodes of AOM. Patients and methods. The study was prospective. Patients suffering from non-perforated AOM were included. The tympanic membrane was photographed. A prediction of the causative bacterium was made and tympanocentesis was performed. Effusion from the middle ear and a nasopharyngeal swab were obtained for bacterial culturing. The causative bacteria were categorized into gram-positive (Streptococcus pneumoniae and S. pyogenes) or gram-negative (non-typable Haemophilus influenzae and Moraxella catarrhalis). Results. A total of 82 patients were included in the study. A correct prediction was made in 47/63, a false prediction in 16/63 (kappa 0.48, p<0.001).     

Balance and otitis media with effusion

Dizziness can be caused by a variety of peripheral vestibular, central, and systemic disease processes. Eustachian tube dysfunction with and without middle-ear effusion has been considered one of the most common causes of balance disturbances in young children. Several studies have indicated that during an episode of otitis media the child's balance deteriorates and the child may become clumsy and fall more often. Thus, not only the adverse effect on hearing should be considered in the management of a child with otitis media, but also the child's balance.     

Histopathology of otitis media with effusion

Summary Ultrastructural studies of the middle ear mucosa appear to be of significant value in better understanding the pathology of otitis media with effusion (OME). Our present study was undertaken in order to take advantage of the use of electron microscopy in investigating all areas of the middle ear mucosa. Tissues studied were obtained from the fresh postmortem temporal bones of three patients with OME and terminal head and neck malignancies. In the mucoid type of effusion (cases 1 and 2), goblet cells were seen to proliferate and secretory activity was greatly enhanced. In contrast, there was no evidence of secretory cell proliferation in the serous type of effusion. It was noteworthy that accumulated fluid was not homogeneous in the same ear, as exemplified by case 1, in which both mucoid and serous effusions were present. This occurrence was possibly the result of topographic diversity involving the secretory activity of the middle ear.Presented at the Extraordinary International Symposium on Recent Advances in Otitis Media with Effusion, Kyoto, Japan, 12–15 January 1985     

Efficacy of allergy immunotherapy as a treatment for patients with chronic otitis media with effusion

OBJECTIVE: Controversy persists over the significance of allergy as it might relate to chronic middle-ear disease as no controlled study of the efficacy of allergy immunotherapy has been published. The aim of this study was (1) to evaluate the atopic status of patients with intractable chronic otitis media with effusion or drainage from their middle ear and (2) to determine in this select population the efficacy of specific allergy immunotherapy in preventing or limiting the duration of their chronic middle-ear disease. METHODS: This was a prospective, cohort study of patients cared for in a private community practice. History, examination, audiogram, tympanometry and recurrence of effusion/infection were recorded on 89 patients (52 children <15 years old, 37 adults) referred with (1) effusion found to warrant myringotomy and ventilation tubes, or (2) chronic drainage from a perforation or tube. All were evaluated for allergy by intradermal skin testing according to criteria of the American Academy of Otolaryngic Allergy. A control cohort of 21 patients who refused therapy was included. Intervention consisted of immunotherapy for dust, pollen, and molds. Recurrence or persistence of fluid or drainage following 2-8 years of therapy was compared to the patient's pretreatment status. RESULTS: All 89 OME patients proved to be atopic. Most were allergic to dust (94%), animals (44%) and molds (88%) while 9% were allergic only to seasonal pollens. Associated allergic diseases included asthma (21%) and allergic rhinitis/sinusitis (63%). Otitis was the sole symptom among 37%. Immunotherapy provided complete resolution of effusion or drainage in 85% of 127 ears. CONCLUSION: Intradermal testing proved all 89 patients with intractable middle-ear disease in this study who presented with chronic effusion or chronic draining perforations or tubes to be atopic. Specific allergy immunotherapy significantly improved 5.5% and completely resolved 85% of chronic otitis media with effusion in these ears. None of the controls resolved spontaneously (p<0.001). This supports the hypothesis that in many, otitis media with effusion is an immune mediated allergic disease and suggests that these patients deserve consideration for aggressive evaluation and allergy treatment, as most respond to immunotherapy.     

The diagnostic and prognostic value of eardrum mobility in otitis media with effusion

Diagnostic and prognostic values of eardrum mobility were determined by pneumatic otoscopy in 37 patients (56 ears) having otitis media with effusion (OME). Eardrum mobility was impaired or lost in less than half of the ears (46.4%), while a tympanogram detected 77.8% of OME. In 27 of the 37 patients (42 of the 56 ears), aeration of the middle ear space was examined by CT and demonstrated that the presence or absence of aeration was significantly correlated with the presence or absence of eardrum mobility. In another 38 children (62 ears with OME), effect of antibiotics was correlated with eardrum mobility before treatment, and the improvement rate was found to be significantly higher in ears with positive mobility of eardrum (34.3%) than in ears without eardrum mobility (10.0%). These results indicate that eardrum mobility is a good prognostic indicator of OME rather than its diagnostic indicator alone. Received: 6 May 1998 / Accepted: 13 August 1998     

Intranasal surfactant aerosol therapy for otitis media with effusion

OBJECTIVE: To determine the effect of surfactant alone and with other medications delivered intranasally as a metered dose inhaler (MDI) aerosol on the resolution of experimentally induced otitis media with effusion (OME). BACKGROUND: Eustachian tube dysfunction is a primary factor in the pathogenesis of OME. Intranasal surfactant via MDI has been shown in this laboratory to reduce passive opening pressure of the eustachian tube in normal gerbils and mice. STUDY DESIGN: OME was developed in 35 gerbils by transtympanic injection of 10 microg lipopolysaccharide from Klebsiella pneumoniae. Pretreatment otomicroscopy and tympanometry were performed to exclude pre-existing middle ear disease, and postinfection evaluations were performed on alternate days for a period of 30 days. Five animals received no treatment (control group); four were treated with propellant only (placebo); seven received surfactant alone; eight received surfactant and betamethasone; and six received surfactant with phenylephrine. All medications were sprayed intranasally as an aerosolized MDI and administered daily from postinfection day 2 onward. RESULTS: OME resolved after 16.0 +/- 0.44 days (mean + SD) in controls. There was no difference seen in the placebo or the surfactant with phenylephrine groups. Treatment with surfactant yielded resolution in 10.57 +/- 0.37 days; this was reduced to 8.57 +/- 0.37 days with surfactant plus betamethasone. These differences are statistically significant. There was no recurrence of OME in any group. CONCLUSION: This study demonstrates that using an aerosolized MDI surfactant with and without betamethasone decreases the duration of OME in this in vivo gerbil model.     

Prognostic factors for otitis media with effusion in infants

To determine the prognostic factors for otitis media with effusion (OME) in 1-year-old infants, we studied 240 patients and 366 controls in a case-cohort study. On univariate analysis factors which were associated with OME were family history, older siblings, upper respiratory infections and acute otitis media (AOM). After multivariate analysis, however, only the occurrence of more than four upper respiratory infections and children with older siblings were associated with OME. Thus, upper respiratory infections and older siblings appear to be related to the development of OME.     

儿童分泌性中耳炎危险因素分析

目的 探讨武汉市部分幼儿园儿童分泌性中耳炎的危险因素,并与相关文献分析比较.方法 调查武汉市部分幼儿园3～6岁的儿童,对其进行常规耳鼻咽喉科体检,电耳镜检查鼓膜结合声导抗测试,并问卷调查母亲牛育年龄、生产情况、喂养情况,家庭吸烟史,耳科病史,鼻漏,喷嚏,鼻塞,睡眠打鼾,扁桃体炎发作情况等.结果 144例分泌性中耳炎患儿和288例对照者进行危险因素统计学分析,发现鼻塞(OR=2.60,P=0.002),鼻涕(OR=1.442,P=0.003),硬腭高拱(OR=4.411,P＜0.0001),急性中耳炎病史(OR=1.77,P=0.025)是患病的危险因素.进行多因素同归分析后发现喂养情况(OR=0.746,P=0.047),鼻塞(OR=2.56,P=0.003),硬腭高拱(OR=4.35,P＜0.001),鼻炎(OR=1.397,P=0.098),急性中耳炎病史(OR=1.735,P=0.032)为分泌性中耳炎的影响因素.结论 中耳炎病史是分泌性中耳炎的危险因素.但急性扁桃体炎并不是分泌性中耳炎的危险因素,另外发现母乳喂养是分泌性中耳炎的保护因素.有急性中耳炎病史且经常鼻塞的儿童应定期进行耳鼻咽喉科体检.     

儿童分泌性中耳炎的外科手术干预

目的探讨儿童分泌性中耳炎的手术干预方式，为儿童听力筛查中分泌性中耳炎患儿的干预措施选择提供临床资料。方法总结2004-2008年我院90例儿童分泌性中耳炎接受手术治疗且资料完整者45例（82耳）的年龄特点、听力下降时间、手术方式、手术前后听力状况比较。结果术前平均纯音听阈FrrA（pure-tone threshold average，500Hz，1000Hz，2000Hz，4000Hz听阈均值）从8dBHL-61dBHL，平均（34.8&#177;12.09）dBHL。术后PTA从0dB HL-38dB HL，平均（15.9&#177;7.88）dB HL，3耳术后听闯提高，4耳无改善，75耳听阈降低，占91.5％，平均听阈降低18.9dBHL。手术方式：鼓膜置管术9例，腺样体切除＋鼓膜置管术29例，腺样体切除＋扁桃体切除＋鼓膜置管术7例。结论腺样体切除＋鼓膜置管术是我们治疗儿童分泌性中耳炎的基本术式；扁桃体切除术不作为治疗分泌性中耳炎常规选择；对儿童分泌性中耳炎的术式选择应该个体化。     

分泌性中耳炎临床疗效观察

目的随访分泌性中耳炎患者经单纯鼓膜切开、鼓膜切开冲洗灌药后的恢复情况，探讨有效的治疗方法。方法对2006年1月-2008年12月因分泌性中耳炎住院手术治疗的病人共168例进行随访，实际回应预约随访者40例（67耳）。术后随访时间为6个月-3年，通过手术前后I临床表现、纯音测听、声导抗及鼓膜改善情况评估各组疗效。结果单纯鼓膜切开组与鼓膜切开冲洗灌药组的有效率分别是55.56％和74.19％，两组之间无统计学差异。结论单纯鼓膜切开和鼓膜切开冲洗灌药是治疗分泌性中耳炎的有效方法。