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Wie K, Shaw S, Allen P, Castle M, McKenna M, Faria J. Risk Factors for Replacement of Tympanostomy Tubes After Surgical Removal for Pediatric Patients. Otolaryngol Head Neck Surg 2024. [PMID: 39015070 DOI: 10.1002/ohn.909] [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: 09/30/2023] [Revised: 06/11/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES Ear tube removal and patch myringoplasty are frequently performed. The indication and timing for surgery varies among otolaryngologists. This study identifies risk factors associated with the need for the replacement of tympanostomy tubes after tube removal and myringoplasty. STUDY DESIGN Case series with chart review. SETTING Single institution academic otolaryngology practice. METHODS Patients younger than 12 years of age who underwent tympanostomy tube removal and myringoplasty at the University of Rochester Medical Center from March 2011 to September 2019. Patients with tympanostomy tube removal due to chronic otorrhea were excluded. RESULTS One hundred sixty-one patients (230 ears) met inclusion criteria and had sufficient follow-up. Myringoplasty success after tube removal was 94.8%. Successful myringoplasty was associated with shorter tube duration (32 months) versus unsuccessful myringoplasty (40 months) (P = .02). Replacement tympanostomy tubes after myringoplasty occurred in 9.6% of ears. There was no difference in average patient age (P = .96) or duration of tubes (P = .74) in patients who required replacement of tympanostomy tubes versus patients who did not require tube replacement. Patients with a cleft abnormality were more likely to require tympanostomy tube replacement (P < .001). CONCLUSIONS Most children do not need tubes replaced after removal. This study identified cleft abnormality as a factor that increased the need for replacement tubes. Longer tube durations of over 3 years negatively impacted myringoplasty success. Tympanostomy tube removal should be considered 2 to 3 years after placement in most patients with longer tube durations considered in children with a repaired cleft palate.
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Affiliation(s)
- Kathryn Wie
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Shalini Shaw
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Paul Allen
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Michael Castle
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Margo McKenna
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - John Faria
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
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Greenlund LK, Sajjadi A, Nowariak M, Chinnadurai S, Tibesar R, Morrell N, Roby B. Timing of First Set of Pressure Equalization Tubes in Pediatric Patients With Cleft Deformities. Laryngoscope 2024; 134:3391-3394. [PMID: 38214369 DOI: 10.1002/lary.31285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES Children with cleft palates often have comorbid eustachian tube dysfunction requiring pressure equalization tubes (PETs). PETs can relieve middle ear effusions that impede hearing. Ideal PET placement timing in this population is controversial. In this study, the audiologic exam passing rates of patients with cleft palate prior to and following PET insertion were assessed. Rates for patients receiving PETs at different ages were compared. It was hypothesized that earlier PET placement may benefit patients with additional months of improved hearing. METHODS A retrospective chart review was performed of patients with cleft palate between November 22, 2016 and November 22, 2021 at a tertiary center. Statistical analysis compared passing/normal audiologic exams in patients receiving PETs at different ages. RESULTS A total of 348 patients had cleft palate diagnoses, received PETs, and had adequate hearing data for inclusion. Those with PETs inserted at 3 months of age or less had an increase in percent of patients passing audiologic exams following versus prior to PET insertion of 13% (1.3 times improvement). Those receiving PETs between 7- and 12-months had the largest rate of improvement (42%) (2.4 times improvement); other groups had changes in passing rates between 31% and 40%. The rate of passing audiologic exams following PET insertion was high across all groups, ranging from 66% to 81%. CONCLUSION This is one of the first studies exploring the timing of PET placement in this population and showed that patients receiving PETs at 3 months of age or younger passed subsequent audiologic exams at similar rates relative to those receiving PETs later in life. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3391-3394, 2024.
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Affiliation(s)
| | - Autefeh Sajjadi
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Meagan Nowariak
- University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | - Siva Chinnadurai
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Children's Minnesota, Pediatric ENT and Facial Plastic Surgery, St. Paul, Minnesota, U.S.A
| | - Robert Tibesar
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Children's Minnesota, Pediatric ENT and Facial Plastic Surgery, St. Paul, Minnesota, U.S.A
| | - Noelle Morrell
- Children's Minnesota, Pediatric ENT and Facial Plastic Surgery, St. Paul, Minnesota, U.S.A
| | - Brianne Roby
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Children's Minnesota, Pediatric ENT and Facial Plastic Surgery, St. Paul, Minnesota, U.S.A
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Solis RN, Young K, Velazquez-Castro OS, Farber NI, Tollefson TT, Senders CW, Funamura JL. Tympanostomy Tube Otorrhea: Microbiological Differences Between Children with and Without Cleft Palate. Cleft Palate Craniofac J 2024:10556656241258567. [PMID: 38841772 DOI: 10.1177/10556656241258567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE To characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate. DESIGN Retrospective cohort study. SETTING Pediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center. PATIENTS Children with and without cleft palate <18 years of age who underwent tympanostomy tube placement between 2017-2021. MAIN OUTCOME MEASURES Otopathogen profiles and antibiotic resistance patterns in ear culture specimens obtained in children presenting for treatment of recalcitrant post-tympanostomy tube otorrhea. RESULTS Of the 886 children with tympanostomy tubes placed between 2017-2021, 345 (38.9%) had clinically significant otorrhea defined as requiring at least one otolaryngology visit for treatment. Children with cleft palate had higher rates of otorrhea (50.0% versus 35.7%; P < .01). In the 128 cultures obtained, Staphylococcus aureus was the most common organism in both groups present in 39.8% of cultures; 49% were methicillin-resistant (MRSA). Pseudomonas aeruginosa was also frequently isolated (20.0% versus 23.4%, P = .69) in children with and without cleft palate. Collectively, fluoroquinolone resistance was observed in 68.6% and 27.6% of the S. aureus and P. aeruginosa isolates, respectively, however, no differences in fluoroquinolone resistance were observed between cleft and non-cleft cohorts. Corynebacterium species were isolated more frequently in children with cleft palate (26.7% versus 6.1%, P < .01), a finding of unclear significance. CONCLUSIONS Recalcitrant post-tympanostomy tube otorrhea is more common in children with cleft palate. MRSA was the most common isolate, which was commonly resistant to first-line fluoroquinolone therapy.
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Affiliation(s)
- Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Kurtis Young
- Department of Otolaryngology-Head and Neck Surgery, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Oscar S Velazquez-Castro
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Nicole I Farber
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Travis T Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Craig W Senders
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Jamie L Funamura
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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4
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Maina G, Pollock D, Lockwood C, Cook L, Ooi E. Managing Chronic otitis media with Effusion in Children with non-Syndromic Cleft Palate: Short-Term Ventilation Tubes Versus Surveillance. Cleft Palate Craniofac J 2024; 61:905-916. [PMID: 36600676 DOI: 10.1177/10556656221148368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To compare the effectiveness of short-term ventilation tubes compared to surveillance on conductive hearing loss in children with non-syndromic orofacial clefting involving the muscular palate. INTRODUCTION Chronic otitis media with effusion is a common finding in children with cleft palate. The accepted convention is insertion of short-term ventilation tubes at the time of palate repair, but some centres are choosing conservative management. Each approach has its advantages but there is currently no consensus on the most appropriate management in children with non-syndromic cleft palate. INCLUSION CRITERIA Children <18 years with cleft lip and palate, or isolated cleft palate, not associated with a genetic syndrome, who have been diagnosed with chronic otitis media with effusion. METHODS A systematic search of MEDLINE, CINAHL, Embase and Scopus databases was conducted. Grey literature searches were conducted through Central Register of Controlled Trials, Clinicaltrials.gov and ProQuest. Two reviewers screened the studies, conducted critical appraisal, assessed the methodological quality, and extracted the data. Where possible, studies were pooled in statistical meta-analysis with heterogeneity being assessed using the standard Chi-squared and I2 tests. RESULTS Four studies met the inclusion criteria but were of low quality with a moderate risk of bias. Only data on hearing thresholds could be pooled for analysis which found no statistically significant difference. Other outcomes were presented in narrative form. Certainty of evidence for all outcomes was deemed low to very low using GRADE criteria. CONCLUSIONS No definitive conclusions can be drawn regarding most effective management at improving conductive hearing loss. Missing data and inconsistent reporting of outcomes limited capacity for pooled analysis.
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Affiliation(s)
- Grace Maina
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Danielle Pollock
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Lachlan Cook
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Eng Ooi
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Schild SD, Magge HN, Behzadpour HK, Mantilla-Rivas E, Afsar NM, Rana MS, Manrique M, Oh AK, Reilly BK. Impact of upper airway obstruction management in Robin Sequence on need for myringotomy tubes. Int J Pediatr Otorhinolaryngol 2024; 180:111964. [PMID: 38714046 DOI: 10.1016/j.ijporl.2024.111964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/12/2024] [Accepted: 05/03/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Investigate an association between upper airway obstruction (UAO) management in Robin Sequence (RS) and need for bilateral myringotomy and tubes (BMT). METHODS Retrospective chart review of RS patients treated at a tertiary free-standing pediatric hospital from 1995 to 2020 was performed. Patients were grouped based on airway management: conservative, tracheostomy, tongue-lip adhesion (TLA), and mandibular distraction osteogenesis (MDO). Demographic data, cleft palate (CP) association, numbers of BMT and ear infections, and audiogram data including tympanograms were collected. One-way ANOVA and Chi-square/Fisher's exact tests were used to compare continuous and categorical data, respectively. Multivariable regression analysis was used to compare BMT rates between treatment groups. RESULTS One hundred forty-eight patients were included, 70.3 % of which had CP. Most patients (67.6 %) had at least one BMT; 29.1 % required two or more BMT. The rate of BMT was higher in patients with CP compared to those with intact palates (p = 0.003; 95 % CI 1.30-3.57) and those treated with tracheostomy (p = 0.043; 95 % CI 1.01, 2.27). Surgically managed patients were more likely to have hearing loss (67.5 % vs. 35.3 %, p = 0.017) and ear infections (42.1 % vs. 20.0 %, p = 0.014) pre-compared to post-procedure for airway management. CONCLUSION Most RS patients require at least 1 set of BMT. Those with CP and/or treated with tracheostomy had a higher likelihood of needing BMT. Rate of hearing loss and ear infection was higher in surgically managed RS patients. Patients with RS and overt CP require a statistically higher number of BMTs compared to those with either submucous cleft palate or intact palate.
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Affiliation(s)
- Sam D Schild
- Division of Otolaryngology - Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Hari N Magge
- The George Washington University School of Medicine and Health Sciences, Washington. D.C, USA
| | - Hengameh K Behzadpour
- Division of Otolaryngology - Head and Neck Surgery, Children's National Hospital, Washington. D.C, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington. D.C, USA
| | - Nina M Afsar
- The George Washington University School of Medicine and Health Sciences, Washington. D.C, USA
| | - Md Sohel Rana
- Division of Surgery, Children's National Hospital, Washington. D.C, USA
| | - Monica Manrique
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington. D.C, USA
| | - Albert K Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington. D.C, USA
| | - Brian K Reilly
- Division of Otolaryngology - Head and Neck Surgery, Children's National Hospital, Washington. D.C, USA.
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Martin HL, Poehlein ER, Allori AC, Marcus JR, Cheng J, Lee H, Raynor EM. Relevance of cleft palatal width in short-term otologic outcomes. Int J Pediatr Otorhinolaryngol 2023; 171:111647. [PMID: 37429111 DOI: 10.1016/j.ijporl.2023.111647] [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: 01/29/2023] [Revised: 05/21/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Children with cleft palate are at increased risk for Eustachian tube dysfunction (ETD) and conductive hearing loss from chronic otitis media. While it has been proposed that the severity of ETD is related to the severity of cleft palate, data are lacking to support this hypothesis. An improved understanding of the relevance of cleft width may have prognostic value that could inform decisions on the timing of tympanostomy tube placement and choice of tympanostomy tube design. The objective of this study was to assess severity of ETD in children with narrow, moderate, and wide cleft palate, with examination of hearing outcomes, number of tympanostomy procedures, and incidence of otologic complications. METHODS Retrospective chart review was conducted on 58 patients with primary palatoplasty performed at a single academic medical center from January 1, 2016-December 31, 2019. The primary outcome was the number of otologic procedures performed after the initial palatoplasty. Secondary outcomes included audiometric findings, number of tympanostomy tube placements, presence of effusion at the time of myringotomy, and occurrence of any postoperative otologic complication. Outcomes were compared for patients with narrow (<10 mm), moderate (10-15 mm), and wide (>15 mm) cleft palate. Analysis included consideration of cleft palatal morphology (Veau I - IV), presence of Robin sequence or syndromes, and risk factors for otitis media. RESULTS Patients with moderate and wide cleft palate underwent higher mean numbers of otologic procedures [narrow: 1.3 (95% confidence interval [CI] 0.9, 1.7); moderate: 1.6 (95% CI 1.1, 2.1); wide: 1.8 (95% CI 1.2, 2.4)]. Moderate and wide cleft palate were less likely to have normal hearing after their first tympanostomy (narrow: 50%, 10/20; moderate: 25%, 6/24; wide: 36%, 5/14). Patients with a wide cleft palate had a shorter median time between first and second tympanostomy procedures (median, IQR; narrow: 27.0, 20.8-35.7; moderate 20.4, 16.3-25.9; wide 17.3, 11.5-23.4). CONCLUSION Our findings suggest that patients with wider cleft palate may be more susceptible to severe ETD. Further large-scale study may help to allow for more informed and personalized clinical decision making for management of cleft palate, incorporating cleft width for prognosis of risks for persistent middle ear dysfunction.
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Affiliation(s)
- H L Martin
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
| | - E R Poehlein
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, 27710, Durham, NC, USA.
| | - A C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3974, 27710, Durham, NC, USA.
| | - J R Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3974, 27710, Durham, NC, USA.
| | - J Cheng
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
| | - H Lee
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, 27710, Durham, NC, USA.
| | - E M Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
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7
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Stanton E, Kondra K, Brahme I, Lasky S, Munabi NCO, Jimenez C, Jacob L, Urata MM, Hammoudeh JA, Magee WP. Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care. Cleft Palate Craniofac J 2023; 60:430-445. [PMID: 35044261 DOI: 10.1177/10556656211067901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To understand the indication for and the effects of early ventilation tube insertion (VTI) on hearing and speech for patients with cleft lip and/or palate (CLP). DESIGN We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-guided systematic review of relevant literature. SETTING Setting varied by geographical location and level of clinical care across studies. PATIENTS, PARTICIPANTS Patients with CLP who underwent VTI were included. INTERVENTIONS No interventions were performed. MAIN OUTCOME MEASURE(S) Primary outcome measures were hearing and speech following VTI. Secondary outcome measures were tube-related and middle ear complications. Early VTI occurred before or at time of palatoplasty while late VTI occurred after palatoplasty. RESULTS Twenty-three articles met inclusion criteria. Articles varied among study design, outcome measures, sample size, follow-up, and quality. Few studies demonstrated support for early VTI. Many studies reported no difference in hearing or speech between early and late VTI. Others reported worse outcomes, greater likelihood of complications, or needing repeat VTI following early tympanostomy placement. Several studies had significant limitations, including confounding variables, small sample size, or not reporting on our primary outcome. CONCLUSIONS No consistency was found regarding which patients would benefit most from early VTI. Given the aforementioned variability and sub-optimal methodologies, additional studies are warranted to provide stronger evidence regarding VTI timing in cleft care.
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Affiliation(s)
- Eloise Stanton
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
| | - Katelyn Kondra
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
| | | | - Sasha Lasky
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Christian Jimenez
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
| | - Laya Jacob
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
| | - Mark M Urata
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - William P Magee
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
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Ma X, Lang J, Chen P, Tang W, Shindler S, Yang R. A cascade nanozyme with antimicrobial effects against nontypeable Haemophilus influenzae. NANOSCALE 2023; 15:1014-1023. [PMID: 36602182 DOI: 10.1039/d2nr04306h] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Otitis media (OM) is the main cause of pediatric antibiotic prescriptions. Nontypeable Haemophilus influenzae (NTHi) is a major OM pathogen, which forms a biofilm that resists conventional antimicrobials and immune clearance. Thus, novel treatments that are effective against NTHi and its biofilm are urgently required. Nanozymes (often inorganic nanoparticles) mimic natural enzymes' catalytic activities to generate strong antimicrobials at the site of infection, and thus represent one of the emerging solutions to the crisis of antimicrobial resistance. They mimic natural enzymes' activities, such as generating strong antimicrobials catalytically at the site of infection, to minimize overexposure. However, that in situ generation often relies on Reactive Oxygen Species (ROS) as precursors, a prerequisite that limits the broad deployment of nanozymes. To address this challenge, we designed a cascade nanozyme that generates an antiseptic, HOBr, from a ubiquitous non-ROS, i.e., O2, which successfully eradicates NTHi. The cascade nanozyme simultaneously exhibits glucose oxidase (GOx)-like activity from gold nanoparticles (AuNPs) and haloperoxidase (HPO)-mimicking activity from vanadium pentoxide nanowires (V2O5 NWs) connected using dopamine (DPA). The cascade nanozyme demonstrated strong antimicrobial efficacy against NTHi and its biofilm, while showing improved biocompatibility compared to the nanozyme of V2O5 NWs alone. The cascade nanozyme thus points to a material-oriented infectious disease treatment strategy, where small-molecule antimicrobials are generated in real time at the site of infection for the benefit of autonomous dosing. This strategy potentially mitigates the development of antimicrobial resistance and reduces side effects.
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Affiliation(s)
- Xiaojing Ma
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA.
| | - Jiayan Lang
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA.
| | - Pengyu Chen
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA.
| | - Wenjing Tang
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA.
| | - Simon Shindler
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA.
| | - Rong Yang
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA.
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9
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Otsuka S, Imai R, Kamakura T, Nishimura H, Osaki Y, Furukawa M, Yasui T, Yamashita M, Nakamura M, Iwamoto Y, Kanazu K, Yonei S, Okazaki S, Hirose M. How long do tympanostomy ventilation tubes last in pediatric patients with otitis media with effusion or adhesion? A study using Kaplan-Meier survival analysis. Int J Pediatr Otorhinolaryngol 2022; 159:111210. [PMID: 35724491 DOI: 10.1016/j.ijporl.2022.111210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the functional duration and survival rate of tympanostomy ventilation tubes and the complications associated with their use in pediatric patients who underwent tube insertion for otitis media with effusion (OME). Complications were analyzed including recurrence and tympanic membrane perforation after the tube removal or extrusion. METHODS Altogether, 447 ears from 234 pediatric patients younger than 15 years of age were studied retrospectively. All patients had undergone long-term tympanostomy ventilation tube: the Goode T-tube insertion for OME at the Osaka Women's and Children's Hospital, which is the pediatrics specialty hospital between April 2014 and March 2016. They were typically followed up every 3-4 months or more frequently if necessary due to otorrhea or tube infection. Subsequently, the tube duration, survival rates of the tube especially at 22 months after insertion defined as "full-term placement", and the rates of recurrence and perforation were calculated and statistically evaluated. RESULTS Of 447 ears, 335 ears from 184 patients underwent their first tube insertion, and 112 ears from 64 patients underwent their second or subsequent tube insertion within the targeted period. Two hundred ears from 106 patients were associated with a cleft palate. The survival rate at full-term placement was 51.7%. The recurrence rate was 56.3%, and the rate of the tympanic perforation was 8.5%. CONCLUSIONS Approximately half of the tubes survived for 22 months. The perforation rate was relatively low; however, recurrence of OME was seen in more than half the ears.
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Affiliation(s)
- Shintaro Otsuka
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology, Nara City Hospital, 1-50-1 Higashikideracho, Nara, Nara, 630-8305, Japan
| | - Ryusuke Imai
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroshi Nishimura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Yasuhiro Osaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masashi Furukawa
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Furukawa ENT Clinic, 5-1 Oharacho, Ashiya, Hyogo, 659-0092, Japan
| | - Toshimichi Yasui
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Yasui ENT Clinic, 1294-1 Minaminakayasumatsu, Izumisano, Osaka, 598-0033, Japan
| | - Maki Yamashita
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Megumi Nakamura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Yoriko Iwamoto
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Kimi Kanazu
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Shinichi Yonei
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Suzuyo Okazaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Masayuki Hirose
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
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10
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Maina G, Pollock D, Lockwood C, Ooi E. Effectiveness of ventilation tube insertion for conductive hearing loss in children with chronic otitis media with effusion and non-syndromic cleft palate: a systematic review protocol. JBI Evid Synth 2022; 20:1560-1567. [PMID: 35220383 DOI: 10.11124/jbies-21-00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review will investigate the efficacy of ventilation tube insertion versus non-surgical options in the management of chronic otitis media with effusion in children with non-syndromic cleft palate by assessing the degree of conductive hearing loss. INTRODUCTION Chronic otitis media with effusion is common in children with cleft palate due to associated eustachian tube dysfunction. It can lead to impaired hearing and can hinder speech and language development. The main treatment options are drainage of effusion with ventilation tubes, surveillance, or amplification with hearing aids. Each of these approaches has its advantages but there is currently no consensus on the most appropriate management in children with cleft palate. INCLUSION CRITERIA Eligible studies will include children (<18 years) with cleft palate not associated with a genetic syndrome, diagnosed with chronic otitis media with effusion, who have undergone insertion of ventilation tubes compared with either surveillance or amplification with hearing aids. METHODS A comprehensive search of MEDLINE, CINAHL, Embase, and Scopus will be conducted to find published literature. Gray literature searches will be conducted through the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and ProQuest Dissertations and Theses Global. Two reviewers will screen studies, conduct critical appraisal of eligible studies, assess the methodological quality, and extract the data. Where possible, studies will be pooled in statistical meta-analysis, with heterogeneity of data being assessed using the standard χ 2 and I2 tests. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021255861.
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Affiliation(s)
- Grace Maina
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Danielle Pollock
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Eng Ooi
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
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11
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Şahin MI, Özyürek DD, Vural A, Zararsız G, Ketenci I, Ünlü Y. Can Wideband Tympanometry Predict the Prognosis of Otitis Media With Effusion? J Audiol Otol 2022:jao.2021.00633. [PMID: 35538866 DOI: 10.7874/jao.2021.00633] [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: 11/03/2021] [Accepted: 03/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives This study aims to evaluate the capacity of wideband tympanometry (WBT) in predicting the prognosis of otitis media with effusion (OME). Subjects and Methods Sixty-one ears with effusion and 30 healthy ears of children were enrolled. The patients were followed up monthly using WBT. After the completion of measurements, the ears were separated into four groups according to the duration of recovery; Group 1: Good prognosis (≤1-month, n=18), Group 2: Worse prognosis (>1-month, n=29), Group 3: Surgical (no recovery, n=14), and Group 4: Control (healthy ears, n=30). Tympanometric peak pressure (TPP), resonance frequency (RF), and absorbance levels were compared within and between the groups. Results The TPP and RF values of the study group were lower than those of the controls (p<0.001). The ears with OME had lower absorbance measures than the controls at all frequencies; the differences were significant at 250, 500, and 1,000 Hz (p<0.001). However, at 2,000 Hz, the absorbance levels of the ears with OME were similar with those of the control group only in the good prognosis group (p>0.05). The receiver-operating characteristic analysis revealed that absorbance measures over 0.237 and 0.311 at 1,000 Hz and 2,000 Hz, respectively, have sensitivities and specificities over 70% for prediction of good prognosis, and the calculated odd ratio for these measures were 6 (p<0.05). Conclusions WBT measurement is promising in predicting the recovery of OME in children.
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Affiliation(s)
- Mehmet Ilhan Şahin
- Department of Otorhinolaryngology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Duygu Demirkan Özyürek
- Department of Otorhinolaryngology, Kayseri Education and Research Hospital Kayseri, Kayseri, Turkey
| | - Alperen Vural
- Department of Otorhinolaryngology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gökmen Zararsız
- Department of Biostatistics, Erciyes University, Kayseri, Turkey
| | - Ibrahim Ketenci
- Department of Otorhinolaryngology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Yaşar Ünlü
- Department of Otorhinolaryngology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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12
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Jeon JW, Christensen J, Chisholm J, Zalewski C, Rasooly M, Dempsey C, Magnani A, Frischmeyer-Guerrerio P, Brewer CC, Kim HJ. Audiologic and Otologic Clinical Manifestations of Loeys-Dietz Syndrome: A Heritable Connective Tissue Disorder. Otolaryngol Head Neck Surg 2022; 166:357-362. [PMID: 33971761 PMCID: PMC11007485 DOI: 10.1177/01945998211008899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Loeys-Dietz syndrome (LDS) is a rare genetic connective tissue disorder resulting from TGF-ß signaling pathway defects and characterized by a wide spectrum of aortic aneurysm, arterial tortuosity, and various extravascular abnormalities. This study describes the audiologic, otologic, and craniofacial manifestations of LDS. STUDY DESIGN Consecutive cross-sectional study. SETTING Tertiary medical research institute. METHODS Audiologic and clinical evaluations were conducted among 36 patients (mean ± SD age, 24 ± 17 years; 54% female) with genetically confirmed LDS. Cases were categorized into genetically based LDS types 1 to 4 (TGFBR1, TGFBR2, SMAD3, TGFB2, respectively). Audiometric characteristics included degree and type of hearing loss: subclinical, conductive, mixed, and sensorineural. RESULTS LDS types 1 to 4 included 11, 13, 5, and 7 patients, respectively. In LDS-1, 27% had bilateral conductive hearing loss; 9%, unilateral mixed; and 36%, subclinical. In LDS-2, 38% had conductive hearing loss and 38% subclinical. In LDS-3 and LDS-4, 40% and 43% had bilateral sensorineural hearing loss, respectively. Degree of hearing loss ranged from mild to moderate. Bifid uvula was observed only in LDS-1 (55%) and LDS-2 (62%). Submucosal/hard cleft palates were primarily in LDS-1 and LDS-2. Posttympanostomy tympanic membrane perforations occurred in 45% (10/22 ears) of LDS-1 and LDS-2. There were 4 cases of cholesteatoma: 3 middle ear (LDS-1 and LDS-2) and 1 external ear canal (LDS-3). CONCLUSION Conductive hearing loss, bifid uvula/cleft palate, and posttympanostomy tympanic membrane perforation are more common in LDS-1 and LDS-2 than LDS-3 and LDS-4, while sensorineural hearing loss was present only in LDS-3 and LDS-4. These LDS-associated key clinical presentations may facilitate an early diagnosis of LDS and thus prompt intervention to prevent related detrimental outcomes.
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Affiliation(s)
- Jun W. Jeon
- Office of the Clinical Director, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Julie Christensen
- Audiology Unit, Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Chisholm
- Audiology Unit, Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Zalewski
- Audiology Unit, Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Marjohn Rasooly
- Food Allergy Research Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Caeden Dempsey
- Food Allergy Research Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alaina Magnani
- NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Pamela Frischmeyer-Guerrerio
- Food Allergy Research Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Carmen C. Brewer
- Audiology Unit, Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Hung Jeffrey Kim
- Office of the Clinical Director, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC, USA
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13
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Kacin AJ, Jabbour N, Ford MD, Losee JE, Shaffer AD. The limits of pandemic precautions: Tympanostomy tube placement in children with cleft palate during COVID-19. Am J Otolaryngol 2022; 43:103279. [PMID: 34800861 PMCID: PMC8580857 DOI: 10.1016/j.amjoto.2021.103279] [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: 09/28/2021] [Accepted: 11/07/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Coronavirus Disease-2019 (COVID-19) mitigation measures have led to a sustained reduction in tympanostomy tube (TT) placement in the general population. The present aim was to determine if TT placement has also decreased in children at risk for chronic otitis media with effusion (COME), such as those with cleft palate (CP). MATERIALS AND METHODS A cohort study with medical record review was performed including consecutive children, ages 0-17 years, undergoing primary palatoplasty at a tertiary children's hospital February 2019-January 2020 (pre-COVID) or May 2020-April 2021 (COVID). Revision palatoplasty (n = 29) was excluded. Patient characteristics and middle ear status pre-operatively and at palatoplasty were compared between groups using logistic regression or Wilcoxon rank-sum. RESULTS The pre-COVID and COVID cohorts included 73 and 87 patients, respectively. Seventy (44%) were female and median age at palatoplasty was 13.5 months for CP ± cleft lip (CP ± L) and 5.5 years for submucous cleft palate (SMCP). In patients with CP ± L, TT were placed or in place and patent at palatoplasty in 28/38 (74%) pre-COVID and 37/50 (74%) during COVID (P = 0.97). In patients with SMCP, these proportions were 5/35 (14%) and 6/37 (16%), respectively (P = 0.82). Examining only patients <2 years of age also revealed no difference in TT placement pre-COVID versus COVID (P = 0.99). Finally, the prevalence and type of effusion during COVID was similar to pre-COVID. CONCLUSIONS Reduced infectious exposure has not decreased TT placement or effusion at palatoplasty. Future work could focus on non-infectious immunologic factors underlying the maintenance of COME in these children.
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Affiliation(s)
- Alexa J. Kacin
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Noel Jabbour
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Otolaryngology, Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew D. Ford
- Department of Communication Disorders, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph E. Losee
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Plastic Surgery, Division of Pediatric Plastic Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Amber D. Shaffer
- Department of Otolaryngology, Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA,Corresponding author at: Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 7th Floor, Faculty Pavilion, Pittsburgh, PA 15224, USA
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14
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Ma X, Lang J, Chen P, Yang R. Silver Nanoparticles as an Effective Antimicrobial against Otitis Media Pathogens. AIChE J 2021; 67. [PMID: 35450419 DOI: 10.1002/aic.17468] [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: 01/06/2023]
Abstract
Otitis Media (OM) is the most common reason for U.S. children to receive prescribed oral antibiotics, leading to potential to cause antibiotic resistance. To minimize oral antibiotic usage, we developed polyvinylpyrrolidone-coated silver nanoparticles (AgNPs-PVP), which completely eradicated common OM pathogens, i.e., Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) at 1.04μg/mL and 2.13μg/mL. The greater antimicrobial efficacy against S. pneumoniae was a result of the H2O2-producing ability of S. pneumoniae and the known synergistic interactions between H2O2 and AgNPs. To enable the sustained local delivery of AgNPs-PVP (e.g., via injection through perforated tympanic membranes), a hydrogel formulation of 18%(w/v)P407 was developed. Reverse thermal gelation of the AgNPs-PVP-P407 hydrogel could gel rapidly upon entering the warm auditory bullae and thereby sustained release of antimicrobials. This hydrogel-based local delivery system completely eradicated OM pathogens in vitro without cytotoxicity, and thus represents a promising strategy for treating bacterial OM without relying on conventional antibiotics.
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Affiliation(s)
- Xiaojing Ma
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Jiayan Lang
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Pengyu Chen
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Rong Yang
- Robert F. Smith School of Chemical & Biomolecular Engineering, Cornell University, Ithaca, NY 14850, USA
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15
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Koempel J, Osterbauer B, Badash I, Goel P, Fahradyan A, Zhang Z, Hammoudeh J. Exceptionally early tympanostomy tube placement in pediatric patients with cleft lip and palate. Int J Pediatr Otorhinolaryngol 2021; 145:110744. [PMID: 33940380 DOI: 10.1016/j.ijporl.2021.110744] [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: 02/09/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE At our institution, cleft lip repair is performed at or before 8 weeks of age, and tympanostomy tubes (TT) have been inserted concurrently in some of these patients. Our objective was to determine the feasibility and present the preliminary results of TT placement at this early age. METHODS A retrospective review was conducted of 22 patients born with cleft lip and/or palate who had TT placement in the first 8 weeks of life. Data collected included complications and audiologic function post TT placement. RESULTS Subjects had a mean age of 3.9 weeks at the time of TT placement and cleft lip repair. Thirteen patients (59%) reported otorrhea during the follow-up period. Eighteen of 21 (86%) patients who underwent auditory evaluation had normal audiological function following TT placement. One patient had sensorineural hearing loss and 2 patients had mild conductive hearing loss due to bilateral extruded TT and OME at 15.9 and 39.2 months after surgery. CONCLUSION Exceptionally early TT is feasible. Placing TT at or before 8 weeks of age did not result in any major complications but demonstrated a high incidence of otorrhea. A randomized, prospective study with a larger sample size is necessary to determine the benefits of TT placement at this age.
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Affiliation(s)
- Jeffrey Koempel
- Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd. Mailstop #48, Los Angeles, CA, 90027, USA
| | - Beth Osterbauer
- Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd. Mailstop #48, Los Angeles, CA, 90027, USA.
| | - Ido Badash
- University of Southern California, Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Pedram Goel
- University of Southern California, Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Artur Fahradyan
- Children's Hospital Los Angeles Division of Plastic and Maxillofacial Surgery, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Zhipeng Zhang
- University of Southern California, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, 1450 San Pablo St #5100, Los Angeles, CA, 90033, USA
| | - Jeffrey Hammoudeh
- Children's Hospital Los Angeles Division of Plastic and Maxillofacial Surgery, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
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16
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Goel AN, Omorogbe A, Hackett A, Rothschild MA, Londino AV. Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and Meta-Analysis. Laryngoscope 2020; 131:E2363-E2370. [PMID: 33382113 DOI: 10.1002/lary.29342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/05/2020] [Accepted: 12/14/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine the rate and predictors of receiving multiple tympanostomy tube (TT) placements in children. STUDY DESIGN Systematic review and meta-analysis. METHODS PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting the risk factors for receiving repeat TT (r-TT) placements in children with chronic otitis media with effusion or recurrent acute otitis media. These articles were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Data were pooled using a random-effects model. RESULTS Twenty-one studies involving a total of 290,897 children were included. Among all patients, 24.1% (95% confidence interval (CI), 18.2%-29.9%) underwent ≥2 TT placements and 7.5% (95% CI, 5.7%-9.4%) underwent ≥3 TT placements. Craniofacial disease (odds ratio (OR) 5.13, 95% CI, 1.57-16.74) was the strongest predictor of r-TT. Younger age at initial TT placement and shorter TT retention time were also significantly associated with r-TT. Receipt of primary adenoidectomy with initial TT placement was associated with decreased odds of r-TT (OR, 0.46; 95% CI, 0.39-0.55). Long-term tubes also significantly reduced the odds of r-TT (OR, 0.27; 95% CI, 0.17-0.44). CONCLUSIONS About 1 in 4 children receiving TT will receive at least one repeat set of TT and about 1 in 14 will receive multiple repeat sets. Concurrent adenoidectomy and long-term tubes reduced the incidence of r-TT. Younger patients and those with earlier extrusion of the initial set are at increased risk for repeat surgery. The identification of these risk factors may improve parental counseling and identify patients who might benefit from closer follow-up. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2363-E2370, 2021.
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Affiliation(s)
- Alexander N Goel
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Aisosa Omorogbe
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Alyssa Hackett
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Michael A Rothschild
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Aldo V Londino
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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17
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Luu K, Park J, Shaffer AD, Chi DH. Long-Term Otitis Media Outcomes in Infants With Early Tympanostomy Tubes. Otolaryngol Head Neck Surg 2020; 163:1258-1263. [PMID: 32539603 DOI: 10.1177/0194599820931414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review the otologic outcomes of infants who failed the newborn hearing screen (NBHS) and received early tympanostomy tubes for otitis media with effusion (OME). STUDY DESIGN Retrospective case series. SETTING Tertiary care pediatric hospital. SUBJECTS AND METHODS Consecutive patients (2007-2018) who failed an NBHS and required tympanostomy tubes before 6 months of age were included. Variables including hearing loss and otitis media risk factors, episodes of acute otitis media (AOM), number of subsequent tympanostomy tubes, and posttympanostomy tube audiogram results were recorded. RESULTS The cohort included 171 patients. Median age at referral to otolaryngology was 2.7 months. Sensorineural hearing loss (SNHL) was subsequently identified in 22 (12.9%) of infants after resolution of the effusion. The peak incidence of AOM was during the second year of life (1-1.9 years), with a median of 1 episode. Ninety-five patients (55.6%) had replacement of tubes, 41 of 171 (24.0%) had 2 or more additional sets of tubes, and long-term tubes were eventually placed in 8 of 95 (8.4%) patients. Craniofacial anomalies were identified in 43.3% of patients. Tube replacement (hazard ratio, 3.00; 95% CI, 1.95-4.63; P < .01, log-rank) and AOM (β, 1.04; 95% CI, 0.43-1.65; P = .04, ordered logistic regression) were more common, and SNHL less common (odds ratio, 0.17; 95% CI, 0.031-0.61; P < .01, logistic regression), in children with craniofacial anomalies. CONCLUSION OME is a common cause of failed NBHS. A notable proportion was subsequently found to have SNHL, reiterating the need for postoperative hearing assessments. Infants meeting indication for early tympanostomy tubes for resolution of OME have a high incidence of recurrent AOM and require subsequent tubes.
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Affiliation(s)
- Kimberly Luu
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Park
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amber D Shaffer
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David H Chi
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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18
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Tengroth B, Lohmander A, Hederstierna C. Hearing Thresholds in Young Children With Otitis Media With Effusion With and Without Cleft Palate. Cleft Palate Craniofac J 2019; 57:616-623. [DOI: 10.1177/1055665619889744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate hearing thresholds in children born with cleft palate and in children with otitis media with effusion but no cleft palate. Design: Prospective longitudinal group comparison study. Setting: University hospital. Participants: Sixteen children born with nonsyndromic cleft palate with or without cleft lip (CP±L) and 15 age-matched children with otitis media with effusion (OME) but without cleft. Main Outcome Measures: Hearing was tested at repeated occasions beginning with neonatal auditory brainstem response (ABR) at 1-4 months of age, and age-appropriate hearing tests from 9 to 36 months of age. Results: The median ABR thresholds in both groups were elevated but did not differ significantly. At 12 months of age, the median 4 frequency averages at 500-1000-2000-4000 Hz (4FA) were indicative of mild hearing loss but significantly better in the CP±L-group than in the group without cleft ( P < .01). There were no significant group-wise differences regarding the median 4FA at 24 and 36 months of age, and at 36 months, the median 4FA were normal in both groups. Both groups exhibited a significant improvement over time from the neonatal ABR thresholds to the 4FA at 36 months (CP±L-group P < .05; without CP±L-group P < .01). Conclusion: The hearing loss in children with CP±L was not more severe than among children with OME but without cleft palate; rather, at 12 months of age, the thresholds were significantly better in the CP±L-group than those in the group without cleft. The air conduction thresholds improved with age in both groups.
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Affiliation(s)
- Birgitta Tengroth
- Department of Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | | | - Christina Hederstierna
- Department of Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
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