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Biofilm-Forming Bacteria Implicated in Complex Otitis Media in Children in the Post-Heptavalent Pneumococcal Conjugate Vaccine (PCV7) Era. Microorganisms 2023; 11:microorganisms11030545. [PMID: 36985119 PMCID: PMC10056165 DOI: 10.3390/microorganisms11030545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Background: Chronic media with effusion (COME) and recurrent acute otitis media (RAOM) are closely related clinical entities that affect childhood. The aims of the study were to investigate the microbiological profile of otitis-prone children in the post-PCV7 era and, to examine the biofilm-forming ability in association with clinical history and outcome during a two-year post-operative follow-up. Methods: In this prospective study, pathogens from patients with COME and RAOM were isolated and studied in vitro for their biofilm-forming ability. The minimum inhibitory concentrations (MIC) of both the planktonic and the sessile forms were compared. The outcome of the therapeutic method used in each case and patient history were correlated with the pathogens and their ability to form biofilms. Results: Haemophilus influenzae was the leading pathogen (35% in COME and 40% in RAOM), and Streptococcus pneumoniae ranked second (12% in COME and 24% in RAOM). Polymicrobial infections were identified in 5% of COME and 19% of RAOM cases. Of the isolated otopathogens, 94% were positive for biofilm formation. Conclusions: This is the first Greek research studying biofilm formation in complex otitis media-prone children population in the post-PCV7 era. High rates of polymicrobial infections, along with treatment failure in biofilms, may explain the lack of antimicrobial efficacy in otitis-prone children.
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Pasricha A, Mago V, Sarma H, Jayaprakash P, Vathulya M, Chattopadhyay D. Hearing-related problems in children with cleft palate: A single-center cross-sectional study in the sub-Himalayan population. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2023. [DOI: 10.4103/jclpca.jclpca_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Hidaka H, Ito M, Ikeda R, Kamide Y, Kuroki H, Nakano A, Yoshida H, Takahashi H, Iino Y, Harabuchi Y, Kobayashi H. Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan - 2022 update. Auris Nasus Larynx 2022:S0385-8146(22)00232-2. [PMID: 36577619 DOI: 10.1016/j.anl.2022.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Abstract
This is an update of the 2015 Guidelines developed by the Japan Otological Society and Oto-Rhino-Laryngeal Society of Japan defining otitis media with effusion (OME) in children (younger than 12 years old) and describing the disease rate, diagnosis, and method of examination. Recommended therapies that received consensus from the guideline committee were updated in consideration of current therapies used in Japan and based on available evidence. METHOD Regarding the treatment of OME in children, we developed Clinical Questions (CQs) and retrieved documents on each theme, including the definition, disease state, method of diagnosis, and medical treatment. In the previous guidelines, no retrieval expression was used to designate a period of time for literature retrieval. Conversely, a literature search of publications from March 2014 to May 2019 has been added to the JOS 2015 Guidelines. For publication of the CQs, we developed and assigned strengths to recommendations based on the collected evidence. RESULTS OME in children was classified into one group lacking the risk of developing chronic or intractable disease and another group at higher risk (e.g., children with Down syndrome, cleft palate), and recommendations for clinical management, including follow-up, is provided. Information regarding management of children with unilateral OME and intractable cases complicated by adhesive otitis media is also provided. CONCLUSION In clinical management of OME in children, the Japanese Clinical Practice Guidelines recommends management not only of complications of OME itself, such as effusion in the middle ear and pathologic changes in the tympanic membrane, but also pathologic changes in surrounding organs associated with infectious or inflammatory diseases.
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Affiliation(s)
- Hiroshi Hidaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan.
| | - Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Children's Medical Center Tochigi, Jichi Medical University, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head & Neck Surgery, Iwate Medical University, Japan
| | | | | | - Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, Japan
| | - Haruo Yoshida
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Haruo Takahashi
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Tokyo-Kita Medical Center, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, Japan
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Alaraifi AK, Alkhaldi AS, Ababtain IS, Alsaab F. Predictors of Otitis Media with Effusion Recurrence Following Myringotomy. Indian J Otolaryngol Head Neck Surg 2022; 74:4053-4058. [PMID: 36742680 PMCID: PMC9895307 DOI: 10.1007/s12070-021-02817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/08/2021] [Indexed: 02/07/2023] Open
Abstract
Otitis media with effusion (OME) is the most common cause of acquired pediatric hearing loss. The treatment of persistent OME includes myringotomy with or without tube insertion, with a reported recurrence rate of 19.9-40%. This study aims to investigate the recurrence rate of OME and its predictors following myringotomy. A retrospective study that included 345 ears that underwent myringotomy for persistent OME in 179 pediatric patients during 2016-2018. Patients were followed for 36-48 months post myringotomy procedure to detect the recurrence rate. The study sample was divided into two groups based on recurrence status, and the groups were compared using chi-square test and independent T-test. Significant variables (p-value ≤ 0.05) were included in the logistic regression model to determine the predictors of OME recurrence after myringotomy. OME recurrence was detected in 85 ears (24.64%). The OME recurrence rate is higher in patients who underwent myringotomy alone compared to myringotomy with tube insertion (44.1% vs. 22.8%). The insertion of a tympanostomy tube decreases the recurrence rate of OME by 59.9% (OR 0.401; 95% CI 0.162-0.933). The other socio-demographic and clinical characteristics such as age, siblings, daycare attendance, passive smoking, previous acute otitis media, atopy, and adenoidectomy did not significantly influence OME recurrence (p-value > 0.05). The recurrence rate of OME following myringotomy is high. Myringotomy with tube insertion significantly decreases the recurrence rate and the need for further surgeries compared to myringotomy alone. Adenoidectomy and the patient's age have no impact on the recurrence rate of OME.
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Affiliation(s)
- Abdulaziz K. Alaraifi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, 11426 Saudi Arabia
| | - Abdullah S. Alkhaldi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ibrahim S. Ababtain
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fahad Alsaab
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, 11426 Saudi Arabia
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Muacevic A, Adler JR. An Overview of the Tympanostomy Tube. Cureus 2022; 14:e30166. [PMID: 36397911 PMCID: PMC9647717 DOI: 10.7759/cureus.30166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/11/2022] [Indexed: 01/25/2023] Open
Abstract
Otitis media is a disorder of the middle ear, which can occur at any age but is more common among infants and children. The patient usually presents with earaches, impaired hearing, and fever. If antibiotics and decongestants do not suit the patient, a myringotomy can be performed to achieve middle ear aeration. In myringotomy, a slit is created in the tympanic membrane, and fluid is removed with suction. In cases where myringotomy, aspiration, and medical care don't help and the fluid recurs, a tympanostomy tube is inserted to create continuous aeration of the middle ear. A tympanostomy tube is a small tube inserted in the tympanic membrane which helps in the prevention of fluid accumulation in the middle ear. These tubes are temporary and often fall off after the ear heals. Other names for tympanostomy tubes are grommet, myringotomy tube, or pressure equalizing tube. Initially, tympanostomy tubes were made of metal but now fluoroplastic or silicone elastomers are used to make them. The two basic designs of a tympanostomy tube are short-term tube and long-term tube. The choice of a tympanostomy tube depends on factors like age, the period needed for ventilation, socioeconomic status, and the extent of the retracted eardrum. The incidence of occlusion, infection, functional duration, and persistent perforation following extrusion varies between the designs and materials. Every year, many children are affected by recurrent otitis media, which can negatively influence their quality of life and their ability to hear and communicate. With so many children requiring tympanostomy tubes, choosing the appropriate tube is vital to provide optimal treatment and limit complications.
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Abstract
Acute otitis media (AOM) is an acute infection of the middle ear and, depending on the age of the child, the certainty of diagnosis, and the severity of symptoms, should be either observed closely or treated (with high-dose amoxicillin, if not allergic). Host-related risk factors such as age, sex, cleft palate, or genetic predisposition or environmental risk factors such as seasonality, day care attendance, or tobacco smoke exposure may contribute to recurrent AOM (RAOM) episodes. Tympanostomy tubes are recommended in children with RAOM and an abnormal ear examination at the time of the clinic evaluation.
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Affiliation(s)
- Todd Otteson
- Pediatric Otolaryngology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Suite 4500, Cleveland, OH 44106, USA.
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Vorobyeva MP, Karpova EP, Tulupov DA, Naumov OG, Zakharova IN. [Risk factors and clinical features of the course of recurrent acute otitis media in children]. Vestn Otorinolaringol 2022; 87:9-13. [PMID: 35274886 DOI: 10.17116/otorino2022870119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article discusses the problem of recurrent acute otitis media (RAOM) in children. OBJECTIVE To study the risk factors and the clinical course of RAOM in children. MATERIAL AND METHODS 148 children (81 boys and 67 girls) from 1 to 14 years old were examined with a diagnosis of recurrent otitis media. The work was carried out in the ENT departments of Pediatric Clinical Hospital No. 13 named after N.F. Filatov, Pediatric Clinical Hospital named after Z.A. Bashlyaeva. The average age of the children was 4.1±1.5 years. All children underwent a clinical study, a laboratory study on the content of the main metabolite of vitamin D - 25(OH)D3 (25-hydroxyvitamin D, or calcidiol) in blood serum. RESULTS Our clinical examination of children with RAOM allows us to identify the main risk factors for this pathology. Thus, the most significant risk factors for the development of RAOM in children included in the study were: early visits by children to preschool institutions (50.6%), allergic history (39.1%), pathology during pregnancy (28.3%), mixed (38.5%) or artificial (27.7%) feeding in the first year of life, frequent upper respiratory tract diseases (41.2%), burdened heredity in close relatives according to RAOM (33.7%), smoking in the family of one of the parents (65.5%) presence in the family of one more child (34.4%). CONCLUSION It was shown that the absolute number of children (96%) with RAOM is characterized by a reduced level of 25(OH) vitamin D in the blood serum, which can increase the likelihood of developing episodes of acute otitis media in children and requires therapeutic correction.
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Affiliation(s)
- M P Vorobyeva
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - E P Karpova
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - D A Tulupov
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - O G Naumov
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - I N Zakharova
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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Soh HH, Keefe KR, Sambhu M, Baul TD, Karst DB, Levi JR. Factors Affecting Compliance With Myringotomy Tube Follow-up Care. Ann Otol Rhinol Laryngol 2022; 131:1333-1339. [PMID: 35016528 DOI: 10.1177/00034894211072293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Myringotomy and tube insertion is a commonly practiced procedure within pediatric otolaryngology. Though relatively safe, follow-up appointments are critical in preventing further complications and monitoring for improvement. This study sought to evaluate the factors associated with compliance of post-myringotomy follow-up visits in an urban safety-net tertiary care setting. METHODS This study is a retrospective chart review conducted in outpatient otolaryngology clinic at an urban, safety-net, tertiary-care, academic medical center. All patients from ages 0 to 18 who received myringotomy and tube placement between February 3, 2012, to May 30, 2018 at the aforementioned clinic were included. RESULTS A total of 806 patients had myringotomy tubes placed during this period; 190 patients were excluded due to no visits being scheduled within 1 and 6 month visit windows post-operatively, leaving 616 patients included for analysis. Of 616 patients, 574 patients were seen for the 1-month visit, (42 patients did not have follow-up visits within the 1-month window), and 356 patients were examined for the 6-month visit (260 patients did not schedule follow-up visits within the 6-month window). For the 1-month follow-up visits post-procedure, only race/ethnicity type "Other" was associated with lower no-show rates (OR = 0.330, 95% CI: 0.093-0.968). With the 6-month follow-up visits, having private insurance (OR = 0.446, 95% CI: 0.229-0.867) and not having a 1-month visit scheduled (OR = 0.404, 95% CI: 0.174-0.937) predicted lower no-show rates. CONCLUSION No meaningful factors studied were significantly associated with compliance of short-term, 1-month visits post-myringotomy. Compliance of longer-term, 6-month post-operative visits was associated with insurance type and previous visit status.
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Affiliation(s)
- Helen H Soh
- Boston University School of Medicine, Boston, MA, USA
| | - Katherine R Keefe
- Department of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - Madhav Sambhu
- Boston University School of Medicine, Boston, MA, USA
| | - Tithi D Baul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | | | - Jessica R Levi
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
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Schwarz SJ, Brandenburg LS, Weingart JV, Schupp W, Füssinger MA, Pantke CF, Beck RL, Metzger MC. Prevalence of Tympanostomy Tube Placement in Relation to Cleft Width and Type. Laryngoscope 2021; 131:E2764-E2769. [PMID: 34142721 DOI: 10.1002/lary.29602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS The prevalence of tympanostomy tube surgery (TTS) in patients with a cleft deformity was investigated, in relation to cleft width and cleft type. STUDY DESIGN Retrospective review of medical health records. METHODS Retrospective review of medical health records. Seventy-eight patients with non-syndromic cleft deformity of the palate and/or alveolus and lip between 2003 and 2017 were investigated. All available medical documents were analyzed. The study group was divided into subgroups: 1) patients with isolated cleft palate (CP) and patients with a cleft palate with cleft lip and alveolus (CLP). 2) According to Veau's classification (I-IV), further subgroups were defined. Cleft width was measured using plaster cast models. RESULTS TTS was performed in 55% of the patients (n = 43). Considering Veau's classification, TTS was conducted as follows: Veau I 65.2% (n = 15/23), Veau II 55.0% (n = 11/20), Veau III 47.6% (n = 10/21), and Veau IV 50.0% (n = 7/14). Cleft classifications, maxillary arch width, and absolute/relative cleft width had no statistical impact on TTS occurrence. Although no significant correlation could be found, patients in our study group with CP (Veau I and II) underwent TTS more often (60.5%, n = 26/43) than patients with CPL (Veau III and IV; 48.6%, n = 17/35) during a three-year follow-up. CONCLUSION None of the cleft characteristics examined had a significant impact on the proportion of patients who received TTS. Nevertheless, patients with lower Veau classification and CP received tympanostomy tubes more often. Therefore, otolaryngologists and pediatricians treating children with cleft palate should maintain a high level of suspicion for chronic middle ear effusion, even in patients with small clefts. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Steffen Jochen Schwarz
- Department of Oral and Maxillofacial Surgery, Freiburg University Medical Centre of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Freiburg University Medical Centre of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Julia Vera Weingart
- Department of Oral and Maxillofacial Surgery, Freiburg University Medical Centre of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Wiebke Schupp
- Department of Oral and Maxillofacial Surgery, Freiburg University Medical Centre of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Marc Anton Füssinger
- Department of Oral and Maxillofacial Surgery, Freiburg University Medical Centre of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Chiara-Fabienne Pantke
- Department of Oral and Maxillofacial Surgery, Freiburg University Medical Centre of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Rainer Linus Beck
- Department of Otorhinolaryngology, Freiburg University Medical Centre of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Freiburg University Medical Centre of the Albert-Ludwigs-University Freiburg, Freiburg, Germany
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Lourençone LFM, Batistão GT, de Cassia Rillo Dutka J, de Brito R. Management of acquired cholesteatoma in patients with craniofacial anomalies: An institutional experience. Am J Otolaryngol 2020; 41:102591. [PMID: 32634641 DOI: 10.1016/j.amjoto.2020.102591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/04/2020] [Accepted: 05/24/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze the surgical management of cholesteatoma in patients with craniofacial abnormalities, cleft lip/palate by reviewing the institutional experience. The secondary aim was to identify and describe the epidemiological profile of the collected data, and to relate the cleft palate and cholesteatoma. DESIGN AND METHODS This retrospective chart review includes 97 patients with craniofacial abnormalities and acquired cholesteatoma with anatomopathological proven in 118 ears. The following data were collected from the medical records between 1994 and 2018. RESULTS The first surgery performed on 76 of the 118 ears (64.4%) was the wall up mastoidectomy, while 42 of the 118 ears (35.5%) received the wall down technique. During the follow-up period of these patients, which ranged from 2 to 29 years, with an average of 13.4 years (±5.88), 77 wall up (40.3%) and 114 wall down (59.6%) mastoidectomies were performed. This brought the total to 191 mastoidectomy surgeries in 118 ears of 97 patients. Of the wall up mastoidectomies, 65 of the 77 (84.4%) presented with cholesteatoma recurrence. In the wall down mastoidectomies follow up, there were new surgical approaches in 15 of the 114 procedures (13.1%), with 6 patients (5.2%) having anatomopathologically proven cholesteatoma recurrences and 9 (7.8%) having clinical instability for cavity cleaning without identification of disease recurrence. CONCLUSIONS Early approach with wall down/modified techniques guided by specific indication criteria may be more resolute, prevent multiple procedures, and preserve the bone pathway to facilitate possible future hearing rehabilitation in these patients.
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Affiliation(s)
| | | | - Jeniffer de Cassia Rillo Dutka
- Hospital for Rehabilitation of Craniofacial Anomalies and Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Rubens de Brito
- Hospital for Rehabilitation of Craniofacial Anomalies and Bauru School of Dentistry, University of São Paulo, Bauru, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil
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Herzog C, Homøe P, Koch A, Niclasen J, Dammeyer J, Lous J, Kørvel-Hanquist A. Effects of early childhood otitis media and ventilation tubes on psychosocial wellbeing - A prospective cohort study within the Danish National Birth Cohort. Int J Pediatr Otorhinolaryngol 2020; 133:109961. [PMID: 32169775 DOI: 10.1016/j.ijporl.2020.109961] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Otitis Media (OM) is one of the most common infections among children in developed countries and may result in temporary conductive hearing loss (HL) if accompanied by middle ear effusion (MEE). Ventilation tube insertion (VTI) is recommended as treatment for recurrent acute OM or chronic MEE with HL. HL may lead to impaired development of psychosocial skills. However, evidence for the developmental consequences of OM and the effect of VTI is inconsistent. The objectives of this study were to investigate 1) whether OM in early childhood is associated with long-term consequences of psychosocial development and 2) if VTI prevents the possible negative consequences of OM. METHODS This study examined prospectively collected data from 52.877 children registered in the Danish National Birth Cohort (DNBC). Information about previous OM-episodes and VTI was obtained through systematic follow-up interviews at seven years, and The Strength and Difficulties Questionnaire (SDQ) containing questions about psychological wellbeing was completed. Five groups were defined based on OM-exposure and the presence of VTI. Baseline characteristics were analysed, and comparison of mean SDQ-scores for the five exposure groups was conducted. Means were adjusted for à priori defined confounding factors. RESULTS Data from 52,877 children in the DNBC showed an association between OM and poorer SDQ-scores. VTI was associated with an additional increase, i.e. worsening, of the SDQ-score for boys, and only a slight beneficial effect on the girls' outcome. The groups differed in their baseline characteristics in e.g. maternal education, socio-economic status, breastfeeding, and prematurity. CONCLUSION Significant associations between parent-reported OM in early childhood and later psychosocial health difficulties were found. VTI did not resolve this association.
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Affiliation(s)
- C Herzog
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - A Koch
- Center for Infectious Disease Epidemiology, Statens Serum Institute, Copenhagen, Denmark
| | - J Niclasen
- Steno Diabetes Center, Copenhagen, Denmark
| | - J Dammeyer
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - J Lous
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Kørvel-Hanquist
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
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Vallejo-Valdezate LÁ, Bragado A, Hidalgo-Otamendi A, Gil-Carcedo E, Herrero-Calvo D, Fernandez-Cascón S. Diseño, modelado 3D y optimización del comportamiento mecanoacústico de un nuevo tubo de ventilación transtimpánico. REVISTA ORL 2020. [DOI: 10.14201/orl.22759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y Objetivos: En este trabajo mostramos un nuevo tubo de ventilación transtimpánico cuyo diseño pretende solventar los efectos indeseables aparecidos durante la inserción de tubos de ventilación actualmente comercializados; analizamos su comportamiento mecánico en un modelo 3D del oído a fin de optimizar su comportamiento acústico. Métodos: Para el diseño del tubo se empleó un software autoCAD; El comportamiento mecánico se analizó en un modelo computadorizado dinámico 3D del oído humano basado en el método de los elementos finitos (FEM). Resultados: El nuevo tubo de ventilación posee un tamaño y una masa significativamente menores a los actualmente disponibles en el mercado lo que provoca un menor interferencia en la vibración del sistema tímpano-osicular; su diseño facilita que permanezca insertado mientras las condiciones del paciente así lo aconsejen evitando su caída hacia la caja o su precoz extrusión. Conclusiones: Las ventajas teóricas biológicas y acústicas del nuevo tubo desarrollado (con menor masa y cuyo diseño evita las complicaciones de los actuales) puede abrir una nueva posibilidad de tratamiento de la otitis media seromucosa crónica.
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Beyea JA, Cooke B, Rosen E, Nguyen P. Association of tympanostomy tubes with future assistive hearing devices-a population based study. BMC Pediatr 2020; 20:76. [PMID: 32070307 PMCID: PMC7027285 DOI: 10.1186/s12887-020-1977-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ear (tympanostomy) tube (TT) placement is a common ambulatory surgery in children. Despite the commonality of this treatment, the long-term effects are unknown. The objective of this study was to determine the rate of permanent hearing loss, as measured by use of a rehabilitative hearing device. Methods A retrospective comprehensive population-based cohort study was performed, evaluating all hospitals in the Canadian province of Ontario. Three cohorts of children were constructed: TT – at least one ear tube procedure (n = 193,880), No-TT –recurrent visits to a physician for middle ear disease, did not undergo ear tubes (n = 203,283), and Control – an age/sex matched group who had not undergone ear tubes and who didn’t have repeat physician visits for middle ear disease (n = 961,168). The main outcome measures were risk and odds ratio (OR) of rehabilitative hearing devices. Results The TT cohort had a higher risk of obtaining a hearing aid (OR 4.53 vs. No-TT, p < 0.001; OR 10.81 vs. Control, p < 0.001), an FM system (OR 3.84 vs. No-TT, p < 0.001; OR 15.13 vs. Control, p < 0.001), and an implanted bone conduction device (OR 5.08 vs. No-TT, p < 0.001; OR 15.67 vs. Control, p < 0.001). Conclusions An association between ear tube placement and long-term need for a rehabilitative hearing device was found. This association warrants future prospective research in this area.
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Affiliation(s)
- Jason A Beyea
- Department of Otolaryngology, Kingston Health Sciences Centre, Queen's University, Kingston, 144 Brock Street, Kingston, Ontario, K7L 5G2, Canada. .,ICES Adjunct Scientist ICES Queen's, Queen's University School of Medicine, Kingston, 144 Brock Street, Kingston, Ontario, K7L 5G2, Canada.
| | - Bonnie Cooke
- Department of Speech Language Pathology and Audiology, Hotel Dieu Hospital, Kingston, ON, Canada
| | - Emily Rosen
- Department of Speech Language Pathology and Audiology, Hotel Dieu Hospital, Kingston, ON, Canada
| | - Paul Nguyen
- ICES Adjunct Scientist ICES Queen's, Queen's University School of Medicine, Kingston, 144 Brock Street, Kingston, Ontario, K7L 5G2, Canada
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Bacterial Reservoirs in the Middle Ear of Otitis-prone Children Are Associated With Repeat Ventilation Tube Insertion. Pediatr Infect Dis J 2020; 39:91-96. [PMID: 31725550 DOI: 10.1097/inf.0000000000002541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Repeat ventilation tube insertion (VTI) is common in children with recurrent acute otitis media (rAOM). Identifying risk factors associated with repeat surgery will improve clinical management and prevent repeat VTI. METHODS Surgical records were assessed at 8 years following VTI surgery for rAOM in children 6-36 months of age. Children were grouped according to detection of bacterial otopathogen in their middle ear effusion (MEE) at the time of VTI, and outcomes for future otorhinolaryngology surgery compared. RESULTS Age, gender, pneumococcal vaccination status, antibiotic usage, day-care attendance, number of siblings and number of AOM episodes were similar between groups. Of the 63 children who had PCR +ve MEE, 58.7% required repeat VTI compared with 31.4% of the 51 children with no otopathogen detected in their MEE (odds ratio = 3.1, 95% confidence interval [1.4-6.8]; P = 0.004). Nontypeable Haemophilus influenzae (NTHi) was the predominant otopathogen in MEE (79% of all PCR +ve MEE). Respiratory virus detection was not associated with repeat VTI. CONCLUSIONS Presence of bacterial otopathogen, specifically nontypeable H. influenzae, in the middle ear during VTI was a predictor of children at-risk of repeat VTI. Here, we identify a modifiable microbiologic factor for repeat VTI that can be targeted to improve clinical management of rAOM.
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Myringotomy and tube insertion combined with balloon eustachian tuboplasty for the treatment of otitis media with effusion in children. Eur Arch Otorhinolaryngol 2020; 277:1281-1287. [PMID: 32002612 DOI: 10.1007/s00405-020-05828-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to clarify the role and safety of balloon eustachian tuboplasty (BET) in the treatment of otitis media with effusion (OME) in children. METHODS This retrospective study was performed between January 2017 and February 2018. The study covered 25 OME patients treated with BET combined with myringotomy and tube insertion (MTI), designated as the BET group, and 24 OME patients treated with MTI during the same period considered as the controls. In addition, all patients received adenoidectomy if found with adenoid hypertrophy. The air-bone conduction gap (ABG) and curative effect were compared between the two groups. Tubomanometry (TMM) results were recorded preoperatively to confirm existence of eustachian tube dysfunction (ETD). Otologic history and examination results of all patients were carefully recorded before the operation, at 6, 12 and 18 months postoperatively. RESULTS Six months after surgery, ABG difference between the two groups was less than 1 dB HL. At 12 months after the operation, ABG in the BET group was smaller than that in the control group. There was a marked ABG deterioration (from 10.1 to 15.9 dB HL) in the control group compared to that in BET. Statistically significant differences in ABG difference between the two groups were observed 18 months after surgery with cured and total effective rates of BET at 76.1 and 93.5%, respectively. In the control group, these rates were 60.9 and 89.1% respectively. No serious complications and tympanic perforations were found in all subjects. CONCLUSION MTI combined with BET is effective and safe in the treatment of children with OME. Compared to simple MTI, application of BET can effectively extend improvement period and increase cured rate, especially after removal of the ventilation tube. Directly benefit from the ventilation tube, the curative effect was close during the period of tube retention. Considering the sample size and follow-up time of this study, related studies targeting large cohorts are needed in the future to validate the benefits of BET in children with OME.
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Association of Tympanostomy Tubes With Future Risk of Advanced Ear Surgery—A Population Study. Otol Neurotol 2019; 40:478-484. [DOI: 10.1097/mao.0000000000002145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Blanc F, Ayache D, Calmels MN, Deguine O, François M, Leboulanger N, Lescanne E, Marianowski R, Nevoux J, Nicollas R, Tringali S, Tessier N, Franco-Vidal V, Bordure P, Mondain M. Management of otitis media with effusion in children. Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 135:269-273. [PMID: 29759911 DOI: 10.1016/j.anorl.2018.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines concern the management of otitis media with effusion (OME) in children under the age of 12 years. They are based on extensive review of MEDLINE and Cochrane Library publications in English or French from 1996 to 2016 concerning the methods of diagnosis and assessment of otitis media with effusion, as well as the efficacy of tympanostomy tubes and medical and surgical treatments of OME.
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Affiliation(s)
- F Blanc
- Service d'ORL, hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France.
| | - D Ayache
- Service d'ORL, fondation Rothschild, 75019 Paris, France
| | - M N Calmels
- Service d'ORL, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France
| | - O Deguine
- Service d'ORL, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France
| | - M François
- Service d'ORL, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - N Leboulanger
- Service d'ORL, hôpital Necker, AP-HP, 75015 Paris, France
| | - E Lescanne
- Service d'ORL, CHU de Tours, 37000 Tours, France
| | | | - J Nevoux
- Service d'ORL, hôpital Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - R Nicollas
- Service d'ORL pédiatrique, AP-HM La Timone, 13005 Marseille, France
| | - S Tringali
- Service d'ORL, CHU de Lyon, 69003 Lyon, France
| | - N Tessier
- Service d'ORL, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | | | - P Bordure
- Service d'ORL, CHU de Nantes, 44093 Nantes, France
| | - M Mondain
- Service d'ORL, hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France
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Bradner SA, Galaiya D, Raol N, Kaplan DL, Hartnick CJ. Silk Protein Bioresorbable, Drug-Eluting Ear Tubes: Proof-of-Concept. Adv Healthc Mater 2019; 8:e1801409. [PMID: 30624860 PMCID: PMC6433150 DOI: 10.1002/adhm.201801409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/15/2018] [Indexed: 01/29/2023]
Abstract
Otitis media with effusion (OEM) is a common pediatric pathology treated with topical fluoroquinolones (ear drops) and tympanoplasty tube, also referred to as ear tube, implantation for middle ear drainage. Commercially available ear tubes are fabricated using poly (lactic-co-glycolic acid) synthetic materials that are associated with long-complications due to premature extrusion. Resorbable materials have emerged as desirable alternatives to reduce extrusion-related complications, but often limited by fast resorption rates. Therefore, resorbable tubes with long-term functional integrity are required for future clinical translation. In this communication, a proof-of-concept study is reported on a bioresorbable and drug-eluting silk ear tube device. Preliminary in vitro assessments reveal time-dependent drug elution and antimicrobial properties, while maintaining long-term functional integrity in vivo. This report provides evidence of a silk ear tube with potential for future clinical translation and OEM treatment.
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Affiliation(s)
- Sarah A. Bradner
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, United States
| | - Deepa Galaiya
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, United States
| | - Nikhila Raol
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, United States
| | - David L. Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, United States
| | - Chistopher J. Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, United States
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Vanneste P, Page C. Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review. J Otol 2019; 14:33-39. [PMID: 31223299 PMCID: PMC6570640 DOI: 10.1016/j.joto.2019.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 12/20/2022] Open
Abstract
Otitis media with effusion (OME) is a frequent paediatric disorder. The condition is often asymptomatic, and so can easily be missed. However, OME can lead to hearing loss that impairs the child's language and behavioural development. The diagnosis is essentially clinical, and is based on otoscopy and (in some cases) tympanometry. Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected. Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart. Hearing must be evaluated (using an age-appropriate audiometry technique) before and after treatment, so as not to miss another underlying cause of deafness (e.g. perception deafness). Craniofacial dysmorphism, respiratory allergy and gastro-oesophageal reflux all favour the development of OME. Although a certain number of medications (antibiotics, corticoids, antihistamines, mucokinetic agents, and nasal decongestants) can be used to treat OME, they are not reliably effective and rarely provide long-term relief. The benchmark treatment for OME is placement of tympanostomy tubes (TTs) and (in some cases) adjunct adenoidectomy. The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear. In contrast, TTs do not prevent progression towards tympanic atrophy or a retraction pocket. Adenoidectomy enhances the effectiveness of TTs. In children with adenoid hypertrophy, adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy. Children must be followed up until OME has disappeared completely, so that any complications are not missed.
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Affiliation(s)
- Pauline Vanneste
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Hospital, Amiens, France
| | - Cyril Page
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Hospital, Amiens, France
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Werker CL, van den Aardweg MTA, Coenraad S, Mink van der Molen AB, Breugem CC. Internationally adopted children with cleft lip and/or cleft palate: Middle ear findings and hearing during childhood. Int J Pediatr Otorhinolaryngol 2018; 111:47-53. [PMID: 29958613 DOI: 10.1016/j.ijporl.2018.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adopted children with cleft lip and/or cleft palate form a diverse group of patients. Due to increased age at palatal repair, adopted children have a higher risk of velopharyngeal insuffiency and poor speech outcome. Delayed palate repair may also lead to longer lasting Eustachian tube dysfunction. Decreased function of the Eustachian tube causes otitis media with effusion and recurrent acute otitis media, which can lead to other middle ear problems and hearing loss. METHODS One-hundred-and-thirty-two adopted children treated by the Cleft palate team in Wilhelmina Children's Hospital during January 1994 and December 2014 were included. Retrospectively, middle ear findings, the need for ventilation tube insertion and hearing during childhood were assessed. Findings were compared with 132 locally born children with cleft lip and/or cleft palate. RESULTS Adopted children had a mean age of 26.5 months old when they arrived in our country. After the age of two the total number of otitis media with effusion episodes and the need for ventilation tube placement did not significantly differ among adopted and non-adopted children. Adopted children had significantly more tympanic membrane perforations. Hearing threshold levels normalized with increasing age. Although within normal range, adopted children showed significantly higher pure tone averages than locally born children when they were eight to ten years old. CONCLUSION In general, adopted patients with cleft lip and/or cleft palate did not have more middle ear problems or ventilation tubes during childhood. However, theyhave more tympanic membrane perforations.
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Affiliation(s)
- C L Werker
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - M T A van den Aardweg
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - S Coenraad
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - C C Breugem
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
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Cevizci R, Dilci A, Celenk F, Karamert R, Bayazit Y. Surgical considerations and safety of cochlear implantation in otitis media with effusion. Auris Nasus Larynx 2018; 45:417-420. [DOI: 10.1016/j.anl.2017.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
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Simon F, Haggard M, Rosenfeld RM, Jia H, Peer S, Calmels MN, Couloigner V, Teissier N. International consensus (ICON) on management of otitis media with effusion in children. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S33-S39. [PMID: 29398506 DOI: 10.1016/j.anorl.2017.11.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/31/2022]
Abstract
Otitis media with effusion (OME) is a common childhood disease defined as the presence of liquid in the middle ear without signs or symptoms of acute ear infection. Children can be impacted mainly with hearing impairment and/or co-occurring recurrent acute otitis media (AOM) thus requiring treatment. Although many meta-analyses and national guidelines have been issued, management remains difficult to standardize, and use of surgical and medical treatments continue to vary. We convened an international consensus conference as part of the 2017 International Federation of Oto-rhino-laryngological Societies Congress, to identify best practices in OME management. Overall, regional differences were minor and consensual management was obtained on several important issues. At initial assessment, although a thorough medical examination is necessary to seek reflux, allergy or nasal obstruction symptoms; an age-appropriate auditory test is the only assessment required in children without abnormal history. Non-surgical treatments poorly address the underlying problem of an age-dependent dysfunctional Eustachian tube; auto-inflation seems to be the only beneficial, low-risk and low-cost non-surgical therapy. There was a clear international recommendation against using steroids, antibiotics, decongestants or antihistamines to treat OME, because of side-effects, cost issues and no convincing evidence of long-term effectiveness. Decisions to insert tympanostomy ventilation tubes should be based on an auditory test but also take into account the child's context and overall hearing difficulties. Tubes significantly improve hearing and reduce the number of recurrent AOM with effusion while in place. Adjuvant adenoidectomy should be considered in children over four years of age, and in those with significant nasal obstruction or infection.
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Affiliation(s)
- F Simon
- Department of Pediatric Otolaryngology, hôpital Necker-Enfants-Malades, Paris-Descartes University, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - M Haggard
- Department of Psychology, Cambridge University, Downing Street, Cambridge CB2 3EB, United Kingdom
| | - R M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, 450, Clarkson avenue, MSC 126, Brooklyn, NY 11203, United States of America
| | - H Jia
- Department of Otolaryngology, Shanghai Ninth People's Hospital & Shanghai Jiaotong University School of Medicine, 639, Zhizaoju Road, Shanghai 200011, China
| | - S Peer
- Department of Pediatric Otolaryngology, Red Cross War Memorial Children's Hospital, University of Cape Town,, Rondebosch, Cape Town 7700, South Africa
| | - M-N Calmels
- Department of Otolaryngology, Purpan Hospital, Paul-Sabatier-Toulouse-3 University, CHU de Toulouse, 1, place du Dr-Baylac, 31059 Toulouse, France
| | - V Couloigner
- Department of Pediatric Otolaryngology, hôpital Necker-Enfants-Malades, Paris-Descartes University, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - N Teissier
- Department of Pediatric Otolaryngology, hôpital Robert-Debré, Paris-Diderot University, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
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Decisional regret following ventilation tube insertion. Int J Pediatr Otorhinolaryngol 2017; 99:36-39. [PMID: 28688562 DOI: 10.1016/j.ijporl.2017.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to see if parental regret following ventilation tube (VT) insertion was related to non-resolution of ear infections and thus ongoing need for otolaryngological care and VT reinsertion. MATERIALS AND METHODS All consecutive parents presenting with children who had VT in place were given a validated regret survey and asked the reason for their visit. Chart review was used for medical history. RESULTS Two hundred and ten respondents were included. The children involved had a mean age of 5.2 years, 63.3% were male, and mean number of years since first VT insertion was 1.12 with a range of 0.04-9.28 years. 70.5% had a regret score of 0, with mean score 6.98 (95%CI 5.11-8.85). Scores were significantly higher for parents who presented their child with an ear complaint such as otorrhea (15.52, 95%CI 7.67-23.37, p = 0.004). Parents whose children had a history of reflux had significantly lower regret scores than parents whose children did not have a history of reflux (3.33 versus 7.89, p = 0.007). Parental regret was unrelated to patient age, other comorbidities, indication for initial tube insertion, hearing status on the day of inquiry, number of sets of tubes, visits for otorrhea, prescriptions given for eardrops, clinic visits, or length of follow-up. CONCLUSION Transient factors may influence decisional regret at any given time. For parents whose children receive VT, regret is not related to prolonged specialized ear care and need for VT reinsertion.
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Is It Necessary to Treat Otitis Media With Effusion (OME) Prior to Cochlear Implantation? Results Over a Long-term Follow-up. Otol Neurotol 2016; 37:1529-1534. [DOI: 10.1097/mao.0000000000001221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bruce I, Harman N, Williamson P, Tierney S, Callery P, Mohiuddin S, Payne K, Fenwick E, Kirkham J, O'Brien K. The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation. Health Technol Assess 2016; 19:1-374. [PMID: 26321161 DOI: 10.3310/hta19680] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate. OBJECTIVES To identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies. DESIGN The management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP. SETTING The survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients' homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting. PARTICIPANTS Clinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association. RESULTS The clinician survey revealed that care was predominantly delivered via a 'hub-and-spoke' model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research. CONCLUSIONS There exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered. FUNDING The National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.
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Affiliation(s)
- Iain Bruce
- Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children's Hospital, Manchester, UK
| | - Nicola Harman
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
| | - Paula Williamson
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK.,Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephanie Tierney
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Callery
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Syed Mohiuddin
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Jamie Kirkham
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kevin O'Brien
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
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Brennan-Jones CG, Eikelboom RH, Jacques A, Swanepoel D, Atlas MD, Whitehouse AJO, Jamieson SE, Oddy WH. Protective benefit of predominant breastfeeding against otitis media may be limited to early childhood: results from a prospective birth cohort study. Clin Otolaryngol 2016; 42:29-37. [PMID: 27037737 DOI: 10.1111/coa.12652] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the long-term effects of predominant breastfeeding on incidence of otitis media. DESIGN Prospective birth cohort study. SETTING The West Australian Pregnancy Cohort (Raine) Study recruited 2900 mothers through antenatal clinics at the major tertiary obstetric hospital in Perth, Western Australia, between 1989 and 1992. PARTICIPANTS In total, 2237 children participated in a 6-year cohort follow-up, and a subset of 1344 were given ear and hearing assessments. MAIN OUTCOME MEASURES OM diagnosis at 6 years of age (diagnosed by low-compliance tympanograms, 0-0.1 mmho). This was compared to OM diagnosed at the 3-year cohort follow-up using parent-report measures. Main exposure measures were duration of predominant breastfeeding (defined as the age other milk was introduced) and duration of partial (any) breastfeeding (defined as the age breastfeeding was stopped). RESULTS There was a significant, independent association between predominant breastfeeding (OR = 1.33 [1.04, 1.69]; P = 0.02) and OM, and breastfeeding duration (OR = 1.35 [1.08, 1.68]; P = 0.01) with OM at 3 years of age. However, at 6 years of age, this relationship was no longer statistically significant (predominant breastfeeding OR = 0.78 [0.48, 1.06]; P = 0.09; duration of breastfeeding, OR = 1.34 [0.81, 2.23]; P = 0.25). CONCLUSIONS Our findings are in line with a number of epidemiological studies which show a positive association between breastfeeding and OM in early childhood. However, the long-term follow-up of these children revealed that by 6 years of age, there was no significant influence of breastfeeding on presence of OM. These results suggest that the protective effect of predominant breastfeeding for at least 6 months does not extend to school-age children, where other social and environmental factors may be stronger predictors of OM.
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Affiliation(s)
- C G Brennan-Jones
- Ear Science Institute Australia, Subiaco, WA, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Crawley, WA, Australia
| | - R H Eikelboom
- Ear Science Institute Australia, Subiaco, WA, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Crawley, WA, Australia.,Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - A Jacques
- Telethon Kids Institute, The University of Western Australia, Crawley, WA, Australia.,School of Population Health, The University of Western Australia, Crawley, WA, Australia
| | - D Swanepoel
- Ear Science Institute Australia, Subiaco, WA, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Crawley, WA, Australia.,Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - M D Atlas
- Ear Science Institute Australia, Subiaco, WA, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Crawley, WA, Australia
| | - A J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Crawley, WA, Australia
| | - S E Jamieson
- Telethon Kids Institute, The University of Western Australia, Crawley, WA, Australia
| | - W H Oddy
- Telethon Kids Institute, The University of Western Australia, Crawley, WA, Australia
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Subannular tube insertion: anatomical considerations. The Journal of Laryngology & Otology 2015; 130:69-75. [DOI: 10.1017/s0022215115003072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectives:To assess the distance between the bony groove created during subannular tubes placement and the chorda tympani, and examine the depth of the hypotympanum and retrotympanum.Method:Grooves drilled in cadaver temporal bones at two levels were imaged to measure: the distance between the chorda tympani nerve and the tympanic sulcus, and the depth of the hypotympanum and the retrotympanum relative to the annulus.Results:The chorda tympani was between 0 and 5 mm from the groove cut across the annulus. The hypotympanum average depth was 2 mm (0.44–6.40 mm) and the retrotympanum average depth was 1 mm (0–2.53 mm).Conclusion:Grooves drilled across the tympanic sulcus should be placed at a point 20 per cent of the height of the tympanic membrane or lower; this will ensure least risk of injury to the chorda tympani nerve. The depth of the hypotympanum and retrotympanum dictates that the posteroinferior part of a subannular tube flange should be approximately 2 × 1 mm.
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O'Niel MB, Cassidy LD, Link TR, Kerschner JE. Tracking tympanostomy tube outcomes in pediatric patients with otitis media using an electronic database. Int J Pediatr Otorhinolaryngol 2015; 79:1275-8. [PMID: 26115935 DOI: 10.1016/j.ijporl.2015.05.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/27/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To implement and review a database for children with a diagnosis of otitis media (OM) to facilitate comparative outcomes and long-term prospective follow up of surgical outcomes. Specific aim is to review presenting symptoms, risk factors, tympanostomy tube outcomes and complications, and need for further procedures. METHODS A web-based customized database was constructed to universally enroll all patients seen in consultation with a diagnosis of OM. Unique database fields include demographics, physical exam findings, risk factors, intervention, and long-term outcomes. Major surgical complications measured include: tympanic membrane perforation, retained tubes, chronic otorrhea, and cholesteatoma formation. RESULTS Six hundred and thirty four unique patients have been prospectively enrolled. Five hundred and forty four tubes have been followed to extrusion. Outcomes demonstrate high prevalence of OM risk factors associated with surgical patients including: 63% in day care and 26% with a sibling requiring tympanostomy tubes. Complication rates; 1% developed perforations requiring surgical intervention, 2.6% required removal of retained tubes, 1% extruded early (<60 days), and 0.7% were surgically removed for other complications. Cholesteatoma was identified in 0.56%, all had ongoing chronic ear disease. CONCLUSIONS Long-term, outcome driven investigations assessing the surgical management of OM are needed given the prevalence of this disease and the frequency of surgical intervention required. The current database represents the largest prospective cohort of patients enrolled and followed in this fashion and has generated data demonstrating a procedure associated with significant improvement in patient quality of life in the short-term with low complication rates in the long-term. This ongoing prospective investigation is providing data that have the potential to be important in treatment algorithms, procedure justification, and risk factor modification.
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Affiliation(s)
- Mallory B O'Niel
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Laura D Cassidy
- Institute for Health and Society, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - T Roxanne Link
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Joseph E Kerschner
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Mohiuddin S, Payne K, Fenwick E, O'Brien K, Bruce I. A model-based cost-effectiveness analysis of a grommets-led care pathway for children with cleft palate affected by otitis media with effusion. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:573-587. [PMID: 24906214 DOI: 10.1007/s10198-014-0610-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 05/08/2014] [Indexed: 06/03/2023]
Abstract
There is a paucity of evidence to guide the management of otitis media with effusion (OME), which is a common problem causing significant hearing impairment in children with cleft palate. The insertion of grommets is currently being used to correct hearing impairment and prevent complications of unmanaged OME, but there is ongoing discussion about whether the benefits of grommets outweigh the costs and risks. A decision-tree model was developed to assess the surgical insertion of grommets with two non-surgical alternatives (hearing-aids and do-nothing strategies) in cleft palate children with persistent bilateral OME. The model assumed a 2-year time horizon and a UK National Health Service perspective. Outcomes were valued using quality-adjusted life-years (QALYs) estimated by linking utility values with potential hearing gains measured in decibels. Multiple data sources were used, including reviews of the clinical effectiveness, resource use and utility literature, and supplemented with expert opinion. Uncertainty in the model parameters was assessed using probabilistic sensitivity analysis. Expected value of perfect information analysis was used to calculate the potential value of future research. The results from the probabilistic sensitivity analysis indicated that the grommets strategy was associated with an incremental cost-effectiveness ratio of £9,065 per QALY gained compared with the do-nothing strategy, and the hearing-aids strategy was extended dominated by the grommets strategy. The population expected value of perfect information was £5,194,030 at a willingness to pay threshold of £20,000 per QALY, implying that future research could be potentially worthwhile. This study found some evidence that the insertion of grommets to manage cleft palate children with bilateral OME is likely to be cost-effective, but further research is required to inform this treatment choice.
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Affiliation(s)
- Syed Mohiuddin
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, University of Manchester, Manchester, UK,
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30
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Kostić M, Ribarić Jankes K, Trotić R, Ries M, Ledić B, Bedeković V. Clinical and audiological findings in children with acute otitis media. Acta Otolaryngol 2015; 135:645-50. [PMID: 25873182 DOI: 10.3109/00016489.2015.1017887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION It is recommended to perform follow-up tympanometry and if necessary tonal audiometry in children who have normal plain otoscopy findings after recovering from acute otitis media (AOM). Children with Type B tympanogram, 3 months following the onset of AOM, are very likely to have a conductive hearing loss. Type B tympanogram is a much better indicator of effusion in the middle ear compared to plain otoscopy. OBJECTIVE This study was undertaken to investigate the frequency and duration of middle ear effusion in children following an episode of acute otitis media, to track changes in tonal audiometry and tympanometry findings in the post-AOM period, and recognize the optimal timing for performing both tests. METHODS In this study, 125 children aged 5-7 years with bilateral AOM were randomly selected and separately followed up for 3 months. The children underwent six ear, nose, and throat (ENT 1-6) examinations, six tympanometries (TM 1-6), and three tonal audiometries (TA 1-3). Evaluation of nasopharynx was done at the ENT 1 examination. Children who received ventilation tubes were followed for 21 month altogether. RESULTS At the first otoscopy, pathological findings were recorded in 250 ears/125 children (100.0%). The number of pathological otoscopy findings decreased at each subsequent examination. At ENT 6 all children had normal otoscopy findings. Type B tympanogram was detected in 49/250 (19.6%) ears at TM 6, performed 3 months following the onset of the disease. At the TA 1 conductive hearing impairment was recorded in 158/250 (63.2%) ears, at TA 2 in 66/250 (26.4%), and at TA 3 in 39/250 (15.6%). Most of them were associated with Type B tympanogram.
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Affiliation(s)
- Mirjana Kostić
- University of Zagreb, School of Medicine, Croatian Institute for Health Insurance , Zagreb , Croatia
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31
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Lang-Roth R. Hearing impairment and language delay in infants: Diagnostics and genetics. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc05. [PMID: 25587365 PMCID: PMC4273166 DOI: 10.3205/cto000108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This overview study provides information on important phoniatric and audiological aspects of early childhood hearing and language development with the aim of presenting diagnostic and therapeutic approaches. The article first addresses the universal newborn hearing screening that has been implemented in Germany for all infants since January 2009. The process of newborn hearing screening from the maternity ward to confirmation diagnostics is presented in accordance with a decision by the Federal Joint Committee (G-BA). The second topic is pediatric audiology diagnostics. Following confirmation of a permanent early childhood hearing disorder, the search for the cause plays an important role. Hereditary hearing disorders and intrauterine cytomegalovirus (CMV) infection, probably the most common cause of an acquired hearing disorder, are discussed and compared with the most common temporary hearing disorder, otitis media with effusion, which in some cases is severe enough to be relevant for hearing and language development and therefore requires treatment. The third topic covered in this article is speech and language development in the first 3 years of life, which is known today to be crucial for later language development and learning to read and write. There is a short overview and introduction to modern terminology, followed by the abnormalities and diagnostics of early speech and language development. Only some aspects of early hearing and language development are addressed here. Important areas such as the indication for a cochlear implant in the first year of life or because of unilateral deafness are not included due to their complexity.
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Affiliation(s)
- Ruth Lang-Roth
- Department of Otorhinolaryngology, Cologne University Hospital. Köln, Germany
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32
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Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc11. [PMID: 25587371 PMCID: PMC4273172 DOI: 10.3205/cto000114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.
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Affiliation(s)
- Amir Minovi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
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33
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The psychosocial impact of hearing aids in children with otitis media with effusion. The Journal of Laryngology & Otology 2014; 128:972-5. [DOI: 10.1017/s0022215114002163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractBackground:In children, otitis media with effusion is treated using grommets or hearing aids. Parents considering treatment options express concerns regarding the psychosocial impact of hearing aids in terms of self-esteem and bullying. This study assessed the psychosocial impact of hearing aid use.Methods:A cross-sectional study was undertaken comparing hearing aid users to non hearing aid users with regard to their attitudes towards hearing aids. All subjects, who had been diagnosed with otitis media with effusion, were aged less than 16 years, were without disability and attended mainstream schools. A questionnaire was designed and utilised.Results:The study comprised 47 children with hearing aids and 50 with grommets. Significant between-group differences (p < 0.05) were noted with regard to perceptions related to bullying, feelings of inadequacy and embarrassment. The overall negative perceptions of non hearing aid users were not reported by hearing aid users.Conclusion:Children with hearing aids do not suffer from bullying or low self-esteem to the extent perceived by parents. This information is useful for informed decisions regarding treatment of otitis media with effusion.
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Wu S, Li X, Gunawardana M, Maguire K, Guerrero-Given D, Schaudinn C, Wang C, Baum MM, Webster P. Beta- lactam antibiotics stimulate biofilm formation in non-typeable haemophilus influenzae by up-regulating carbohydrate metabolism. PLoS One 2014; 9:e99204. [PMID: 25007395 PMCID: PMC4090067 DOI: 10.1371/journal.pone.0099204] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/12/2014] [Indexed: 12/31/2022] Open
Abstract
Non-typeable Haemophilus influenzae (NTHi) is a common acute otitis media pathogen, with an incidence that is increased by previous antibiotic treatment. NTHi is also an emerging causative agent of other chronic infections in humans, some linked to morbidity, and all of which impose substantial treatment costs. In this study we explore the possibility that antibiotic exposure may stimulate biofilm formation by NTHi bacteria. We discovered that sub-inhibitory concentrations of beta-lactam antibiotic (i.e., amounts that partially inhibit bacterial growth) stimulated the biofilm-forming ability of NTHi strains, an effect that was strain and antibiotic dependent. When exposed to sub-inhibitory concentrations of beta-lactam antibiotics NTHi strains produced tightly packed biofilms with decreased numbers of culturable bacteria but increased biomass. The ratio of protein per unit weight of biofilm decreased as a result of antibiotic exposure. Antibiotic-stimulated biofilms had altered ultrastructure, and genes involved in glycogen production and transporter function were up regulated in response to antibiotic exposure. Down-regulated genes were linked to multiple metabolic processes but not those involved in stress response. Antibiotic-stimulated biofilm bacteria were more resistant to a lethal dose (10 µg/mL) of cefuroxime. Our results suggest that beta-lactam antibiotic exposure may act as a signaling molecule that promotes transformation into the biofilm phenotype. Loss of viable bacteria, increase in biofilm biomass and decreased protein production coupled with a concomitant up-regulation of genes involved with glycogen production might result in a biofilm of sessile, metabolically inactive bacteria sustained by stored glycogen. These biofilms may protect surviving bacteria from subsequent antibiotic challenges, and act as a reservoir of viable bacteria once antibiotic exposure has ended.
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Affiliation(s)
- Siva Wu
- Life Sciences Division, University of California, Berkeley, California, United States of America
| | - Xiaojin Li
- Molecular Diagnostic Laboratory, ApolloGen Inc., Irvine, California, United States of America
| | - Manjula Gunawardana
- Oak Crest Institute of Science, Pasadena, California, United States of America
| | - Kathleen Maguire
- University of California San Diego, San Diego, California, United States of America
| | | | | | - Charles Wang
- Center for Genomics and Division of Microbiology and Molecular Genetics, School of Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Marc M. Baum
- Oak Crest Institute of Science, Pasadena, California, United States of America
| | - Paul Webster
- Oak Crest Institute of Science, Pasadena, California, United States of America
- Center for Electron Microscopy and Microanalysis, University of Southern California, Los Angeles, California, United States of America
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35
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Alswieleh A, Cheng N, Canton I, Ustbas B, Xue X, Ladmiral V, Xia S, Ducker R, El Zubir O, Cartron ML, Hunter CN, Leggett GJ, Armes SP. Zwitterionic poly(amino acid methacrylate) brushes. J Am Chem Soc 2014; 136:9404-13. [PMID: 24884533 PMCID: PMC4195379 DOI: 10.1021/ja503400r] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Indexed: 12/12/2022]
Abstract
A new cysteine-based methacrylic monomer (CysMA) was conveniently synthesized via selective thia-Michael addition of a commercially available methacrylate-acrylate precursor in aqueous solution without recourse to protecting group chemistry. Poly(cysteine methacrylate) (PCysMA) brushes were grown from the surface of silicon wafers by atom-transfer radical polymerization. Brush thicknesses of ca. 27 nm were achieved within 270 min at 20 °C. Each CysMA residue comprises a primary amine and a carboxylic acid. Surface zeta potential and atomic force microscopy (AFM) studies of the pH-responsive PCysMA brushes confirm that they are highly extended either below pH 2 or above pH 9.5, since they possess either cationic or anionic character, respectively. At intermediate pH, PCysMA brushes are zwitterionic. At physiological pH, they exhibit excellent resistance to biofouling and negligible cytotoxicity. PCysMA brushes undergo photodegradation: AFM topographical imaging indicates significant mass loss from the brush layer, while XPS studies confirm that exposure to UV radiation produces surface aldehyde sites that can be subsequently derivatized with amines. UV exposure using a photomask yielded sharp, well-defined micropatterned PCysMA brushes functionalized with aldehyde groups that enable conjugation to green fluorescent protein (GFP). Nanopatterned PCysMA brushes were obtained using interference lithography, and confocal microscopy again confirmed the selective conjugation of GFP. Finally, PCysMA undergoes complex base-catalyzed degradation in alkaline solution, leading to the elimination of several small molecules. However, good long-term chemical stability was observed when PCysMA brushes were immersed in aqueous solution at physiological pH.
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Affiliation(s)
- Abdullah
M. Alswieleh
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
| | - Nan Cheng
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
| | - Irene Canton
- Department
of Biomedical Science, The University of
Sheffield, Western Bank, Sheffield S10 2TN, United Kingdom
| | - Burcin Ustbas
- Department
of Biomedical Science, The University of
Sheffield, Western Bank, Sheffield S10 2TN, United Kingdom
| | - Xuan Xue
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
| | - Vincent Ladmiral
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
| | - Sijing Xia
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
| | - Robert
E. Ducker
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
| | - Osama El Zubir
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
| | - Michael L. Cartron
- Department
of Molecular Biology and Biotechnology, University of Sheffield, Western Bank, Sheffield S10 2TN, United Kingdom
| | - C. Neil Hunter
- Department
of Molecular Biology and Biotechnology, University of Sheffield, Western Bank, Sheffield S10 2TN, United Kingdom
| | - Graham J. Leggett
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
| | - Steven P. Armes
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, United
Kingdom
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Mohiuddin S, Schilder A, Bruce I. Economic evaluation of surgical insertion of ventilation tubes for the management of persistent bilateral otitis media with effusion in children. BMC Health Serv Res 2014; 14:253. [PMID: 24927784 PMCID: PMC4112653 DOI: 10.1186/1472-6963-14-253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 06/10/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The surgical insertion of Ventilation Tubes (VTs) for the management of persistent bilateral Otitis Media with Effusion (OME) in children remains a contentious issue due to the varying opinions regarding the risks and benefits of this procedure. The aim of this study was to evaluate the economic impact of VTs insertion for the management of persistent bilateral OME in children, providing an additional perspective on the management of one of the commonest medical conditions of childhood. METHODS A decision-tree model was constructed to assess the cost-effectiveness of VTs strategy compared with the Hearing Aids (HAs) alone and HAs plus VTs strategies. The model used data from published sources, and assumed a 2-year time horizon and UK NHS perspective for costs. Outcomes were computed as Quality-Adjusted Life-Years (QALYs) by attaching a utility value to the total potential gains in Hearing Level in decibels (dBHL) over 12 and 24 months. Modelling uncertainty in the specification of decision-tree probabilities and QALYs was performed through Monte Carlo simulation. Expected Value of Perfect Information (EVPI) and partial EVPI (EVPPI) analyses were conducted to estimate the potential value of future research and uncertainty associated with the key parameters. RESULTS The VTs strategy was more effective and less costly when compared with the HAs plus VTs strategy, while the incremental cost-effectiveness ratio for the VTs strategy compared with the HAs strategy was £ 5,086 per QALY gained. At the willingness-to-pay threshold of £ 20,000 per QALY, the probability that the VTs strategy is likely to be more cost-effective was 0.58. The EVPI value at population level of around £ 9.5 million at the willingness-to-pay threshold of £ 20,000 indicated that future research in this area is potentially worthwhile, while the EVPPI analysis indicated considerable uncertainty surrounding the parameters used for computing the QALYs for which more precise estimates would be most valuable. CONCLUSIONS The VTs strategy is a cost-effective option when compared with the HAs alone and HAs plus VTs strategies, but the need for additional information from future study is evident to inform this surgical treatment choice. Future studies of surgical and non-surgical treatment of OME in childhood should evaluate the economic impact of pertinent interventions to provide greater context.
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Affiliation(s)
- Syed Mohiuddin
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Anne Schilder
- UCL Ear, Nose and Throat Clinical Trials Programme, University College London, Gower Street, London WC1E 6BT, UK
| | - Iain Bruce
- Paediatric ENT Department, Royal Manchester Children’s Hospital, Manchester M13 9WL, UK
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Vincenti V, Marra F, Bertoldi B, Tonni D, Saccardi MS, Bacciu S, Pasanisi E. Acquired middle ear cholesteatoma in children with cleft palate: experience from 18 surgical cases. Int J Pediatr Otorhinolaryngol 2014; 78:918-22. [PMID: 24690221 DOI: 10.1016/j.ijporl.2014.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To review an institutional experience with the surgical management of middle ear cholesteatoma in children with cleft palate. MATERIALS AND METHODS We analyzed retrospectively 18 children diagnosed with cleft palate who underwent surgery for acquired middle ear cholesteatoma between 2000 and 2007. The following data were recorded: age, sex, history of ventilation tube insertion, status of the contralateral ear, cholesteatoma location and extension, and surgical technique involved. Cholesteatoma recidivism, stable mastoid cavity and hearing levels were the main outcomes measured. RESULTS Follow-up ranged from 5 to 12 years (mean 8 years). Twelve children underwent planned staged canal wall up mastoidectomy: a residual cholesteatoma was found and removed during the second-look procedure in 2 ears (16.6%); two children (16.6%) showed a recurrent cholesteatoma and required conversion to canal wall down mastoidectomy. A modified Bondy technique was chosen in two children with an epitympanic cholesteatoma with an intact tympano-ossicular system, while in the remaining four subjects a canal wall down mastoidectomy was performed because of an irreparable erosion of the postero-superior canal wall: no cases of recurrent cholesteatoma were observed in these 6 children; revision mastoidectomy was needed in one patient for cavity granulation. A postoperative air-bone gap result of 0-20dB was achieved in 11 children (61.1%); in 5 cases (27.7%) postoperative air-bone gap was between 21 and 30dB, while in 2 (11.1%) was >30dB. Bone conduction thresholds remained unaffected in all cases. CONCLUSIONS Our results indicate that most cleft palate children with cholesteatoma can be managed with a canal wall up mastoidectomy with low complication rates. In extensive disease with large erosion of the canal wall as well in presence of a retraction pocket in the contralateral ear, a canal wall down mastoidectomy should be considered. In epitympanic cholesteatomas with an intact tympano-ossicular system and mesotympanum free of disease, the modified Bondy procedure is an effective surgical option. As in the general pediatric population, improvement or preservation of hearing can be obtained in most patients.
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Affiliation(s)
- Vincenzo Vincenti
- Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Italy.
| | - Francesca Marra
- Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Italy
| | - Barbara Bertoldi
- Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Italy
| | - Daniela Tonni
- Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Italy
| | - Maria Silvia Saccardi
- Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Italy
| | - Salvatore Bacciu
- Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Italy
| | - Enrico Pasanisi
- Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Italy
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Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M. Update on otitis media - prevention and treatment. Infect Drug Resist 2014; 7:15-24. [PMID: 24453496 PMCID: PMC3894142 DOI: 10.2147/idr.s39637] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Acute otitis media and otitis media with effusion are common childhood disorders, a source of significant morbidity, and a leading cause of antibiotic prescription in primary health care. Although effective treatments are available, some shortcomings remain, and thus better treatments would be welcome. Recent discoveries within the field of otitis media research relating to its etiology and pathogenesis have led to further investigation aimed at developing novel treatments. This article provides a review of the latest evidence relating to the understanding of acute otitis media and otitis media with effusion, current treatment strategies, their limitations, new areas of research, and novel strategies for treatment.
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Affiliation(s)
- Ali Qureishi
- Otolaryngology Head and Neck Surgery, Northampton General Hospital, Northampton, UK
| | - Yan Lee
- NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, UK
| | | | - John P Birchall
- Otorhinolaryngology Head and Neck Surgery, The University of Nottingham, Nottingham, UK
| | - Matija Daniel
- NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, UK
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Spilsbury K, Ha JF, Semmens JB, Lannigan F. Cholesteatoma in cleft lip and palate: a population-based follow-up study of children after ventilation tubes. Laryngoscope 2013; 123:2024-9. [PMID: 23737350 DOI: 10.1002/lary.23753] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/24/2012] [Accepted: 09/03/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the association of cleft conditions and the development of secondary cholesteatoma following middle ear ventilation tube insertion (MEVTI) in children. STUDY DESIGN A retrospective cohort study of all children born after 1980 who underwent at least one MEVTI in a Western Australian hospital from 1980 to 2009 using administrative health data. METHODS The timing and number of MEVTIs, adenoidectomy, type of cleft conditions and cholesteatoma were identified along with demographic variables. Flexible parametric proportional hazards models and hazard functions using age as a time scale were used to estimate the relative rate of developing cholesteatoma. RESULTS There were 56,949 children who underwent at least one MEVTI during the study period. There were 869 (1.5%) children who also had a diagnosis of a cleft condition. Overall, 594 (1.0%) children developed a secondary cholesteatoma. After taking length of follow-up into account, 6.9% (95% confidence interval [CI], 5.0-9.6) of children with cleft conditions developed cholesteatoma by 18 years of age compared to 1.5% (95% CI, 1.3-1.6) of children without cleft conditions. After adjusting for demographic and clinical variables, children with cleft conditions developed cholesteatoma 7.5 (95% CI, 3.8-18.2) times faster after first MEVTI compared to children without cleft conditions, although by the third MEVTI this difference was no longer statistically significant (P = .257). The rate of developing cholesteatoma in 2005 to 2009 was 0.5 (95% CI, 0.3-0.8) times that of 1980 to 1990. CONCLUSIONS Children with cleft conditions are at increased risk of developing cholesteatoma compared to other children who had one or two MEVTIs, although the overall rate of cholesteatoma is declining.
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Affiliation(s)
- Katrina Spilsbury
- Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.
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Should homeopathy be considered as part of a treatment strategy for otitis media with effusion in children? HOMEOPATHY 2013; 102:145-50. [DOI: 10.1016/j.homp.2013.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/27/2013] [Accepted: 01/31/2013] [Indexed: 11/21/2022]
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Zhang Q, Banks C, Choroomi S, Kertesz T. A novel technique of otic barotrauma management using modified intravenous cannulae. Eur Arch Otorhinolaryngol 2012. [PMID: 23208527 DOI: 10.1007/s00405-012-2301-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article provides the first detailed description and systematic evaluation of the management of otic barotrauma using modified intravenous cannulae. A 24-gauge IC cannula was modified as a tool for tympanostomy tube placement and middle ear ventilation. The medical records of 271 ears of 156 adult patients (median age 49 years) who underwent this procedure were reviewed retrospectively. Hundred and ninty-one tubes were placed for otalgia because of hyperbaric oxygen therapy, 58 tubes were inserted for air travel prophylaxis and 22 tubes were placed for management of otic barotrauma post-flight. All the patients who had this procedure for prophylaxis experienced regular otic barotrauma symptoms during air travel prior to tube placement. All patients were reviewed 6 weeks (range 2-9 weeks) post-procedure. This technique of otic barotrauma management worked effectively in 99 % of treated patients. On follow-up, 88 % of tubes were found to be extruded and non-extruded tubes were removed in clinic without any anaesthesia. 99.6 % of tympanic membrane had healed completely and spontaneously without sequelae. Given the safety, effectiveness, low risk of complications associated with this novel tympanostomy technique, it provided a simple yet effective therapeutic option for the management of otic barotrauma. Finally, this technique can be easily applied in all health settings as it only requires medical supplies readily available in hospitals, therefore there is no additional cost.
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Affiliation(s)
- Qi Zhang
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales Hospital, Sydney, NSW 2031, Australia.
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Lautermann J, Begall K, Hilger G, Wilhelm T, Mir-Salim P, Kaschke O, Zahnert T. [Guideline "Otitis media with effusion" - long version. S1 Guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery]. HNO 2012; 60:540-3. [PMID: 22669440 DOI: 10.1007/s00106-012-2512-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Lautermann
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Krankenhaus Martha-Maria Halle-Dölau gGmbH, Röntgenstr. 1, 06120, Halle/Saale, Deutschland.
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Bakaletz LO. Bacterial biofilms in the upper airway - evidence for role in pathology and implications for treatment of otitis media. Paediatr Respir Rev 2012; 13:154-9. [PMID: 22726871 PMCID: PMC3509202 DOI: 10.1016/j.prrv.2012.03.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Understanding the nature of the biofilm component in the pathogenesis of otitis media [OM] will likely have a meaningful influence on the development of novel strategies to prevent and/or treat this highly prevalent pediatric disease. The design of vaccine candidates for OM that currently focus on preventing colonization are predicated on the assumption that by reducing the burden of bacteria present in the pediatric nasopharynx, one could reduce or eliminate the likelihood of retrograde ascension of the Eustachian tube by bacteria from the nasopharynx to the middle ear. If effective, this strategy could prevent biofilms from ever forming in the middle ear. Additionally, gaining an improved understanding of the unique properties of bacteria resident within a biofilm and the proteins they express while growing as part of this organized community has the potential to identify novel and perhaps biofilm-specific molecular targets for the design of either therapeutic agents or vaccine candidates for the resolution of existing OM.
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Affiliation(s)
- Lauren O. Bakaletz
- Correspondence info: Lauren O. Bakaletz, Ph.D., Director, Center for Microbial Pathogenesis, The Research Institute at Nationwide Children’s Hospital, 700 Children's Drive, W591, Columbus, OH 43205, Phone: (614)722-2915 Fax: (614)722-2818,
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A review of hearing loss in cleft palate patients. Int J Otolaryngol 2012; 2012:548698. [PMID: 22518157 PMCID: PMC3299272 DOI: 10.1155/2012/548698] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/24/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Cleft palate is associated with recurrent otitis media with effusion and hearing loss. This study analysed the way these patients' hearing is managed in Alder Hey Children's Hospital. Method. A retrospective audit was carried out on cleft palate patients in Alder Hey Children's Hospital. Audiology assessment and treatment options were reviewed. Comparisons were made between the use of ventilation tubes (VTs) and hearing aids (HAs). The types of cleft, types of hearing loss, and the management output of the audiology regions were also reviewed. Results. The audiology assessments of 254 patients were examined. The incidence of VT insertion in this group of patients was 18.9%. The hearing aid incidence rate was 10.1%. The VT-related complication rate was 25.5% and the HA related complication rate was 9.1%. Conclusion. The data demonstrates that both treatments are viable, and a new protocol which combines the short term benefit of VT insertion with the lower complication rate of HA is required.
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Velepic M, Starcevic R, Bonifacic M, Ticac R, Kujundzic M, Udovic DS, Manestar D, Malvic G, Zubovic S, Velepic M. The clinical status of the eardrum: an inclusion criterion for the treatment of chronic secretory otitis media in children. Int J Pediatr Otorhinolaryngol 2011; 75:686-90. [PMID: 21397957 DOI: 10.1016/j.ijporl.2011.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/13/2011] [Accepted: 02/15/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion. METHODS 161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum. RESULTS The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes (z=1.565; p=0.0587). There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz (t=2.173; p=0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower. Sequelae: scars of the eardrum (chi-square=28.107; ss=1; p<0.001) and attic retractions (chi-square=4.592; ss=1; p=0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on. CONCLUSION A criterion that could influence the approach to the therapy of CSOM in children.
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Affiliation(s)
- Marko Velepic
- Clinic of Otorhinolaryngology Head and Neck Surgery, Clinical Medical Center University of Rijeka, Croatia
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Heslop A, Lildholdt T, Gammelgaard N, Ovesen T. Topical ciprofloxacin is superior to topical saline and systemic antibiotics in the treatment of tympanostomy tube otorrhea in children: The results of a randomized clinical trial. Laryngoscope 2010; 120:2516-20. [DOI: 10.1002/lary.21015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Verhaegh SJC, Snippe ML, Levy F, Verbrugh HA, Jaddoe VWV, Hofman A, Moll HA, van Belkum A, Hays JP. Colonization of healthy children by Moraxella catarrhalis is characterized by genotype heterogeneity, virulence gene diversity and co-colonization with Haemophilus influenzae. MICROBIOLOGY-SGM 2010; 157:169-178. [PMID: 20847012 DOI: 10.1099/mic.0.042929-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The colonization dynamics of Moraxella catarrhalis were studied in a population comprising 1079 healthy children living in Rotterdam, The Netherlands (the Generation R Focus cohort). A total of 2751 nasal swabs were obtained during four clinic visits timed to take place at 1.5, 6, 14 and 24 months of age, yielding a total of 709 M. catarrhalis and 621 Haemophilus influenzae isolates. Between January 2004 and December 2006, approximate but regular 6-monthly cycles of colonization were observed, with peak colonization incidences occurring in the autumn/winter for M. catarrhalis, and winter/spring for H. influenzae. Co-colonization was significantly more likely than single-species colonization with either M. catarrhalis or H. influenzae, with genotypic analysis revealing no clonality for co-colonizing or single colonizers of either bacterial species. This finding is especially relevant considering the recent discovery of the importance of H. influenzae-M. catarrhalis quorum sensing in biofilm formation and host clearance. Bacterial genotype heterogeneity was maintained over the 3-year period of the study, even within this relatively localized geographical region, and there was no association of genotypes with either season or year of isolation. Furthermore, chronological and genotypic diversity in three immunologically important M. catarrhalis virulence genes (uspA1, uspA2 and hag/mid) was also observed. This study indicates that genotypic variation is a key factor contributing to the success of M. catarrhalis colonization of healthy children in the first years of life. Furthermore, variation in immunologically relevant virulence genes within colonizing populations, and even within genotypically identical M. catarrhalis isolates, may be a result of immune evasion by this pathogen. Finally, the factors facilitating M. catarrhalis and H. influenzae co-colonization need to be further investigated.
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Affiliation(s)
- Suzanne J C Verhaegh
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Martine L Snippe
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Foster Levy
- Department of Biological Sciences, East Tennessee State University, Johnson City, TN, USA
| | - Henri A Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Alex van Belkum
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - John P Hays
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
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Popova D, Varbanova S, Popov TM. Comparison between myringotomy and tympanostomy tubes in combination with adenoidectomy in 3-7-year-old children with otitis media with effusion. Int J Pediatr Otorhinolaryngol 2010; 74:777-80. [PMID: 20399511 DOI: 10.1016/j.ijporl.2010.03.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 03/21/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
The specific aim of this study was to compare, by means of a randomized clinical trial, the efficacy between the two surgical combinations - adenoidectomy with myringotomy and tympanostomy (A+T) and adenoidectomy with myringotomy (A+M) - in reducing middle ear disease in children with otitis media with effusion (OME). Seventy-eight 3-7-year-old patients (156 ears) with a history of bilateral middle ear effusion for at least 3 months were randomly assigned to either A+T or A+M. Hearing threshold levels, recurrence rate of the effusion and episodes of acute otitis media (AOM) and otorrhea were evaluated for a follow-up period of 1 year. Audiometry testing showed that there was no statistically significant difference in the hearing loss levels of both groups during the whole follow-up period. Free of AOM episodes were 72% of the patients in the A+T group and 75% of those in the A+M group. None of the patients with A+M had episodes with otorrhea which contrasted with the 40% occurrence rate in the A+T group. During the follow-up period we documented a 10% recurrence rate of OME in the A+T group and 14% recurrence rate in the A+M group. Overall our data suggests that the insertion of tympanostomy tubes in association with adenoidectomy provides no additional benefit to adenoidectomy in association with myringotomy alone in terms of hearing loss or AOM episode occurrences in patients with bilateral otitis media with effusion. Furthermore no relationship was found between the choice of operative intervention and the recurrence rate of OME despite the slightly greater relative risk in the A+M group.
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Affiliation(s)
- D Popova
- Department of ENT, Medical University Sofia, Sofia, Bulgaria.
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Grevers G. Challenges in reducing the burden of otitis media disease: an ENT perspective on improving management and prospects for prevention. Int J Pediatr Otorhinolaryngol 2010; 74:572-7. [PMID: 20409595 DOI: 10.1016/j.ijporl.2010.03.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 03/22/2010] [Accepted: 03/23/2010] [Indexed: 11/25/2022]
Abstract
Acute otitis media (AOM) is a major public health concern. This frequent disease of childhood is a leading cause of physician visits, a major component of paediatric healthcare burden, and a key contributor to antibiotic resistance. An international expert group comprising mainly ear, nose, and throat physicians met in June 2008 to discuss the optimal management of AOM, particularly with regards to unmet needs in diagnosis and management. Current guidelines do not help identify which patients are most at risk for severe or complicated AOM. Diagnosis of AOM is also complicated by a lack of correlation between clinical signs and symptoms and responsible pathogens. Consequently, treatment of AOM is not always appropriate, and the long-term overuse of antibiotics in AOM reduces the effectiveness of treatment and places children at risk for drug-resistant infections. There is a need for educational and research initiatives to improve diagnostic accuracy and management of AOM. Because there is currently no ideal treatment, vaccination is an attractive additional approach for managing AOM and reducing its burden.
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Yaman H, Guclu E, Yilmaz S, Ozturk O. Myringosclerosis after tympanostomy tube insertion: relation with tube retention time and gender. Auris Nasus Larynx 2010; 37:676-9. [PMID: 20392579 DOI: 10.1016/j.anl.2010.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 01/25/2010] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine relationship between myringosclerosis and tube retention time and sex in children with chronic otitis media with effusion who were treated with tympanostomy tube insertion. Also, the relationship between myringosclerosis both sex and initial age of tube insertion were investigated. METHODS A total of 101 children (195 ears) were reviewed. Ears were divided into four groups according to retention time of tympanostomy tubes. Group I: Retention time of tympanostomy tube less than 6 months. Group II: Retention time of tympanostomy tube from 6 months to 12 months. Group III: Retention time of tympanostomy tube of 12 months or more. Group IV: Myringotomy group without tympanostomy tube insertion. RESULTS The order of the myringosclerosis rates were as follows from the highest to lowest one; group III (44.1%), group II (42.4%), group I (14.3%), and group IV (7.7%). Myringosclerosis was more common in group I compared with group IV, but the difference was statistically not significant (p>0.05). There were no statistically significant differences in myringosclerosis rates between the group II and group III (p>0.05). On the other hand, statistically significant differences were observed in myringosclerosis rates between group I and group II (p<0.05), and between group I and group III (p<0.05); also similar significant differences were present in myringosclerosis rates between group IV and group II (p<0.05), and between group IV and group III (p<0.05). There was no significant difference between preschool age group and school age group. Myringosclerosis was observed in 40% of boys and in 51.2% of girls. CONCLUSION Myringosclerosis is frequent in patients who underwent tympanostomy tube insertion. The frequency of myringosclerosis is much higher in tympanic membranes with tympanostomy tube insertion than tympanic membranes with myringotomy, and the location of sclerotic plaques does not always correspond to the tympanostomy area. The myringosclerosis rate was increased when the tympanostomy tubes stay on tympanic membrane for a long time. Highest myringosclerosis rates were observed if the extrusion time was 12 months or longer. In our analysis, sex and initial age of tube insertion were not significant factors for the development of myringosclerosis after extrusion of tympanostomy tubes.
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Affiliation(s)
- Huseyin Yaman
- Duzce University, Duzce Medical Faculty, Department of Otorhinolaryngology, Turkey.
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