International consensus (ICON) on management of otitis media with effusion in children

Otitis Media With Effusion (OME) and Eustachian Tube Dysfunction: The Role of Allergy and Immunity-An EAACI Position Paper

IgE-mediated allergies play a significant role in respiratory diseases. Given the similar mucosal epithelium of the upper and lower respiratory tracts and their shared (patho)physiological immune responses, the "unified airways" concept views these tracts as a single system. Recently, this model has been extended to include the middle ear, with studies confirming that the Eustachian tube and middle ear are both anatomically and functionally part of the upper airways. However, the relationship between allergies and middle ear disorders remains controversial, with conflicting findings regarding pathogenesis and treatment. The increasing prevalence of allergies highlights the importance of further research. In Germany, the current sensitization rate to aeroallergens is 33.6%, with similar trends across Europe, where rates commonly range up to 30%. This widespread increase underscores the urgent need for a deeper understanding of the correlation between allergies and middle ear disorders across diverse European populations. Ineffective pharmacotherapy or possibly harmful medication for acute and chronic OME, such as systemic steroids, is most likely used globally in an uninformed way, due to a lack of evidence on the connection between allergic inflammation and eustachian tube dysfunction. Further research is essential to clarify the mechanisms linking IgE-mediated allergies to middle ear pathologies and to develop effective treatment strategies. Addressing these knowledge gaps is critical for improving patient outcomes and managing the rising burden of allergic diseases.

A novel approach to the follow up of children with otitis media with effusion: wideband absorbance findings

PURPOSE

Otitis media with effusion (OME) is one of the most common childhood diseases. It is recommended to use tympanometry in addition to otoscopy and/or pneumatic otoscopy for the diagnosis and follow-up of OME. Clinitians are using Wideband absorbance (WBA), which is one of the methods of evaluating the middle ear in the diagnosis of OME, more widely.

METHODS

The relationship between the changes in the examination findings obtained by otoscopy and pneumatic otoscopy and the findings of WBA in the monthly follow-ups performed during the three-month period of children diagnosed with OME, was examined. In the study, 48 ears of 26 individuals aged 24-71 month who were diagnosed with OME were evaluated. Otoscopy, pneumatic otoscopy, 226 Hz tympanometry and WBA measurements were performed at the initial, first, second and third month examinations. The relationship between the difference between consecutive measurements was examined because it was thought that consecutive measurements might be more significant in the relationship between measurements. The Spearman test was used to determine whether there was a relationship between WBA and otoscopic and pneumatic otoscopic examination results. For assessing parameters where there was a significant difference between the groups compared, the variables were assessed using Kruskal-Wallis analysis of variance. The Dunn test was used for post hoc testing.

RESULTS

The change observed with both otoscopy and pneumatic otoscopy between the initial and first month control could not be adequately determined by 226 Hz tympanometry, but the change in the amount absorbance at 2520 Hz and 3175 Hz was moderately correlated with the examination findings. However, it was observed that the change between the first and the second follow-up examinations was significant at the frequency range of 226-630 Hz in WBA and the change between the second and third months was significant at the frequency range of 226-4000 Hz in WBA.

CONCLUSIONS

The findings obtained in the study show that, 226 Hz tympanometry may be insufficient to reflect the change in examination findings while WBA can provide more detailed information to support the examination findings during the follow-up period as well as the diagnosis of OME.

Increased Incidence of Surgical Intervention for Otitis Media With Effusion Among Patients With Type 2 Inflammatory Diseases

BACKGROUND

Otitis media with effusion (OME) is associated with comorbidities such as allergic rhinitis, gastroesophageal reflux disease, asthma, and more. Many of these comorbidities can be caused by type 2 inflammation (T2I). This study aims to determine the risk of undergoing OME surgery in patients with and without T2I disease.

OBJECTIVE

To determine whether T2I disease is associated with an increased incidence of OME surgery.

METHODS

This retrospective, matched-cohort study involved the retrospective recruitment of patients with T2I disease (n = 31,603) and non-T2I disease (n = 31,603) from 2010 to 2019, using the Taiwan National Health Insurance Research Database. Statistical analyses were performed using t tests, Cox proportional regression models, Kaplan-Meier estimators, and log-rank tests.

RESULTS

Among patients with OME, those with T2I disease had a greater risk of undergoing OME surgery, with an adjusted hazard ratio of 9.84 (95% confidence interval [CI], 8.90-10.88), than those without T2I disease. The adjusted relative risk for the number of OME surgeries in patients with T2I disease was 11.14 (95% CI, 10.30-12.05). Kaplan-Meier analysis showed consistently higher cumulative incidence curves in patients with T2I disease throughout the follow-up period (log-rank test: P < .001).

CONCLUSIONS

OME patients with T2I disease had a significantly higher incidence of undergoing surgery due to failed conservative treatment, indicating that T2I may play an important role in middle ear disorders. Further research on this topic should be considered significant and worthy of investigation.

Modifiable risk factors for developing otitis media with effusion in children under 12 years in high-income countries: a systematic review

OBJECTIVE

To systematically assess the modifiable risk factors for developing otitis media with effusion (OME) in children under 12 years.

METHODS

We searched Embase, MEDLINE, INAHTA database, CENTRAL, CDSR and Epistemonikos for cohort studies with ≥40 children per arm/prognostic factor, published in English from 2000 to November 2022. We assessed risk of bias using the Quality in Prognosis Studies checklist, and overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Outcomes were analysed as risk ratio (RR), OR or Peto OR.

RESULTS

Seven studies totalling 2 760 292 children were included. The evidence was very low quality. Fluid or pus discharge from ears (OR 2.1, 95% CI 1.01 to 4.35) and exposure to other children (RR 2.79, 95% CI 1.98 to 3.93) (OR 5.21, 95% CI 2.9 to 9.36) were strongly associated with development of OME. Coughs/colds ≥5 times (OR 1.91, 95% CI 1.22 to 2.99), breathing problems ≥5 times (RR 1.78, 95% CI 1.26 to 2.53) and ear infections (RR 1.95, 95% CI 1.39 to 2.72) in past year were associated with development of OME. Adenoid hypertrophy was strongly associated with development of fluctuating OME (recurrent OME) (OR 9.96, 95% CI 5.17 to 19.19). There was scare evidence for some potential modifiable risk factors, including breast feeding, household smoking, gastro-oesophageal reflux, dummy use and swimming.

CONCLUSIONS

Upper respiratory tract infection, ear infection, adenoid hypertrophy and exposure to other children could be the predictors for development of OME. Further observational studies are needed to investigate other potential modifiable risk factors.

Clinical value of wideband acoustic immittance in the diagnosis of otitis media with effusion under negative intratympanic pressure in adults

BACKGROUND

Normative clinical values for wideband acoustic immittance (WAI) are not well-established.

AIMS

This study aims to define the normative contour plot characteristics of WAI and evaluate its diagnostic value in detecting tympanic effusion.

MATERIALS AND METHODS

Data were collected from subjects with normal hearing (76 ears) and type C tympanograms on 226-Hz tympanometry (130 ears). Matlab was used to process and analyze the data. The maximum absorbance of WAI was used as the primary indicator, and the receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value. WAI contour plots were compared to 226-Hz tympanometry and otoendoscopy, the latter being the gold standard.

RESULTS

Mean WAI plots in the normal group showed single peaks (absorbance, >70%) and a nearly symmetrical distribution of the peak area around the 0 daPa pressure line. The ROC curve indicated an AUC value of 0.910, with 78% as the optimal cut-off value of maximum absorbance for detecting effusion. WAI demonstrated better diagnostic performance (sensitivity: 82.26%, specificity: 86.76%, kappa: 0.691) than 226-Hz tympanometry (sensitivity: 61.29%, specificity: 61.76%, kappa: 0.230).

CONCLUSIONS AND SIGNIFICANCE

Normative WAI values were established, and WAI proved more accurate than 226-Hz tympanometry for identifying tympanic effusion, offering valuable guidance for selecting treatment options.

Impact of Habitual Yogurt Intake in Mother-Child Dyads on Incidence of Childhood Otitis Media: The Japan Environment and Children's Study (JECS)

Otitis media, one of the most common childhood diseases, is characterized by inflammation or infection of the middle ear. Due to their ease of access, daily probiotics are recommended for the prevention of early childhood otitis media. This study aimed to assess the impact of probiotics on the incidence of otitis media using a dataset (n = 95,380) from the Japan Environment and Children's Study, a nationwide birth cohort study. After multiple imputations, the association between the incidence of otitis media in early childhood and the daily frequency of yogurt intake in children and mothers was examined using a generalized linear model after adjusting for several confounders. Repeated incidence of otitis media during the 2 years after birth was found in 14,874 participants (15.6%). Based on participants with the lowest frequency of yogurt intake ("almost never") as the reference group, risk ratios for otitis media incidence decreased with higher frequencies of yogurt intake in children at one year of age, but also independently in mothers during pregnancy. The lowest risk ratio (95% confidence interval) for otitis media incidence at six months of age was observed with the most frequent yogurt intake (once/day or more) (0.54 [0.46-0.63]). Additionally, although a similar association was observed in the subgroup of those with cleft lip and/or palate (CL/P), a high-risk group for severe recurrent otitis media, no statistical significance was observed. Thus, increased regular yogurt intake in both children and mothers was associated with a decrease of otitis media during early childhood.

The Unneglectable Disease Burden of Otitis Media Among Children in China: A Systematic Review and Meta-analysis

BACKGROUND

Otitis media (OM) is one of the most commonly diagnosed infections among children yet with obscure disease burden.

METHODS

The literature published from 1980 to 2022 was retrieved in PubMed, Ovid-EMBASE, Web of Science, CNKI, Wanfang and VIP. Literature screening, quality assessment and data extraction were conducted by 2 independent reviewers. Heterogeneity and publication bias were detected by I2 , Egger's and Begg's tests. The data were pooled using the random-effects model. The number of OM cases was estimated by the multiplied model based on pooled results and the 2020 China census data.

RESULTS

A total of 28,378 literatures were identified with 67 finally included for data analysis. The OM incidence among children was 7.89% [95% confidence interval (CI): 5.43%-11.33%] and the prevalence of OM was 5.13% (95% CI: 3.49%-7.49%). The most common pathogen of the OM cases was Streptococcus pneumoniae ( S. pneumoniae ), with a positive rate of 33.52% (95% CI: 26.55%-41.29%). The most common serotypes of S. pneumoniae isolated from OM cases were serotypes 19F, 19A, 6B, 23F and 3, with 85.8% covered by the PCV13. We estimated that there were 8,950,797 (95% CI: 6,080,533-12,928,051) OM cases among under-fives in China in 2020, of which 3,374,451 (95% CI: 1,698,901-6,277,862) cases of OM were caused by S. pneumoniae .

CONCLUSIONS

The burden of OM in China was considerable yet neglected. To date, S. pneumoniae was the most frequently detected bacterial pathogen of OM. Vaccination may be effective to protect young children from OM.

Retrospective observational study analysing the trends in ventilation tube insertion in children in Scotland between 2001 and 2018

OBJECTIVES

Otitis media with effusion (OME) is common, affecting up to 90% of children. Around 25% will have a persistent effusion with conductive hearing loss which can impact their development. Ventilation tubes (VTs) can improve their hearing in the short term. This study aims to analyse the trends in VT insertion rates across Scotland.

DESIGN

Retrospective observational study.

SETTING

All mainland Scottish health boards.

PARTICIPANTS

All children aged 0-16 who underwent a VT insertion procedure from 2001 to 2018 were included.

MAIN OUTCOME MEASURES

Data were provided by the Scottish Public Health Observatory, using Scottish Morbidity Records. Mid-year population estimates were obtained from the National Records Office of Scotland. Socioeconomic deprivation was estimated based on area of residence using the Scottish Index of Multiple Deprivation. VT insertion rates were calculated and trends analysed.

RESULTS

A total of 35 878 VT procedures were performed in total with a mean rate of 2.02 per 1000 children per year. The highest insertion rates were observed in children aged 4-6. VT insertion rates reduced during the study period (R = -0.729, p = .001). Variability in VT insertion rates between health boards reduced. There was a significant association between socioeconomic deprivation and VT insertion rate, with the most deprived children having the highest rate (p < .001).

CONCLUSIONS

VT insertion rates and the variability between Scottish health boards have reduced over the past two decades, suggesting a more equitable system. Our data intimates that the decision to perform VT insertion is based upon disease prevalence rather than clinician preference.

Implantable hearing devices in clinical practice. Systematic review and consensus statements

Objective

Implantable hearing devices represent a modern and innovative solution for hearing restoration. Over the years, these high-tech devices have increasingly evolved but their use in clinical practice is not universally agreed in the scientific literature. Congresses, meetings, conferences, and consensus statements to achieve international agreement have been made. This work follows this line and aims to answer unsolved questions regarding examinations, selection criteria and surgery for implantable hearing devices.

Materials and methods

A Consensus Working Group was established by the Italian Society of Otorhinolaryngology. A method group performed a systematic review for each single question to identify the current best evidence on the topic and to guide a multidisciplinary panel in developing the statements.

Results

Twenty-nine consensus statements were approved by the Italian Society of Otorhinolaryngology. These were associated with 4 key area subtopics regarding pre-operative tests, otological, audiological and surgical indications.

Conclusions

This consensus can be considered a further step forward to establish realistic guidelines on the debated topic of implantable hearing devices.

Inflammatory endotypes of adenoidal hypertrophy based on a cluster analysis of biomarkers

OBJECTIVE

To identify adenoid inflammatory endotypes based on inflammatory markers, match endotypes to phenotypes, and predict endotypes.

METHODS

This cross-sectional study included 72 children with adenoid hypertrophy. Thirteen inflammatory markers and total immunoglobulin E (TIgE) in adenoid tissue were analyzed using Luminex and enzyme-linked immunosorbent assay (ELISA) for performing cluster analysis. Correlation analysis was used to examine the characteristics of each cluster. Receiver operating characteristic (ROC) curve analysis was performed to screen for preoperative characteristic data with predictive value for adenoid inflammation endotype.

RESULTS

The patients were divided into four clusters. Cluster 1 exhibited non-type 2 signatures with low inflammatory marker concentrations, except for the highest expression of Th1-related cytokines. Cluster 2 showed a non-type 2 endotype with the highest concentration of interleukin (IL)-17A and IL-22. Cluster 3 exhibited moderate type 2 inflammation, with the highest concentration of neutrophil factors. Cluster 4 demonstrated significant type 2 inflammation and moderate neutrophil levels. The proportions of AR and serum TIgE levels increased from clusters 1 to 4, and there was a gradual increase in the prevalence of chronic sinusitis from low to high neutrophilic inflammation. The area under the ROC curve for serum TIgE was higher than those for combined or other separate preoperative characteristics for predicting non-type 2 and type 2 inflammation in the adenoid tissue.

CONCLUSIONS

The evaluation of cytokines in adenoid tissue revealed four endotypes. Serum TIgE level was an important indicator of the endotype of adenoid inflammation. Identification of adenoid inflammatory endotypes can facilitate targeted treatment decisions.

Otitis media: recent advances in otitis media vaccine development and model systems

Otitis media is an inflammatory disorder of the middle ear caused by airways-associated bacterial or viral infections. It is one of the most common childhood infections as globally more than 80% of children are diagnosed with acute otitis media by 3 years of age and it is a common reason for doctor's visits, antibiotics prescriptions, and surgery among children. Otitis media is a multifactorial disease with various genetic, immunologic, infectious, and environmental factors predisposing children to develop ear infections. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common culprits responsible for acute otitis media. Despite the massive global disease burden, the pathogenesis of otitis media is still unclear and requires extensive future research. Antibiotics are the preferred treatment to cure middle ear infections, however, the antimicrobial resistance rate of common middle ear pathogens has increased considerably over the years. At present, pneumococcal and influenza vaccines are administered as a preventive measure against otitis media, nevertheless, these vaccines are only beneficial in preventing carriage and/or disease caused by vaccine serotypes. Otitis media caused by non-vaccine serotype pneumococci, non-typeable H. influenza, and M. catarrhalis remain an important healthcare burden. The development of multi-species vaccines is an arduous process but is required to reduce the global burden of this disease. Many novel vaccines against S. pneumoniae, non-typeable H. influenza, and M. catarrhalis are in preclinical trials. It is anticipated that these vaccines will lower the disease burden and provide better protection against otitis media. To study disease pathology the rat, mouse, and chinchilla are commonly used to induce experimental acute otitis media to test new therapeutics, including antibiotics and vaccines. Each of these models has its advantages and disadvantages, yet there is still a need to develop an improved animal model providing a better correlated mechanistic understanding of human middle ear infections, thereby underpinning the development of more effective otitis media therapeutics. This review provides an updated summary of current vaccines against otitis media, various animal models of otitis media, their limitations, and some future insights in this field providing a springboard in the development of new animal models and novel vaccines for otitis media.

Comparison of ASSR and frequency specificity ABR induced by NB CE-Chirp for prediction of behavioral hearing thresholds in children with conductive hearing loss

BACKGROUND

Electrophysiological tests are often used to evaluate hearing loss in infants and young children with conductive hearing loss, no matter to quantify or characterize. However, there are advantages and disadvantages associated with the various electrophysiological tests that are currently available. Therefore, there is no gold standard test. This study aimed to compare the value of narrow-band (NB) CE-Chirp-induced auditory steady-state response (ASSR) and auditory brainstem response (ABR) for assessing hearing thresholds in children with conductive hearing loss. We hope to identify an effective electrophysiological testing method to evaluate conductive hearing loss and provide a reference for clinical hearing assessment of infants with conductive hearing loss.

SUBJECTS

and Methods: We selected 27 children (41 ears) aged 3-6 years with otitis media with effusion (OME). Within 1 day, they underwent behavioral audiometry and NB CE-Chirp-induced ASSR and ABR tests in sequence. Pearson's correlation analysis was performed to compare behavioral audiometry thresholds and ASSR and ABR response thresholds at 500, 1000, 2000, and 4000 Hz.

RESULTS

The behavioral audiometry thresholds of all children were strongly correlated with the response thresholds of the two electrophysiological tests, with correlation coefficients of 0.659, 0.605, 0.723, and 0.857 for ASSR, and 0.587, 0.684, 0.753, and 0.802 for ABR. The proportion of children with a difference of ≤10 dB between ASSR and behavioral audiometry thresholds or between ABR and behavioral audiometry thresholds was not high, especially in the low frequencies. ABR results were superior to ASSR results in terms of predicting actual hearing levels. At 0.5, 1, 2, and 4 kHz, the average differences between the behavioral hearing thresholds and ASSR thresholds in the 41 ears were 5.6, 5.7, 2, and 5.6 dB, respectively. The average differences between behavioral hearing thresholds and ABR thresholds was -5.6, -1.4, -6.8, and 3.2 dB, respectively. The hearing loss configuration of the ASSR exhibited a peaked pattern, similar to behavioral audiometry, whereas the ABR exhibited an ascending pattern. The time to perform the single-ear ASSR test was 5.9 min, whereas the ABR test took 17.0 min.

CONCLUSION

ASSR and ABR induced by the NB CE-Chirp correlated well with behavioral audiometry in children with conductive hearing loss. The NB CE-Chirp ASSR has advantages in terms of testing time and hearing configuration evaluation, whereas ABR has better reliability than ASSR. However, the stability of ASSR and ABR induced by the NB CE-Chirp is poor, and the thresholds obtained cannot replace behavioral audiometry in evaluating the true hearing of children with conductive hearing loss. However, ASSR and ABR can be used as auxiliary tests for cross-validation.

Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm

Acute otitis media (AOM) is one of the most common ENT diseases in children. In the antibiotic/post-antibiotic era, facial paralysis is a very rare complication of AOM (0.004-0.005%). Despite the rarity of this complication, it should be known by all physicians for proper therapeutic management to avoid serious sequelae. The aim of this review is to provide a management guide based on the current literature.

MATERIALS AND METHODS

Fifteen studies published between 2000 and 2022 were selected, including 120 patients (62 M/58 F) with an average age of 4.96 years old (range = 4 months-16 years; SD: 4.2). The paralysis frequently has a sudden onset and is of a severe grade (medium House-Brackmann (HB) score at onset: 4.68; SD: 0.5); however, it tends to have an almost complete recovery in most patients (88.49% HB 1 at follow-up).

RESULTS

Its first-line treatment must be based on the use of antibiotics (beta-lactam antibiotics as penicillins or cephalosporins). Corticosteroids should be used concomitantly for their anti-inflammatory and neuroprotective actions; however, there is no unanimity between authors about their application. Myringotomy, with or without ventilation tube insertion, is indicated in cases where the tympanic membrane is intact. Other kinds of surgery should be performed only in patients who have a worsening of their AOM symptoms or a worsening in HB score even with clinical treatment.

CONCLUSIONS

The obtained data show that a conservative treatment can be sufficient for complete recovery in most patients, and it is preferred as the first-line therapy. Mastoidectomy should be performed only in patients with acute mastoiditis and without symptom improvement after a conservative approach. There are insufficient data in the current literature to provide clear selection criteria for patients who need to undergo mastoidectomy with facial nerve decompression. The choice of this treatment is based on an individual center expertise. Further studies are needed to clarify the role of corticosteroids and the role of facial nerve decompression in this clinical scenario.

National Quality Evaluation of Medication Use for Pediatric Otitis Media With Effusion

OBJECTIVES

Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without the presentation of signs or symptoms of acute ear infection. The point prevalence of OME reaches as high as 60% in children younger than 2 years of age. We used the National Health Insurance Research Database (NHIRD) to investigate the use of medication in children with OME before receiving ventilation tube insertion (VTI).

METHODS

Data of pediatric patients (age ≤ 12 years) who had OME and received VTI from January 1, 2011, to December 30, 2012, were retrieved from the Taiwan NHIRD. We surveyed the use of 4 medications to understand whether health care providers achieved the standards of medication use recommended by clinical practice guidelines.

RESULTS

This study examines the factors affecting the use of medication for pediatric OME. Overall, according to the study's operational definitions, the use of systemic antibiotics was most common (59.9%), followed by systemic antihistamines (23.4%), systemic steroids (8.8%), and intranasal steroids (9.6%). Systemic antibiotics use was associated with 12 factors. Ten of the 12 factors increase the use of systemic antibiotics, including namely age (age > 2 years), comorbidities, teaching hospital, and community hospital. In contrast, namely catastrophic illness and watchful waiting are the 2 factors that decrease systemic antibiotics use. For the use of systemic antihistamines, systemic steroids, and intranasal steroids were related to 6, 5, and 2 factors, respectively.

CONCLUSIONS

The rate of drug use differs from the rate of use recommended by commonly used clinical practice guidelines. We found that the higher the number of factors that influenced the patients' drug use, the higher the rate of drug use. According to these results, drafting a treatment guideline for OME patients in accordance with current clinical practices in Taiwan is highly recommended.

Adenoidectomy for otitis media with effusion (OME) in children

BACKGROUND

Otitis media with effusion (OME) is an accumulation of fluid in the middle ear cavity, common amongst young children. The fluid may cause hearing loss. When persistent, it may lead to developmental delay, social difficulty and poor quality of life. Management of OME includes watchful waiting, autoinflation, medical and surgical treatment. Adenoidectomy has often been used as a potential treatment for this condition.

OBJECTIVES

To assess the benefits and harms of adenoidectomy, either alone or in combination with ventilation tubes (grommets), for OME in children.

SEARCH METHODS

The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 January 2023.

SELECTION CRITERIA

Randomised controlled trials and quasi-randomised trials in children aged 6 months to 12 years with unilateral or bilateral OME. We included studies that compared adenoidectomy (alone, or in combination with ventilation tubes) with either no treatment or non-surgical treatment.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Primary outcomes (determined following a multi-stakeholder prioritisation exercise): 1) hearing, 2) otitis media-specific quality of life, 3) haemorrhage.

SECONDARY OUTCOMES

1) persistence of OME, 2) adverse effects, 3) receptive language skills, 4) speech development, 5) cognitive development, 6) psychosocial skills, 7) listening skills, 8) generic health-related quality of life, 9) parental stress, 10) vestibular function, 11) episodes of acute otitis media. We used GRADE to assess the certainty of evidence for each outcome. Although we included all measures of hearing assessment, the proportion of children who returned to normal hearing was our preferred method to assess hearing, due to challenges in interpreting the results of mean hearing thresholds.

MAIN RESULTS

We included 10 studies (1785 children). Many of the studies used concomitant interventions for all participants, including insertion of ventilation tubes or myringotomy. All included studies had at least some concerns regarding the risk of bias. We report results for our main outcome measures at the longest available follow-up. We did not identify any data on disease-specific quality of life for any of the comparisons. Further details of additional outcomes and time points are reported in the review. 1) Adenoidectomy (with or without myringotomy) versus no treatment/watchful waiting (three studies) After 12 months there was little difference in the proportion of children whose hearing had returned to normal, but the evidence was very uncertain (adenoidectomy 68%, no treatment 70%; risk ratio (RR) 0.97, 95% confidence interval (CI) 0.65 to 1.46; number needed to treat to benefit (NNTB) 50; 1 study, 42 participants). There is a risk of haemorrhage from adenoidectomy, but the absolute risk appears small (1/251 receiving adenoidectomy compared to 0/229, Peto odds ratio (OR) 6.77, 95% CI 0.13 to 342.54; 1 study, 480 participants; moderate certainty evidence). The risk of persistent OME may be slightly lower after two years in those receiving adenoidectomy (65% versus 73%), but again the difference was small (RR 0.90, 95% CI 0.81 to 1.00; NNTB 13; 3 studies, 354 participants; very low-certainty evidence). 2) Adenoidectomy (with or without myringotomy) versus non-surgical treatment No studies were identified for this comparison. 3) Adenoidectomy and bilateral ventilation tubes versus bilateral ventilation tubes (four studies) There was a slight increase in the proportion of ears with a return to normal hearing after six to nine months (57% adenoidectomy versus 42% without, RR 1.36, 95% CI 0.98 to 1.89; NNTB 7; 1 study, 127 participants (213 ears); very low-certainty evidence). Adenoidectomy may give an increased risk of haemorrhage, but the absolute risk appears small, and the evidence was uncertain (2/416 with adenoidectomy compared to 0/375 in the control group, Peto OR 6.68, 95% CI 0.42 to 107.18; 2 studies, 791 participants). The risk of persistent OME was similar for both groups (82% adenoidectomy and ventilation tubes compared to 85% ventilation tubes alone, RR 0.96, 95% CI 0.86 to 1.07; very low-certainty evidence). 4) Adenoidectomy and unilateral ventilation tube versus unilateral ventilation tube (two studies) Slightly more children returned to normal hearing after adenoidectomy, but the confidence intervals were wide (57% versus 46%, RR 1.24, 95% CI 0.79 to 1.96; NNTB 9; 1 study, 72 participants; very low-certainty evidence). Fewer children may have persistent OME after 12 months, but again the confidence intervals were wide (27.2% compared to 40.5%, RR 0.67, 95% CI 0.35 to 1.29; NNTB 8; 1 study, 74 participants). We did not identify any data on haemorrhage. 5) Adenoidectomy and ventilation tubes versus no treatment/watchful waiting (two studies) We did not identify data on the proportion of children who returned to normal hearing. However, after two years, the mean difference in hearing threshold for those allocated to adenoidectomy was -3.40 dB (95% CI -5.54 to -1.26; 1 study, 211 participants; very low-certainty evidence). There may be a small reduction in the proportion of children with persistent OME after two years, but the evidence was very uncertain (82% compared to 90%, RR 0.91, 95% CI 0.82 to 1.01; NNTB 13; 1 study, 232 participants). We noted that many children in the watchful waiting group had also received surgery by this time point. 6) Adenoidectomy and ventilation tubes versus non-surgical treatment No studies were identified for this comparison.

AUTHORS' CONCLUSIONS

When assessed with the GRADE approach, the evidence for adenoidectomy in children with OME is very uncertain. Adenoidectomy may reduce the persistence of OME, although evidence about the effect of this on hearing is unclear. For patients and carers, a return to normal hearing is likely to be important, but few studies measured this outcome. We did not identify any evidence on disease-specific quality of life. There were few data on adverse effects, in particular postoperative bleeding. The risk of haemorrhage appears to be small, but should be considered when choosing a treatment strategy for children with OME. Future studies should aim to determine which children are most likely to benefit from treatment, rather than offering interventions to all children.

Proteomic Study of Middle Ear Effusion and Its Clinical Application for Otitis Media with Effusion

Background

Proteins found in middle ear effusion play crucial roles in the physiological and pathological processes of otitis media with effusion (OME), influencing the etiology and clinical characteristics of this disease. The qualitative and quantitative composition of these proteins depending on the underlying pathogenesis of middle ear effusion. Understanding their physiological and pathological functions is of great importance.

Methods

We collected samples from 19 volunteers diagnosed with OME. After offline separation using high-pH reversed-phase liquid chromatography (RPLC), the pooled sample was subjected to LC-MS/MS analysis to obtain a comprehensive profile of the OME proteome. Functional analysis was performed using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Ingenuity Pathway Analysis (IPA) annotations. Data-independent acquisition (DIA) technology was utilized to analyze samples and fix whether the OME proteome could replicate the pathophysiological features associated with this disease. We conducted a differential proteomic analysis between patients with simple OME and patients who had received radiotherapy. The radiotherapy-reduced group was further divided into two subgroups: nasopharyngeal carcinoma (NPC) and other types of carcinoma. Parallel reaction monitoring (PRM) technology was used for validation of 36 differentially expressed proteins (DEPs).

Results

A number of 732 proteins were identified in the OME proteome database. Among them, 527 proteins were quantified using peak intensity-based semi-quantification (iBAQ), covering a wide dynamic range of approximately 8 orders of magnitude. Based on the functional analysis, we proposed a hypothetical mechanism of OME.

Conclusion

This study managed to put up an inclusive analysis of the OME proteome, establishing the first human OME proteome database. We focused on differential proteomic analysis among different groups to gain a more comprehensive concept of the OME proteome and search for meaningful biomarkers.

Outcomes and Prognostic Factors of Balloon Eustachian Tuboplasty Combined With Ventilation Tubes Insertion in Children: A Retrospective Study

Objective: To evaluate the efficacy and safety of balloon eustachian tuboplasty (BET) combined with ventilation tube (VT) insertion in pediatric population and to identify the predictive factors for symptom recurrence. Methods: We conducted a retrospective study between August 2018 and February 2022 at Shenzhen Children's Hospital. The study analyzed the data of pediatric patients who underwent BET + VT insertion, as well as the data of pediatric patients who underwent VT insertion alone. The outcomes were efficacy, safety, and predictive factors of BET combined with VT. Kaplan‒Meier curves were used to examine the failure-free survival rate. A multivariate Cox regression model was used to identify the independent predictors of BET failure. Results: We evaluated the data of 29 pediatric patients (48 ears) who underwent BET with VT insertion (BET + VT group) and the data of 29 pediatric patients (46 ears) who underwent VT insertion alone (VT group). The total effectiveness rates at the first follow-up after VT removal and at 12 months in the BET + VT group were 90.9% and 84.6%, respectively. The decrease in the air-bone gap (ABG) was more significant in the BET + VT group at 12 months (13.7 ± 10.8 vs 6.4 ± 15.3, P < .05). The subgroup analyses did not show any significant difference between the groups in high-risk. For non-high-risk patients, the decrease in the ABG was more significant in the BET + VT group (14.2 ± 10.6 vs 4.3 ± 13.1, P < .05) at 12 months. The multivariate analysis showed that a history of VT insertion was independently associated with a higher rate of recurrence in the BET + VT group (hazard ratio 3.177; 95% CI, 1.027-9.826; P < .05). Conclusions: BET + VT insertion is an effective procedure to decrease the ABG in pediatric patients with eustachian tube dysfunction (ETD) who have no risk factors for conventional therapy failure. Treatment of patients with ETDs who have coexisting risk factors remains a challenge that warrants further high-quality prospective research.

Appropriateness of Diagnosis and Management for Otitis Media With Effusion in Pediatric Urgent Care Clinics

BACKGROUND

Otitis media with effusion (OME)'s clinical presentation is often confused with acute otitis media (AOM) by clinicians. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. The aim of this study was to determine the clinician diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 urgent care clinics within a pediatric health care system.

METHODS

We retrospectively reviewed a random sample of encounters for children aged 0 to 18 years with a billing diagnosis of OME in 2019. We recorded clinical symptoms, antibiotic prescribed, and the clinicians' diagnosis. We used the American Academy of Pediatrics guidelines to assign an AOM diagnosis and compared those with the clinicians' final diagnoses using Pearson χ 2 .

RESULTS

Of the 912 eligible charts, clinicians' final diagnoses were as follows: AOM for 271 (29.7%) patients, OME for 638 (70.0%) patients, and no ear pathology for 3 (0.3%) patients. Antibiotics were prescribed for 519 (56.9%) patients; of those, only 242 (46.6%) had a final clinician diagnosis of AOM. Antibiotic prescribing rates were higher when a clinician diagnosed AOM compared with OME (89.3% vs 43.2%; P < 0.001). Per American Academy of Pediatrics guidelines, up to 273 (29.9%) patients qualified for an AOM diagnosis, but those were not the same as those diagnosed with AOM by clinicians ( P < 0.001).

CONCLUSIONS

When evaluating children with a billing diagnosis of OME, a third fit a diagnosis of AOM. Clinicians commonly misdiagnosed AOM, but also prescribed antibiotics to almost half of those they diagnose with OME.

Does social distancing impact pediatric upper airway infections? An observational controlled study and a brief literature review

PURPOSE

SARS-CoV-2 pandemic has reduced social interaction even among children. The objective of the study was to assess the role of social distancing in the course of common pediatric upper airway recurrent diseases.

MATERIALS AND METHODS

Patients aged ≤14 years with at least one ENT-related clinical condition were retrospectively recruited. All patients had two outpatient evaluations in the same period (April - September): the control group had the first evaluation in 2018 and second in 2019, whereas the case group had the first evaluation in 2019 and second in 2020. Patients of each group were individually compared between their two visits and deemed improved/unchanged/worsened for each specific ENT condition. The percentage of children improved/unchanged/worsened were then collectively compared between the two groups for each condition.

RESULTS

Patients who experienced social distancing presented a significantly higher improvement rate than controls for recurrent acute otitis media episodes (35.1 % vs. 10.8 %; Fisher's exact test p = 0.033) and for tympanogram type (54.5 % vs. 11.1 %, Fisher's exact test p = 0.009).

CONCLUSIONS

The anti-contagion social restrictions decreased the prevalence of middle ear infections and effusion in children. Further studies on larger cohorts are required to better elucidate these findings.

Update of the consensus document on the aetiology, diagnosis and treatment of acute otitis media and sinusitis

Update of the consensus on acute otitis media (AOM) (2012) and sinusitis (2013) following the introduction of pneumococcal vaccines in the immunization schedule, and related changes, such as epidemiological variation, colonization by of nonvaccine serotypes and emerging antimicrobial resistances. A majority of studies show that the introduction of the pneumococcal 13-valent conjugate vaccine has been followed by a reduction in the nasopharyngeal carriage of pneumococcus, with an increase in the proportion of drug-resistant nonvaccine serotypes. The diagnosis of AOM is still clinical, although more stringent criteria are proposed, which are based on the visualization of abnormalities in the tympanic membrane and the findings of pneumatic otoscopy performed by trained clinicians. The routine diagnosis of sinusitis is also clinical, and the use of imaging is restricted to the assessment of complications. Analgesia with acetaminophen or ibuprofen is the cornerstone of AOM management; watchful waiting or delayed antibiotic prescription may be suitable strategies in select patients. The first-line antibiotic drug in children with AOM and sinusitis and moderate to severe disease is still high-dose amoxicillin, or amoxicillin-clavulanic acid in select cases. Short-course regimens lasting 5-7 days are recommended for patients with uncomplicated disease, no risk factors and a mild presentation. In allergic patients, the selection of the antibiotic agent must be individualized based on severity and whether or not the allergy is IgE-mediated. In recurrent AOM, the choice between watchful waiting, antibiotic prophylaxis or surgery must be individualized based on the clinical characteristics of the patient.

Micro RNAs and Circular RNAs in Different Forms of Otitis Media

The aim of this comprehensive review was to present the current knowledge on the role of microRNAs (miRNAs) in acute, recurrent, and chronic forms of otitis media. Special attention was focused on cholesteatoma of the middle ear. MicroRNAs modulate gene expression, which, in turn, influences the development and likelihood of the recurrence of acute and aggressive chronic middle ear inflammatory processes. Moreover, this study discusses the modulating role of a specific subgroup of noncoding RNA, circular RNA (circRNA). Recognizing the precise potential pathways and the mechanisms of their function may contribute to a better understanding of the molecular bases of middle ear diseases and identifying novel methods for treating this demanding pathology. Articles published between 2009 and 2022 were used in this analysis. In this review, we provide a complete overview of the latest progress in identifying the role and mechanisms of particular miRNAs and circRNAs in acute, recurrent and chronic forms of otitis media.

Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP.

Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice.

Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP.

Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001).

Conclusion The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) on OME, either perioperatively and postoperatively, or regarding the option of placing a ventilation tube. This part of the care also varied depending on the respondents' work location and experience in the medical practice.

Hearing Status and Ventilation Tube at Time of Palatoplasty in Cleft Lip and Palate Patients: A Retrospective Study

Background and Objectives: There is no consensus regarding the indications for and timing of ventilation tube (VT) insertion in cleft lip and palate (CLP) patients. Our aim was to search for clinical and surgical (i.e., VT insertion) characteristics that influence the hearing status in CLP. Materials and Methods: We reviewed the hearing outcome of consecutive CLP cases operated on at a single referral center. Univariate and multivariate analysis were applied as appropriate. Results: We included 285 consecutive CLP patients, 109 female and 176 male; the mean age at last follow-up was 16.2 years. Unilateral CLP was found in 249 cases and bilateral CLP in 36. Early VTs (i.e., at the time of hard palate surgery) were applied in 75 (26.3%) patients. Late VTs (i.e., after hard palate surgery during follow-up) were applied in 69 (24.2%) children, at a mean age of 6.7 years old. Hearing loss (pure-tone average > 20 dB) was found in 114 (40%) CLP patients at last available follow-up (mild hearing loss in 96 patients, moderate in 18). In univariate and multivariate analyses, we found that only the absence of early VT insertion (p = 0.0003; OR = 18.2) was an independent prognostic factor of hearing loss in CLP patients. Furthermore, when early VTs were not inserted, there was a high risk of late VT (p = 0.002; OR 13.6). Conclusions: According to our results, the absence of VT insertion at the time of hard palate surgery is an independent prognostic risk factor of hearing loss in CLP patients. Early VT placement in CLP patients may prevent hearing loss and related consequences. These findings should be tested in a large, randomized clinical trial.

Ten years' experience with bone conduction hearing aids in the Western Cape, South Africa

Untreated conductive and mixed hearing losses as a result of middle ear pathology or congenital ear malformations can lead to poor speech, language and academic outcomes in children. Lack of access to centralised hearing healthcare in resource-constrained environments limits opportunities for children with hearing loss. Red Cross War Memorial Children's Hospital (RCWMCH) is one of only two dedicated paediatric hospitals in sub-Saharan Africa. Between 2016 and 2021, 29 children received implanted bone conduction hearing devices, and 104 children were fitted with bone conduction devices on softbands. The authors' experience at RCWMCH suggests that bone-anchored hearing devices, either fitted on softbands or on implanted abutments, can provide solutions in settings where patients have limited access to hearing healthcare and optimal classroom environments. Hearing healthcare should be accessible and delivered at the appropriate level of care to mitigate the adverse effects of hearing loss in children.Contribution: This article describes strategies employed at RCWMCH such as fitting bone conduction hearing devices on a softband immediately after hearing loss diagnosis and conducting follow-up via remote technology to make hearing healthcare more accessible to vulnerable populations.

Analysis of factors that influence the occurrence of otitis media with effusion in pediatric patients with adenoid hypertrophy

Objective

Adenoid hypertrophy (AH) and otitis media with effusion (OME) are common pediatric otolaryngological diseases and often occur concurrently. The purpose of this study was to comprehensively analyze the factors that influence the occurrence of OME pediatric patients with AH.

Methods

Patients younger than 12 years with AH, who were hospitalized for treatment at Beijing Tsinghua Changgung Hospital in Beijing, China, between March 2018 and February 2022 were enrolled. The patients were divided into an AH group and an AH + OME group based on the presence of OME. The authors collected the following clinical data for univariable analysis: sex; age; body mass index (BMI); comorbid nasal congestion/rhinorrhea, recurrent tonsillitis, or allergic rhinitis (AR); adenoid and tonsil grade; tonsillar hypertrophy; food/drug allergy; history of adenoidectomy and congenital diseases; breastfeeding status; preterm birth; exposure to environmental tobacco smoke (ETS); family history of adenotonsillectomy, otitis media, and AR; main data of polysomnography and oropharyngeal conditional pathogen culture data of some patients. Univariate analysis was performed as a basis for logistic regression analysis.

Results

A total of 511 children (329 boys and 182 girls) were included, their mean age was 5.37 ± 2.10 years. Of them, 407 (79.6%) were in the AH group and 104 (20.4%) in the AH + OME group. Univariate analysis revealed statistically significant differences in age, BMI, adenoid grade, AR, breastfeeding status, and ETS exposure between the two groups. Multivariate stepwise logistic regression analysis showed that age, adenoid grade, AR, breastfeeding status, and ETS influenced the occurrence of OME in pediatric patients with AH. The risk of OME decreased with increasing age. High adenoid grade, ETS exposure, and comorbid AR were risk factors for OME in pediatric patients with AH, but breastfeeding was a protective factor. The final analytical results of the oropharyngeal conditional pathogen culture data showed that Streptococcus pneumoniae positivity was associated with OME in AH.

Conclusion

The pathogenesis of AH with OME is complex. Young age, high adenoid grade, ETS exposure, non-breastfed status, comorbid AR, and the presence of S. pneumoniae in the oropharynx are risk factors for OME in pediatric patients with AH.

Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan - 2022 update

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.

A Case-Control Study of Titanium and Fluoroplastic Ventilation Tubes

Background Tympanostomy ventilation tube (VT) insertion is one of the most common procedures performed in otorhinolaryngology. VTs have been proven to effectively manage otitis media (OM) with effusion (OME) and to improve the quality of life of children postoperatively. Although there are multiple types of VT shapes, materials, and sizes, few studies have investigated and compared the effects of titanium VT with those of VTs made of other materials. This study aimed to compare titanium VTs and the more commonly used fluoroplastic VTs in a retrospective, age-matched, case-control study. We studied the postoperative outcomes and rates of extrusion, infection, otorrhea, tube obstruction, and residual perforation. Methodology Medical records of patients who underwent myringotomy with VT insertion from January 2018 to December 2020 were reviewed. A total of 34 patients met the inclusion criteria, of whom 17 had undergone titanium VT insertion bilaterally (titanium group) and 17 had undergone fluoroplastic VT insertion bilaterally (control group). Both groups were followed up with regular postoperative examinations for 18 months. Results Postoperative complications were categorized as early and late complications. The most common early postoperative complication was early extrusion of VT (six months or less after insertion) (67.6%); this was documented most often in the titanium group. Other early postoperative complications included transient otorrhea (14.7%), tube blockage (8.8%), and recurrent acute otitis media (AOM) (occurring within one month from completion of therapy of AOM episode) (5.9%); these rates were similar in both groups. Late complications were not significantly variable between groups. Tympanic membrane retraction was the most common late complication (8.8%). Conclusions VT insertion is associated with the risk of complications with varying degrees. Although factors affecting the VT complication rates are multiple and various, these rates were not different between groups in this study. However, further studies including larger population samples are needed to statistically confirm these results and their generalizability.

Frequency of otitis media with effusion among children aged 1-5 years presenting to immunization center of tertiary care hospitals, Rawalpindi

Objective

We conducted this study to assess the etiopathogenic relation of otitis media with effusion (OME) in a group of children aged 1-5 years among the local population of Rawalpindi.

Methods

This was a cross-sectional retrospective study. Study was conducted among the children presenting to the immunization center of three tertiary care hospitals of Rawalpindi. Otitis media was assessed by clinical examination and tympanometry from August 2019 to January 2020. Multi-factor regression analysis was then applied to recognize the statistical significance and association of various risk factors to OME.

Results

Out of 400 children enrolled in this study, 108 (27.0%) had OME, out of which 65 (60.2%) were males and 30 (27.8%) were of age group 2-3 years. Multivariable regression analysis of risk factors associated with OME showed it was strongly associated with snoring (P < 0.001), last year symptoms (attack of ear aches with hearing loss [P = 0.002]), drugs (URTI antibiotics [P = 0.026], All 3 drugs [P = 0.013]).

Conclusions

We found out that OME is a common disease which if not identified or treated timely can lead to other hard to cure health problems. Control of its etiopathogenic factors can play a major role in its prevention.

Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment

OBJECTIVES

To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years.

METHODS

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

RESULTS

The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children.

CONCLUSIONS

In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.

Wideband absorbance for the assessment of pressure equalizing tubes patency in children

OBJECTIVES

To analyze the feasibility of using wideband absorbance to verify the patency of pressure equalizing tubes (PETs) in clinical practice and to present the response pattern of this measure for ears with patent PET.

METHODS

This observational case-control type study evaluated 48 ears of 30 children with severe or profound hearing loss, aged 10-44 months, of both sexes. The subjects were subdivided into two groups: 24 ears with Sheppard type PET (experimental group - EG) and 24 ears with normal middle ear (control group - CG), paired with the EG, according to age, sex, and ear evaluated. To obtain the wideband absorbance, a Middle-Ear Power Analyzer, version 5.0 (Mimosa Acoustics), was used, and absorbance values for pure tone and chirp stimuli were analyzed.

RESULTS

There was no influence of ear (right or left) on the measurements obtained. The EG showed higher absorbance values at low frequencies. Although the two stimuli made it possible to identify the difference in acoustic transfer function between the groups studied, compared to pure tone, the chirp stimulus allowed identification of differences in a higher number of frequencies.

CONCLUSIONS

Ears with a patent PET present an acoustic transfer pattern that differs from that obtained for normal middle ears, with a higher absorbance at low frequencies. Both pure tone and chirp stimuli can be used to identify such differences, nevertheless, the use of chirp stimulus is recommended, since it allows differentiation over a wider frequency range.

Adenotonsillectomy and adenoidectomy in children: The impact of timing of surgery and post-operative outcomes

AIM

To investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post-operative complications.

METHODS

We included all children aged <16 years undergoing ADT (tonsillectomy ± adenoidectomy) or AD in New South Wales, Australia, 2008-2017. Health information was obtained from administrative hospitalisation data. Rates of post-operative complications and reoperation were evaluated using generalised estimating equations and Kaplan-Meier methods, respectively.

RESULTS

Out of 156 500 included children, 112 361 had ADT and 44 139 had AD. Population rates increased during 2008-2017 (ADT: 68-79 per 10 000 children; AD: 25-34 per 10 000), and children were increasingly operated on at a younger age. Overall, 7262 (6.5%) and 1276 (2.9%) children had post-operative complications (mostly haemorrhage), and 4320 (3.8%) and 5394 (12.2%) required reoperation, following ADT and AD, respectively. Complication rates were highest among children aged 0-1 years, lowest for those 2-5 years and increased with age thereafter. Three-year reoperation rates for children aged 0-1 years were 9.0% and 25.9% following ADT and AD, respectively, decreasing thereafter to 0.5% and 2.1% in children aged 12-13 years.

CONCLUSIONS

ADT and AD in Australian children have both increased in frequency and are being done at a younger age. Post-operative complications and reoperation rates highlight surgery is not without risk, especially for children under 2 years old. These findings support a more conservative approach to management of upper respiratory symptoms, with surgery reserved for cases where potential benefits are most likely to outweigh harms.

Autoinflation compared to ventilation tubes for treating chronic otitis media with effusion

BACKGROUND

Otitis media with effusion (OME) is the most common cause of acquired hearing loss and surgery in children. Autoinflation has been suggested as an alternative treatment for OME.

OBJECTIVES

The aim of the study was to compare treatment outcome with a new autoinflation device versus ventilation tube (VT) surgery or watchful waiting in children with chronic bilateral OME from the waiting list for surgery.

METHODS

Forty-five children performed autoinflation during four weeks, forty-five were submitted to VT surgery, and twenty-three were enrolled as control group. Tympanometry was performed in the autoinflation and the control groups and audiometry in all groups.

RESULTS

An equivalent hearing improvement was achieved in the autoinflation and the VT group at one (p=.19), six (p=.23) and twelve (p=.31) months with no significant alteration in the control group. In the autoinflation group 80% of the children avoided surgery and no complications were reported compared to 34% complication rate in the VT group.

CONCLUSION

Autoinflation achieved an equivalent improvement in hearing thresholds compared to VT surgery for treating OME.

SIGNIFICANCE

Autoinflation may be a reasonable first-line treatment for children with OME to potentially avoid surgery.Article Summary: The Moniri autoinflation device is well tolerated and an effective alternative to ventilation tubes for treatment of chronic otitis media with effusion in young children.What's known on this subject: Previous studies have shown that autoinflation may reduce effusion in children with otitis media with effusion; however limited compliance to treatment, lack of adequate hearing evaluation, short follow-up time and also lack of comparative data to ventilation tube surgery have been reported.What this study adds: A new device was developed to allow for the performance of autoinflation in young children. The effect is compared to ventilation tube surgery and equivalent improvement in hearing is achieved in the short and the long-term follow-up.

Comparing of anteroinferior and posteroinferior tympanostomy tube insertion: a cohort study

BACKGROUND

Tympanostomy tube insertion (TTI) is one of the primary treatments for Otitis media with effusion (OME) in children, a common condition in children. However, there is still no conclusion on the better choice of tube position, and no relevant research has been found in the literature. This study analyzed the results of the two commonly selected tube insert positions, anteroinferior quadrant (AQ) and posteroinferior quadrant (PQ), in order to determine which is the better choice.

METHODS

Children with bilateral OME who received TTI in Beijing Tongren Hospital from May 2020 to January 2021 were selected as subjects. one side on AQ and the other side on PQ randomly. Follow-up visits were arranged at 1 week, 1 month, 6 months and 12 months after surgery. The results of audiology and the tube status of the two positions were recorded and compared statistically.

RESULTS

A total of 90 patients with bilateral OME were selected. There was no difference in preoperative hearing between the 2 groups. The AQ group's average air conduction threshold was significantly higher than that of the PQ group 1 week after surgery. Although there was no significant difference in tube fall-off rate between the two groups within 6 months, it was significantly higher in AQ group than that in PQ group at 12 months after surgery.

CONCLUSIONS

Compared to TTI on AQ, TTI on PQ is more stable and better improves hearing, and the operation is also more convenient for surgeons. This study provides reference for a better position of TTI in OME therapy.

Eustachian tube insufflation with thermal water: Effectiveness in the treatment of pediatric otitis media with effusion

PURPOSE

Otitis media with effusion (OME) is the most common ear disease in childhood. The hearing loss associated with OME impacts on children's language development and behavior. Eustachian tube insufflation are among possible treatments for OME, but data regarding their effectiveness are scarce. The aim of this investigation was to analyze the effect of inhalatory thermal therapy and Eustachian tube insufflation in a consecutive cohort of pediatric patients with OME.

MATERIALS AND METHODS

Seventy-four pediatric patients referred for OME to the thermal medical center "La Contea" (Battaglia Terme, Padova, Italy) were considered. Data from tympanometry and pure tone audiometry performed immediately before (T0), at the end of treatment (T1) and at a follow-up control (T2) were analyzed.

RESULTS

Data from 148 ears were available. The pressure values of tympanometry significantly improved from T0 to T1 (p = 0.0001), and further improvement was recorded at T2, when 60.8% of patients had normal tympanograms. A significant gain of the air-conduction threshold in the T0-T2 interval was observed (p = 0.0001). At otoscopy, a significant reduction of tympanic membranes with fluid or air-fluid levels presence (p < 0.00001) and a significant increase of normal tympanic membranes (p = 0.0001) were found.

CONCLUSION

Eustachian tube insufflation represented a well-tolerated and effective treatment in children with OME. Further investigations should deepen these results in randomized, double-blind settings, possibly with long-term follow-up periods. A quality-of-life and cost-effectiveness evaluation of this treatment approach for pediatric OME could be helpful for public health decision-making.

Water protection in paediatric patients with ventilation tubes: Myth or reality? A systematic review

BACKGROUND

Myringotomy with ventilation tube (VT) insertion is one the most performed procedures in children and adolescents worldwide. VTs usually remain in the eardrum between 6 and 12 months and during this period otorrhoea is the most frequent complication. For years, parents have been advised to protect the ears of children with VTs from contact with water, as water exposure in the middle ear is likely to cause acute otitis media. However, there is a growing evidence that water should not traverse VTs unless under significant pressure, so routine water precautions should not be prescribed. Despite these recommendations, many otolaryngologists and paediatricians continue to prescribe earplugs during bathing or swimming or advise against aquatic activities. There are already two reviews in the current literature on this topic: the first used strict selection criteria and included only 2 high-quality studies, while the second presented evidence up to 2005. The aim of this review is to identify, summarize and critically appraise the current evidence concerning water precautions for children with VTs.

METHODS

Two independent reviewers separately searched for related scientific papers. A qualitative synthesis analysis was performed considering the selected studies regarding the effects of water exposure on paediatric subjects with VTs.

RESULTS

Four randomized clinical trials (RCT) and five prospective cohort studies were included, for a total of 1299 patients aged from 3 months to 14 years. No statistically significant difference in otorrhoea incidence between water exposure with and without ear protection in children with VTs, and between water exposure and no water exposure in children with VTs, was found. Therefore avoiding water is at best inconvenient and at worst may delay learning to swim. The decision to protect the ear when exposed to water should be individualized and protection should be recommended during the first month after surgery and in cases of recurrent otorrhoea.

CONCLUSION

Based on the literature available, allowing water surface activities with no ear protection seems to present a minimum risk, so it is not necessary to prohibit patients from swimming. However, some recommendations should be followed.

Interleukin-33 and thymic stromal lymphopoietin are primary cytokines involved in the Th1/Th2 inflammatory response in chronic secretory otitis media

Background:

T-helper (Th)1/Th2 inflammatory responses are responsible for secretory otitis media (SOM) development. However, the mechanisms underlying these immune responses remain unknown. This study aims to identify the primary cytokines that play essential roles in chronic SOM.

Methods:

Two groups were established for the present study: chronic SOM group ( n = 21) and control group ( n = 10). The middle ear effusion and serum samples of the expression cytokines (interleukin IL-2, IL-4, IL-5, IL-13, IL-17, IL-25, IL-33, interferon [IFN]-γ, thymic stromal lymphopoietin [TSLP], immunoglobulin IgE, and pepsins) were analyzed by enzyme-linked immunosorbent assay.

Results:

The levels of IL-4, IL-5, IL-13, IL-17, IL-25, IFN-γ, TLSP, pepsins, IL-2, and IL-33 (all, p < 0.001) were higher in middle ear effusion, when compared to those in serum, in chronic SOM group (non-paired sample). However, there was no significant difference in serum expression for those cytokines compared chronic SOM group and control group. The paired sample expression for IL-33 and TLSP (both, p = 0.046) were higher compared the effusion and serum in chronic SOM group.

Conclusions:

IL-33 produces inflammatory cytokines, such as IL-1b, IL-6, TNF-α, IL-10, IL-4, and TGF-β, which through nucleus into cytoplasm causing inflammatory responses. The present study revealed that IL-33 also produce IL-17, IL-4, IL-5, and IL-13 inflammatory factors, triggering an inflammatory response. Study reported that the combined stimulation of TSLP and IL-33 elicits an approximately 10-fold increase in cytokine production, when compared to the stimulation of IL-33 alone. This suggests that IL-33 and TLSP may be the primary cytokines involved in Th1/Th2 inflammatory responses in chronic SOM.

Otitis Media and Tympanostomy Tubes

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.

Pharmacotherapy focusing on for the management of otitis media with effusion in children: Systematic review and meta-analysis

OBJECTIVE

To examine the evidence for treating children with otitis media with effusion with pharmacotherapy.

DATA SOURCES

For the systematic review, data were retrieved from PubMed, Cochrane database, and the Japan Medical Abstracts Society Database (1st January 1995 through 31th May 2019).

STUDY SELECTION

Articles addressing pharmacotherapy for the management of otitis media with effusion in children were selected in English.

DATA EXTRACTION

The database was searched using the keywords "Otitis Media with effusion or secretory otitis media" and the following medical agents: carbocysteine, antihistamines, leukotriene receptor antagonist, and steroid nasal spray.

DATA SYNTHESIS

After a critical review of 18 studies, studies addressing steroid nasal spray were eligible for quantitative synthesis. Intranasal steroids for OME showed no benefit with OR 1.155 (95% CI 0.834-1.598) within one month. Conversely, intranasal steroids have effects for OME with OR 1.858 (95% CI 1.240-2.786) for more than one month.

CONCLUSIONS

We found evidence of benefit from treatment of OME in children with intranasal steroids and S-carboxymethylcysteine at longer-term follow-up.

The Long-Term Effects of 12-Week Intranasal Steroid Therapy on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study in Preschool Children

BACKGROUND

The purpose of this study is to analyse the long-term effects of a 12-week course of topical steroids on adenoid size and its mucus using endoscopy and on middle ear effusion measured by tympanometry.

METHODS

The study presents an endoscopic choanal assessment of the change in adenoid size (adenoid to choanae ratio, A/C ratio) and its mucus coverage in 165 children with Grade II and III adenoid hypertrophy three to six months after finishing a 12-week course of intranasal steroid treatment with mometasone furoate. Additionally, tympanometry was performed to measure middle ear effusion. Changes in the tympanograms were analysed.

RESULTS

The mean A/C ratio before treatment was 65.73%. Three to six months after finishing a 12-week course of intranasal steroid treatment, the mean A/C ratio decreased to 65.52%, although the change was not statistically significant (p = 0.743). There was no change in adenoid mucus according to the MASNA scale before and three to six months after the end of the steroid treatment (p = 0.894). Long-term observations of tympanograms before and three to six months after the end of the treatment did not show improvement (p = 0.428).

CONCLUSIONS

The results indicate that there was no effect of topical steroids on adenoid size, its mucus and otitis media with effusion (OME) three to six months after finishing a 12-week course of treatment. In the light of performed study, decision of adenoidectomy and tympanostomy should not be procrastinated.

Prevalence and Co-Morbidities of Adult-Onset Otitis Media With Effusion

BACKGROUND

Adult-onset otitis media with effusion (AO-OME) is relatively difficult to characterize, because of its associated co-morbidities.

OBJECTIVES

To quantify the burden, assess co-existing diseases, and management of patients with AO-OME.

DESIGN OF THE STUDY

A descriptive observational prospective study.

SETTING

Clinical department in a tertiary hospital.

MATERIALS AND METHODS

Adult patients with conductive hearing impairment without ear discharge (excluding other pathologies) nor external ear pathology were eligible. The patients also had tympanometry with type B tracings (tympanograms).

INTERVENTIONS

Clinico-demographic characteristics, history of otologic symptoms, affected ear, and hearing impairment were obtained. Pure-tone audiometry (PTA), tympanometry, and radiological investigations were performed. Other existing diseases (co-morbidities) were noted. The main outcome measure was audiologically confirmed AO-OME.

RESULTS

Prevalence of AO-OME was (110/3452) 3.2%. Young adults (age group 18-30 years) constituted 33.7% (28/83), mean age was 37.3 ± 11.5 years, and 46/83 (55.4%) were males and 37/83 (44.6%) were females. The common otologic symptoms were feeling of fullness in the ear in 27.7% (23/83), hearing loss in 24.1% (20/83), and bilateral ear involvement in 32.5% (27/83). PTA revealed 8.2% (9/110) had normal hearing, whereas 62.7% (69/110) ears had conductive hearing loss. Patients had radiological investigations, namely plain X rays in 67.5% (56/83) and computerized tomography scan of sinuses in 10.8% (9/83). Three (3/83) patients (3.6%) each had nasoendoscopy, and nasal and nasopharyngeal examination under anaesthesia and biopsy. The major associated diseases (co-morbidities) were allergy in 38.6% (32/83), infective rhinosinusitis in 24.1% (20/83), and upper respiratory tract infection in 14.5% (12/83).

CONCLUSION

Prevalence of AO-OME was 3.2%. AO-OME co-existed commonly with allergy and other inflammatory diseases of the upper respiratory tract. The management was conservative medical management.

Nasal autoinflation devices for middle ear disease in cleft palate children: are they effective?

Objective

Cleft lip palate (CLP) and cleft palate (CP) patients have a higher incidence of otitis media with effusion (OME) and conductive hearing problems. This article aims to evaluate the effectiveness of a 6-month course of self-administered autoinflation therapy in paediatric CP/CLP patients in terms of conductive hearing loss (CHL) and OME prevalence.

Methods

Fifty-one patients with surgically corrected CP/CLP and diagnosis of OME received indication to 6-months autoinflation therapy with an Otovent^® device. Clinical evaluation, tympanogram and pure tone audiometry were carried out at the time of prescription (T0), at the end of treatment (T1) and at 6-month follow-up (T2). Patients were divided in 2 groups based on therapeutic compliance (29 compliant children, group A, vs 22 non-compliant children, group B).

Results

Case series showed better audiological results and tympanometries at both time points (p < 0.001). Group A showed better outcomes at tympanograms and at each frequency, but were statistically significant only in terms of CHL at 250 and 1000 Hz frequencies at T1 (respectively 0.024 and 0.012).

Conclusions

Nasal autoinflation therapy accelerates improvement of OME and hearing thresholds at short-/mid-term, leading to an earlier improved hearing performance.

Water protection in paediatric patients with ventilation tubes: Myth or reality? A systematic review

BACKGROUND

Myringotomy with ventilation tube (VT) insertion is one the most performed procedures in children and adolescents worldwide. VTs usually remain in the eardrum between 6 and 12 months and during this period otorrhoea is the most frequent complication. For years, parents have been advised to protect the ears of children with VTs from contact with water, as water exposure in the middle ear is likely to cause acute otitis media. However, there is a growing evidence that water should not traverse VTs unless under significant pressure, so routine water precautions should not be prescribed. Despite these recommendations, many otolaryngologists and paediatricians continue to prescribe earplugs during bathing or swimming or advise against aquatic activities. There are already two reviews in the current literature on this topic: the first used strict selection criteria and included only 2 high-quality studies, while the second presented evidence up to 2005. The aim of this review is to identify, summarize and critically appraise the current evidence concerning water precautions for children with VTs.

METHODS

Two independent reviewers separately searched for related scientific papers. A qualitative synthesis analysis was performed considering the selected studies regarding the effects of water exposure on paediatric subjects with VTs.

RESULTS

Four randomized clinical trials (RCT) and five prospective cohort studies were included, for a total of 1299 patients aged from 3 months to 14 years. No statistically significant difference in otorrhoea incidence between water exposure with and without ear protection in children with VTs, and between water exposure and no water exposure in children with VTs, was found. Therefore avoiding water is at best inconvenient and at worst may delay learning to swim. The decision to protect the ear when exposed to water should be individualized and protection should be recommended during the first month after surgery and in cases of recurrent otorrhoea.

CONCLUSION

Based on the literature available, allowing water surface activities with no ear protection seems to present a minimum risk, so it is not necessary to prohibit patients from swimming. However, some recommendations should be followed.

Association Between Laryngopharyngeal Reflux and Media Otitis: A Systematic Review

OBJECTIVES

To investigate the relationship between laryngopharyngeal reflux (LPR) and recurrent (ROM) or chronic otitis media with effusion (COME).

DATABASES

PubMed, Scopus, and Cochrane Library.

METHODS

Three authors searched articles published between January 1980 and September 2020 about the association between LPR and the development of recurrent or chronic otitis media. Inclusion, exclusion, diagnostic criteria, and clinical outcome evaluation of included studies were analyzed using PRISMA criteria. The bias analysis of included studies was evaluated with the Tool to assess Risk of Bias of the CLARITY group.

RESULTS

Twenty-six clinical and three experimental articles met our inclusion criteria, accounting for 1,624 children and 144 adults with COME or ROM. According to the pH study type, the prevalence of LPR and gastroesophageal reflux disease (GERD) in OM patients were 28.7% (range, 8-100%) and 40.7 (range, 18-64%), respectively. The majority of studies identified pepsin or pepsinogen in middle ear effusion, with a range of mean concentrations depending on the technique used to measure pepsin. There was an important heterogeneity between studies regarding definition of COME, ROM, and LPR, exclusion criteria, methods used to measure pepsin/pepsinogen in middle ear secretions and outcome assessments.

CONCLUSION

The association between LPR and OM is still unclear. Future clinical and experimental studies are needed to investigate the association between LPR and OM in both children and adults through extensive gastric content analysis in middle ear suppurations and impedance-pH monitoring considering acid, weakly acid, and alkaline reflux events.

Effects of the Traditional Mediterranean Diet in Patients with Otitis Media with Effusion

INTRODUCTION

Otitis media with effusion (OME) is common in pediatric primary care consultations. Its etiology is multifactorial, although it has been proven that inflammation factors mediate and that immunity is in a phase of relative immaturity. The objective of this study was to assess the effects of the Traditional Mediterranean Diet (TMD) modulating inflammation and immunity in patients diagnosed with OME.

MATERIALS AND METHODS

A analysis as a single-group pre-test/post-test was conducted on 40 girls and 40 boys between 18 months and 5 years old. Tympanometry normalization was the main test to control the benefit of diet. Clinical and therapeutic variables were studied through evaluation questionnaires, a quality test of the diet, as well as various anthropometric parameters.

RESULTS

At the end of one year, tympanometry had normalized in 85% of patients. The remaining 15% had normal audiometry and/or associated symptoms had decreased. Likewise, episodes of recurrent colds decreased from 5.96 ± 1.41 to 2.55 ± 0.37; bacterial complications of 3.09 ± 0.75 to 0.61 ± 0.06 and persistent nasal obstruction of 1.92 ± 0.27 to 0.26 ± 0.05. The degree of satisfaction of the families with the program was very high.

CONCLUSIONS

The application of the Traditional Mediterranean Diet could have promising effects in the prevention and treatment of otitis media with effusion.

Intradermal Testing Doubles Identification of Allergy among 110 Immunotherapy-Responsive Patients with Eustachian Tube Dysfunction

The purpose of this study was to determine whether the sensitivity advantage of intradermal dilutional testing (IDT) is clinically relevant in patients with obstructive Eustachian tube dysfunction (ETD) or otitis media with effusion (OME). This retrospective, private-practice cohort study compared the sensitivity of skin prick tests (SPT) vs. IDT in 110 adults and children with suspected allergy and OME. Primary outcome measure was symptom resolution from allergy immunotherapy (AIT). IDT identified 57% more patients as being allergic, and 8.6 times more reactive allergens than would have been diagnosed using only SPT. Patients diagnosed by IDT had the same degree of symptom improvement from immunotherapy, independent of allergen sensitivity (66% by SPT vs. 63% by IDT; p = 0.69, not different). Low-sensitivity allergy tests, which may fail to identify allergy in over two thirds of children aged 3 to 15 as being atopic, or among 60% of patients with ETD, may explain why many physicians do not consider allergy as a treatable etiology for their patient's OME/ETD. IDT offers superior sensitivity over SPT for detecting allergens clinically relevant to treating OME/ETD. These data strongly support increased utilization of intradermal testing and invite additional clinical outcome studies.

Otitis media in children: Which phenotypes are most linked to allergy? A systematic review

BACKGROUND

Allergic rhinitis is a common childhood disease responsible for a major impact on quality of life and healthcare resources. Many hypotheses have been proposed to explain the link between allergy and otitis media, although a definitive mechanism has not been identified yet. One of the major critical points is that authors failed in distinguishing among different phenotypes of middle ear inflammation. This review pointed out literature evidence from the laboratory and clinical experience linking allergy to different phenotypes of otitis media in children.

METHODS

We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process. Our search yielded 3010 articles that were finally screened. This resulted in 20 manuscripts of which the full texts were included in a qualitative analysis. We paid particular attention in distinguishing among phenotypes of otitis media.

RESULTS

Clinical evidence and analyses of biomarkers suggested that allergy may be linked to some phenotypes of otitis media and, in particular, to otitis media with effusion (OME) and acute re-exacerbations in children with middle ear effusion. It was not possible to perform the analysis for allergy and acute and chronic otitis media because of paucity and heterogeneity of data.

CONCLUSION

Allergy should be considered in the diagnostic workup of children with OME as well as OME should be excluded in children with persistent moderate to severe AR. In these cases, clinicians should evaluate prompt and accurate treatment of allergy in improving outcomes, although futures studies are required to increase evidence supporting that anti-allergy treatment may be effective in the recovery and outcome of otitis media with effusion.

Macrophage Depletion in CCR2-/- Mice Delays Bacterial Clearance and Enhances Neutrophil Infiltration in an Acute Otitis Media Model

BACKGROUND

Otitis media (OM) is a common and potentially serious disease of childhood. Although OM is multifactorial on origin, bacterial infection is a unifying component. Many studies have established a critical role for innate immunity in bacterial clearance and OM resolution. A key component of innate immunity is the recruitment of immune and inflammatory cells, including macrophages.

METHODS

To explore the role of macrophages in OM, we evaluated the expression of genes related to macrophage function during a complete episode of acute OM in the mouse caused by middle ear (ME) inoculation with Haemophilus influenzae. We also combined CCR2 deficiency with chlodronate liposome toxicity to deplete macrophages during OM.

RESULTS

Macrophage genes were robustly regulated during OM. Moreover, macrophage depletion enhanced and prolonged the infiltration of neutrophils into the infected ME and increased the persistence of bacterial infection.

CONCLUSIONS

The results illustrate the critical role played by macrophages in OM resolution.