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Martens S, Dhooge I, Dhondt C, Vanaudenaerde S, Sucaet M, Rombaut L, Maes L. Pediatric Vestibular Assessment: Clinical Framework. Ear Hear 2023; 44:423-436. [PMID: 36534710 DOI: 10.1097/aud.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Although vestibular deficits can have severe repercussions on the early motor development in children, vestibular assessment in young children has not yet been routinely integrated in clinical practice and clear diagnostic criteria to detect early vestibular deficits are lacking. In young children, specific adjustments of the test protocol are needed, and normative data are age-dependent as the vestibular pathways mature through childhood. Therefore, this study aims to demonstrate the feasibility of an extensive age-dependent vestibular test battery, to provide pediatric normative data with the concurrent age trends, and to offer a clinical framework for pediatric vestibular testing. DESIGN This normative study included 133 healthy children below the age of 4 years (mean: 22 mo, standard deviation: 12.3 mo, range: 5-47 mo) without history of hearing loss or vestibular symptoms. Children were divided into four age categories: 38 children younger than 1 year old, 37 one-year olds, 33 two-year olds, and 25 three-year olds. Children younger than 3 years of age were examined with the video Head Impulse Test (vHIT) of the horizontal semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) with bone conduction stimuli, and the rotatory test at 0.16, 0.04, and 0.01 Hz. In 3-year old children, the vHIT of the vertical semicircular canals and ocular vestibular evoked myogenic potentials (oVEMP) using a minishaker were added to the protocol. RESULTS The horizontal vHIT appeared to be the most feasible test across age categories, except for children younger than 1-year old in which the success rate was the highest for the cVEMP. Success rates of the rotatory test varied the most across age categories. Age trends were found for the vHIT as the mean vestibulo-ocular reflex (VOR) gain increased significantly with age (r = 0.446, p < 0.001). Concerning the cVEMP, a significant increase with age was found for latency P1 (r = 0.420, p < 0.001), rectified interpeak amplitude P1-N1 (r = 0.574, p < 0.001), and averaged electromyographic (EMG) activity (r = 0.430, p < 0.001), whereas age trends for the latency N1 were less pronounced (r = 0.264, p = 0.004). Overall, the response parameters of the rotatory test did not show significant age effects ( p > 0.01), except for the phase at 0.01 Hz (r = 0.578, p < 0.001). Based on the reported success rates and age-dependent normative vestibular data, straightforward cutoff criteria were proposed (vHIT VOR gain < 0.7, cVEMP rectified interpeak amplitude < 1.3, oVEMP interpeak amplitude < 10 µV) with accompanying clinical recommendations to diagnose early vestibular impairment. CONCLUSIONS In this large cohort of typically developing children below the age of 4 years, the vHIT and cVEMP were the most feasible vestibular tests. Moreover, the age-dependent normative vestibular data could specify age trends in this group of young children. Finally, based on the current results and clinical experience of more than ten years at the Ghent University Hospital (Belgium), a clinical framework to diagnose early vestibular deficits in young patients is proposed.
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Affiliation(s)
- Sarie Martens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Cleo Dhondt
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Marieke Sucaet
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Thorsen J, Pedersen TM, Mora-Jensen ARC, Bjarnadóttir E, Bager SC, Bisgaard H, Stokholm J. Middle ear effusion, ventilation tubes and neurological development in childhood. PLoS One 2023; 18:e0280199. [PMID: 36638109 PMCID: PMC9838841 DOI: 10.1371/journal.pone.0280199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Otitis media with middle ear effusion (MEE) can be treated with ventilation tubes (VT) insertion, and it has been speculated that prolonged MEE in childhood can affect neurological development, which in turn may be important for later academic achievements. OBJECTIVE To investigate the association between middle ear effusion (MEE), treatment with ventilation tubes (VT) and childhood neurological development. STUDY DESIGN We examined 663 children from the Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010) unselected mother-child cohort study. Children were followed by study pediatricians with regular visits from pregnancy until 3 years of age. MEE was diagnosed using tympanometry at age 1, 2 and 3 years. Information regarding VT from age 0-3 years was obtained from national registries. We assessed age at achievement of gross motor milestones from birth, language scores at 1 and 2 years, cognitive score at 2.5 years and general development score at age 3 years using standardized quantitative tests. RESULTS Children with MEE had a lower 1-year word production vs. children with no disease: (median 2, IQR [0-6] vs. 4, IQR [1-7]; p = 0.017), and a lower 1-year word comprehension (median 36; IQR [21-63] vs. 47, IQR [27-84]; p = 0.03). Children with VT had a lower 2-5-year cognitive score vs. children with no disease; estimate -2.34; 95% CI [-4.56;-0.12]; p = 0.039. No differences were found between children with vs. without middle ear disease regarding age at achievement of gross motor milestones, word production at 2 years or the general developmental score at 3 years. CONCLUSION Our study supports the previous findings of an association between MEE and concurrent early language development, but not later neurological endpoints up to the age of 3. As VT can be a treatment of those with symptoms of delayed development, we cannot conclude whether treatment with VT had positive or negative effects on neurodevelopment.
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Affiliation(s)
- Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tine Marie Pedersen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Anna-Rosa Cecilie Mora-Jensen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Elín Bjarnadóttir
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Søren Christensen Bager
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
- * E-mail:
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Zawawi F, Papsin BC, Dell S, Cushing SL. Vestibular and Balance Impairment Is Common in Children With Primary Ciliary Dyskinesia. Otol Neurotol 2022; 43:e355-e360. [PMID: 35061636 DOI: 10.1097/mao.0000000000003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Primary ciliary dyskinesia (PCD) is a rare genetic disorder that presents with a wide range of respiratory complaints. The most common otologic associated disorder is middle ear effusion. We ask if children with PCD suffer from vestibular impairment. STUDY DESIGN Cross-sectional cohort study. SETTING Tertiary pediatric referral hospital. PATIENTS/PARTICIPANTS Children with confirmed PCD. INTERVENTION/METHODS All included participants were clinically assessed to be at baseline then basic demographics and medical histories were collected, including the specific genetic mutation these patients have. After which, all patients underwent two vestibular tests. The first was to assess their ability to stand on one foot with their eyes open and then with their eyes closed and the second was video head impulse test (vHIT). MAIN OUTCOME MEASURES Ability standing on one foot with the eyes closed and vHIT. RESULTS During this period, 25 children with PCD were recruited for the study. The mean age at recruitment was 11.26 years (4-18 yr). There were 11 women and 14 men. All patients were able to participate in both tests. Nineteen participants (76%) had vestibular impairment. Fifteen of them failed to stand on one foot with their eyes closed and six of 25 had abnormal vHIT. The most common involved gene was DNAH5 8/25 (32%) and it was associated with vestibular impairment in seven of eight participants (87.5%). CONCLUSION The majority of children with PCD that we tested suffered from vestibular impairment that was previously undiagnosed. This potentially indicates that imbalance and vestibular pathology is under-diagnosed in children with PCD.
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Affiliation(s)
- Faisal Zawawi
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery
- Archie's Cochlear Implant Laboratory
| | - Sharon Dell
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto
- Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery
- Archie's Cochlear Implant Laboratory
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Zhang N, Qian T, Sun S, Cao W, Wang Z, Liu D, Li P, Wu J, Li H, Yang J. IL-17 is a Potential Therapeutic Target in a Rodent Model of Otitis Media with Effusion. J Inflamm Res 2022; 15:635-648. [PMID: 35140496 PMCID: PMC8818970 DOI: 10.2147/jir.s338598] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Otitis media with effusion (OME) is a non-suppurative inflammation of the middle ear that is characterized by middle ear effusion and hearing loss. However, the mechanisms of OME are not fully understood. The aim of this study was to determine the function and the mechanism of the IL-17 cytokine in the pathogenesis of OME and to investigate IL-17 as a potential strategy for the treatment of OME. Methods In this study, the OME rat model was induced by ovalbumin (OVA) as previously described. The severity of OME was determined with an oto-endoscope, by histochemical analysis, and by acoustic immittance. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis of RNA-sequencing (RNA-seq) data was carried out to analyze the signaling pathways related to the pathogenesis of OME, which indicated that IL-17 is involved in OME. The anti-IL-17A monoclonal antibody was administrated by nasal drip to block IL-17 to treat OME in the rat model. The rats were finally injected intraperitoneally with the inhibitor of Notch signaling pathway to study the mechanisms of IL-17-induced inflammation. Serum and lavage fluid were collected for the detection of related cytokines, and middle ear tissue was collected for Western blot, quantitative real-time PCR (qRT-PCR), and immunohistochemical and immunofluorescence analysis. Results KEGG analysis of RNA-seq data suggested that the IL-17 signaling pathway might be involved in the onset of OME. IL-17 expression was confirmed to be increased in both the serum and the middle ear of the rat model. The monoclonal antibody against IL-17 neutralized IL-17, inhibited the inflammation in the middle ear, and reduced the overall severity of OME in vivo. Furthermore, the Notch signaling pathway was activated upon IL-17 upregulation in OME and was suppressed by IL-17 blockage. However, there was no change in IL-17 expression after Notch inhibitor treatment, which reduced the severity of OME in the rat middle ear. Conclusion IL-17 plays a key role in the pathogenesis of the OVA-induced OME rat model. IL-17 induced inflammatory responses via the Notch signaling pathway and targeting IL-17 might be an effective approach for OME therapy.
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Affiliation(s)
- Nanfeng Zhang
- Department of ENT, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230031, People’s Republic of China
| | - Tingting Qian
- Department of ENT Institute and Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Shan Sun
- Department of ENT Institute and Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Wei Cao
- Department of ENT, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230031, People’s Republic of China
| | - Zhixian Wang
- Department of ENT, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230031, People’s Republic of China
| | - Danling Liu
- Department of ENT Institute and Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Peifan Li
- Department of ENT Institute and Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Jingfang Wu
- Department of ENT Institute and Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Huawei Li
- Department of ENT, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230031, People’s Republic of China
- Department of ENT Institute and Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Jianming Yang
- Department of ENT, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230031, People’s Republic of China
- Correspondence: Jianming Yang; Huawei Li, Email ;
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Leyssens L, Van Hecke R, Moons K, Luypaert S, Danneels M, Patru J, Willems M, Maes L. Postural balance problems in people with intellectual disabilities: Do not forget the sensory input systems. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:280-294. [PMID: 34693604 DOI: 10.1111/jar.12948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/06/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This pilot study aimed to explore the impact of visual, auditory and vestibular dysfunctions on the postural balance performance in adults with intellectual disabilities. Additionally, a comparison was made between the subjects with intellectual disabilities and a control group concerning static and dynamic balance tasks. METHOD Thirty adults with intellectual disabilities and 25 control subjects received a postural balance assessment. Additionally, the experimental group was subjected to a visual, auditory and vestibular screening. RESULTS The experimental group performed significantly worse and/or showed more sway compared to the control group for all balance tasks (p < .01) except the timed up and go test. Within the experimental group, a significant positive correlation (rs (24) = 0.513, p = .007) was observed between the number of failed sensory screening items and the number of failed balance tasks. CONCLUSIONS These findings suggest significant involvement of peripheral sensorial deficits in the balance problems that people with intellectual disabilities often experience.
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Affiliation(s)
- Laura Leyssens
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Ruth Van Hecke
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Karlien Moons
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Sofie Luypaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Maya Danneels
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Julie Patru
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Melina Willems
- Department of Audiology, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium
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Richard C, Kjeldsen C, Findlen U, Gehred A, Maitre NL. Hearing Loss Diagnosis and Early Hearing-Related Interventions in Infants With or at High Risk for Cerebral Palsy: A Systematic Review. J Child Neurol 2021; 36:919-929. [PMID: 33913778 DOI: 10.1177/08830738211004519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To synthesize published evidence regarding hearing impairment diagnosis and interventions in infants with or at high risk for cerebral palsy in the first year after birth. METHOD Nine databases were searched for MeSH terms up to February 2020. Included studies were published in English, enrolled infants with or at high risk for cerebral palsy, and addressed hearing evaluation/rehabilitation within the first year after birth. Quality of evidence was evaluated using RTI Item Bank and QUADAS-2. RESULTS Eighteen articles met inclusion criteria. Quality of the evidence ranged from low to high, revealing variability in diagnostic assessment methodologies and adherence to diagnostic schedules. Concerns for bias included lack of recognition of cerebral palsy effects and etiologies on functional hearing assessment methods and results. Two interventions (hearing aid and cochlear implantation) were identified; however, reported use was inconsistent. INTERPRETATION Hearing screening in infants with or at high risk for cerebral palsy requires evaluation of the entire auditory pathway preferentially using comprehensive electrophysiological panels of assessments. For infants with perinatal neural insults, pediatric neurologists are uniquely positioned to recommend adherence to systematic surveillance and comprehensive audiology assessments, regardless of comorbidities and motor impairments.
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Affiliation(s)
- Céline Richard
- Center for Perinatal Research, 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatric Otorhinolaryngology, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Caitlin Kjeldsen
- Center for Perinatal Research, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Ursula Findlen
- 2650Nationwide Children's Hospital, Division of Clinical Therapies, Columbus, OH, USA.,The Ohio State Wexner Medical Center, College of Medicine, Department of Otolaryngology-Head & Neck Surgery, OSU Eye and Ear Institute, Columbus, OH, USA
| | - Alison Gehred
- Nationwide Children's Hospital, Grant Morrow III Library, Columbus, OH, USA
| | - Nathalie L Maitre
- Center for Perinatal Research, 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Chronic Effects of Pediatric Ear Infections on Postural Stability. Int J Pediatr 2021; 2021:6688991. [PMID: 33628279 PMCID: PMC7899764 DOI: 10.1155/2021/6688991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Ear infections in children often cause abnormal postural stability. However, the long-term effects of recurrent ear infections on postural stability have not been investigated. Purpose The purpose of this study was to examine the long-term effects of multiple ear infections on pediatric postural stability. Methods Forty children aged 10-12 years were divided into two groups (18 participants with a history of tympanostomy tubes and/or 3 or more ear infections prior to age five and 22 participants without a history of tympanostomy tubes and/or 0-2 ear infections prior to age five). Computerized Stability Evaluation Test (SET) and noncomputerized postural stability were measured for all participants. Results A significant difference was found in median postural stability scores in the SET during a tandem stance on an unstable surface between the two groups (median (minimum, maximum) of 9.1 (1.4, 11.4) versus 5.8 (1.7, 12.8), p = 0.04). In addition, there was a significant difference in median Pediatric Balance Scale scores between participants with versus without ear infection (54 (47, 56) versus 56 (55, 56), p = 0.001). Conclusions Results suggest that children ages 10-12 with a history of tympanostomy tubes and/or 3 or more ear infections prior to age five have decreased postural stability.
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Stephens JH, O’Keefe M, Schembri M, Baghurst PA. Parents Need More Support: A Qualitative Study of the Experiences of Australian Parents Who Are Waiting for Surgical Intervention for Their Children With Otitis Media. J Patient Exp 2020; 7:717-725. [PMID: 33294607 PMCID: PMC7705822 DOI: 10.1177/2374373519883495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the experiences, expectations, and motivations of parents/caregivers of children with otitis media who were booked to undergo tympanostomy tube insertion. METHOD A cross-sectional cohort study was conducted using semistructured interviews with 39 parents. Interviews were conducted via telephone and analyzed for key themes. RESULTS Three themes emerged that incorporated a range of subthemes: (1) the impact of the child's underlying condition on the family, (2) the cues and prompts that influenced parents to seek intervention, and (3) the parents' expectations of the health-care system. The child's otitis media disrupted the day-to-day functioning of the family and the child's well-being, but despite this, the families found ways to adapt and cope. Parents were influenced by their friends, family, and medical practitioners when making treatment decisions and had differing expectations of the health-care system. CONCLUSION Parents need support during their child's illness to help with pressures placed on the family and also in making health-care decisions for their child. Clinicians should consider these issues when discussing treatment options with parents.
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Affiliation(s)
- Jacqueline H Stephens
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maree O’Keefe
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Schembri
- Ear, Nose and Throat Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Peter A Baghurst
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Su JY, Guthridge S, He VY, Howard D, Leach AJ. Impact of hearing impairment on early childhood development in Australian Aboriginal children: A data linkage study. J Paediatr Child Health 2020; 56:1597-1606. [PMID: 32725651 DOI: 10.1111/jpc.15044] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 05/05/2020] [Accepted: 05/29/2020] [Indexed: 12/01/2022]
Abstract
AIM To investigate the association between hearing impairment (HI) and measures of early childhood development in Aboriginal children at age 5 years. METHODS An observational cohort study (n = 1037) of children aged 4.0-7.3 years (median 5.4 years), living in remote Northern Territory (NT) communities, was conducted using multiple linked administrative datasets, including the NT Perinatal Data Register, Remote Hearing Assessment records (2007-2015) and Australian Early Development Censuses (AEDC, 2009, 2012 and 2015). Outcome measures were summary and domain-specific AEDC results using both dichotomous and continuous variables (domain scores). RESULTS Compared with normal hearing children, after adjustment for selected confounding factors, those with moderate or worse HI had an adjusted odds ratio of 1.69 (95% confidence interval (CI), 1.03-2.77) for being developmentally vulnerable in two or more of the five AEDC domains. Children with mild HI and those with moderate to worse HI had lower domain score sum by -1.60 (95% CI, -3.02 to -0.18) and - 2.40 (95% CI, -4.50 to -0.30), respectively. There was also evidence for an association between HI and poorer outcomes in the 'language and cognitive skills', 'communication skills and general knowledge' and 'physical health and wellbeing' domains. CONCLUSIONS Otitis media-related HI is associated with increased risk for poorer outcomes in early childhood development and this risk appears to increase with higher levels of HI. Prevention and early treatment of otitis media will reduce both the disease and the associated negative impact on early child development, especially the development of language, cognitive and communication skills and physical health and wellbeing.
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Affiliation(s)
- Jiunn-Yih Su
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Vincent Y He
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Damien Howard
- Phoenix Consulting, Darwin, Northern Territory, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Horowitz G, Ungar OJ, Levit Y, Himmelfarb M, Handzel O. The impact of conductive hearing loss on balance. Clin Otolaryngol 2019; 45:106-110. [DOI: 10.1111/coa.13473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/24/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Gilad Horowitz
- Department of Otolaryngology Head & Neck and Maxillofacial Surgery Tel Aviv “Sourasky” Medical Center "Sackler" School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Omer J. Ungar
- Department of Otolaryngology Head & Neck and Maxillofacial Surgery Tel Aviv “Sourasky” Medical Center "Sackler" School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Yael Levit
- Department of Otolaryngology Head & Neck and Maxillofacial Surgery Tel Aviv “Sourasky” Medical Center "Sackler" School of Medicine, Tel Aviv University Tel Aviv Israel
- Department of Communication Disorders Ariel University Ariel Israel
| | - Mordechai Himmelfarb
- Department of Otolaryngology Head & Neck and Maxillofacial Surgery Tel Aviv “Sourasky” Medical Center "Sackler" School of Medicine, Tel Aviv University Tel Aviv Israel
- Department of Communication Disorders Ariel University Ariel Israel
| | - Ophir Handzel
- Department of Otolaryngology Head & Neck and Maxillofacial Surgery Tel Aviv “Sourasky” Medical Center "Sackler" School of Medicine, Tel Aviv University Tel Aviv Israel
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Harrison A, Hardison RL, Wallace RM, Fitch J, Heimlich DR, Bryan MO, Dubois L, John-Williams LS, Sebra RP, White P, Moseley MA, Thompson JW, Justice SS, Mason KM. Reprioritization of biofilm metabolism is associated with nutrient adaptation and long-term survival of Haemophilus influenzae. NPJ Biofilms Microbiomes 2019; 5:33. [PMID: 31700653 PMCID: PMC6831627 DOI: 10.1038/s41522-019-0105-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/03/2019] [Indexed: 01/14/2023] Open
Abstract
Nontypeable Haemophilus influenzae (NTHI) is a human-restricted pathogen with an essential requirement for heme-iron acquisition. We previously demonstrated that microevolution of NTHI promotes stationary phase survival in response to transient heme-iron restriction. In this study, we examine the metabolic contributions to biofilm formation using this evolved NTHI strain, RM33. Quantitative analyses identified 29 proteins, 55 transcripts, and 31 metabolites that significantly changed within in vitro biofilms formed by RM33. The synthesis of all enzymes within the tryptophan and glycogen pathways was significantly increased in biofilms formed by RM33 compared with the parental strain. In addition, increases were observed in metabolite transport, adhesin production, and DNA metabolism. Furthermore, we observed pyruvate as a pivotal point in the metabolic pathways associated with changes in cAMP phosphodiesterase activity during biofilm formation. Taken together, changes in central metabolism combined with increased stores of nutrients may serve to counterbalance nutrient sequestration.
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Affiliation(s)
- Alistair Harrison
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Rachael L. Hardison
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Rachel M. Wallace
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - James Fitch
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Steve and Cindy Rasmussen Institute for Genomic Medicine, 575 Children’s Crossroad, Columbus, OH 43215 USA
| | - Derek R. Heimlich
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Meghan O’ Bryan
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Laura Dubois
- Duke Proteomics and Metabolomics Core Facility, Duke Center for Genomic and Computational Biology, Duke University, 701 West Main Street, Durham, NC 27701 USA
| | - Lisa St. John-Williams
- Duke Proteomics and Metabolomics Core Facility, Duke Center for Genomic and Computational Biology, Duke University, 701 West Main Street, Durham, NC 27701 USA
| | - Robert P. Sebra
- Icahn School of Medicine at Mount Sinai, Icahn Institute and Department of Genetics & Genomic Sciences, 1 Gustave L. Levy Place, New York, NY 10029 USA
| | - Peter White
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Steve and Cindy Rasmussen Institute for Genomic Medicine, 575 Children’s Crossroad, Columbus, OH 43215 USA
| | - M. Arthur Moseley
- Duke Proteomics and Metabolomics Core Facility, Duke Center for Genomic and Computational Biology, Duke University, 701 West Main Street, Durham, NC 27701 USA
| | - J. Will Thompson
- Duke Proteomics and Metabolomics Core Facility, Duke Center for Genomic and Computational Biology, Duke University, 701 West Main Street, Durham, NC 27701 USA
| | - Sheryl S. Justice
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
- Infectious Diseases Institute, The Ohio State University College of Medicine, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Kevin M. Mason
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
- Infectious Diseases Institute, The Ohio State University College of Medicine, 700 Children’s Drive, Columbus, OH 43205 USA
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Wolter NE, Gordon KA, Campos JL, Vilchez Madrigal LD, Pothier DD, Hughes CO, Papsin BC, Cushing SL. BalanCI: Head-Referenced Cochlear Implant Stimulation Improves Balance in Children with Bilateral Cochleovestibular Loss. Audiol Neurootol 2019; 25:60-71. [PMID: 31678979 DOI: 10.1159/000503135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To determine the impact of a head-referenced cochlear implant (CI) stimulation system, BalanCI, on balance and postural control in children with bilateral cochleovestibular loss (BCVL) who use bilateral CI. METHODS Prospective, blinded case-control study. Balance and postural control testing occurred in two settings: (1) quiet clinical setting and (2) immersive realistic virtual environment (Challenging Environment Assessment Laboratory [CEAL], Toronto Rehabilitation Institute). Postural control was assessed in 16 and balance in 10 children with BCVL who use bilateral CI, along with 10 typically developing children. Children with neuromotor, cognitive, or visual deficits that would prevent them from performing the tests were excluded. Children wore the BalanCI, which is a head-mounted device that couples with their CIs through the audio port and provides head-referenced spatial information delivered via the intracochlear electrode array. Postural control was measured by center of pressure (COP) and time to fall using the WiiTM (Nintendo, WA, USA) Balance Board for feet and the BalanCI for head, during the administration of the Modified Clinical Test of Sensory Interaction in Balance (CTSIB-M). The COP of the head and feet were assessed for change by deviation, measured as root mean square around the COP (COP-RMS), rate of deviation (COP-RMS/duration), and rate of path length change from center (COP-velocity). Balance was assessed by the Bruininks-Oseretsky Test of Motor Proficiency 2, balance subtest (BOT-2), specifically, BOT-2 score as well as time to fall/fault. RESULTS In the virtual environment, children demonstrated more stable balance when using BalanCI as measured by an improvement in BOT-2 scores. In a quiet clinical setting, the use of BalanCI led to improved postural control as demonstrated by significant reductions in COP-RMS and COP-velocity. With the use of BalanCI, the number of falls/faults was significantly reduced and time to fall increased. CONCLUSIONS BalanCI is a simple and effective means of improving postural control and balance in children with BCVL who use bilateral CI. BalanCI could potentially improve the safety of these children, reduce the effort they expend maintaining balance and allow them to take part in more complex balance tasks where sensory information may be limited and/or noisy.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L Campos
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | | | - David D Pothier
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Cían O Hughes
- UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Blake C Papsin
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, .,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada, .,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada, .,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada,
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Hülse R, Warken C, Biesdorf A, Erhart M, Rotter N, Hörmann K, Wenzel A. Prävalenz peripher-vestibulärer Erkrankungen bei Kindern in Deutschland. HNO 2019; 68:360-366. [DOI: 10.1007/s00106-019-00747-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
This article focuses on vestibular rehabilitation (VR) for children. Reports of the presence of vestibular dysfunction in infants, young children, and adolescents have increased over the past decade. In addition to being a comorbidity of sensorineural hearing loss, vestibular dysfunction has been noted in children with cytomegalovirus, late prematurity, and concussion, to name a few. Despite ample evidence and reports of VR for adults, the selection and provision of exercises to be included in the VR protocol for children vary, depending on the nature of the lesion, impairments identified, age at the time of lesion, and developmental factors such as critical periods of development and intermodality interdependence. Unlike adults, children with loss of function or hypofunction of the vestibular apparatus since or shortly after birth present with a developmental delay that is progressive. Very young children may not be able to describe symptoms but rather only avoid activities or cry. This report provides a review of vestibular-related impairments in children, determinants of the symptoms and functional impairments of vestibular dysfunction, the mechanisms of recovery in children, the challenges of VR for children, and a summary of research on the efficacy for VR for children.
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Brodsky J, Kaur K, Shoshany T, Lipson S, Zhou G. Benign paroxysmal migraine variants of infancy and childhood: Transitions and clinical features. Eur J Paediatr Neurol 2018; 22:667-673. [PMID: 29656928 DOI: 10.1016/j.ejpn.2018.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/30/2018] [Accepted: 03/25/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Migraine variant disorders of childhood include benign paroxysmal torticollis of infancy (BPTI) and benign paroxysmal vertigo of childhood (BPVC). This study aimed to review our experience with BPTI and BPVC and determine the incidence of children transitioning between each of these disorders and to vestibular migraine (VM). METHODS We retrospectively reviewed the medical records of patients seen at the Balance and Vestibular Program at Boston Children's Hospital between January 2012 and December 2016 who were diagnosed with BPTI, BPVC, and/or VM. RESULTS Fourteen patients were diagnosed with BPTI, 39 with BPVC, and 100 with VM. Abnormal rotary chair testing was associated with progression from BPTI to BPVC (n = 8, p = 0.045). Eight (57.1%) patients with BPTI and 11 (28.2%) with BPVC had motor delay. Eleven (78.6%) patients with BPTI and 21 (53.8%) with BPVC had balance impairment. Six BPTI patients developed BPVC (42.9%), six BPVC patients developed VM (15.4%), and two patients progressed through all three disorders (2%). One BPTI patient progressed directly to VM. DISCUSSION Most patients with BPTI will experience complete resolution in early childhood, but some will progress to BPVC, and similarly many patients with BPVC will progress to VM. Parents of children with these disorders should be made aware of this phenomenon, which we refer to as "the vestibular march." Children with BPTI and BPVC should also be screened for hearing loss, otitis media, and motor delay.
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Affiliation(s)
- Jacob Brodsky
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA; Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
| | - Karampreet Kaur
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA; Vanderbilt University School of Medicine, 1161 21st Ave South, Nashville, TN, 37232, USA
| | - Talia Shoshany
- Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Sophie Lipson
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Guangwei Zhou
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA; Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
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Rotational and Collic Vestibular-Evoked Myogenic Potential Testing in Normal Developing Children and Children With Combined Attention Deficit/Hyperactivity Disorder. Ear Hear 2018; 38:e352-e358. [PMID: 28562425 DOI: 10.1097/aud.0000000000000451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Vestibular dysfunction in childhood can have a major effect on a child's developmental process. Balance function has been reported to be poorer in children with attention deficit and hyperactivity disorder (ADHD) than in their typically developing peers. Due to contradictory available evidence and the paucity of research on vestibular function specifically in children with combined ADHD (cADHD), we designed this aged-matched study to assess vestibular function in children with cADHD. DESIGN We enrolled 30 typically developing children (15 boys and 15 girls; mean age, 9 years 6 months; range, 7 to 12 years) and 33 children (19 boys and 14 girls; mean age, 9 years 0 months; range, 7 to 12 years) with cADHD diagnosed by our research psychiatrist. Typically developing controls were used to obtain normative data on vestibular testing and to examine the impact of age on the vestibular response parameters, and these results were compared with those of the cADHD group. All children underwent the sinusoidal harmonic acceleration subtype of the rotary chair test (0.01, 0.02, 0.08, 0.16, and 0.32 Hz) and the cervical vestibular-evoked myogenic potential (cVEMP) test. RESULTS At all five frequencies in the sinusoidal harmonic acceleration test, there was no significant correlation between age and any of the following rotary chair response parameters in typically developing children: vestibulo-ocular reflex (VOR) gain, phase, asymmetry, and fixation index. Furthermore, there was no significant correlation between age and any of the following cVEMP parameters for the right and left ears of control group: p1 and n1 latency, amplitude, threshold, and amplitude ratio. Significantly higher VOR gains were observed for children with cADHD at frequencies of 0.01 (p = 0.001), 0.08 (p < 0.001), 0.16 (p = 0.001), and 0.32 (p = 0.003) Hz, when compared with the control group. Furthermore, fixation abilities were significantly lower in the cADHD group than in the control group at 0.16 (p < 0.001) and 0.32 (p < 0.001) Hz. cVEMP parameters showed no significant differences between the two groups. CONCLUSIONS Our results showed higher VOR gains and poorer fixation abilities in children with cADHD compared with typically developing children. Cerebellar dysfunction in patients with ADHD has been well documented in the literature, and our findings of cVEMP and rotary chair tests for these children showed impaired vestibular function in these children, based on increased VOR gain values and decreased fixation capabilities. Because VOR gain is mediated through the inferior olive and controlled by the cerebellum, our results suggest that central inhibition of vestibular function may be deficient in children with cADHD, resulting in higher VOR gains. Also, there is general agreement that failure of fixation suppression indicates a central lesion. The lesion can originate from the parietal-occipital cortex, the pons, or the cerebellum. However, failure of fixation suppression is most prominent in lesions involving the midline cerebellum that could be counted for children with cADHD. We believe that this contribution is theoretically and practically relevant as high VOR gains and decreased suppression capabilities may result in symptoms of reading and writing difficulties, learning disabilities, vertigo, and motion sickness in these children. Therefore, assessment of vestibular function in children with cADHD at a young age must be considered when developing rehabilitation protocols for these children.
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Janky KL, Thomas MLA, High RR, Schmid KK, Ogun OA. Predictive Factors for Vestibular Loss in Children With Hearing Loss. Am J Audiol 2018; 27:137-146. [PMID: 29482202 DOI: 10.1044/2017_aja-17-0058] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/05/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study was to determine if there are factors that can predict whether a child with hearing loss will also have vestibular loss. METHOD A retrospective chart review was completed on 186 children with hearing loss seen at Boys Town National Research Hospital for vestibular testing from 1999 to 2015 through neurosensory genetics clinic or cochlear implant candidacy. Each child's medical chart was reviewed to obtain the following data: vestibular loss severity (classified as normal, bilateral, or mild to moderate), degree of hearing loss (bilateral pure-tone average [PTA]), imaging abnormalities (classified as "normal" or "abnormal"), parental concerns for gross motor delay (classified as "yes, there is concern" or "no, there is not a concern"), parent report of age when their child sat (months) and walked independently (months), comorbidities (classified as "yes" if there were 1 or more comorbidities or "no" if there were no comorbidities), and score on the Developmental Profile-3. RESULTS Children were grouped according to vestibular loss severity; 115 children had normal vestibular function, 31 had bilateral vestibular loss, and 40 had mild-to-moderate vestibular loss. As severity of vestibular loss increased, children (a) sat and walked later, (b) scored more poorly on the Developmental Profile-3 physical subscale, (c) had more severe hearing loss, (d) had parents who more frequently reported concern for gross motor delay, and (e) were more likely to have other comorbidities. Of these factors, age-to-sit, age-to-walk, PTA, and parental concerns for gross motor developmental delay had the greatest ability to differentiate children with vestibular loss from children with normal vestibular function. For age-to-sit, using a cutoff value of 7.25 months yielded a sensitivity of 62% and a specificity of 81%. For age-to-walk, a cutoff value of 14.5 months yielded a sensitivity of 78% and a specificity of 77%. For PTA for the neurosensory genetics group, a cutoff value of 40 dB yielded a sensitivity of 80% and a specificity of 55%; however, a cutoff value of 66 dB yielded a sensitivity of 33% and an improved specificity of 91%. CONCLUSIONS A referral for vestibular evaluation should be considered for children whose hearing loss is greater than 66 dB and particularly those who sit later than 7.25 months or walk later than 14.5 months or whose parents report concerns for gross motor development. Collectively, these factors appear to be more sensitive for identifying children with bilateral vestibular loss compared with children with mild-to-moderate vestibular loss. Because of the benefit of physical therapy, children identified with vestibular loss should then be referred to physical therapy for further evaluation and treatment.
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Affiliation(s)
- Kristen L. Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE
| | - Megan L. A. Thomas
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE
| | - Robin R. High
- Department of Biostatistics, University of Nebraska Medical Center, Omaha
| | - Kendra K. Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha
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Chang J, Hwang SY, Park SK, Kim JH, Kim HJ, Chae SW, Song JJ. Prevalence of Dizziness and Associated Factors in South Korea: A Cross-Sectional Survey From 2010 to 2012. J Epidemiol 2017; 28:176-184. [PMID: 29151473 PMCID: PMC5865008 DOI: 10.2188/jea.je20160113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dizziness is one of the most common complaints in medicine and a frequent symptom among older people. Dizziness has a considerable impact on life quality and is associated with high economic costs. The purpose of this study was to evaluate the prevalence of dizziness in the general population and to describe its clinical characteristics and associated factors. METHODS The Korea National Health and Nutrition Examination Survey (KNHANES) is a cross-sectional survey of the civilian, non-institutionalized population of South Korea. We evaluated data for 12,653 participants (5,450 men and 7,203 women), aged 40 years and above, whom participated in the KNHANES between 2010 and 2012. RESULTS In the age group over 40 years old, the 1-year prevalence of dizziness was 20.10%. Dizziness was more prevalent among women (25.18%) than among men (14.57%; P < 0.001) and the prevalence rate increased with age (P < 0.001). In multivariable analysis, female sex, older age, serum triglyceride level, experience of depression, limited functional status owing to visual acuity impairment, limited physical performance, smoking, alcohol consumption, and perception of stress were independently associated with dizziness. CONCLUSIONS In our study, the prevalence of dizziness in the general population was 20.10%. There was a stronger relationship between dizziness and physical performance, chronic diseases, and health behaviors compared to that with otologic diseases. Interventions for dizziness should be approached in a multifactorial manner and an understanding of various factors is necessary for the prevention and management of this condition.
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Affiliation(s)
- Jiwon Chang
- Department of Otolaryngology Head and Neck Surgery, Hallym University College of Medicine
| | - Soon Young Hwang
- Department of Biostatistics, College of Medicine, Korea University
| | - Su Kyoung Park
- Department of Otolaryngology Head and Neck Surgery, Hallym University College of Medicine
| | - Jin Hwan Kim
- Department of Otolaryngology Head and Neck Surgery, Hallym University College of Medicine
| | - Hyung-Jong Kim
- Department of Otolaryngology Head and Neck Surgery, Hallym University College of Medicine
| | - Sung-Won Chae
- Department of Otolaryngology Head and Neck Surgery, Korea University College of Medicine
| | - Jae-Jun Song
- Department of Otolaryngology Head and Neck Surgery, Korea University College of Medicine
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Blanco-Sánchez B, Clément A, Phillips JB, Westerfield M. Zebrafish models of human eye and inner ear diseases. Methods Cell Biol 2016; 138:415-467. [PMID: 28129854 DOI: 10.1016/bs.mcb.2016.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Eye and inner ear diseases are the most common sensory impairments that greatly impact quality of life. Zebrafish have been intensively employed to understand the fundamental mechanisms underlying eye and inner ear development. The zebrafish visual and vestibulo-acoustic systems are very similar to these in humans, and although not yet mature, they are functional by 5days post-fertilization (dpf). In this chapter, we show how the zebrafish has significantly contributed to the field of biomedical research and how researchers, by establishing disease models and meticulously characterizing their phenotypes, have taken the first steps toward therapies. We review here models for (1) eye diseases, (2) ear diseases, and (3) syndromes affecting eye and/or ear. The use of new genome editing technologies and high-throughput screening systems should increase considerably the speed at which knowledge from zebrafish disease models is acquired, opening avenues for better diagnostics, treatments, and therapies.
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Affiliation(s)
| | - A Clément
- University of Oregon, Eugene, OR, United States
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Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based Study. J Pediatr 2016; 171:240-7.e1-3. [PMID: 26826885 DOI: 10.1016/j.jpeds.2015.12.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/23/2015] [Accepted: 12/04/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study national prevalence of dizziness and balance problems in US children and explore associated risk factors and patterns of healthcare utilization. STUDY DESIGN A multistage, nationally representative, probability sample of children (n = 10,954; aged 3-17 years) was examined based on the 2012 National Health Interview Survey Child Balance Supplement. Parents were asked if during the past year their child was bothered by symptoms of dizziness and balance problems: vertigo (motion sensation), light-headedness/fainting, clumsiness/poor coordination, poor balance/unsteadiness when standing-up or walking, frequent falls, or other dizziness and balance problems. Logistic regression was used to examine associations with sociodemographic information, birth weight, developmental delays, and significant health conditions. RESULTS Prevalence of dizziness and balance problems was 5.3% (3.3 million US children); females, 5.7%, males, 5.0%. Non-Hispanic white (6.1%) had increased prevalence compared with Hispanic (4.6%) and non-Hispanic black (4.3%) children, P = .01. Prevalence increased with age, from 4.1% for children aged 3-5 years to 7.5% for children aged 15-17 years, P < .001. Even though the majority had symptoms rated as "no problem" or "a small problem," 18.6% (600,000 US children) had symptoms rated as "moderate," "big," or "very big" problems. Overall, 36.0% of children with dizziness and balance problems were seen by healthcare professionals during the past year and 29.9% received treatment. Among children with dizziness and balance problems rated as moderate/big/very big problems, 71.6% had seen healthcare professionals and 62.4% received treatment for dizziness and balance problems. CONCLUSIONS The risk factors identified provide useful epidemiologic information about dizziness and balance problems in children and will be used in tracking the Healthy People 2020 goal to increase utilization of healthcare services for these children.
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Guerin V, Hampel R, Ter Haar G. Video-otoscopy-guided tympanostomy tube placement for treatment of middle ear effusion. J Small Anim Pract 2015; 56:606-12. [PMID: 26329126 DOI: 10.1111/jsap.12397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/24/2015] [Accepted: 07/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe video-otoscopy-guided tympanostomy tube placement in 12 cavalier King Charles spaniels with middle ear effusion and assess the clinical outcome. METHODS A retrospective review of medical records of cavalier King Charles spaniels diagnosed with middle ear effusion and treated with tympanostomy tubes placement between 2012 and 2014 was performed. Outcome was assessed based on a telephone questionnaire. RESULTS Twenty-two tympanostomy tubes were successfully placed in the tympanic membrane in 12 cavalier King Charles spaniels under video-otoscopic guidance using a rigid endoscope and grasping forceps. Follow-up based on an owner questionnaire was available for 11/12 dogs. Subjective improvement in hearing was observed in 9/11 dogs with three dogs achieving normal hearing, according to the owners, and six demonstrating partial improvements. Out of 11 dogs, 10 dogs were reported with improved quality of life. Pruritus of the ears resolved in 3/9 dogs. Clinical signs recurred in four dogs because of tube dislodgement. CLINICAL SIGNIFICANCE Video-otoscopic tympanostomy tube placement appeared to be indicated as a treatment for middle ear effusion in cavalier King Charles spaniels. It subjectively improved hearing, pruritus and quality of life in most dogs. The tympanostomy tubes dislodged in some cases, leading to recurrence of clinical signs, which were effectively eliminated by replacement of a fresh tube.
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Affiliation(s)
- V Guerin
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA
| | - R Hampel
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA
| | - G Ter Haar
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA
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Said EA, Ahmed MK, Mohamed ES. Role of vestibular testing in deciding treatment strategies for children with otitis media with effusion. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ejenta.2015.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Batuecas-Caletrio A, Santa Cruz-Ruiz S, Muñoz-Herrera A, Perez-Fernandez N. The map of dizziness in vestibular schwannoma. Laryngoscope 2015; 125:2784-9. [DOI: 10.1002/lary.25402] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Angel Batuecas-Caletrio
- Department of Otorhinolaryngology, Otoneurology Unit; University Hospital of Salamanca, University of Salamanca; Salamanca
| | - Santiago Santa Cruz-Ruiz
- Department of Otorhinolaryngology, Otoneurology Unit; University Hospital of Salamanca, University of Salamanca; Salamanca
| | - Angel Muñoz-Herrera
- Department of Otorhinolaryngology, Otoneurology Unit; University Hospital of Salamanca, University of Salamanca; Salamanca
| | - Nicolas Perez-Fernandez
- Clínica Universidad de Navarra; University Hospital and Medical School; University of Navarra; Pamplona Spain
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Swarts JD, Casselbrant ML, Teixeira MS, Mandel EM, Richert BC, Banks JM, El-Wagaa J, Doyle WJ. Eustachian tube function in young children without a history of otitis media evaluated using a pressure chamber protocol. Acta Otolaryngol 2014; 134:579-87. [PMID: 24828350 DOI: 10.3109/00016489.2014.882017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Protocol limitations were identified and accounted for in the analysis. Percent gradient equilibrated (PGE) was affected by driving gradient direction in a similar manner to other efficiency measures. A finer resolution of possible age-related changes in eustachian tube opening efficiency is expected with the application of more sophisticated statistical models to the complete dataset at study end. OBJECTIVE To report the results of an interim analysis for an ongoing study designed to characterize the age-related changes in eustachian tube opening efficiency measured using a pressure chamber protocol in children without a history of middle ear disease. METHODS To date, 41 children aged 3 years without a history of otitis media have been enrolled in a longitudinal study of the age-related changes in eustachian tube function and evaluated at yearly intervals between 3 and 7 years of age. Eustachian tube opening efficiency, the percent of the applied pressure gradient equilibrated by swallowing, was measured by repeat tympanometry during a pressure chamber protocol. Data (120 tests) were analyzed using an ANOVA with variance partitioned by age (3 through 6 years), gradient direction (positive/negative), and ear (left/right). RESULTS PGE was higher for left ears and positive driving gradients, but was not different among age groups.
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Affiliation(s)
- John Douglas Swarts
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA
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Woo JI, Kil SH, Brough DE, Lee YJ, Lim DJ, Moon SK. Therapeutic potential of adenovirus-mediated delivery of β-defensin 2 for experimental otitis media. Innate Immun 2014; 21:215-24. [PMID: 24842664 DOI: 10.1177/1753425914534002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Otitis media (OM), one of the most prevalent diseases in young children, is clinically important owing to its high incidence in children and its potential impact on language development and motor coordination. OM is the most common reason for the prescription of antibiotics (accounting for 25% of prescriptions) due to its extremely high incidence. A recent increase in antibiotic resistance among OM pathogens is emerging as a major public health concern globally, which led us to consider non-antibiotic approaches for the management of OM. In this study, we evaluated gene transfer of an antimicrobial peptide, human β-defensin 2 (DEFB4), using an adenoviral vector (Ad5 with deletions of E1/E3/E4) as a potential therapeutic approach. We demonstrated that the transduction of human β-defensin 2 induces the production of human β-defensin 2 and suppresses non-typeable Haemophilus influenzae (NTHi) adhesion to human middle ear epithelial cells. Moreover, intratympanic inoculation of Ad-DEFB4 was found to attenuate NTHi-induced middle ear effusions without eliciting a significant immune response. Most importantly, intratympanic inoculation of Ad-DEFB4 appeared to significantly augment clearance of NTHi from middle ear cavity. Collectively, our results suggest that intratympanic gene delivery of antimicrobial molecules may serve as an alternative/adjuvant approach for the management of OM.
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Affiliation(s)
- Jeong-Im Woo
- Department of Head and Neck Surgery, University of California, Los Angeles, CA, USA
| | - Sung-Hee Kil
- Department of Head and Neck Surgery, University of California, Los Angeles, CA, USA
| | | | - Yoo Jin Lee
- Department of Head and Neck Surgery, University of California, Los Angeles, CA, USA
| | - David J Lim
- Department of Head and Neck Surgery, University of California, Los Angeles, CA, USA
| | - Sung K Moon
- Department of Head and Neck Surgery, University of California, Los Angeles, CA, USA
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Abstract
PURPOSE To determine reliability, diagnostic values, and minimal detectable change scores, 90% confidence (MDC90) of pediatric clinical tests of vestibular function. METHODS Twenty children with severe to profound bilateral sensorineural hearing loss and 23 children with typical development, aged 6 to 12 years, participated. The Head Thrust Test, Emory Clinical Vestibular Chair Test, Bucket Test, Dynamic Visual Acuity, Modified Clinical Test of Sensory Interaction on Balance, and Sensory Organization Test were completed twice for reliability. Reference standard diagnostic tests were rotary chair and vestibular evoked myogenic potential. Reliability, sensitivity, specificity, predictive values, likelihood ratios, and MDC90 scores were calculated. RESULTS Reliability ranged from an intraclass correlation coefficient of 0.73 to 0.95. Sensitivity, specificity, and predictive values, using cutoff scores for each test representing the largest area under the curve, ranged from 63% to 100%. The MDC90 for Dynamic Visual Acuity and Modified Clinical Test of Sensory Interaction on Balance were 8 optotypes and 16.75 seconds, respectively. CONCLUSIONS Clinical tests can be used accurately to identify children with vestibular hypofunction.
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Doyle WJ, Swarts JD, Banks J, Casselbrant ML, Mandel EM, Alper CM. Sensitivity and specificity of eustachian tube function tests in adults. JAMA Otolaryngol Head Neck Surg 2013; 139:719-27. [PMID: 23868429 DOI: 10.1001/jamaoto.2013.3559] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The study demonstrates the utility of eustachian tube (ET) function (ETF) test results for accurately assigning ears to disease state. OBJECTIVES To determine if ETF tests can identify ears with physician-diagnosed ET dysfunction (ETD) in a mixed population at high sensitivity and specificity and to define the interrelatedness of ETF test parameters. DESIGN, SETTING, AND PARTICIPANTS Through use of the forced-response, inflation-deflation, Valsalva, and sniffing tests, ETF was evaluated in 15 control ears of adult subjects after unilateral myringotomy (group 1) and in 23 ears of 19 adult subjects with ventilation tubes inserted for ETD (group 2). Data were analyzed using logistic regression including each parameter independently and then a step-down discriminant analysis including all ETF test parameters to predict group assignment. Factor analysis operating over all parameters was used to explore relatedness. EXPOSURES ETF testing. MAIN OUTCOMES AND MEASURES ETF parameters for the forced response, inflation-deflation, Valsalva, and sniffing tests measured in 15 control ears of adult subjects after unilateral myringotomy (group 1) and in 23 ears of 19 adult subjects with ventilation tubes inserted for ETD (group 2). RESULTS The discriminant analysis identified 4 ETF test parameters (Valsalva, ET opening pressure, dilatory efficiency, and percentage of positive pressure equilibrated) that together correctly assigned ears to group 2 at a sensitivity of 95% and a specificity of 83%. Individual parameters representing the efficiency of ET opening during swallowing showed moderately accurate assignments of ears to their respective groups. Three factors captured approximately 98% of the variance among parameters: the first had negative loadings of the ETF structural parameters; the second had positive loadings of the muscle-assisted ET opening parameters; and the third had negative loadings of the muscle-assisted ET opening parameters and positive loadings of the structural parameters. CONCLUSIONS AND RELEVANCE These results show that ETF tests can correctly assign individual ears to physician-diagnosed ETD with high sensitivity and specificity and that ETF test parameters can be grouped into structural-functional categories.
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Affiliation(s)
- William J Doyle
- Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Oh S, Woo JI, Lim DJ, Moon SK. ERK2-dependent activation of c-Jun is required for nontypeable Haemophilus influenzae-induced CXCL2 upregulation in inner ear fibrocytes. THE JOURNAL OF IMMUNOLOGY 2012; 188:3496-505. [PMID: 22379036 DOI: 10.4049/jimmunol.1103182] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The inner ear, composed of the cochlea and the vestibule, is a specialized sensory organ for hearing and balance. Although the inner ear has been known as an immune-privileged organ, there is emerging evidence indicating an active immune reaction of the inner ear. Inner ear inflammation can be induced by the entry of proinflammatory molecules derived from middle ear infection. Because middle ear infection is highly prevalent in children, middle ear infection-induced inner ear inflammation can impact the normal development of language and motor coordination. Previously, we have demonstrated that the inner ear fibrocytes (spiral ligament fibrocytes) are able to recognize nontypeable Haemophilus influenzae, a major pathogen of middle ear infection, and upregulate a monocyte-attracting chemokine through TLR2-dependent NF-κB activation. In this study, we aimed to determine the molecular mechanism involved in nontypeable H. influenzae-induced cochlear infiltration of polymorphonuclear cells. The rat spiral ligament fibrocytes were found to release CXCL2 in response to nontypeable H. influenzae via activation of c-Jun, leading to the recruitment of polymorphonuclear cells to the cochlea. We also demonstrate that MEK1/ERK2 signaling pathway is required for nontypeable H. influenzae-induced CXCL2 upregulation in the rat spiral ligament fibrocytes. Two AP-1 motifs in the 5'-flanking region of CXCL2 appeared to function as a nontypeable H. influenzae-responsive element, and the proximal AP-1 motif was found to have a higher binding affinity to nontypeable H. influenzae-activated c-Jun than that of the distal one. Our results will enable us better to understand the molecular pathogenesis of middle ear infection-induced inner ear inflammation.
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Affiliation(s)
- Sejo Oh
- Division of Clinical and Translational Research, House Research Institute, Los Angeles, CA 90057, USA
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Selecting infants with OM that need referral and further assessment: creating a case-finding instrument. Int J Pediatr Otorhinolaryngol 2011; 75:1301-7. [PMID: 21840067 DOI: 10.1016/j.ijporl.2011.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/12/2011] [Accepted: 07/16/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In the Netherlands, many children are surgically treated for OM. Recent publications question the need for surgical treatment in common uncomplicated OM, although there is certainly a subgroup of infants that do need further assessment and possible treatment. The present study explores the possibility of using known and presumed risk factors for OM as an instrument for selecting and routing an infant with OM to further care. METHODS Two questionnaires were used. A questionnaire embracing a wide range of OM-related factors was sent to 6531 children aged nine months that were routinely invited for the hearing screen at nine months. In a second stage, a structured history questionnaire regarding ear and/or hearing problems, subsequent referral and/or treatment, was sent to all parents of children at age 21 months, responding to the first questionnaire. Univariate analysis was performed for identification of potential predictors for surgical treatment of OM for the whole sample as well as for 4 different subsets. Multivariable regression analysis with stepwise backward deletion was applied to arrive at a model for optimal prediction of tube insertion. A ROC (receiver operating characteristic) curve and the accompanying sensitivity and specificity values were analyzed to determine cut off values. RESULTS Univariate analysis found 10 items predicting surgical treatment for OM. Multivariable regression analysis resulted in a model with a ROC curve having an area of 0.801 and estimated coefficients for risk factors which were used to calculate a OM-score for each case. CONCLUSION The developed scoring sheet, e.g., to be used in combination with physical examinations and/or tympanometry looks promising as a predictor for those children that might benefit from further assessment and eventually surgically treatment for OM.
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Spiral ligament fibrocyte-derived MCP-1/CCL2 contributes to inner ear inflammation secondary to nontypeable H. influenzae-induced otitis media. BMC Infect Dis 2010; 10:314. [PMID: 21029462 PMCID: PMC2988798 DOI: 10.1186/1471-2334-10-314] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 10/28/2010] [Indexed: 12/20/2022] Open
Abstract
Background Otitis media (OM), one of the most common pediatric infectious diseases, causes inner ear inflammation resulting in vertigo and sensorineural hearing loss. Previously, we showed that spiral ligament fibrocytes (SLFs) recognize OM pathogens and up-regulate chemokines. Here, we aim to determine a key molecule derived from SLFs, contributing to OM-induced inner ear inflammation. Methods Live NTHI was injected into the murine middle ear through the tympanic membrane, and histological analysis was performed after harvesting the temporal bones. Migration assays were conducted using the conditioned medium of NTHI-exposed SLFs with and without inhibition of MCP-1/CCL2 and CCR2. qRT-PCR analysis was performed to demonstrate a compensatory up-regulation of alternative genes induced by the targeting of MCP-1/CCL2 or CCR2. Results Transtympanic inoculation of live NTHI developed serous and purulent labyrinthitis after clearance of OM. THP-1 cells actively migrated and invaded the extracellular matrix in response to the conditioned medium of NTHI-exposed SLFs. This migratory activity was markedly inhibited by the viral CC chemokine inhibitor and the deficiency of MCP-1/CCL2, indicating that MCP-1/CCL2 is a main attractant of THP-1 cells among the SLF-derived molecules. We further demonstrated that CCR2 deficiency inhibits migration of monocyte-like cells in response to NTHI-induced SLF-derived molecules. Immunolabeling showed an increase in MCP-1/CCL2 expression in the cochlear lateral wall of the NTHI-inoculated group. Contrary to the in vitro data, deficiency of MCP-1/CCL2 or CCR2 did not inhibit OM-induced inner ear inflammation in vivo. We demonstrated that targeting MCP-1/CCL2 enhances NTHI-induced up-regulation of MCP-2/CCL8 in SLFs and up-regulates the basal expression of CCR2 in the splenocytes. We also found that targeting CCR2 enhances NTHI-induced up-regulation of MCP-1/CCL2 in SLFs. Conclusions Taken together, we suggest that NTHI-induced SLF-derived MCP-1/CCL2 is a key molecule contributing to inner ear inflammation through CCR2-mediated recruitment of monocytes. However, deficiency of MCP-1/CCL2 or CCR2 alone was limited to inhibit OM-induced inner ear inflammation due to compensation of alternative genes.
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