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Bhutta MF, Leach AJ, Brennan-Jones CG. Chronic suppurative otitis media. Lancet 2024; 403:2339-2348. [PMID: 38621397 DOI: 10.1016/s0140-6736(24)00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/12/2023] [Accepted: 02/08/2024] [Indexed: 04/17/2024]
Abstract
Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation.
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Affiliation(s)
- Mahmood F Bhutta
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK; Department of ENT, Royal Sussex County Hospital, Brighton, UK.
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Darwin, NT, Australia
| | - Christopher G Brennan-Jones
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Ear Health Group, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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2
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Azar A, Bhutta MF, Del-Pozo J, Milne E, Cheeseman M. Trans-cortical vessels in the mouse temporal bulla bone are a means to recruit myeloid cells in chronic otitis media and limit peripheral leukogram changes. Front Genet 2022; 13:985214. [PMID: 36246635 PMCID: PMC9555619 DOI: 10.3389/fgene.2022.985214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic otitis media, inflammation of the middle ear, is a sequel to acute otitis media in ∼8% of children. Chronic otitis media with effusion is the most common cause of childhood deafness and is characterised by effusion of white blood cells into the auditory bulla cavity. Skull flat bones have trans-cortical vessels which are responsible for the majority of blood flow in and out of the bone. In experimental models of stroke and aseptic meningitis there is preferential recruitment of myeloid cells (neutrophils and monocytes) from the marrow in skull flat bones. We report trans-cortical vessels in the mouse temporal bone connect to the bulla mucosal vasculature and potentially represent a means to recruit myeloid cells directly into the inflamed bulla. The mutant mouse strains Junbo (MecomJbo/+) and Jeff (Fbxo11Jf/+) develop chronic otitis spontaneously; MecomJbo/+ mice have highly cellular neutrophil (90%) rich bulla exudates whereas Fbxo11Jf/+ mice have low cellularity serous effusions (5% neutrophils) indicating differing demand for neutrophil recruitment. However we found peripheral leukograms of MecomJbo/+ and Fbxo11Jf/+ mice are similar to their respective wild-type littermate controls with healthy bullae and infer preferential mobilization of myeloid cells from temporal bulla bone marrow may mitigate the need for a systemic inflammatory reaction. The cytokines, chemokines and haematopoietic factors found in the inflamed bulla represent candidate signalling molecules for myeloid cell mobilization from temporal bone marrow. The density of white blood cells in the bulla cavity is positively correlated with extent of mucosal thickening in MecomJbo/+, Fbxo11Jf/+, and EdaTa mice and is accompanied by changes in epithelial populations and bone remodelling. In MecomJbo/+ mice there was a positive correlation between bulla cavity WBC numbers and total bacterial load. The degree of inflammation varies between contralateral bullae and between mutant mice of different ages suggesting inflammation may wax and wane and may be re-initiated by a new wave of bacterial infection. Clearance of white blood cells and inflammatory stimuli from the bulla cavity is impaired and this may create a pro-inflammatory feedback loop which further exacerbates otitis media and delays its resolution.
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Affiliation(s)
- Ali Azar
- Developmental Biology Division, Roslin Institute and The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Mahmood F. Bhutta
- Brighton and Sussex Medical School, Brighton, United Kingdom
- Department of ENT, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Jorge Del-Pozo
- Veterinary Pathology, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Elspeth Milne
- Veterinary Pathology, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Michael Cheeseman
- Developmental Biology Division, Roslin Institute and The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Division of Pathology, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Centre for Comparative Pathology, Division of Pathology, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- *Correspondence: Michael Cheeseman,
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Abstract
PURPOSE OF REVIEW Otitis media (OM) is a disease with very high prevalence in infancy, substantial burden on healthcare resources, and relevant impact on the quality of life of families. The link between OM and allergy is controversial and still debated. However, a fundamental premise has to be placed before introducing this topic: there is the need to use clear and unambiguous terms. Literature abounds with misleading terms that significantly affect the methodology and consequently the outcomes. Moreover, it is essential to differentiate patients according to the OM type (i.e., acute OM, OM with effusion, and chronic suppurative OM), the allergic disease, and mainly the age. RECENT FINDINGS There are some recent studies exploring this issue through different approaches, such as epidemiological, mechanistic, and therapeutic. To identify allergy as a pathogenic factor for OM could improve the management of OM patients. Vice versa, to suspect allergy in OM patients could be reasonable in selected patients. The current narrative review provides an overview of the evidence concerning the potential role of allergy in OM. As there are conflicting findings, a possible interpretation of pathophysiological events and a pragmatic approach are proposed.
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Wiesen BM, Hafrén L, Einarsdottir E, Kere J, Mattila PS, Santos-Cortez RLP. ABO Genotype and Blood Type Are Associated with Otitis Media. Genet Test Mol Biomarkers 2020; 23:823-827. [PMID: 31693456 DOI: 10.1089/gtmb.2019.0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aim: To determine if there is an association between ABO variants or blood types and otitis media. Methods: DNA samples from 214 probands from Finnish families with recurrent acute (RAOM) and/or chronic otitis media with effusion (COME) were submitted for exome sequencing. Fisher exact tests were performed when (a) comparing frequencies of ABO genotypes in the Finnish probands with otitis media vs. counts in gnomAD Finnish, and (b) within the Finnish family cohort, comparing occurrence of RAOM vs. COME according to ABO genotype/haplotype and predicted blood type. Results: Female sex is protective against having both RAOM and COME. The wildtype genotype for the ABO c.260insG (p.Val87_Thr88fs*) variant resulting in blood type O was protective against RAOM. On the other hand, type A was associated with increased risk for COME. These findings remained significant after adjustment for age and sex. Conclusions: Within the Finnish family cohort, the wildtype genotype for the ABO c.260insG (p.Val87_Thr88fs*) variant and type O are protective against RAOM while type A increases risk for COME. This suggests that the association between the ABO locus and otitis media is specific to blood type, otitis media type and cohort.
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Affiliation(s)
- Brett M Wiesen
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Lena Hafrén
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elisabet Einarsdottir
- Folkhälsan Institute of Genetics and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Juha Kere
- Folkhälsan Institute of Genetics and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Petri S Mattila
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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5
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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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6
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Lappan R, Jamieson SE, Peacock CS. Reviewing the Pathogenic Potential of the Otitis-Associated Bacteria Alloiococcus otitidis and Turicella otitidis. Front Cell Infect Microbiol 2020; 10:51. [PMID: 32117817 PMCID: PMC7033548 DOI: 10.3389/fcimb.2020.00051] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/27/2020] [Indexed: 12/20/2022] Open
Abstract
Alloiococcus otitidis and Turicella otitidis are common bacteria of the human ear. They have frequently been isolated from the middle ear of children with otitis media (OM), though their potential role in this disease remains unclear and confounded due to their presence as commensal inhabitants of the external auditory canal. In this review, we summarize the current literature on these organisms with an emphasis on their role in OM. Much of the literature focuses on the presence and abundance of these organisms, and little work has been done to explore their activity in the middle ear. We find there is currently insufficient evidence available to determine whether these organisms are pathogens, commensals or contribute indirectly to the pathogenesis of OM. However, building on the knowledge currently available, we suggest future approaches aimed at providing stronger evidence to determine whether A. otitidis and T. otitidis are involved in the pathogenesis of OM. Such evidence will increase our understanding of the microbial risk factors contributing to OM and may lead to novel treatment approaches for severe and recurrent disease.
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Affiliation(s)
- Rachael Lappan
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sarra E Jamieson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Christopher S Peacock
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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7
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Akcan FA, Dündar Y, Bayram Akcan H, Cebeci D, Sungur MA, Ünlü İ. The Association between Iron Deficiency and Otitis Media with Effusion. J Int Adv Otol 2020; 15:18-21. [PMID: 30541726 DOI: 10.5152/iao.2018.5394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The purpose of this trial is to examine the clinical role of iron metabolism on development of Otitis media with effusion. MATERIALS AND METHODS This prospective study was conducted in a tertiary referral center. The study group made up of children who had surgery for Otitis media with effusion (OME). Control group was comprised of children who had surgery by a pediatric surgeon for inguinal hernia repair or circumcision operations with normal ear nose throat examination. Each group was evaluated depending on the serum iron metabolism parameters. RESULTS One-hundred-thirteen children with OME and 117 control patients were included to the study. Iron deficiency anemia was detected in 18 out of 113 patients (15.9%) in study group while there were 4 out of the 117 patients (3.4%) in control group (p:0.001).The mean hemoglobin level was 12.16 ± 1.16 in OME group and 12.93 ± 1.08 in control group (p<0.001). CONCLUSION The current study shows the rate of iron deficiency anemia is higher in patients with OME than controls. Iron-deficiency anemia might be considered a potential risk factor for development of otitis media with effusion, and iron parameters should be evaluated in these children.
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Affiliation(s)
- Fatih Alper Akcan
- Department of Otorhinolaryngology, Düzce University School of Medicine, Düzce, Turkey
| | - Yusuf Dündar
- Department Of Otolaryngology - Head - Neck Surgery, Wayne State University School of Medicine, Michigan, USA
| | | | - Derya Cebeci
- Department of Otorhinolaryngology, Düzce University School of Medicine, Düzce, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, Düzce University School of Medicine, Düzce, Turkey
| | - İlhan Ünlü
- Department of Otorhinolaryngology, Düzce University School of Medicine, Düzce, Turkey
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8
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Mittal R, Sanchez-Luege SV, Wagner SM, Yan D, Liu XZ. Recent Perspectives on Gene-Microbe Interactions Determining Predisposition to Otitis Media. Front Genet 2019; 10:1230. [PMID: 31850076 PMCID: PMC6901973 DOI: 10.3389/fgene.2019.01230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/06/2019] [Indexed: 01/15/2023] Open
Abstract
A comprehensive understanding about the pathogenesis of otitis media (OM), one of the most common pediatric diseases, has the potential to alleviate a substantial disease burden across the globe. Advancements in genetic and bioinformatic detection methods, as well as a growing interest in the microbiome, has enhanced the capability of researchers to investigate the interplay between host genes, host microbiome, invading bacteria, and resulting OM susceptibility. Early studies deciphering the role of genetics in OM susceptibility assessed the heritability of the phenotype in twin and triplet studies, followed by linkage studies, candidate gene approaches, and genome-wide association studies that have helped in the identification of specific loci. With the advancements in techniques, various chromosomal regions and genes such as FBXO11, TGIF1, FUT2, FNDC1, and others have been implicated in predisposition to OM, yet questions still remain as to whether these implicated genes truly play a causative role in OM and to what extent. Meanwhile, 16S ribosomal RNA (rRNA) sequencing, microbial quantitative trait loci (mbQTL), and microbial genome-wide association studies (mGWAS) have mapped the microbiome of upper airways sites and therefore helped in enabling a more detailed study of interactions between host polymorphisms and host microbiome composition. Variants of specific genes conferring increased OM susceptibility, such as A2ML1, have also been shown to influence the microbial composition of the outer and middle ear in patients with OM, suggesting their role as mediators of disease. These interactions appear to impact the colonization of known otopathogens (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis), as well as Neisseria, Gemella, Porphyromonas, Alloprevotella, and Fusobacterium populations that have also been implicated in OM pathogenesis. Meanwhile, studies demonstrating an increased abundance of Dolosigranulum and Corynebacterium in healthy patients compared to those with OM suggest a protective role for these bacteria, thereby introducing potential avenues for future probiotic treatment. Incorporating insights from these genetic, microbiome, and host-pathogen studies will allow for a more robust, comprehensive understanding of OM pathogenesis that can ultimately facilitate in the development of exciting new treatment modalities.
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Affiliation(s)
- Rahul Mittal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sebastian V Sanchez-Luege
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Shannon M Wagner
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Denise Yan
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Xue Zhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States.,Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States.,Dr. John T. Macdonald Foundation, Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
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9
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Mangia LRL, Tramontina B, Tonocchi R, Polanski JF. Correlation between Type of Clefting and the Incidence of Otitis Media among Children with Lip and/or Palate Clefts. ORL J Otorhinolaryngol Relat Spec 2019; 81:338-347. [PMID: 31722340 DOI: 10.1159/000503237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Otitis media is a frequent condition among children with high morbidity. Orofacial clefts are undoubtedly one of the most well-established risk factors for otitis media during childhood. The clinical spectrum of disease in orofacial clefting is broad according to the subtype of malformation. This study aims to correlate the occurrence of otitis media among lip and/or palate cleft children with clinical and epidemiological parameters, in particular with the subtypes of malformation diagnosed. METHODS This is a clinical, retrospective, case-control type of study. Epidemiological and clinical data were obtained from medical records of children born between 2005 and 2008 and attending a multidisciplinary center for cleft patients. RESULTS 53% of the patients had registers of middle ear disorder during follow-up, and secretory otitis media was the most frequently diagnosed condition. Five children (1.39%) had chronic otitis media during the study period. Those patients with malformations including involvement of structures located posteriorly to the incisive foramen were more frequently diagnosed with otitis media than those with isolated pre-foramen cleft (p value < 0.001, odds ratio: 5.33). Gender and bilateral malformations did not correlate with increased occurrence of middle ear disease (p value > 0.05). CONCLUSION Otitis media is frequent among lip and/or palate cleft children, although the grade of middle ear involvement seems to vary widely within this population. Post-foraminal malformations are clearly associated with increased incidence of otitis media, as well as with more severe diseases.
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Affiliation(s)
- Lucas R L Mangia
- Department of Otolaryngology - Head and Neck Surgery, Universidade Federal do Paraná, Curitiba, Brazil,
| | | | - Rita Tonocchi
- Centro de Atendimento Integral do Fissurado Lábio Palatal, CAIF/AFISSUR, Curitiba, Brazil
| | - José Fernando Polanski
- Department of Otolaryngology - Head and Neck Surgery, Universidade Federal do Paraná, Curitiba, Brazil
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Abstract
PURPOSE OF REVIEW To examine the relationship between vitamin D and otitis media. RECENT FINDINGS Vitamin D deficiency has been associated with several respiratory diseases, including otitis media. Vitamin D supplementation may reduce the risk of otitis media. This relationship may be explained by vitamin D supporting the immune system by upregulating antimicrobial peptides which are effective against otopathogens and biofilm formation, supporting a less inflammatory immune response, or promoting beneficial commensal bacteria. This review will explore risk factors of both otitis media and vitamin D deficiency, the evidence of vitamin D being beneficial for various forms of otitis media, and possible mechanisms of action.
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11
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Diagnosis and Treatment of Otitis Media With Effusion: CODEPEH Recommendations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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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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13
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Pediatric Otitis Media. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Akcan FA, Dündar Y, Akcan HB, Uluat A, Cebeci D, Sungur MA, Ünlü İ. Clinical role of vitamin D in prognosis of otitis media with effusion. Int J Pediatr Otorhinolaryngol 2018; 105:1-5. [PMID: 29447793 DOI: 10.1016/j.ijporl.2017.11.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the clinical role of Vitamin D in prognosis of Otitis media with effusion. METHODS This prospective-controlled study was conducted at otolaryngology department in Duzce University, Turkey. The study group comprised children who were diagnosed with Otitis media with effusion between September 2016 and February 2017. Control group was conducted with children underwent circumcision or inguinal hernia repair operations that confirmed with ENT examination they do not have any sign of otitis media. After 3 months of follow-up without any treatment, unresolved cases who were accepted as chronic otitis media with effusion were operated under general anesthesia for ventilation tube application. Study and control groups were assessed depending on the serum 25(OH)Vitamin D levels at the end of 3 months; < 15 ng/mL was accepted as vitamin D deficiency. The results were compared with the control group in terms of vitamin D levels. Also, subgroup analysis was performed addressing to the complete recovery otitis media with effusion and chronic otitis media with effusion. RESULTS One-hundred-seventy-four children with otitis media with effusion and 80 control patients were included to the study. One-hundred-eight (62%) out of 174 patients with otitis media with effusion was completely recovered after a 3-months follow up. Of those 66 out of 174 children, they had persistent diseases, underwent ventilation tube insertion after a 3-months follow-up. The mean 25(OH)Vitamin D level was 18.98 ± 10.60 in otitis media with effusion group and 28.07 ± 14.10 in control group and the difference was statistically significant between the study and control group (p < 0.001). Vitamin D deficiency was observed in 33 out of 66 patients (50.0%) in chronic otitis media with effusion group whilst 35 out of 108 patients (32.4%) in complete recovery otitis media with effusion group (p = 0.021). The rate of 25(OH)Vitamin D deficiency was 25% in control group which was statistically different from chronic otitis media with effusion and recovery chronic otitis media with effusion groups (p = 0.006). CONCLUSIONS This study not only shows the relationship between Vitamin D and otitis media with effusion development, but also demonstrates the effects of Vitamin D on otitis media with effusion prognosis. There is a significant association between 25(OH)Vitamin D deficiency and follow-up outcomes of otitis media with effusion.
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Affiliation(s)
- Fatih Alper Akcan
- Düzce University School of Medicine, Department of Otorhinolaryngology, Düzce, Turkey.
| | - Yusuf Dündar
- Wayne State University, Department of Otolaryngology -Head &Neck Surgery, Detroit, MI, USA
| | - Hümeyra Bayram Akcan
- Ministry of Health, Atatürk Hospital, Department of Internal Medicine, Düzce, Turkey
| | - Ahmet Uluat
- Ministry of Health, Evliya Çelebi Training and Research Hospital, Department of Otolaryngology, Kutahya, Turkey
| | - Derya Cebeci
- Düzce University School of Medicine, Department of Otorhinolaryngology, Düzce, Turkey
| | - Mehmet Ali Sungur
- Düzce University School of Medicine, Department of Biostatistics, Düzce, Turkey
| | - İlhan Ünlü
- Düzce University School of Medicine, Department of Otorhinolaryngology, Düzce, Turkey
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15
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Torretta S, Pignataro L, Carioli D, Ibba T, Folino F, Rosazza C, Fattizzo M, Marchisio P. Phenotype Profiling and Allergy in Otitis-Prone Children. Front Pediatr 2018; 6:383. [PMID: 30564563 PMCID: PMC6288470 DOI: 10.3389/fped.2018.00383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Otitis-prone children can present some distinctive clinical patterns and although a number of known risk factors for recurrent acute otitis media (RAOM) are known, no dedicated epidemiological models have been developed to explain clinical heterogeneity. Methods: A preliminary retrospective pilot study was planned to evaluate the possible effect of allergic disease in the development of different disease phenotypes in otitis-prone children aged 3-10 years, particularly the absence (simple RAOM), or presence of episodes of otitis media with effusion between acute infections (RAOM with OME). Results: Analysis was based on the data contained in 153 charts (55.6% males, mean age of 59.4 ± 16.4 months). 75.8% of children had a simple RAOM and 24.2% a RAOM with OME. Atopy or allergy were documented in respectively 47.7 and 41.3% of children considered as a whole. The prevalence of atopy or allergy was significantly higher in the children with a RAOM with OME (atopy: 73.0 vs. 39.5%, p < 0.001; allergy: 60.0 vs. 36.1%, p = 0.049), who also more frequently showed adenoidal hypertrophy (p = 0.016), chronic adenoiditis (p = 0.007), conductive hearing loss (p = 0.004), and impaired tympanometry (p < 0.001). Conclusions: These data suggest that children with a RAOM with OME are clinically different from children with simple RAOM, as they have a more complex clinical presentation that includes not only adenoidal disease and audiological impairment, but also an underlying allergy or atopy. The possibility that the factors mentioned above may be differently involved in the heterogeneous clinical manifestations occurring in otitis-prone children needs to be further investigated in ad hoc epidemiological studies.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniela Carioli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tullio Ibba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Folino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Chiara Rosazza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Miriam Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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16
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Acute Otitis Media and Acute Coalescent Mastoiditis. MIDDLE EAR DISEASES 2018. [PMCID: PMC7122426 DOI: 10.1007/978-3-319-72962-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute otitis media is a frequent manifestation of otitis media, mainly during the early childhood. The multifactorial pathogenesis and risk factors are exposed along with its most microbiological agents. The clinical manifestations and their differential diagnoses are presented. General concepts and different actual guidelines of the treatment are described, also the efficient preventive measures are proposed. The second main issue of this chapter is to deal with the complications of acute otitis media, especially the acute coalescent mastoiditis, that is the most common suppurative complication of AOM. The pathogenesis of coalescent acute mastoiditis, its epidemiology, risk factors and the microbiological agents are presented. The clinical features and differential diagnosis are described, as the specific imaging findings. Complications of acute coalescent mastoiditis are typically the subperiosteal abscess, due to the cortical bony necrosis of the mastoid and its septa, or the intracranial spread of the infection (meningitis, intracranial abscesses and venous sinus thrombosis). The general concept of management is exposed, with emphasis on the antimicrobial treatment and the different surgical options.
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17
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Diagnosis and treatment of otitis media with effusion: CODEPEH recommendations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 70:36-46. [PMID: 29033123 DOI: 10.1016/j.otorri.2017.07.004] [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] [Received: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 11/24/2022]
Abstract
The incidence and the prevalence rates of otitis media with effusion (OME) are high. However, there is evidence that only a minority of professionals follow the recommendations provided in clinical practice guidelines. For the purpose of improving diagnosis and treatment of OME in children to prevent and/or reduce its impact on children's development, the Commission for the Early Detection of Deafness (CODEPEH) has deeply reviewed the scientific literature on this field and has drafted a document of recommendations for a correct clinical reaction to of OME, including diagnosis and medical and surgical treatment methodology. Among others, medication, in particular antibiotics and corticoids, should not be prescribed and 3 months of watchful waiting should be the first adopted measure. If OME persists, an ENT doctor should assess the possibility of sugical treatment. The impact of OME in cases of children with a comorbidity is higher, so it requires immediate reaction, without watchful waiting.
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18
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Bhutta MF, Lambie J, Hobson L, Goel A, Hafrén L, Einarsdottir E, Mattila PS, Farrall M, Brown S, Burton MJ. A mouse-to-man candidate gene study identifies association of chronic otitis media with the loci TGIF1 and FBXO11. Sci Rep 2017; 7:12496. [PMID: 28970529 PMCID: PMC5624881 DOI: 10.1038/s41598-017-12784-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/15/2017] [Indexed: 01/18/2023] Open
Abstract
Chronic otitis media with effusion (COME) is the most common cause of hearing loss in children, and known to have high heritability. Mutant mouse models have identified Fbxo11, Evi1, Tgif1, and Nisch as potential risk loci. We recruited children aged 10 and under undergoing surgical treatment for COME from 35 hospitals in the UK, and their nuclear family. We performed association testing with the loci FBXO11, EVI1, TGIF1 and NISCH and sought to replicate significant results in a case-control cohort from Finland. We tested 1296 families (3828 individuals), and found strength of association with the T allele at rs881835 (p = 0.006, OR 1.39) and the G allele at rs1962914 (p = 0.007, OR 1.58) at TGIF1, and the A allele at rs10490302 (p = 0.016, OR 1.17) and the G allele at rs2537742 (p = 0.038, OR 1.16) at FBXO11. Results were not replicated. This study supports smaller studies that have also suggested association of otitis media with polymorphism at FBX011, but this is the first study to report association with the locus TGIF1. Both FBX011 and TGIF1 are involved in TGF-β signalling, suggesting this pathway may be important in the transition from acute to chronic middle ear inflammation, and a potential molecular target.
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Affiliation(s)
- Mahmood F Bhutta
- Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK. .,Nuffield Department of Surgical Sciences, University of Oxford, Headley Way, Oxford, OX3 9DU, UK. .,MRC Harwell Institute, Harwell, OX11 0RD, UK.
| | - Jane Lambie
- Nuffield Department of Surgical Sciences, University of Oxford, Headley Way, Oxford, OX3 9DU, UK.,MRC Harwell Institute, Harwell, OX11 0RD, UK
| | - Lindsey Hobson
- Nuffield Department of Surgical Sciences, University of Oxford, Headley Way, Oxford, OX3 9DU, UK.,MRC Harwell Institute, Harwell, OX11 0RD, UK
| | - Anuj Goel
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Lena Hafrén
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, HUS, Finland
| | - Elisabet Einarsdottir
- Folkhälsan Institute of Genetics, and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, HUS, Finland
| | - Martin Farrall
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Steve Brown
- MRC Harwell Institute, Harwell, OX11 0RD, UK
| | - Martin J Burton
- Nuffield Department of Surgical Sciences, University of Oxford, Headley Way, Oxford, OX3 9DU, UK.,The UK Cochrane Centre, Summertown Pavilion, 18-24 Middle Way Oxford, Oxford, OX2 7LG, UK
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19
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Walker RE, Bartley J, Camargo CA, Flint D, Thompson JMD, Mitchell EA. Higher serum 25(OH)D concentration is associated with lower risk of chronic otitis media with effusion: a case-control study. Acta Paediatr 2017; 106:1487-1492. [PMID: 28477429 DOI: 10.1111/apa.13908] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 04/24/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Abstract
AIM Vitamin D supplementation and higher 25(OH)-vitamin D concentration are associated with reduced risk of acute respiratory infection. This study examined whether there is a similar association between higher serum 25(OH)D concentration and lower risk of chronic otitis media with effusion (COME). METHODS In a case-control study, serum 25(OH)D concentration in children referred for tympanostomy tube placement for COME (n = 178) was compared to that of healthy children randomly sampled from primary care practices (n = 179). Subjects aged three and four years were recruited in Auckland, New Zealand between May 2011 and November 2013. Blood samples were collected from the children, and their guardians were interviewed. Odds ratios were calculated using logistic regression. RESULTS In a multivariable analysis, higher serum 25(OH)D concentration was associated with a lower risk of COME (OR: 0.86 per 10 nmol/L; 95% CI 0.77-0.97) after adjusting for age, sex, deprivation index, ethnicity, tobacco smoke exposure, duration of breastfeeding and season of blood sampling. Further adjustment for eight additional risk factors did not change the result. CONCLUSION This finding supports further investigation into whether the risk of COME could be reduced by increasing serum 25(OH)D concentration through increased sun exposure, higher dietary intake or vitamin D supplementation.
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Affiliation(s)
- Rebecca E. Walker
- Department of Paediatrics: Child and Youth Health; The University of Auckland; Auckland New Zealand
| | - Jim Bartley
- Division of Otolaryngology-Head and Neck Surgery; Counties-Manukau District Health Board; Auckland New Zealand
| | - Carlos A. Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy, and Immunology; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
- Department of Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - David Flint
- Division of Otolaryngology-Head and Neck Surgery; Counties-Manukau District Health Board; Auckland New Zealand
| | - John M. D. Thompson
- Department of Paediatrics: Child and Youth Health; The University of Auckland; Auckland New Zealand
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth Health; The University of Auckland; Auckland New Zealand
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20
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Torretta S, Marchisio P. Otitis media in children: A proposal for a new nosological classification. Int J Pediatr Otorhinolaryngol 2017; 93:174-175. [PMID: 28011068 DOI: 10.1016/j.ijporl.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sara Torretta
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
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21
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Einarsdottir E, Hafrén L, Leinonen E, Bhutta MF, Kentala E, Kere J, Mattila PS. Genome-wide association analysis reveals variants on chromosome 19 that contribute to childhood risk of chronic otitis media with effusion. Sci Rep 2016; 6:33240. [PMID: 27632927 PMCID: PMC5025747 DOI: 10.1038/srep33240] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/22/2016] [Indexed: 02/07/2023] Open
Abstract
To identify genetic risk factors of childhood otitis media (OM), a genome-wide association study was performed on Finnish subjects, 829 affected children, and 2118 randomly selected controls. The most significant and validated finding was an association with an 80 kb region on chromosome 19. It includes the variants rs16974263 (P = 1.77 × 10(-7), OR = 1.59), rs268662 (P = 1.564 × 10(-6), OR = 1.54), and rs4150992 (P = 3.37 × 10(-6), OR = 1.52), and harbors the genes PLD3, SERTAD1, SERTAD3, HIPK4, PRX, and BLVRB, all in strong linkage disequilibrium. In a sub-phenotype analysis of the 512 patients with chronic otitis media with effusion, one marker reached genome-wide significance (rs16974263, P = 2.92 × 10(-8)). The association to this locus was confirmed but with an association signal in the opposite direction, in a UK family cohort of 4860 subjects (rs16974263, P = 3.21 × 10(-4), OR = 0.72; rs4150992, P = 1.62 × 10(-4), OR = 0.71). Thus we hypothesize that this region is important for COME risk in both the Finnish and UK populations, although the precise risk variants or haplotype background remain unclear. Our study suggests that the identified region on chromosome 19 includes a novel and previously uncharacterized risk locus for OM.
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Affiliation(s)
- Elisabet Einarsdottir
- Folkhälsan Institute of Genetics, and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Lena Hafrén
- Folkhälsan Institute of Genetics, and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland
| | - Eira Leinonen
- Folkhälsan Institute of Genetics, and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland
| | | | - Erna Kentala
- Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland
| | - Juha Kere
- Folkhälsan Institute of Genetics, and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland
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22
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Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, Hoelting D, Hunter LL, Kummer AW, Payne SC, Poe DS, Veling M, Vila PM, Walsh SA, Corrigan MD. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg 2016; 154:S1-S41. [PMID: 26832942 DOI: 10.1177/0194599815623467] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME. PURPOSE The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients <2 months or >12 years old. ACTION STATEMENTS The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME.The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time); (4) should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae; (6) should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth R Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Robyn Coggins
- Society for Middle Ear Disease, Pittsburgh, Pennsylvania, USA
| | - Lisa Gagnon
- Connecticut Pediatric Otolaryngology, Madison, Connecticut, USA
| | | | - David Hoelting
- American Academy of Family Physicians, Pender, Nebraska, USA
| | - Lisa L Hunter
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ann W Kummer
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Spencer C Payne
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dennis S Poe
- Department of Otology and Laryngology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maria Veling
- University of Texas-Southwestern Medical Center/Children's Medical Center-Dallas, Dallas, Texas, USA
| | - Peter M Vila
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Davis, California, USA
| | - Maureen D Corrigan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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23
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Bruijnzeel H, Draaisma K, van Grootel R, Stegeman I, Topsakal V, Grolman W. Systematic Review on Surgical Outcomes and Hearing Preservation for Cochlear Implantation in Children and Adults. Otolaryngol Head Neck Surg 2016; 154:586-96. [PMID: 26884363 DOI: 10.1177/0194599815627146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/23/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The mastoidectomy with facial recess approach (MFRA) is considered the reference standard for cochlear implantation. The suprameatal approach (SMA) was developed more recently and does not require mastoidectomy, which could influence postoperative outcomes. We aim to identify the optimal operative approach for cochlear implantation based on postoperative complications and hearing preservation in children and adults. DATA SOURCES PubMed, EMBASE, Scopus, and Google Scholar. REVIEW METHODS Studies comparing MFRA and SMA in children and adults were eligible for inclusion. Original reports with moderate relevance and validity were included. Relevance and validity were assessed with a self-modified critical appraisal tool. This review was reported in accordance to PRISMA guidelines. RESULTS We retrieved 294 citations. Only retrospective nonrandomized studies were identified (level III evidence). Six articles were selected for full-text inclusion and 4 articles for data extraction. No article found a significant difference between MFRA and SMA with respect to postoperative complications in children and adults. One study found a significantly (P < .023) higher pediatric MFRA mastoiditis rate; however, meta-analysis did not indicate an overall effect. Hearing preservation was reported only in adults, and outcomes between techniques did not differ. CONCLUSION No evidence was noted for lower complication rates or improved hearing preservation between the MFRA and SMA for cochlear implantation in children and adults. Pediatric data were available for children implanted above the age of 24 months only. Level I evidence is needed to resolve the uncertainty regarding differences in postoperative outcomes of pediatric and adult MFRA and SMA.
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Affiliation(s)
- Hanneke Bruijnzeel
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kaspar Draaisma
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roderick van Grootel
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vedat Topsakal
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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24
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Bruijnzeel H, Ziylan F, Cattani G, Grolman W, Topsakal V. Retrospective complication rate comparison between surgical techniques in paediatric cochlear implantation. Clin Otolaryngol 2015; 41:666-672. [PMID: 26541783 DOI: 10.1111/coa.12582] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare paediatric complication occurrence between the Mastoidectomy with Posterior Tympanotomy and the SupraMeatal Approach for cochlear implantation. DESIGN Retrospective cohort study. SETTING Children receiving a cochlear implant before 5 years of age between 1996 and 2014 in our tertiary center. PARTICIPANTS A total of 144 patients receiving a cochlear implant (121 by Mastoidectomy with Posterior Tympanotomy and 23 by SupraMeatal Approach) operated on 165 ears (129 and 39 respectively). MAIN OUTCOME MEASURES The severity (minor or major) using Cohen and Hoffman criteria and time of occurrence of complications (intraoperative, early postoperative or late postoperative) were identified. Intraoperative surgical challenges were correlated to complication occurrence. RESULTS The mean age at implantation was 2.13 ± 1.14 years old. Patients operated by the SupraMeatal Approach (1.27 ± 0.69 years old) were significantly (P < .001) younger than those receiving a cochlear implant by Mastoidectomy with Posterior Tympanotomy Approach (2.40 ± 1.12). Most complications were minor (Mastoidectomy with Posterior Tympanotomy Approach: 64.0%; SupraMeatal Approach: 73.1%) and occurred early postoperatively (Mastoidectomy with Posterior Tympanotomy Approach: 61.5%; SupraMeatal Approach: 76.9%). More overall complications occurred in SupraMeatal compared to Mastoidectomy with Posterior Tympanotomy Approach cases (61.5% versus 20.6%; P < .001). Younger SupraMeatal Approach cohort patients (6 - 12 and 18 - 24 months; P < .008 and P = .016) most often developed these complications. When looking at specific complications, more infectious complications occurred in patients receiving a cochlear implant through the SupraMeatal Approach (P < .05). Logistic regression showed that the surgical technique and not the age at implantation was responsible for the documented complications. No relationship between complications and intraoperative difficulties was identified. CONCLUSION In our institution, cochlear implantation in young patients through the SupraMeatal Approach resulted in significantly more (infectious) complications than those operated through the Mastoidectomy with Posterior Tympanotomy Approach. Outcomes from our institution recommends using the Mastoidectomy with Posterior Tympanotomy Approach when opting for a cochlear implant surgical technique in young children who are more prone to develop infectious complications.
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Affiliation(s)
- H Bruijnzeel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands.,Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - F Ziylan
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands
| | - G Cattani
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands
| | - W Grolman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands.,Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - V Topsakal
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands.,Brain Centre Rudolf Magnus, Utrecht, The Netherlands
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25
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Predisposition to Childhood Otitis Media and Genetic Polymorphisms within the Toll-Like Receptor 4 (TLR4) Locus. PLoS One 2015; 10:e0132551. [PMID: 26177520 PMCID: PMC4503307 DOI: 10.1371/journal.pone.0132551] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/16/2015] [Indexed: 12/22/2022] Open
Abstract
Background Predisposition to childhood otitis media (OM) has a strong genetic component, with polymorphisms in innate immunity genes suspected to contribute to risk. Studies on several genes have been conducted, but most associations have failed to replicate in independent cohorts. Methods We investigated 53 gene polymorphisms in a Finnish cohort of 624 cases and 778 controls. A positive association signal was followed up in a tagging approach and tested in an independent Finnish cohort of 205 cases, in a British cohort of 1269 trios, as well as in two cohorts from the United States (US); one with 403 families and the other with 100 cases and 104 controls. Results In the initial Finnish cohort, the SNP rs5030717 in the TLR4 gene region showed significant association (OR 1.33, P = .003) to OM. Tagging SNP analysis of the gene found rs1329060 (OR 1.33, P = .002) and rs1329057 (OR 1.29, P = .003) also to be associated. In the more severe phenotype the association was stronger. This finding was supported by an independent Finnish case cohort, but the associations failed to replicate in the British and US cohorts. In studies on TLR4 signaling in 20 study subjects, the three-marker risk haplotype correlated with a decreased TNFα secretion in myeloid dendritic cells. Conclusions The TLR4 gene locus, regulating the innate immune response, influences the genetic predisposition to childhood OM in a subpopulation of patients. Environmental factors likely modulate the genetic components contributing to the risk of OM.
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Fuchs JC, Linden JF, Baldini A, Tucker AS. A defect in early myogenesis causes Otitis media in two mouse models of 22q11.2 Deletion Syndrome. Hum Mol Genet 2014; 24:1869-82. [PMID: 25452432 PMCID: PMC4355021 DOI: 10.1093/hmg/ddu604] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Otitis media (OM), the inflammation of the middle ear, is the most common disease and cause for surgery in infants worldwide. Chronic Otitis media with effusion (OME) often leads to conductive hearing loss and is a common feature of a number of craniofacial syndromes, such as 22q11.2 Deletion Syndrome (22q11.2DS). OM is more common in children because the more horizontal position of the Eustachian tube (ET) in infants limits or delays clearance of middle ear effusions. Some mouse models with OM have shown alterations in the morphology and angle of the ET. Here, we present a novel mechanism in which OM is caused not by a defect in the ET itself but in the muscles that control its function. Our results show that in two mouse models of 22q11.2DS (Df1/+ and Tbx1(+/-)) presenting with bi- or unilateral OME, the fourth pharyngeal arch-derived levator veli palatini muscles were hypoplastic, which was associated with an earlier altered pattern of MyoD expression. Importantly, in mice with unilateral OME, the side with the inflammation was associated with significantly smaller muscles than the contralateral unaffected ear. Functional tests examining ET patency confirmed a reduced clearing ability in the heterozygous mice. Our findings are also of clinical relevance as targeting hypoplastic muscles might present a novel preventative measure for reducing the high rates of OM in 22q11.2DS patients.
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Affiliation(s)
- Jennifer C Fuchs
- Department of Craniofacial Development and Stem Cell Biology, King's College London, London SE1 9RT, UK
| | - Jennifer F Linden
- Ear Institute and Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 8XX, UK
| | - Antonio Baldini
- Institute of Genetics and Biophysics, National Research Council, and Department of Molecular Medicine and Medical Biotechnology, University Federico II, Naples 80138, Italy
| | - Abigail S Tucker
- Department of Craniofacial Development and Stem Cell Biology, King's College London, London SE1 9RT, UK,
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