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Alamri AA, Amoodi HA, Alsubaie SA, Alsehly AA, Alshuaibi RO, Alotaibi LA, Almaghrabi SJ, Mozahim SF, Mozahim NF, Tonkal A. Efficacy of Adenoidectomy versus Tympanostomy on the Otitis Media with Effusion: A Systematic Review and Meta-Analysis. Afr J Paediatr Surg 2024; 21:236-241. [PMID: 39254052 DOI: 10.4103/ajps.ajps_144_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/03/2023] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to investigate the current evidence on the efficacy of tympanostomy and adenoidectomy in children with otitis media with effusion in comparison with tympanostomy alone following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MATERIALS AND METHODS We completed a comprehensive search of PubMed, Web of Science, Scopus and Cochrane Library databases for relevant studies published in the literature with no date restrictions. We collected the results of the databases search and removed duplicated studies by Rayyan QCRI and EndNote Software X8. We used an Excel sheet for screening titles and abstracts, full text and data extraction. For quality assessment, we used Cochrane Handbook of Systematic Reviews of Interventions 5.1.0 using the quality assessment table provided in Part 2 and Chapter 8.5, and quantitative data synthesis was done using Review Manager (RevMan) software version 5.4. RESULTS The literature search showed 1510 studies, of which five studies were included in data synthesis. The study measured the effect through number of acute otitis media (AOM) episodes, cumulative number of AOM episodes, siblings with Otitis media (OM), hearing level hearing loss scale of the left, and right ears. The pooled effect estimates showed significant difference between tympanostomy with adenoidectomy versus tympanostomy alone in hearing level hearing loss scale of both ears (SMD -0.17, 95% CI [-0.29, -0.05], P -value=0.005). However, the pooled results were not heterogeneous ( P < 0.25, I2 = 24%). CONCLUSIONS Tympanostomy with adenoidectomy improves hearing compared to tympanostomy alone, but both treatments have similar effects on ear infection rates. Further research with larger samples is needed to confirm these findings and assess long-term benefits.
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Affiliation(s)
- Abdullah A Alamri
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hosam A Amoodi
- Department of Otolaryngology, Head and Neck Surgery, Jeddah University, Jeddah, Saudi Arabia
- Department of Otolaryngology, Head and Neck Surgery, Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Shahad A Alsubaie
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Areej A Alsehly
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Razan O Alshuaibi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Leena A Alotaibi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sahar J Almaghrabi
- College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sarah F Mozahim
- College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Naif F Mozahim
- College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Albaraa Tonkal
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Homøe AS, Thorup N, Larsen CVL, Homøe P. Prevalence of self-reported middle ear disease, hearing loss and vertigo in two adult population-based cohorts over a 20-year period in Greenland. Int J Circumpolar Health 2023; 82:2183588. [PMID: 36853877 PMCID: PMC9980023 DOI: 10.1080/22423982.2023.2183588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
To estimate the frequencies of self-reported middle ear and hearing complaints and vertigo/dizziness in adult Greenlanders. Furthermore, to examine if there has been a development in the frequency of these complaints within a 20-year period. A structured questionnaire concerning middle ear disease and related neuro-otological symptoms was mailed to 400 randomly selected adult Greenlanders between 18 and 60 years of age in 1995. In 2014, the questions were included for the same age group in the general Greenlandic Health Survey. The questionnaires contained a total of six identical questions. In 1995, 281 participants (70%) replied to the questionnaire. In 2014, 1,639 participants (78%) replied. We found that in 1995 the two youngest age groups (18-29- and 30-39-year-olds) had the highest relative number of ear discharge. Approximately one-third of the participants in these two age groups reported to have had ear discharge, while this was only reported by 17% of the 18-29-year-olds and 16% of the 30-39-year-olds in 2014 (95% CI [0.03, 0.3] and [0.1, 0.3], respectively). The oldest age group indicated the lowest relative number of experiences of ear discharge in both 1995 and 2014 (18% and 17%, respectively). In 1995, 30% in the age group 30-39-year-olds reported hearing loss, whereas only 18% reported hearing loss in 2014 (p < 0.05, 95% CI [-0.003,0.2]). There was no significant difference in reported ear discharge since childhood and otitis media in childhood among the age groups between 1995 and 2014. However, in 1995 significantly more females had experienced ear discharge in the age groups 18-29 and 30-39 year-olds compared to 2014. Females in the age group 18-29 year-olds also showed a significant difference in having experienced otitis media in childhood, where 32% answered "yes" in 1995, and 18% answered "yes" in 2014 (p < 0.05). In 2014, females reported more frequent complaints of vertigo compared to males, 16% and 9%, respectively (p < 0.05). In 1995, there was no significant difference in experienced vertigo between males and females. Ear and hearing health problems and vertigo are reported frequently in the Greenlandic population. Overall, a tendency of less complaints in 2014 compared to 1995 except for vertigo. It is important to follow this trend and increase the prophylactic efforts to reduce common health disabilities like early otitis media in childhood and noise created symptoms even more.
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Affiliation(s)
- AS Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark,CONTACT AS Homøe Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, Køge4600, Denmark
| | - N Thorup
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - CVL Larsen
- University of Greenland, Nuussuaq, Greenland,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark,University of Greenland, Nuussuaq, Greenland,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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Pauli N, Sunnergren O, Florentzson R. High frequency hearing 25 years after transmyringeal ventilation tube treatment. Int J Pediatr Otorhinolaryngol 2023; 167:111509. [PMID: 36907111 DOI: 10.1016/j.ijporl.2023.111509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/22/2023] [Accepted: 03/04/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES The main aim of the study was to compare hearing outcome between a healthy control group and patients treated with transmyringeal ventilation tubes, 25 years after primary surgery. Another aim was to analyse the relation between ventilation tube treatment in childhood and the occurrence of persistent middle ear pathology 25 years later. METHODS In 1996, children treated with transmyringeal ventilation tubes were recruited for a prospective study on the outcome of ventilation tube treatment. In 2006, a healthy control group were recruited and examined together with the original participants (case group). All participants in the 2006 follow-up were eligible for this study. A clinical ear microscopy examination including eardrum pathology grading and high frequency audiometry (10-16 kHz) was carried out. RESULTS A total of 52 participants were available for analysis. Hearing outcome was worse in the treatment group (n = 29) compared to the control group (n = 29), both in regard to standard frequency range hearing, (0.5-4 kHz), and high frequency hearing (HPTA3 10-16 kHz). Almost half the case group (48%) had eardrum retraction to some extent, compared to 10% in the control group. No case of cholesteatoma was found in this study and eardrum perforation was rare (<2%). CONCLUSION In the long term, high frequency hearing (HPTA3 10-16 kHz) was more often affected in the patients with transmyringeal ventilation tube treatment during childhood compared with the healthy controls. Middle ear pathology of greater clinical significance was rare.
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Affiliation(s)
- Nina Pauli
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, Gothenburg, Sweden.
| | - Ola Sunnergren
- Region Jönköping County, Ryhov Hospital, Ear, Nose and Throat Clinic, Jönköping, Sweden
| | - Rut Florentzson
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, Gothenburg, Sweden
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Hidaka H, Ito M, Ikeda R, Kamide Y, Kuroki H, Nakano A, Yoshida H, Takahashi H, Iino Y, Harabuchi Y, Kobayashi H. Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan - 2022 update. Auris Nasus Larynx 2022:S0385-8146(22)00232-2. [PMID: 36577619 DOI: 10.1016/j.anl.2022.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Abstract
This is an update of the 2015 Guidelines developed by the Japan Otological Society and Oto-Rhino-Laryngeal Society of Japan defining otitis media with effusion (OME) in children (younger than 12 years old) and describing the disease rate, diagnosis, and method of examination. Recommended therapies that received consensus from the guideline committee were updated in consideration of current therapies used in Japan and based on available evidence. METHOD Regarding the treatment of OME in children, we developed Clinical Questions (CQs) and retrieved documents on each theme, including the definition, disease state, method of diagnosis, and medical treatment. In the previous guidelines, no retrieval expression was used to designate a period of time for literature retrieval. Conversely, a literature search of publications from March 2014 to May 2019 has been added to the JOS 2015 Guidelines. For publication of the CQs, we developed and assigned strengths to recommendations based on the collected evidence. RESULTS OME in children was classified into one group lacking the risk of developing chronic or intractable disease and another group at higher risk (e.g., children with Down syndrome, cleft palate), and recommendations for clinical management, including follow-up, is provided. Information regarding management of children with unilateral OME and intractable cases complicated by adhesive otitis media is also provided. CONCLUSION In clinical management of OME in children, the Japanese Clinical Practice Guidelines recommends management not only of complications of OME itself, such as effusion in the middle ear and pathologic changes in the tympanic membrane, but also pathologic changes in surrounding organs associated with infectious or inflammatory diseases.
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Affiliation(s)
- Hiroshi Hidaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan.
| | - Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Children's Medical Center Tochigi, Jichi Medical University, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head & Neck Surgery, Iwate Medical University, Japan
| | | | | | - Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, Japan
| | - Haruo Yoshida
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Haruo Takahashi
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Tokyo-Kita Medical Center, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, Japan
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Abstract
Acute otitis media (AOM) is an acute infection of the middle ear and, depending on the age of the child, the certainty of diagnosis, and the severity of symptoms, should be either observed closely or treated (with high-dose amoxicillin, if not allergic). Host-related risk factors such as age, sex, cleft palate, or genetic predisposition or environmental risk factors such as seasonality, day care attendance, or tobacco smoke exposure may contribute to recurrent AOM (RAOM) episodes. Tympanostomy tubes are recommended in children with RAOM and an abnormal ear examination at the time of the clinic evaluation.
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Affiliation(s)
- Todd Otteson
- Pediatric Otolaryngology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Suite 4500, Cleveland, OH 44106, USA.
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Chang FL, Chen CH, Cheng HL, Chang CY, Leong JL, Chang YT, Cheng YF, Liao WH. Efficacy of Ventilation Tube Insertion with Palatal Repair for Otitis Media in Cleft Palate: Meta-Analysis and Trial Sequential Analysis. J Pers Med 2022; 12:255. [PMID: 35207742 PMCID: PMC8875192 DOI: 10.3390/jpm12020255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Cleft palate is the most common congenital facial deformity and may result in multiple sequelae and disabilities. One common comorbidity is refractory otitis media with effusion (OME), as patients with cleft palate have impaired eustachian tube function with alteration of the nearby muscular structures. Ventilation tube insertion (VTI) is regarded as an effective mean to address OME in addition to palatal repair surgery. However, controversy regarding the efficacy of VTI and the timing of VTI remains. We aimed to assess the efficacy of VTI with palatal repair for cleft palate on OME development via a meta-analysis with systematic review and trial sequential analysis (TSA). Studies including patients with cleft palate who underwent palatal repair with or without VTI were considered eligible. After searching the Cochrane Library, PubMed, EMBASE, Web of Science, Scopus and China National Knowledge Infrastructure (CNKI) from inception through 5 September 2021, 9 studies involving 929 patients were included. Overall, a significantly higher OME-free rate was noted in those who underwent VTI and palatal repair than in those who underwent palatal repair alone (OR, 2.73; 95% CI, 1.37 to 5.42; p = 0.004; I2 = 84%). Subgroup analysis revealed that the OME-free rate remained higher in the concurrent VTI group (OR, 3.29; 95% CI, 1.64 to 6.59; p < 0.001; I2 = 81%). TSA indicated that all the analyses provided conclusive results by meeting the required information size and Z-value. The meta-analysis indicated that VTI is an effective procedure to prevent OME in patients with cleft palate and that VTI is beneficial when performed concurrently with palatal repair surgery.
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Affiliation(s)
- Feng-Liang Chang
- Department of Otolaryngology—Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (F.-L.C.); (C.-H.C.); (H.-L.C.)
| | - Chih-Hao Chen
- Department of Otolaryngology—Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (F.-L.C.); (C.-H.C.); (H.-L.C.)
| | - Hsiu-Lien Cheng
- Department of Otolaryngology—Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (F.-L.C.); (C.-H.C.); (H.-L.C.)
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chun-Yu Chang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
| | - Jing-Li Leong
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 112, Taiwan;
| | - Yen-Ting Chang
- Department of Medical Education, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
| | - Yen-Fu Cheng
- Department of Otolaryngology—Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (F.-L.C.); (C.-H.C.); (H.-L.C.)
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Wen-Huei Liao
- Department of Otolaryngology—Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; (F.-L.C.); (C.-H.C.); (H.-L.C.)
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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Effectiveness of Surgical Approach of Insertion Ventilation Tubes (Tympanostomy) and Adenoidectomy in Comparison with Non-Surgical Approach (Watchful Waiting Approach) in Children at the Age between 1 and 6 and Who Suffer from Otitis Media with Effusion (OME) in 12-Month Period of Observation-The Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312502. [PMID: 34886228 PMCID: PMC8657213 DOI: 10.3390/ijerph182312502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Otitis media with effusion (OME) is one of the most common diseases in childhood. The objective was to assess clinically the effectiveness of the surgical approach (tube insertion with adenoidectomy) in comparison with the non-surgical approach (watchful waiting) during a 12-month observation period. (2) Methods: This study was retrospective and obtained approval from the bioethics committee. The criteria of inclusion in the first group (surgical approach) were: (1) a diagnosis of chronic otitis media with effusion in children aged between 1 and 6 years; (2) their medical history showed that they had undergone adenoidectomy and tympanostomy with the insertion of ventilation tubes (VTs). The criteria for inclusion in the second group (non-surgery) were similar to the first group except that their medical history showed they had not undergone adenoidectomy or tympanostomy with the insertion of VTs. There were 422 children included in the surgical group and 50 children in the non-surgical group, and the period of observation was 12 months. (3) Results: For the entire surgical group, the number of healthy days ranged from 20 to 365, with a mean of 328.0 days (SD = 91.4).In the non-surgical group, the number of healthy days ranged from 13 to 365, with a mean of 169.2 days (SD = 127.3). The difference in the number of healthy days was statistically significant (p < 0.001). The certainty of treatment in the first group was higher than in the second group, and the number of days without recurrence was significantly higher than in the second group. In the first group, there were 71 recurrences from 422 children (16.8%), and, in the second subgroup, there were 40 recurrences of acute otitis media (AOM) from 50 children (80%). The RR was 0.21. (4) Conclusions: The surgical approach in children aged 1-6 years who have been diagnosed with otitis media with effusion is reasonable and beneficial for the child.
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Song CI, Kang BC, Shin CH, An YS, Kim TS, Lim HW, Shim HJ, Yoo MH, Ahn JH. Postoperative results of ventilation tube insertion: a retrospective multicenter study for suggestion of grading system of otitis media with effusion. BMC Pediatr 2021; 21:375. [PMID: 34465299 PMCID: PMC8406977 DOI: 10.1186/s12887-021-02855-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022] Open
Abstract
Background In otitis media with effusion (OME), it is important to know when to surgically intervene and when careful monitoring is more appropriate. This study aimed to visualize and classify the clinical manifestations of OME and the correlation between the new grading system and postoperative results after ventilation tube insertion (VTI). Methods We classified the collective 1,012 ears from 506 patients into six groups: grade 0 (no effusion), grade I (scant effusion, but abnormal), grade II (effusion less than half of the tympanic cavity), grade III (effusion over half of the tympanic cavity, with air bubbles), grade IV (complete effusion), and grade V (retracted tympanic membrane or hemotympanum without air bubbles). Results The mean age at VTI was 5.2 (±2.9) years and mean duration between diagnosis and operation was 4.1 (±1.8) months. Between the grades, the nature of the middle ear effusion was also significantly different (p < 0.001). The duration of ventilation tube retention after VTI was significantly different when compared between two groups: grade I-IV and grade V (p = 0.019). Our results showed that the recurrence rate, as well as rate of revision VTI, increased as the grade increased (p < 0.001). Conclusions The new grading system of OME using endoscopic otoscope evaluation had a significant correlation with the age at VTI, the nature of middle ear effusion, the recurrence rate of OME, and the rate of revision VTI.
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Affiliation(s)
- Chan Il Song
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Chul Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chol Ho Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea
| | - Yun Suk An
- Department of Otorhinolaryngology-Head and Neck Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Tae Su Kim
- Department of Otolaryngology, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Hyun Woo Lim
- Department of Otolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyun Joon Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Myung Hoon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Joong Ho Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea.
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Kaya S, Keseroglu K, Tokgoz SA, Barmak E, Saylam G, Korkmaz MH. Multifrequency multicomponent tympanometry in children with a history of ventilation tube insertion. Int J Pediatr Otorhinolaryngol 2021; 147:110798. [PMID: 34147907 DOI: 10.1016/j.ijporl.2021.110798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To use multifrequency multicomponent tympanometry (MF-MCT) for evaluating the middle ear mechano-acoustics of children with a history of ventilation tube (VT) insertion and to determine the effects of tube insertion sequelae on middle ear function. METHODS A prospective case-control study in a tertiary referral center involving 26 children (51 ears) aged 3-15 years. The children had undergone VT insertion surgery at least one-year previously and had no other known ear diseases. In addition, 13 age-matched healthy controls (26 ears) with no prior history of ear disease were included. The patients and control subjects underwent an otoscopic examination, standard 226 Hz tympanometry, and MF-MCT. RESULTS In 13.7% of cases, the VT was still in place in the operated ears. Post-operative myringosclerosis and/or eardrum retraction were noticed in 30% of ears with intact tympanic membranes in the patient group. While patients exhibited a great variability of tympanometric types (with standard 226 Hz tympanometry and tympanometric patterns with 1000 Hz MF-MCT), all cases in the control group had type A tympanograms and 3B1G patterns. CONCLUSION The effects of VT treatment on the mechano-acoustics of the middle ear have been revealed in this study. It has also been determined that VT application may increase the mass effect on the middle ear functions, which can be detected in the tympanometric shape and pattern.
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Affiliation(s)
- Sule Kaya
- Ankara Yildirim Beyazit University, Faculty of Health Sciences, Audiology Department, Ankara, Turkey.
| | - Kemal Keseroglu
- University of Health Sciences Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Otolarnygology Head and Neck Surgery Department, Ankara, Turkey
| | - Sibel Alicura Tokgoz
- University of Health Sciences Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Otolarnygology Head and Neck Surgery Department, Ankara, Turkey
| | - Elife Barmak
- Ankara Yildirim Beyazit University, Faculty of Health Sciences, Speech-Language Pathology Department, Ankara, Turkey
| | - Güleser Saylam
- University of Health Sciences Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Otolarnygology Head and Neck Surgery Department, Ankara, Turkey
| | - Mehmet Hakan Korkmaz
- Ankara Yildirim Beyazit University, Faculty of Medicine, Otolarnygology Head and Neck Surgery Department, Ankara, Turkey
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Lou Z, Lou Z, Sun J, Chen Z, Yin S. Microwave ablation eustachian tuboplasty: a preliminary investigation with long-term follow-up. J Otolaryngol Head Neck Surg 2021; 50:39. [PMID: 34167591 PMCID: PMC8223355 DOI: 10.1186/s40463-021-00520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/14/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study was performed to evaluate the efficacy of microwave ablation (MWA) eustachian tuboplasty for the treatment of patients with retracted tympanic membrane (TM) due to eustachian tube dysfunction (ETD). Methods This was a prospective study of 20 patients with ETD (middle ear atelectasis) who underwent MWA eustachian tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, audiometry results, tympanometry results, ETD Questionnaire (ETDQ-7) score, and TM status. Results Eighteen patients (18 ears) were included in this study. There were statistically and clinically significant improvements in the mean ETDQ-7 score at 6 months postoperatively (change in mean score of 16.7 ± 3.6, P < 0.001) and at 30 months postoperatively (change in mean score of 18.9 ± 2.9, P < 0.001). Type A tympanogram was obtained in 27.8% of patients (5/18) at 6 months postoperatively, and in 77.7% at 30 months postoperatively. A Valsalva maneuver was possible in 72.2% of patients at 6 months postoperatively and in 88.9% of patients at 30 months postoperatively. In addition, the ears of 13 patients (72.2%) showed both normal tympanograms and TM at 30 months postoperatively. Interestingly, 38.5% of patients (5/13) exhibited complete sclerosis of the pars tensa. None of the patients experienced severe MWA-related complications during follow-up. Conclusions MWA eustachian tuboplasty is a feasible alternative to conventional tuboplasty, and can improve subjective and objective outcomes in patients with ETD for up to 30 months following treatment. In addition, this study showed that the extent of sclerotic plaque increased over time, whereas the extents of atrophy and tensa retraction decreased following tuboplasty in most patients. Graphical abstract ![]()
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Provice, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China. .,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
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11
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Bhutta MF, Lambie J, Hobson L, Williams D, Tyrer HE, Nicholson G, Brown SDM, Brown H, Piccinelli C, Devailly G, Ramsden J, Cheeseman MT. Transcript Analysis Reveals a Hypoxic Inflammatory Environment in Human Chronic Otitis Media With Effusion. Front Genet 2020; 10:1327. [PMID: 32153623 PMCID: PMC7047850 DOI: 10.3389/fgene.2019.01327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic otitis media with effusion (COME) is the most common cause of childhood hearing loss in the developed world. Underlying pathophysiology is not well understood, and in particular the factors that lead to the transition from acute to chronic inflammation. Here we present the first genome-wide transcript analysis of white blood cells in the effusion of children with COME. Analysis of microarray data for enriched pathways reveals upregulation of hypoxia pathways, which is confirmed using real-time PCR and determining VEGF protein titres. Other pathways upregulated in both mucoid and serous effusions include Toll-like receptor signaling, complement, and RANK-RANKL. Cytology reveals neutrophils and macrophages predominated in both serous and mucoid effusions, however, serous samples had higher lymphocyte and eosinophil differential counts, while mucoid samples had higher neutrophil differential counts. Transcript analysis indicates serous fluids have CD4+ and CD8+ T-lymphocyte, and NK cell signatures. Overall, our findings suggest that inflammation and hypoxia pathways are important in the pathology of COME, and targets for potential therapeutic intervention, and that mucoid and serous COME may represent different immunological responses.
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Affiliation(s)
- Mahmood F Bhutta
- Department of ENT, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Jane Lambie
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Lindsey Hobson
- Department of ENT, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Debbie Williams
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell, United Kingdom
| | - Hayley E Tyrer
- Faculty of Health and Wellbeing, University of Lancashire, Preston, United Kingdom
| | - George Nicholson
- Department of Statistics, University of Oxford, Oxford, United Kingdom
| | - Steve D M Brown
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell, United Kingdom
| | - Helen Brown
- The Roslin Institute, University of Edinburgh, Midlothian, United Kingdom
| | - Chiara Piccinelli
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, United Kingdom
| | | | - James Ramsden
- Department of ENT, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Michael T Cheeseman
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, United Kingdom
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12
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Sederberg-Olsen JF, Sederberg-Olsen N, Holmelund M. Grommets in otitis media: a 25-year follow up. Acta Otolaryngol 2018; 138:1057-1060. [PMID: 30702024 DOI: 10.1080/00016489.2018.1511060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study is unique as it is the first study which can describe the long term sequelae of treatment of otitis media with effusion (OME) with insertion of grommets in the Primary Health Sector in Denmark. OBJECTIVES Eardrum pathology and hearing acuity 25 years after treatment of OME by insertion of grommets, in a private ear-, nose-, and throat practice. MATERIAL AND METHODS 262 children with OME were treated from 1975 to 1978. The patients were re-examined by otomicroscopy, tympanometry and pure tone audiometry after 7.5, 12, and 25 years. RESULTS Hearing level, flaccida retraction and incudo pexi was equivalent. For atrophy and myringosclerosis no equivalence was shown using 95% confidence intervals. Tympanometry was fairly unchanged. CONCLUSION AND SIGNIFICANCE The insertion of a grommet in treating OME has no influence on hearing acuity in the long term. The prevalence of myringosclerosis and atrophy was unchanged in 70-80% of the eardrums. Most important is that the small increase in myringosclerosis and atrophy does not seem to influence the hearing acuity. We show that long term sequelae from the Primary Health Sector are similar to those from the Secondary Health sector.
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13
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Bhutta MF, Thornton RB, Kirkham LAS, Kerschner JE, Cheeseman MT. Understanding the aetiology and resolution of chronic otitis media from animal and human studies. Dis Model Mech 2018; 10:1289-1300. [PMID: 29125825 PMCID: PMC5719252 DOI: 10.1242/dmm.029983] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Inflammation of the middle ear, known clinically as chronic otitis media, presents in different forms, such as chronic otitis media with effusion (COME; glue ear) and chronic suppurative otitis media (CSOM). These are highly prevalent diseases, especially in childhood, and lead to significant morbidity worldwide. However, much remains unclear about this disease, including its aetiology, initiation and perpetuation, and the relative roles of mucosal and leukocyte biology, pathogens, and Eustachian tube function. Chronic otitis media is commonly modelled in mice but most existing models only partially mimic human disease and many are syndromic. Nevertheless, these models have provided insights into potential disease mechanisms, and have implicated altered immune signalling, mucociliary function and Eustachian tube function as potential predisposing mechanisms. Clinical studies of chronic otitis media have yet to implicate a particular molecular pathway or mechanism, and current human genetic studies are underpowered. We also do not fully understand how existing interventions, such as tympanic membrane repair, work, nor how chronic otitis media spontaneously resolves. This Clinical Puzzle article describes our current knowledge of chronic otitis media and the existing research models for this condition. It also identifies unanswered questions about its pathogenesis and treatment, with the goal of advancing our understanding of this disease to aid the development of novel therapeutic interventions. Summary: Chronic middle ear inflammation is a common disease. Animal models, and in particular mouse models, have been used to elucidate some potential mechanisms, including dysfunction in immune signalling, mucociliary function or Eustachian tube function.
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Affiliation(s)
- Mahmood F Bhutta
- Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 5BE, England .,Division of Paediatrics, University of Western Australia, Subiaco, WA 6008, Australia
| | - Ruth B Thornton
- Division of Paediatrics, University of Western Australia, Subiaco, WA 6008, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, WA 6008, Australia
| | - Lea-Ann S Kirkham
- Division of Paediatrics, University of Western Australia, Subiaco, WA 6008, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, WA 6008, Australia
| | - Joseph E Kerschner
- Office of the Dean, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Michael T Cheeseman
- Division of Developmental Biology, Roslin Institute, University of Edinburgh, Midlothian, EH23 9RG, Scotland
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14
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Guo P, Sun W, Wang W. Prognostic and influencing factors of tinnitus in chronic otitis media after tympanoplasty. Eur Arch Otorhinolaryngol 2017; 275:39-45. [PMID: 29063965 DOI: 10.1007/s00405-017-4742-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 09/12/2017] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to investigate what characteristics of tinnitus in patients with chronic otitis media was reduced after tympanoplasty and to assess the relationship between post-operative tinnitus reduction and pre-operative tinnitus tone, tinnitus duration, post-operative hearing recovery, and tympanogram. Medical records were prospective between March 2013 and May 2016. Audiologic evaluation by pure tone audiometry and acoustic impedance and tinnitus assessment using scores on the Tinnitus Handicap Inventory (THI) was conducted preoperatively and 6 months post-operatively. The data were analyzed using the Wilcoxon test, Student's and paired t test, and ANOVA. The pre-operative incidence of tinnitus in patients with COM was 47%. There was a very significant difference between pre-operative and post-operative mean THI scores (p < 0.05). Tinnitus was reduced or alleviated in 83% of tinnitus patients. Pre-operative low-tone tinnitus was significantly reduced 6 months after surgery. After surgery, air-conducted hearing improvement at 250, 500, and 1000 Hz in the tinnitus significant recovery group was greater than the tinnitus non-significant recovery group (p < 0.05). Tinnitus reduction in tympanogram A was significantly greater than in tympanograms B or C (p < 0.05). There was no statistically significant correlation between tinnitus duration and tinnitus reduction (p > 0.05). There was no significant effect of presence cholesteatoma and dry period on the gain THI (p > 0.05). The types of tympanoplasty had no effect on tinnitus improvement (p > 0.05). No patients experienced new tinnitus after surgery. Following tympanoplasty, most patients experienced a reduction in tinnitus. Pre-operative low-tone tinnitus is easier to reduce after tympanoplasty. Post-operative normal tympanogram and improved low-frequency AC hearing were important to tinnitus reduction.
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Affiliation(s)
- Ping Guo
- Department of Otolaryngology, Fudan University Eye Ear Nose and Throat Hospital, 83 Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Wenfang Sun
- Department of Otolaryngology, Fudan University Eye Ear Nose and Throat Hospital, 83 Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Wuqing Wang
- Department of Otolaryngology, Fudan University Eye Ear Nose and Throat Hospital, 83 Fenyang Rd, Shanghai, 200031, People's Republic of China.
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15
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Jennings B, Prinsley P, Philpott C, Willis G, Bhutta M. The genetics of cholesteatoma. A systematic review using narrative synthesis. Clin Otolaryngol 2017; 43:55-67. [DOI: 10.1111/coa.12900] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 02/04/2023]
Affiliation(s)
- B.A. Jennings
- Norwich Medical School; University of East Anglia; Norwich UK
| | - P. Prinsley
- ENT Department; James Paget University Hospitals NHS Foundation Trust; Great Yarmouth UK
| | - C. Philpott
- Norwich Medical School; University of East Anglia; Norwich UK
- ENT Department; James Paget University Hospitals NHS Foundation Trust; Great Yarmouth UK
| | - G. Willis
- Department of Molecular Genetics; Norfolk and Norwich University Hospital; Norwich UK
| | - M.F. Bhutta
- School of Paediatrics and Child Health; University of Western Australia; Subiaco WA Australia
- Royal Perth Hospital; Perth WA Australia
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16
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Endo S, Mizuta K, Takahashi G, Nakanishi H, Yamatodani T, Misawa K, Hosokawa S, Mineta H. The effect of ventilation tube insertion or trans-tympanic silicone plug insertion on a patulous Eustachian tube. Acta Otolaryngol 2016; 136:551-5. [PMID: 26903085 DOI: 10.3109/00016489.2016.1143118] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusions This study suggests that long-term ventilation tube insertion is the first-choice surgical treatment for a 'sniff-type' patulous Eustachian tube (PET). When treating a refractory PET, it is important to determine whether the patient had a habitual sniff. Objectives PET patients were divided into two groups: patients with a habitual sniff (sniff-type PET) and those without a habitual sniff (non-sniff-type PET). This study examined the effects of ventilation tube insertion or silicone plug insertion in each group. Methods Surgical procedures such as ventilation tube insertion or trans-tympanic silicone plug insertion were performed for these patients. Tubotympanoaero-dynamic graphy (TTAG) was also performed to determine the mechanisms underlying these treatments. Results There were 11 cases (17 ears) of sniff-type PET and 20 cases (27 ears) of non-sniff-type PET. An improvement in symptoms was found in 72.7% of the patients who underwent silicone plug insertion (66.7% for sniff-type PET and 74.1% for non-sniff-type PET) and in 90.9% of the patients who underwent ventilation tube insertion for sniff-type PET. In TTAG assessments, many sniff-type PET patients showed significant synchronous changes at high levels of pressure (over 40 daPa) in the external auditory meatus and nasopharynx when performing a slight Valsalva manoeuvre (below 200 daPa).
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Affiliation(s)
- Shiori Endo
- Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kunihiro Mizuta
- Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Goro Takahashi
- Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroshi Nakanishi
- Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takashi Yamatodani
- Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kiyoshi Misawa
- Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Seiji Hosokawa
- Department of Otorhinolaryngology, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Hiroyuki Mineta
- Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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17
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Avnstorp MB, Homøe P, Bjerregaard P, Jensen RG. Chronic suppurative otitis media, middle ear pathology and corresponding hearing loss in a cohort of Greenlandic children. Int J Pediatr Otorhinolaryngol 2016; 83:148-53. [PMID: 26968069 DOI: 10.1016/j.ijporl.2016.01.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/24/2015] [Accepted: 01/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Otitis media (OM) has been observed at elevated prevalence rates in Greenlandic children. OM associated hearing loss (HL) may compromise the children's linguistic skills, social development and educational achievements. OBJECTIVES We investigated the prevalence of chronic suppurative otitis media (CSOM), otitis media with effusion (OME) and tympanic membrane sequelae of OM, and compared the corresponding hearing thresholds. METHODS In 2010 we examined a cohort of 223 Greenlandic children aged 4-10 years by video otoscopy, tympanometry and tested hearing thresholds for the low-frequencies: 500, 1000 and 2000Hz and the high-frequencies: 4000 and 6000Hz. HL was categorized according to the worst hearing ear and was compared within the groups: CSOM, OME, tympanic membrane sequelae of OM and normal. RESULTS Of 207 children, 5.8% had CSOM, 13.9% had OME and 55.6% had tympanic membrane sequelae of OM. The median pure tone average in low-frequencies/high-frequencies were: CSOM: 34.2/31.3dB, OME: 23.3/22.5dB, Sequelae of OM: 13.3/15dB and normal ears: 11.7/12.5dB. We found a significant difference (p<0.05) between the four groups. In 56.5% of all children a HL>15dB in any frequency was found, while 6.5% suffered from a bilateral low-frequency HL>25dB. CONCLUSION The severity of OM significantly corresponded to increased HL. The burden of CSOM and HL remains high in young Greenlandic children. Aggressive treatment with antibiotics, improved hearing rehabilitation, sound field amplification in classrooms and otosurgical capacity should be further promoted in Greenland.
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Affiliation(s)
- Magnus Balslev Avnstorp
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark.
| | - Preben Homøe
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark; Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, University of Copenhagen, Denmark
| | - Peter Bjerregaard
- National Institute of Public Health, Centre for Health Research in Greenland, University of Southern Denmark, Odense, Denmark
| | - Ramon Gordon Jensen
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark; Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, University of Copenhagen, Denmark
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18
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Djurhuus BD, Christensen K, Skytthe A, Faber CE. The impact of ventilation tubes in otitis media on the risk of cholesteatoma on a national level. Int J Pediatr Otorhinolaryngol 2015; 79:605-9. [PMID: 25724629 DOI: 10.1016/j.ijporl.2015.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the impact of treatment with middle ear ventilation tube insertion (VTI) in children with otitis media (OM) on the risk of cholesteatoma on a national level. METHODS Data were obtained from the Danish National Patient Register, the National Health Service Register and Statistics Denmark. Cumulative incidence proportions were estimated by the Kaplan-Meier method and hazard ratios with Cox regression analysis. The first surgically treated middle ear cholesteatoma in a child (STMEC1) was considered an event. RESULTS A total of 217,206 children, born after December 31, 1996, who had VTI from January 1, 1997 to August 31, 2011 were identified. Of these, 374 subsequently had a STMEC1. A corresponding 36,981 children without any VTI were identified for comparison using a random 5% sample of the Danish population. Of these, 5 had a STMEC1. The cumulative incidence proportion with STMEC1 at 12 years of age for children with 0, 1, 2, 3, and ≥4 VTI's was 0.04% (95% confidence interval 0.02-0.12%), 0.21% (0.18-0.26%), 0.35% (0.28-0.43%), 0.40% (0.30-0.54%), and 0.55% (0.44-0.70%), respectively. In the regression model each additional year of age before the first VTI increased the risk of STMEC1 by 54% (47-63%), while each additional year between two successive tube insertions increased the risk by 28% (15-43%). CONCLUSION We found that prolonged OM requiring multiple VTIs was associated with an increased risk of STMEC1. Early age at first VTI and short time between two VTIs was associated with a lower risk of STMEC1. This may be the result of reduced time with negative middle ear pressure and OM. However, these findings may be susceptible to selection bias, as age at first VTI and time between VTIs, as well as the outcome variable, STMEC1, may all depend on the underlying indication for VTI. In short the present study suggests that treatment with VTI in children with OM reduces the risk of STMEC1 on a population level. However, for the individual child the absolute risk reduction is very small, and the decision of treatment with VTI must always rely on the symptoms and clinical findings in the individual child.
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Affiliation(s)
| | - Kaare Christensen
- Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Axel Skytthe
- Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christian Emil Faber
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense, Denmark
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19
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Bhutta MF, Cheeseman MT, Brown SDM. Myringotomy in the Junbo mouse model of chronic otitis media alleviates inflammation and cellular hypoxia. Laryngoscope 2014; 124:E377-83. [PMID: 24706577 DOI: 10.1002/lary.24698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/14/2014] [Accepted: 04/01/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS Ventilation of the chronically inflamed middle ear is a key outcome in functional middle ear surgery. Grommets eliminate middle ear effusion, but there is also evidence that they downregulate inflammation. The reason for this is not understood, but there is little to suggest alteration in eustachian tube ventilatory capacity. Previous work has shown that the Junbo mouse model of chronic otitis media has hypoxic middle ear mucosa and bulla fluid leucocytes. Here we explore whether surgical ventilation may alleviate chronic otitis media through downregulation of hypoxia. STUDY DESIGN Surgical intervention on a mouse model of disease. METHODS We established patency of myringotomy incision as 5 days in wild-type mice. We performed unilateral myringotomy on three cohorts of mice: 10 wild-type controls, 12 Junbo mice, and 15 Junbo mice with additional removal of middle ear effusion. A small cohort of these mice were labeled in vivo by intraperitoneal injection of pimonidazole to identify tissue hypoxia. Tissues were assessed for mucoperiosteal thickening and pimonidazole labeling, comparing operated to nonoperated ears. RESULTS Ventilation of the inflamed Junbo middle ear revealed significant reduction in inflammatory thickening associated with loss of pimonidazole labeling, suggesting resolution of cellular hypoxia. CONCLUSIONS Surgical ventilation may achieve therapeutic effect through alleviation of cellular hypoxia in the chronically inflamed middle ear. Targeted molecular therapy of hypoxia signaling may offer future alternative therapy for chronic otitis media.
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Affiliation(s)
- Mahmood F Bhutta
- UCL Ear Institute, London, United Kingdom; MRC Harwell, Harwell Science and Innovation Campus, Oxfordshire, United Kingdom; Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Department of Otolaryngology, Barts Health NHS Trust, London, United Kingdom
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20
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Hong HR, Kim TS, Chung JW. Long-term follow-up of otitis media with effusion in children: comparisons between a ventilation tube group and a non-ventilation tube group. Int J Pediatr Otorhinolaryngol 2014; 78:938-43. [PMID: 24735607 DOI: 10.1016/j.ijporl.2014.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/18/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the long-term outcomes in children with otitis media with effusion who received either medical treatment or ventilation tubes. METHODS We retrospectively analyzed the medical records of 89 bilateral cases of otitis media with effusion in children who were recommended to receive ventilation tube insertion and were followed up for more than 5 years. Tympanic membrane was inspected by otoscopic examination. Hearing was evaluated with pure tone audiometry. The mean duration of follow-up was 8.4 years (range, 5.2-15.7 years). Twenty-three children were treated without surgery, while 22 were treated once by ventilation tube insertion and 44 were treated more than once by ventilation tube insertion. RESULTS At the fifth year of follow-up, both groups of children who underwent ventilation tube insertion had more frequent tympanic membrane abnormalities than the medication group (8.7% in those treated without surgery, 72.7% in those treated once by ventilation tube insertion, and 88.6% in those treated more than once by ventilation tube insertion). Common tympanic membrane abnormalities were retraction (27.0%) and tympanosclerotic plaque (23.6%), regardless of the treatment modality. At the fifth year follow-up, the average air-conduction threshold was 10.0 dB (± 6.5 dB) in patients treated without surgery, 15.9 dB (± 11.2dB) in patients treated once by ventilation tube insertion, and 17.8 dB (± 7.6 dB) in those treated more than once by ventilation tube insertion. The audiological difference was significant when we compared the hearing level of children treated by medication without surgery to the two ventilation tube groups. CONCLUSION Though ventilation tube insertion can resolve hearing loss quickly, there were more tympanic membrane abnormalities and a decline in hearing levels in our ventilation tube insertion group vs. the observation group measured 5 years later. Physicians should therefore be cautious when applying a ventilation tube in patients with otitis media with effusion and should explain the risks to patients who are a candidate for repeated ventilation tube insertion.
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Affiliation(s)
- Hye Ran Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Su Kim
- Department of Otolaryngology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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21
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Austad B, Hetlevik I, Bugten V, Wennberg S, Olsen AH, Helvik AS. Can general practitioners do the follow-ups after surgery with ventilation tubes in the tympanic membrane? Two years audiological data. BMC EAR, NOSE, AND THROAT DISORDERS 2014; 14:2. [PMID: 24708658 PMCID: PMC4233627 DOI: 10.1186/1472-6815-14-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 04/01/2014] [Indexed: 11/20/2022]
Abstract
Background A university hospital in Mid-Norway has modified their guidelines for follow-up after insertion of ventilation tubes (VTs) in the tympanic membrane, transferring the controls of the healthiest children to general practitioners (GPs). The aim of this study was to evaluate the implementation of these guidelines by exploring audiological outcome and subjective hearing complaints two years after surgery, assessing if follow-ups in general practice resulted in poorer outcome. Methods A retrospective observational study was performed at the university hospital and in general practice in Mid-Norway. Children below 18 years who underwent surgery with VTs between Nov 1st 2007 and Dec 31st 2008 (n = 136) were invited to participate. Pure tone audiometry, speech audiometry and tympanometry were measured. A self-report questionnaire assessed subjective hearing, ear complaints and the location of follow-ups. This study includes enough patients to observe group differences in mean threshold (0.5–1–2–4 kHz) of 9 dB or more. Results There were no preoperative differences in audiometry or tympanometry between the children scheduled for follow-ups by GPs (n = 23) or otolaryngologists (n = 50). Two years after surgery there were no differences between the GP and otolaryngologist groups in improvement of mean hearing thresholds (12.8 vs 12.6 dB, p = 0.9) or reduction of middle ears with effusion (78.0 vs 75.0%, p = 0.9). We found no differences between the groups in terms of parental reports of child hearing or ear complaints. Conclusions Implementation of new clinical guidelines for follow-ups after insertion of VTs did not negatively affect audiological outcomes or subjective hearing complaints two years after surgery.
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Affiliation(s)
- Bjarne Austad
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491 Trondheim, Norway.
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22
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Wallace IF, Berkman ND, Lohr KN, Harrison MF, Kimple AJ, Steiner MJ. Surgical treatments for otitis media with effusion: a systematic review. Pediatrics 2014; 133:296-311. [PMID: 24394689 DOI: 10.1542/peds.2013-3228] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The near universality of otitis media with effusion (OME) in children makes a comparative review of treatment modalities important. This study's objective was to compare the effectiveness of surgical strategies currently used for managing OME. METHODS We identified 3 recent systematic reviews and searched 4 major electronic databases. Eligible studies included randomized controlled trials, nonrandomized trials, and cohort studies that compared myringotomy, adenoidectomy, tympanostomy tubes (tubes), and watchful waiting. Using established criteria, pairs of reviewers independently selected, extracted data, rated risk of bias, and graded strength of evidence of relevant studies. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively. RESULTS We identified 41 unique studies through the earlier reviews and our independent searches. In comparison with watchful waiting or myringotomy (or both), tubes decreased time with OME and improved hearing; no specific tube type was superior. Adenoidectomy alone, as an adjunct to myringotomy, or combined with tubes, reduced OME and improved hearing in comparison with either myringotomy or watchful waiting. Tubes and watchful waiting did not differ in language, cognitive, or academic outcomes. Otorrhea and tympanosclerosis were more common in ears with tubes. Adenoidectomy increased the risk of postsurgical hemorrhage. CONCLUSIONS Tubes and adenoidectomy reduce time with OME and improve hearing in the short-term. Both treatments have associated harms. Large, well-controlled studies could help resolve the risk-benefit ratio by measuring acute otitis media recurrence, functional outcomes, quality of life, and long-term outcomes. Research is needed to support treatment decisions in subpopulations, particularly in patients with comorbidities.
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Affiliation(s)
- Ina F Wallace
- Division for Health Services and Social Policy Research, RTI International, Research Triangle Park, North Carolina; and
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Abstract
The placement of myringotomy tubes remains an effective treatment of recurrent acute otitis media and chronic otitis media with effusion. Infants and young children are prone to these entities because of their immature anatomy and immunology. Several host, pathogenic, and environmental factors contribute to the development of these conditions. The identification and modification of some these factors can preclude the need for intervention. The procedure continues to be one of the most common outpatient pediatric procedures. Close vigilance and identification of potential complications is of utmost importance in the ongoing management of the child with middle ear disease.
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Affiliation(s)
- Elton Lambert
- Department of Otorhinolaryngology, University of Texas-Houston School of Medicine, Houston, TX 77030, USA
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Jensen RG, Koch A, Homøe P, Bjerregaard P. Tobacco smoke increases the risk of otitis media among Greenlandic Inuit children while exposure to organochlorines remain insignificant. ENVIRONMENT INTERNATIONAL 2013; 54:112-118. [PMID: 23434818 DOI: 10.1016/j.envint.2013.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/24/2013] [Accepted: 01/25/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND Prenatal exposure to environmental levels of organochlorines (OCs) has been demonstrated to have immunotoxic effects in humans. We investigated the relationship between prenatal exposure to OCs and the occurrence of otitis media (OM) among Inuit children in Greenland. METHODS We estimated the concentration of 14 PCB congeners and 11 pesticides in maternal and cord blood samples and in breast milk in a population-based cohort of 400 mother-child pairs. At follow-up, we examined the children's ears and used their medical records to assess the OM occurrence and severity. Multivariate regression analyses were used with adjustments for passive smoking, crowding, dietary habits, parent's educational level, breast feeding and the use of child-care. RESULTS The children were 4-10 years of age at follow-up and 223 (85%) participated. We found no association between prenatal OC exposure and the development of OM. Factors associated with the child's hazard of OM during the first 4 years of life were: mother's history of OM (HR 1.70, 95% CI 1.11-2.59, p=0.01); mother's smoking habits: current (HR 2.47, 95% CI 1.45-4.21, p<0.01) and previous (HR 2.00, 95% CI 1.19-3.36, p<0.01); number of smokers in the home (HR 1.17, 95% CI 1.05-1.31, p<0.01). After adjustment mothers' smoking habits remained significant. CONCLUSION We found no relationship between high levels of prenatal exposure of OCs and occurrence of OM. Passive smoking was found as the strongest environmental risk factor for the development of OM. Interventions to reduce passive smoke in children's environment are needed.
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Affiliation(s)
- Ramon Gordon Jensen
- Department of Otolaryngology, Head & Neck Surgery, Rigshospitalet, University Hospital of Copenhagen, Denmark.
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Hearing 25 years after surgical treatment of otitis media with effusion in early childhood. Int J Pediatr Otorhinolaryngol 2013; 77:241-7. [PMID: 23218983 DOI: 10.1016/j.ijporl.2012.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 11/07/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the long-term hearing following surgical treatment of chronic OME in early childhood (myringotomy or ventilation tube) and to determine the impact of the occurrence and the extension of specific eardrum pathology on the hearing level. PATIENTS AND METHODS In 1977-1978, 224 consecutive children (91 girls and 133 boys) with chronic bilateral OME were enrolled and treated by adenoidectomy, bilateral myringotomy and insertion of a ventilation tube on the right side only. In 2002, a follow-up examination included otomicroscopy and audiometry. Hearing thresholds were compared to an age- and gender-matched normative data set. For the determination of the impact of specific eardrum pathology on the hearing, multiple linear regression modelling was used in adjustment for age and concomitant eardrum pathologies. RESULTS Long-term hearing after chronic OME and associated treatment is not different from age and gender-matched normal hearing. Treatment modality (myringotomy or ventilation tube) has no impact on the long-term hearing level. The regression analyses showed that the presence of myringosclerosis is associated with an overall hearing loss in myringotomised ears (4-5 dB), but not in tubed ears, for which only high frequencies were affected. Conversely, tensa atrophy is associated with an overall hearing loss in tubed ears (3-4 dB), but not in myringotomised ears, for which only high frequencies were affected. CONCLUSIONS Hearing 25 years after surgical treatment of chronic OME is not different from age and gender matched normal hearing. In addition, treatment modality (myringotomy or ventilation tube) has no impact on the long-term hearing level. However, atrophy is associated with a hearing loss in tubed ears, whereas myringosclerosis is associated with a hearing loss in myringotomised ears. The hearing loss associated with pathology is of limited magnitude (up to about 5 dB PTA). Even though pathology does occur more frequently and more extensively in tubed ears, the effect on the hearing at the group level is too small to have an impact. It is important to note, that this may be due to a type 2-error (number of patients too small to show an effect).
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Lee HJ, Park SK, Choi KY, Park SE, Chun YM, Kim KS, Park SN, Cho YS, Kim YJ, Kim HJ. Korean clinical practice guidelines: otitis media in children. J Korean Med Sci 2012; 27:835-48. [PMID: 22876048 PMCID: PMC3410229 DOI: 10.3346/jkms.2012.27.8.835] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/26/2012] [Indexed: 11/20/2022] Open
Abstract
Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media.
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Affiliation(s)
- Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Su-Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | | | - Kyu-Sung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Korea
| | - Shi-Nae Park
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Jae Kim
- Department Healthcare Center, Kyobo Life Insurance Co., Seoul, Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
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Hassman-Poznańska E, Kurzyna A, Trzpis K, Poznańska M. The status of the contralateral ear in children with acquired cholesteatoma. Acta Otolaryngol 2012; 132:404-8. [PMID: 22235981 DOI: 10.3109/00016489.2011.646009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The high prevalence of pathological changes in the contralateral ear (CLE) among children treated because of middle ear cholesteatoma (MEC) was observed. Evolution of many retraction pockets into cholesteatoma points to the need for early intervention in those patients, especially those with concomitant attic retraction pockets and secretory otitis media (SOM). OBJECTIVES The aim of the study was to assess the frequency of pathological changes in the CLE of children operated because of MEC, and to determine their clinical evolution. METHODS Retrospective analysis was performed on the basis of medical records of 202 patients treated surgically for MEC in the years 1998-2011. The mean age of included patients was 11 years and the mean observation period was 54 months. Otoscopic findings before surgery were compared with the latest examination. RESULTS At the time of surgery for MEC, 54.5% of CLEs presented with abnormalities. The most frequent findings were retraction of the tympanic membrane (30%) and SOM, 22.4%. Also, 7% of patients presented with bilateral MEC. Thirty-four percent (20 cases) of retraction pockets diagnosed at the beginning of the observation period required surgical intervention. During the intervention in 20% of cases (12/59 cases) diagnosis of cholesteatoma was confirmed. At the end of the observation period bilateral cholesteatoma was diagnosed in 12.9% of children.
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Long-term tympanic membrane pathology dynamics and spontaneous healing in chronic suppurative otitis media. Pediatr Infect Dis J 2012; 31:139-44. [PMID: 22001967 DOI: 10.1097/inf.0b013e318238c0a4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children in the developing parts of the world have a high prevalence of chronic suppurative otitis media (CSOM). It is estimated that 65 to 330 million people worldwide have CSOM, yet very little is known about the natural course of the disease. The Inuit population of the Arctic regions is among those with the highest prevalences of CSOM. The aim of this study was to examine the long-term tympanic membrane changes since childhood among Inuit adolescents in Greenland and estimate the proportion of individuals affected by CSOM. METHODS Follow-up study (2009) on a population-based cohort of 591 children originally examined during 1993 to 1994 at 3 to 8 years of age. Follow-up was attempted among 348 individuals still living in the areas. Video otoscopy and tympanometry were used. Data on otologic disease, ear surgery, and antibiotic use for otitis media were collected from medical records. RESULTS Of 226 participants (65% of those contacted; median age, 22 years), 28 (12%) had present CSOM or had been surgically treated. Eleven were new cases of CSOM not seen between 1993 and 1994. Of those with CSOM in the initial study, 39% had healed spontaneously. The proportion of spontaneous healing was not influenced by the age at which CSOM was diagnosed in the initial study. Thirty-nine individuals (17%) had CSOM in either the initial study or at follow-up. Of these, 2 had never received antibiotic treatment for otitis media, and 15 had been treated less than 3 times. Eighty individuals (35%) at follow-up had CSOM, had undergone ear surgery, or had sequelae in the form of circular atrophy or myringosclerosis. CONCLUSIONS The proportion of spontaneous healing and the findings of new cases show that CSOM is a dynamic disease both on the individual as well as on the population level. Every third participant at follow-up had a perforation or sequelae from recurrent or long-lasting perforations, indicating a burden of disease from otitis media larger than what can be estimated in cross-sectional studies. There is a potential for increased treatment of otitis media in this population, which requires raised awareness of the disease in the population and the creation of guidelines customized to conditions in Greenland.
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Jensen RG, Homøe P, Andersson M, Koch A. Long-term follow-up of chronic suppurative otitis media in a high-risk children cohort. Int J Pediatr Otorhinolaryngol 2011; 75:948-54. [PMID: 21592588 DOI: 10.1016/j.ijporl.2011.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/20/2011] [Accepted: 04/22/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Chronic suppurative otitis media (CSOM) is the leading cause of mild to moderate hearing impairment in children worldwide and a major public health problem in many indigenous populations. There is a lack of basic epidemiological facts and knowledge on the development of CSOM, as the disease primarily affects developing countries where research capacities often are limited. The purpose of this study was to determine the long-term outcome of CSOM in a high-risk population and to identify risk factors. METHODS Follow-up study (2008) on a population-based cohort of 465 children in Greenland, initially examined (1996-8) between the ages 0 and 4 years. Follow-up was attempted among 307 children living in the two major towns. Binomial logistic regression analysis was made to identify risk factors for developing CSOM and for maintaining disease in to adolescence (odds ratios). Log linear binomial regression was used to estimate risk ratios and absolute risks. RESULTS At follow-up 236 participated (77% of those available). The prevalence of CSOM was 32/236 (14%) at age group 0-4 years and 21/236 (9%) at age group 11-15 years. Thirteen had disease debut after the initial study. Of those with CSOM in the initial study 24/32 (75%) healed spontaneously. Risk factors for the development of CSOM at any time in childhood was the mother's history of CSOM OR 2.55 (95% CI 1.14-5.70; p=0.02), and mothers with low levels of schooling OR 1.57 (1.03-2.40; p=0.04). Once CSOM had developed boys were more likely to have persistent disease OR 5.46 (95% CI 1.47-20.37; p=0.01). The absolute risk of CSOM if the mother had both a history of CSOM and low schooling was for boys 45.4% (95% CI 26.5-77.7) and for girls 30.7% (95% CI 17.8-53.10). The cumulative risk of CSOM was 19% at follow-up. CONCLUSIONS Even though a large number of CSOM cases seemed to heal spontaneously, the prevalence of untreated CSOM among school-age children in Greenland remained high as new cases were found at follow-up. Increased focus on prevention and identification of children at special risk could reduce the high prevalence of CSOM.
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Affiliation(s)
- Ramon Gordon Jensen
- Department of Otolaryngology, Head & Neck Surgery, Rigshospitalet, University Hospital of Copenhagen, Denmark.
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Lee CH, Yoo CK, Hong JE, Kim HJ, Lim DG, Kim KJ. Resolved effusion on myringotomy: a study of dry tap without general anesthesia. Int J Pediatr Otorhinolaryngol 2011; 75:635-8. [PMID: 21362577 DOI: 10.1016/j.ijporl.2011.01.040] [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: 11/22/2010] [Revised: 01/28/2011] [Accepted: 01/29/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Finding a resolution of middle ear effusion using myringotomy, or dry tap (DT), is relatively common, but its clinical outcome is confounded by general anesthesia (GA). The confounding effect of GA and a time delay can be removed because laser myringotomy can be completed under topical anesthesia, which is a routine procedure for otitis media with effusion (OME) before GA in our clinic. DT without GA would clarify the clinical outcome, and the percentage of recurrence for OME after DT would be clinically relevant. The objectives of the present study are (1) to clarify the clinical nature of DT without including the confounding effect of GA and a time delay and (2) to determine if OME recurs when a ventilation tube (VT) is not used for DT. METHODS The control group consisted of 308 children who received an unilateral myringotomy due to a natural resolution in the contralateral ear. The experimental group consisted of 296 children who had a bilateral myringotomy, and a ventilation tube was not inserted for DTs after laser myringotomy under topical anesthesia. The rate of DT and the recurrence rate of OME without tube insertion was the main outcome measure. RESULTS In the control group, which showed a natural resolution, the rate of DT was 16.9% (52/308) of patients, and DT was more common in non-B tympanometry, which only had a recurrence rate of 17.3% (9/52). In the study group, 3.7% of patients showed unilateral DT (UDT) with contralateral positive effusion, and 5.4% of patients showed bilateral DTs (BDTs). BDT showed a non-B tympanometry pattern and a low rate of recurrence (25.0%), which was similar to the control group. UDT showed a B-type tympanometry in 81.8% of the patients, and the recurrence rate was significantly higher (68.2%; 15/22) than the BDT and control patients. BDT or DT with signs of natural resolution showed a low rate of OME recurrence regardless of tympanometry, and thus, patients do not need a VT. CONCLUSIONS DT was not rare even without GA and the associated time delay, and DT was more common in the children that showed a natural resolution. However, microscopy and tympanometry was imperfect to predict dry tap, and thus, the surgeon needs to be prepared for individualized management of DT. UDT with B-type tympanometry and contralateral persistent effusion frequently recurred without tubes, and thus, VT for UDT appeared to be necessary.
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Affiliation(s)
- Chang Ho Lee
- Department of Otolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-712, Republic of Korea
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McCall AA, Linthicum FH, O'Malley JT, Adams JC, Merchant SN, Bassim MK, Gellibolian R, Fayad JN. Extralabyrinthine manifestations of DFNA9. J Assoc Res Otolaryngol 2010; 12:141-9. [PMID: 21052762 DOI: 10.1007/s10162-010-0245-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 10/20/2010] [Indexed: 12/20/2022] Open
Abstract
DFNA9 is an autosomal dominant cause of non-syndromic adult-onset sensorineural hearing loss with associated variable vestibular dysfunction caused by mutations in the COCH gene. DFNA9 has previously been characterized by the presence of unique histopathologic features limited to the cochlear and vestibular labyrinth. This report describes newly discovered extralabyrinthine findings within the middle ear in DFNA9 and discusses their implications. The histopathologic anatomy of extralabyrinthine structures was reviewed in 12 temporal bones from seven individuals with DFNA9 and compared with age-matched controls. All temporal bones with DFNA9 had abnormal deposits within the tympanic membrane, incudomalleal joint, and incudostapedial joint. Hematoxylin and eosin stain and Movat's pentachrome stain both revealed different staining patterns of the extralabyrinthine deposits compared with the intralabyrinthine deposits suggesting that the composition of the deposits varies with location. The deposits within the tympanic membrane resembled cartilage morphologically and stained positively for aggrecan, an extracellular matrix protein found in cartilage. However, the cellular component of the tympanic membrane deposits did not stain with immunomarkers for chondrocytes (s100 and connective tissue growth factor). These novel findings in DFNA9 have implications for the phenotypic expression of the disorder and the clinical workup of adult-onset sensorineural hearing loss.
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Affiliation(s)
- Andrew A McCall
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2010:CD001801. [PMID: 20927726 DOI: 10.1002/14651858.cd001801.pub3] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Otitis media with effusion (OME; 'glue ear') is common in childhood and surgical treatment with grommets (ventilation tubes) is widespread but controversial. OBJECTIVES To assess the effectiveness of grommet insertion compared with myringotomy or non-surgical treatment in children with OME. SEARCH STRATEGY We searched the Cochrane ENT Disorders Group Trials Register, other electronic databases and additional sources for published and unpublished trials (most recent search: 22 March 2010). SELECTION CRITERIA Randomised controlled trials evaluating the effect of grommets. Outcomes studied included hearing level, duration of middle ear effusion, language and speech development, cognitive development, behaviour and adverse effects. DATA COLLECTION AND ANALYSIS Data from studies were extracted by two authors and checked by the other authors. MAIN RESULTS We included 10 trials (1728 participants). Some trials randomised children (grommets versus no grommets), others ears (grommet one ear only). The severity of OME in children varied between trials. Only one 'by child' study (MRC: TARGET) had particularly stringent audiometric entry criteria. No trial was identified that used long-term grommets.Grommets were mainly beneficial in the first six months by which time natural resolution lead to improved hearing in the non-surgically treated children also. Only one high quality trial that randomised children (N = 211) reported results at three months; the mean hearing level was 12 dB better (95% CI 10 to 14 dB) in those treated with grommets as compared to the controls. Meta-analyses of three high quality trials (N = 523) showed a benefit of 4 dB (95% CI 2 to 6 dB) at six to nine months. At 12 and 18 months follow up no differences in mean hearing levels were found.Data from three trials that randomised ears (N = 230 ears) showed similar effects to the trials that randomised children. At four to six months mean hearing level was 10 dB better in the grommet ear (95% CI 5 to 16 dB), and at 7 to 12 months and 18 to 24 months was 6 dB (95% CI 2 to 10 dB) and 5 dB (95% CI 3 to 8 dB) dB better.No effect was found on language or speech development or for behaviour, cognitive or quality of life outcomes.Tympanosclerosis was seen in about a third of ears that received grommets. Otorrhoea was common in infants, but in older children (three to seven years) occurred in < 2% of grommet ears over two years of follow up. AUTHORS' CONCLUSIONS In children with OME the effect of grommets on hearing, as measured by standard tests, appears small and diminishes after six to nine months by which time natural resolution also leads to improved hearing in the non-surgically treated children. No effect was found on other child outcomes but data on these were sparse. No study has been performed in children with established speech, language, learning or developmental problems so no conclusions can be made regarding treatment of such children.
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Affiliation(s)
- George G Browning
- MRC Institute of Hearing Research (Scottish Section), Glasgow Royal Infirmary, Queen Elizabeth Building, 16 Alexandra Parade, Glasgow, UK, G31 2ER
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Kurzyna A, Trzpis K, Hassmann-Poznańska E. [The status of contralateral ear in children with cholesteatoma]. Otolaryngol Pol 2010; 64:152-6. [PMID: 20731204 DOI: 10.1016/s0030-6657(10)70051-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Recently published data indicate that over 60% of patients with middle ear cholesteatoma (MEC) have concomitant changes in the contralateral ear (CE). Studies concerning the condition of the CE are few and rarely present the situation in the pediatric population. THE AIM OF THIS STUDY was to assess the frequency of pathological changes occurring in the CE in children operated on MEC, as well as to determine their clinical evolution. MATERIAL AND METHOD Retrospective analysis was performed on basis of medical records of 193 patients treated surgically for MEC in 1998-2008 at the Department of Pediatric Otolaryngology in Bialystok. The comparison of otoscopic evaluation before first operation with the latest examination was undertaken. The evolution of abnormalities was analyzed and the effect of age and type of cholesteatoma was assessed. RESULTS The opposite ears were abnormal in 46.1% of patients. Most frequently observed changes in the CE were retraction pockets (23%). Cholesteatoma was found in 8 of 45 identified cases of retraction pocket. The incidence of abnormalities in the CE was not correlated with patients age or type of cholesteatoma. Cholesteatoma occurred on both sides in 9,3% of children. In these cases, the attic cholesteatoma was presented in 66.67%, tensa cholesteatoma in 16.67%. CONCLUSIONS In patients with MEC contralateral ear should be systematically examined to detect early any abnormality, or to assess their evolution and take appropriate treatment.
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Affiliation(s)
- Agnieszka Kurzyna
- Klinika Otolaryngologii Dzieciecej, Uniwersytetu Medycznego w Białymstoku.
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Popova D, Varbanova S, Popov TM. Comparison between myringotomy and tympanostomy tubes in combination with adenoidectomy in 3-7-year-old children with otitis media with effusion. Int J Pediatr Otorhinolaryngol 2010; 74:777-80. [PMID: 20399511 DOI: 10.1016/j.ijporl.2010.03.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 03/21/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
The specific aim of this study was to compare, by means of a randomized clinical trial, the efficacy between the two surgical combinations - adenoidectomy with myringotomy and tympanostomy (A+T) and adenoidectomy with myringotomy (A+M) - in reducing middle ear disease in children with otitis media with effusion (OME). Seventy-eight 3-7-year-old patients (156 ears) with a history of bilateral middle ear effusion for at least 3 months were randomly assigned to either A+T or A+M. Hearing threshold levels, recurrence rate of the effusion and episodes of acute otitis media (AOM) and otorrhea were evaluated for a follow-up period of 1 year. Audiometry testing showed that there was no statistically significant difference in the hearing loss levels of both groups during the whole follow-up period. Free of AOM episodes were 72% of the patients in the A+T group and 75% of those in the A+M group. None of the patients with A+M had episodes with otorrhea which contrasted with the 40% occurrence rate in the A+T group. During the follow-up period we documented a 10% recurrence rate of OME in the A+T group and 14% recurrence rate in the A+M group. Overall our data suggests that the insertion of tympanostomy tubes in association with adenoidectomy provides no additional benefit to adenoidectomy in association with myringotomy alone in terms of hearing loss or AOM episode occurrences in patients with bilateral otitis media with effusion. Furthermore no relationship was found between the choice of operative intervention and the recurrence rate of OME despite the slightly greater relative risk in the A+M group.
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Affiliation(s)
- D Popova
- Department of ENT, Medical University Sofia, Sofia, Bulgaria.
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