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Bicalho de Castro LGR, Carvalho SADS, Côrtes Gama AC, Gonçalves DU, Macedo de Resende L, Giraudet F, Friche AADL, Parlato-Oliveira E, Avan P. Psychometric Validation of a Hearing Screening Questionnaire for Preschoolers Based on Language Development Evaluation by Caregivers. Folia Phoniatr Logop 2024:1-8. [PMID: 38643754 DOI: 10.1159/000538989] [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: 10/01/2023] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION This study aimed to validate three age-adjusted versions of a Hearing Screening Questionnaire for Preschoolers, in Brazilian Portuguese, based on parents' perception of their children's hearing and oral language. METHODS Psychometric validation was conducted on three questionnaires, each comprising nine items with yes/no responses. Three items focused on hearing screening at birth, and six assessed hearing and oral language. The study included 152 parents and their children, who attended daycare centers in Belo Horizonte, Brazil. The children were categorized into three age bands: 12-18 months, 19-35 months, and 36-48 months. Audiological assessments, including tympanometry, transient-evoked otoacoustic emissions (TEOAE), and pure-tone audiometry (when applicable), were performed on the children. In case of abnormal findings in the previous exams, auditory brainstem response (ABR) testing was conducted. Descriptive data, false alarm, and false-negative analyses were carried out. RESULTS Considering any type of hearing loss, whether unilateral or bilateral, the questionnaires showed a false-negative rate of 41.17% (7/17 children). However, when considering only bilateral hearing loss, the questionnaire showed a false alarm rate of 31.69% (45/142) and a false-negative rate of 30.0% (3/10). When focusing exclusively on sensorineural hearing loss, the questionnaire identified two children (1.31%), with a false-negative rate of 0% but a false-positive rate of 33.33%. CONCLUSION Language-development-oriented questionnaires allowed quick screening of potential hearing loss in preschoolers. This study found a robust hit rate with these questionnaires. Their validation signifies a promising and cost-effective tool for conducting hearing screenings in preschool children, especially in nations lacking a comprehensive school screening policy. The validated questionnaire affords an easy-to-apply, low-cost, and effective instrument for preschool hearing screening.
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Affiliation(s)
| | | | - Ana Cristina Côrtes Gama
- Post-graduation Center, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Denise Utsch Gonçalves
- Post-graduation Center, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciana Macedo de Resende
- Post-graduation Center, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fabrice Giraudet
- UMR INSERM 1107, Neurosensory Biophysics, School of Medicine, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - Erika Parlato-Oliveira
- Post-graduation Center, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paul Avan
- UMR INSERM 1107, Neurosensory Biophysics, School of Medicine, Université Clermont Auvergne, Clermont-Ferrand, France
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Harkus S, Marnane V, O'Keeffe I, Kung C, Ward M, Orr N, Skinner J, Hughes JK, Fonua Wiradjuri L, Kennedy Wiradjuri M, Kong Worimi K, Belfrage M. Development of the national consensus statement on ear health and hearing check recommendations for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: systematic scoping review and e-Delphi. BMC PRIMARY CARE 2024; 25:86. [PMID: 38486181 PMCID: PMC10938761 DOI: 10.1186/s12875-024-02307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Early detection of long-term, often asymptomatic, middle ear infection in young Aboriginal and Torres Strait Islander children is more likely to be achieved when ear health and hearing checks are routinely undertaken in primary healthcare. Evidence consistently demonstrates the adverse impacts of this condition on the development and wellbeing of children and their families. We aimed to develop feasible, evidence- and consensus-based primary healthcare recommendations addressing the components and timing of ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years, not already known to have, nor being actively managed for, ear and hearing problems. METHODS A 22-person working group comprising Aboriginal and Torres Strait Islander and non-Indigenous members from the primary healthcare, ear, hearing, and research sectors provided guidance of the project. A systematic scoping review addressed research questions relating to primary health ear health and hearing checks for Aboriginal and Torres Strait Islander and other populations at increased risk of persistent ear health problems. Twelve primary studies and eleven guidelines published between 1998 and 2020 were identified and reviewed. Quality and certainty of evidence and risk of bias ratings were completed for studies and guidelines. In the absence of certain and direct evidence, findings and draft recommendations were presented for consensus input to a 79-member expert panel using a modified e-Delphi process. Recommendations were finalised in consultation with working group members and presented to expert panel members for input on considerations relating to implementation. RESULTS Overall, the quality, certainty, and directness of evidence in the studies and guidelines reviewed was low. However, the findings provided a basis and structure for the draft recommendations presented during the consensus-building process. After two e-Delphi rounds, seven goals and eight recommendations on the components and timing of Ear Health and Hearing Checks in primary healthcare for young Aboriginal and Torres Strait Islander children were developed. CONCLUSIONS The systematic scoping review and consensus-building process provided a pragmatic approach for producing strong recommendations within a reasonably short timeframe, despite the low quality and certainty of evidence, and paucity of studies pertaining to primary healthcare settings.
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Affiliation(s)
| | | | | | | | - Meagan Ward
- National Acoustic Laboratories, Sydney, Australia
| | - Neil Orr
- Macquarie University, Sydney, Australia
| | | | | | | | | | | | - Mary Belfrage
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
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Wu X, Huang W, Zhao S, Huang M, Kuang Y, Liu G. Comparative study on wound healing and infection between open and minimally invasive surgical methods in pediatric otolaryngology surgery. Int Wound J 2024; 21:e14728. [PMID: 38385835 PMCID: PMC10883252 DOI: 10.1111/iwj.14728] [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: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Pediatric otolaryngology surgeries are crucial interventions requiring careful consideration of surgical methods to optimize outcomes. The choice between open and minimally invasive surgical approaches in this context warrants thorough investigation. While both methods aim to address ear, nose, and throat conditions in children, a comparative study assessing their impact on crucial factors such as intraoperative parameters, wound healing, complications, and postoperative pain is essential. This study aims to compare the effects of open and minimally invasive surgical methods on wound healing and infection in pediatric otolaryngology surgery, and provide a scientific basis for the selection of surgical methods. Two groups of patients were selected, with 90 people in each group. One group received open surgery and the other received minimally invasive surgery. Recording the intraoperative time, anesthesia time, and intraoperative blood loss; the number of days required for wound healing; the occurrence of wound-related complications; the comparison of pain on postoperative Days 1, 3, and 7; and the factors influencing postoperative wound healing were analyzed. In the minimally invasive surgery group, the intraoperative time was shorter, the anesthesia time was relatively reduced, and the amount of bleeding was significantly reduced. Wounds also take fewer days to heal and have lower rates of wound-related complications. When comparing the pain on 1, 3, and 7 days after surgery, the minimally invasive surgery group had relatively mild pain. Analysis of postoperative wound healing factors showed that minimally invasive surgical methods have a positive impact on healing. In pediatric otolaryngology surgery, minimally invasive surgery performs better than open surgery in terms of intraoperative operation time, anesthesia time, blood loss, wound healing time, complication rate, and postoperative pain. Therefore, minimally invasive surgery may be a safer and more effective surgical method.
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Affiliation(s)
- Xionghui Wu
- Department of Otolaryngology, Head and Neck Surgery, Hunan Children's Hospital, Changsha City, China
| | - Weiqing Huang
- Department of Neonatology, Hunan Children's Hospital, Changsha City, China
| | - Sijun Zhao
- Department of Otolaryngology, Head and Neck Surgery, Hunan Children's Hospital, Changsha City, China
| | - Min Huang
- Department of Otolaryngology, Head and Neck Surgery, Hunan Children's Hospital, Changsha City, China
| | - Yuting Kuang
- Department of Otolaryngology, Head and Neck Surgery, Hunan Children's Hospital, Changsha City, China
| | - Guangliang Liu
- Department of Otolaryngology, Head and Neck Surgery, Hunan Children's Hospital, Changsha City, China
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Bower C, Reilly BK, Richerson J, Hecht JL. Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening. Pediatrics 2023; 152:e2023063288. [PMID: 37635686 DOI: 10.1542/peds.2023-063288] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/29/2023] Open
Abstract
Children who are deaf or hard of hearing (D/HH) are at high risk for permanent deficits in language acquisition and downstream effects such as poor academic performance, personal-social maladjustments, and emotional difficulties. Identification of children born D/HH through newborn hearing screening and subsequent timely early intervention can prevent or reduce many of these adverse consequences. Ongoing surveillance for changes in hearing thresholds after infancy is also important and should be accomplished by subjective assessment for signs of atypical hearing and with objective screening tests. Scheduled hearing screening may take place in the primary care setting, or via referral to an audiologist according to the Bright Futures/American Academy of Pediatrics "Recommendations for Preventive Pediatric Health Care" (also known as the periodicity schedule). This report covers hearing assessment beyond the newborn period, reviews risk factors for hearing level change, and provides guidance for providers of pediatric primary care on the assessment and care of children who are D/HH.
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Affiliation(s)
- Charles Bower
- Department of Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Brian Kip Reilly
- Division of Otolaryngology, Children's National Medical Center, Washington, District of Columbia
| | | | - Julia L Hecht
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Bulut KŞ, Kutluhan A, Çetin H, Gul F, Babademez MA, Kale H, Sancak M. Single Sequence Magnetic Resonance Imaging in Serous Otitis Media. Cureus 2023; 15:e38261. [PMID: 37261153 PMCID: PMC10226835 DOI: 10.7759/cureus.38261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION We evaluated the usability of short-term (approximately 3 minutes) T2 sequence temporal bone magnetic resonance imaging (MRI) in the diagnosis of serous otitis media (SOM) in our study. METHODS A prospective study. Otoscopic examination and audiometry-tympanometry were performed on all 73 patients included in the study. All patients underwent short-term T2 sequence temporal bone MRI before the paracentesis procedure. RESULTS The mean age of 73 patients (30 female and 43 male) was 7.78 ± 3.01 (3 to 17 years). A total of 134 ear paracentesis operations were performed. As a result of the intraoperative paracentesis procedure, 107 Type B tympanogram and 13 Type C tympanogram were found out of 120 ears that had fluid in the middle ear. Out of 14 ears without fluid flow in the middle ear, five were found to be Type B tympanogram and nine to be Type C tympanogram. The sensitivity of the type B tympanogram in the diagnosis of SOM was 89.1%, the specificity was 64.2%, the positive predictive value was 95.5%, and the negative predictive value was 40.9%. The sensitivity and specificity of short-term T2 sequence MRI in diagnosing SOM were found to be 100% and 100%. CONCLUSION Among the available methods, the short-term T2 sequence temporal MRI is the most effective method for evaluating fluid in mastoid cells.
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Affiliation(s)
- Kadir Şinasi Bulut
- Department of Otolaryngology, Head and Neck Surgery, Haymana State Hospital, Ankara, TUR
| | - Ahmet Kutluhan
- Department of Otolaryngology, Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, TUR
| | - Hüseyin Çetin
- Department of Radiology, Yildirim Beyazit University Faculty of Medicine, Ankara, TUR
| | - Fatih Gul
- Department of Otolaryngology, Head and Neck Surgery, Yildirim Beyazit University Faculty of Medicine, Ankara, TUR
| | - Mehmet Ali Babademez
- Department of Otolaryngology, Head and Neck Surgery, Yildirim Beyazit University Faculty of Medicine, Ankara, TUR
| | - Hayati Kale
- Department of Otorhinolaryngology, Private Otorhinolaryngology Clinic, Istanbul, TUR
| | - Mecit Sancak
- Department of Otolaryngology, Head and Neck Surgery, Lokman Hekim Hospital, Ankara, TUR
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Hicks KL, Robler SK, Platt A, Morton SN, Egger JR, Emmett SD. Environmental Factors for Hearing Loss and Middle Ear Disease in Alaska Native Children and Adolescents: A Cross-Sectional Analysis from a Cluster Randomized Trial. Ear Hear 2023; 44:2-9. [PMID: 35998103 PMCID: PMC9780156 DOI: 10.1097/aud.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Infection-related childhood hearing loss is one of the few preventable chronic health conditions that can affect a child's lifelong trajectory. This study sought to quantify relationships between infection-mediated hearing loss and middle ear disease and environmental factors, such as exposure to wood smoke, cigarette smoke, household crowding, and lack of access to plumbed (running) water, in a northwest region of rural Alaska. DESIGN This study is a cross-sectional analysis to estimate environmental factors of infection-related hearing loss in children aged 3 to 21 years. School hearing screenings were performed as part of two cluster randomized trials in rural Alaska over two academic years (2017-2018 and 2018-2019). The first available screening for each child was used for this analysis. Sociodemographic questionnaires were completed by parents/guardians upon entry into the study. Multivariable regression was performed to estimate prevalence differences and prevalence ratios (PR). A priori knowledge about the prevalence of middle ear disease and the difficulty inherent in obtaining objective hearing loss data in younger children led to analysis of children by age (3 to 6 years versus 7 years and older) and a separate multiple imputation sensitivity analysis for pure-tone average (PTA)-based infection-related hearing loss measures. RESULTS A total of 1634 children participated. Hearing loss was present in 11.1% of children sampled based on otoacoustic emission as the primary indicator of hearing loss and was not associated with exposure to cigarette smoke (PR = 1.07; 95% confidence interval [CI], 0.48 to 2.38), use of a wood-burning stove (PR = 0.85; 95% CI, 0.55 to 1.32), number of persons living in the household (PR = 1.06; 95% CI, 0.97 to 1.16), or lack of access to running water (PR = 1.38; 95% CI, 0.80 to 2.39). Using PTA as a secondary indicator of hearing loss also showed no association with environmental factors. Middle ear disease was present in 17.4% of children. There was a higher prevalence of middle ear disease in homes without running water versus those with access to running water (PR = 1.53; 95% CI, 1.03 to 2.27). There was little evidence to support any cumulative effects of environmental factors. Heterogeneity of effect models by age found sample prevalence of hearing loss higher for children aged 3 to 6 years (12.2%; 95% CI, 9.3 to 15.7) compared to children 7 years and older (10.6%; 95% CI, 8.9 to 2.6), as well as for sample prevalence of middle ear disease (22.7%; 95% CI, 18.9 to 26.9 and 15.3%; 95% CI, 13.3 to 17.5, respectively). CONCLUSIONS Lack of access to running water in the home was associated with increased prevalence of middle ear disease in this rural, Alaska Native population, particularly among younger children (aged 3 to 6 years). There was little evidence in this study that cigarette smoke, wood-burning stoves, and greater numbers of persons in the household were associated with infection-mediated hearing loss or middle ear disease. Future research with larger sample sizes and more sensitive measures of environmental exposure is necessary to further evaluate these relationships. Children who live in homes without access to running water may benefit from earlier and more frequent hearing health visits.
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Affiliation(s)
- Kelli L. Hicks
- University of North Carolina – Chapel Hill, Department of Otolaryngology/Head and Neck Surgery, Chapel Hill, NC
| | - Samantha Kleindienst Robler
- Department of Audiology, Norton Sound Health Corporation, Nome, AK
- Department of Otolaryngology, Head & Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Alyssa Platt
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
- Duke Global Health Institute, Durham, NC
| | - Sarah N. Morton
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
- Duke Global Health Institute, Durham, NC
| | | | - Susan D. Emmett
- Duke Global Health Institute, Durham, NC
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC
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Hicks KL, Robler SK, Simmons RA, Ross A, Egger JR, Emmett SD. Hearing-related quality of life in children and adolescents in rural Alaska. Laryngoscope Investig Otolaryngol 2022; 8:269-278. [PMID: 36846414 PMCID: PMC9948564 DOI: 10.1002/lio2.973] [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: 06/03/2022] [Revised: 09/19/2022] [Accepted: 10/29/2022] [Indexed: 12/04/2022] Open
Abstract
Objective This study evaluated the Hearing Environments and Reflection on Quality of Life (HEAR-QL) questionnaire in rural Alaska, including an addendum crafted through community feedback to reflect the local context. The objectives were to assess whether HEAR-QL score was inversely correlated with hearing loss and middle ear disease in an Alaska Native population. Methods The HEAR-QL questionnaires for children and adolescents were administered as part of a cluster randomized trial in rural Alaska from 2017 to 2019. Enrolled students completed an audiometric evaluation and HEAR-QL questionnaire on the same day. A cross-sectional evaluation of questionnaire data was utilized. Results A total of 733 children (ages 7-12 years) and 440 adolescents (ages ≥13 years) completed the questionnaire. Median HEAR-QL scores were similar among children with and without hearing loss (Kruskal-Wallis, p = .39); however, adolescent HEAR-QL scores significantly decreased with increasing hearing loss (p < .001). Median HEAR-QL scores were significantly lower in both children (p = .02) and adolescents (p < .001) with middle ear disease compared with those without. In both children and adolescents, the addendum scores were strongly correlated with total HEAR-QL score (ρSpearman = 0.72 and 0.69, respectively). Conclusions The expected negative association between hearing loss and HEAR-QL score was observed in adolescents. However, there was significant variability that could not be explained by hearing loss, and further investigation is warranted. The expected negative association was not observed in children. HEAR-QL scores were associated with middle ear disease in both children and adolescents, making it potentially valuable in populations where the prevalence of ear infections is high. Level of Evidence Level 2 Clinicaltrials.gov registration numbers: NCT03309553.
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Affiliation(s)
- Kelli L. Hicks
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Samantha Kleindienst Robler
- Department of AudiologyNorton Sound Health CorporationNomeAlaskaUSA,Department of Otolaryngology‐Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Ryan A. Simmons
- Department of Biostatistics & BioinformaticsDuke UniversityDurhamNorth CarolinaUSA,Duke Global Health InstituteDurhamNorth CarolinaUSA
| | - Alexandra Ross
- Department of Head and Neck Surgery and Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA,Center for Health Policy and Inequalities Research, Duke UniversityDurhamNorth CarolinaUSA
| | | | - Susan D. Emmett
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA,Duke Global Health InstituteDurhamNorth CarolinaUSA,Department of Head and Neck Surgery and Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA,Center for Health Policy and Inequalities Research, Duke UniversityDurhamNorth CarolinaUSA,Department of EpidemiologyFay W. Boozman College of Public Health, University of Arkansas for Medical SciencesLittle RockArkansasUSA
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Tavor O, Schnapp Z, Soffer GP, DeRowe A, Rimon A. The Outcome of Cerumen Removal in the Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e1369-e1371. [PMID: 35616537 DOI: 10.1097/pec.0000000000002756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cerumen obstructs the visualization of the tympanic membrane (TM) in up to 40% of children, sometimes posing a challenge to rule out the diagnosis of acute otitis media (AOM) as the source of otalgia (for verbal children), irritability, fever, and febrile seizures. We aim to determine the rate at which removing the cerumen from blocking the view of the TM could change the management of these patients in the pediatric emergency department (PED). METHODS We retrospectively investigated all medical records of patients who underwent cerumen removal in the PED at a tertiary children's hospital from 2018 to 2019. We analyzed the effect of the procedure on the subsequent workup during their PED visit. RESULTS Of 482 children who presented to the PED with otalgia, irritability, fever, and/or febrile seizures and who were referred to an otolaryngologist for subsequent treatment after preliminary evaluation in the PED, 176 were included in the study group after having the cerumen removed from one or both ears. Seventy-three of them were given a diagnosis of AOM, 93 had a normal-appearing TM, and 10 had external otitis. Twenty-one percent of those with AOM and 46% of those with a normal TM ( P = 0.008) had blood drawn as part of their workup in their PED visit. The rate of chest x-rays was also significantly less for the AOM group (16% vs 30%, P = 0.03), and they also underwent fewer urine tests ( P = NS). CONCLUSION Cerumen removal changes the management of children in the PED who present with a possible diagnosis of an ear infection. Cerumen removal could avoid unnecessary laboratory and imaging studies, which could save time, costs, and suffering.
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Affiliation(s)
| | | | | | - Ari DeRowe
- Pediatric Otolaryngology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fermo S, Frosolini A, Parrino D, Chiappetta A, Marioni G, de Filippis C. Eustachian tube insufflation with thermal water: Effectiveness in the treatment of pediatric otitis media with effusion. Am J Otolaryngol 2022; 43:103504. [PMID: 35605520 DOI: 10.1016/j.amjoto.2022.103504] [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: 02/14/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Otitis media with effusion (OME) is the most common ear disease in childhood. The hearing loss associated with OME impacts on children's language development and behavior. Eustachian tube insufflation are among possible treatments for OME, but data regarding their effectiveness are scarce. The aim of this investigation was to analyze the effect of inhalatory thermal therapy and Eustachian tube insufflation in a consecutive cohort of pediatric patients with OME. MATERIALS AND METHODS Seventy-four pediatric patients referred for OME to the thermal medical center "La Contea" (Battaglia Terme, Padova, Italy) were considered. Data from tympanometry and pure tone audiometry performed immediately before (T0), at the end of treatment (T1) and at a follow-up control (T2) were analyzed. RESULTS Data from 148 ears were available. The pressure values of tympanometry significantly improved from T0 to T1 (p = 0.0001), and further improvement was recorded at T2, when 60.8% of patients had normal tympanograms. A significant gain of the air-conduction threshold in the T0-T2 interval was observed (p = 0.0001). At otoscopy, a significant reduction of tympanic membranes with fluid or air-fluid levels presence (p < 0.00001) and a significant increase of normal tympanic membranes (p = 0.0001) were found. CONCLUSION Eustachian tube insufflation represented a well-tolerated and effective treatment in children with OME. Further investigations should deepen these results in randomized, double-blind settings, possibly with long-term follow-up periods. A quality-of-life and cost-effectiveness evaluation of this treatment approach for pediatric OME could be helpful for public health decision-making.
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Affiliation(s)
- Salvatore Fermo
- Department of Neuroscience, Audiology Unit, University of Padova, Treviso, Italy
| | - Andrea Frosolini
- Department of Neuroscience, Audiology Unit, University of Padova, Treviso, Italy
| | - Daniela Parrino
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Gino Marioni
- Department of Neuroscience, Section of Otolaryngology, University of Padova, Padova, Italy.
| | - Cosimo de Filippis
- Department of Neuroscience, Audiology Unit, University of Padova, Treviso, Italy
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Zeng J, Kang W, Chen S, Lin Y, Deng W, Wang Y, Chen G, Ma K, Zhao F, Zheng Y, Liang M, Zeng L, Ye W, Li P, Chen Y, Chen G, Gao J, Wu M, Su Y, Zheng Y, Cai Y. A Deep Learning Approach to Predict Conductive Hearing Loss in Patients With Otitis Media With Effusion Using Otoscopic Images. JAMA Otolaryngol Head Neck Surg 2022; 148:612-620. [PMID: 35588049 DOI: 10.1001/jamaoto.2022.0900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Otitis media with effusion (OME) is one of the most common causes of acquired conductive hearing loss (CHL). Persistent hearing loss is associated with poor childhood speech and language development and other adverse consequence. However, to obtain accurate and reliable hearing thresholds largely requires a high degree of cooperation from the patients. Objective To predict CHL from otoscopic images using deep learning (DL) techniques and a logistic regression model based on tympanic membrane features. Design, Setting, and Participants A retrospective diagnostic/prognostic study was conducted using 2790 otoscopic images obtained from multiple centers between January 2015 and November 2020. Participants were aged between 4 and 89 years. Of 1239 participants, there were 209 ears from children and adolescents (aged 4-18 years [16.87%]), 804 ears from adults (aged 18-60 years [64.89%]), and 226 ears from older people (aged >60 years, [18.24%]). Overall, 679 ears (54.8%) were from men. The 2790 otoscopic images were randomly assigned into a training set (2232 [80%]), and validation set (558 [20%]). The DL model was developed to predict an average air-bone gap greater than 10 dB. A logistic regression model was also developed based on otoscopic features. Main Outcomes and Measures The performance of the DL model in predicting CHL was measured using the area under the receiver operating curve (AUC), accuracy, and F1 score (a measure of the quality of a classifier, which is the harmonic mean of precision and recall; a higher F1 score means better performance). In addition, these evaluation parameters were compared to results obtained from the logistic regression model and predictions made by three otologists. Results The performance of the DL model in predicting CHL showed the AUC of 0.74, accuracy of 81%, and F1 score of 0.89. This was better than the results from the logistic regression model (ie, AUC of 0.60, accuracy of 76%, and F1 score of 0.82), and much improved on the performance of the 3 otologists; accuracy of 16%, 30%, 39%, and F1 scores of 0.09, 0.18, and 0.25, respectively. Furthermore, the DL model took 2.5 seconds to predict from 205 otoscopic images, whereas the 3 otologists spent 633 seconds, 645 seconds, and 692 seconds, respectively. Conclusions and Relevance The model in this diagnostic/prognostic study provided greater accuracy in prediction of CHL in ears with OME than those obtained from the logistic regression model and otologists. This indicates great potential for the use of artificial intelligence tools to facilitate CHL evaluation when CHL is unable to be measured.
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Affiliation(s)
- Junbo Zeng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weibiao Kang
- The second Hospital, Medical College, Shantou University, Shantou, Guangdong Province, China
| | - Suijun Chen
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Lin
- Jarvis Lab, Tencent, Shen Zhen city, Guangdong Province, China.,Hong Kong University of Science and Technology, Hong Kong, China
| | - Wenting Deng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yajing Wang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guisheng Chen
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kai Ma
- Jarvis Lab, Tencent, Shen Zhen city, Guangdong Province, China
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Wales, United Kingdom
| | - Yefeng Zheng
- Jarvis Lab, Tencent, Shen Zhen city, Guangdong Province, China
| | - Maojin Liang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Linqi Zeng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Weijie Ye
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Peng Li
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yubin Chen
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guoping Chen
- Department of Otolaryngology, Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong Province, China
| | - Jinliang Gao
- Department of Otolaryngology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong Province, China
| | - Minjian Wu
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuejia Su
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiqing Zheng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Shenzhen-Shanwei Central Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei City, Guangdong Province, China
| | - Yuexin Cai
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Shenzhen-Shanwei Central Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei City, Guangdong Province, China
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11
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Transmastoid Ultrasound Detection of Middle Ear Effusion and Its Association with Clinical Audiometric Tests. Life (Basel) 2022; 12:life12040599. [PMID: 35455090 PMCID: PMC9028690 DOI: 10.3390/life12040599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/23/2022] Open
Abstract
Medical history taking, otoscopy, tympanometry, and audiometry are clinical methods to diagnose middle ear effusion (MEE); however, these procedures are experience-dependent and result in misdiagnosis under unfavorable conditions of the external auditory canal in non-cooperative young children. This study aimed to explore the use of transmastoid ultrasound combined with the Nakagami parameter analysis to detect MEE in children aged 3−5 years and to compare the proposed method with clinical evaluation methods. A total of forty subjects were enrolled; for each subject, a single-element ultrasound transducer of 2.25 MHz was used to measure backscattered signals returned from the mastoid for estimating the Nakagami parameter, which is a measure of the echo amplitude distribution. Tympanogram and hearing loss were also measured for comparisons. The results showed that the Nakagami parameter in the patients with MEE was significantly larger than that of the normal group (p < 0.05). The area under the receiver operating characteristic curve (AUROC) for using the Nakagami parameter to detect MEE was 0.90, and the sensitivity, specificity, and accuracy were 82.5%, 97.5%, and 79.6%, respectively. The Nakagami parameter for tympanogram types B/C was higher than that for tympanogram type A (p < 0.05); it was also higher in the subjects with hearing loss (p < 0.05). Quantitative transmastoid ultrasound based on the Nakagami parameter analysis has the potential to detect MEE and evaluate hearing loss.
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12
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Binol H, Niazi MKK, Elmaraghy C, Moberly AC, Gurcan MN. OtoXNet—automated identification of eardrum diseases from otoscope videos: a deep learning study for video-representing images. Neural Comput Appl 2022. [DOI: 10.1007/s00521-022-07107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Calatayud-Sáez FM, Calatayud B, Calatayud A. Effects of the Traditional Mediterranean Diet in Patients with Otitis Media with Effusion. Nutrients 2021; 13:2181. [PMID: 34202888 PMCID: PMC8308248 DOI: 10.3390/nu13072181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Otitis media with effusion (OME) is common in pediatric primary care consultations. Its etiology is multifactorial, although it has been proven that inflammation factors mediate and that immunity is in a phase of relative immaturity. The objective of this study was to assess the effects of the Traditional Mediterranean Diet (TMD) modulating inflammation and immunity in patients diagnosed with OME. MATERIALS AND METHODS A analysis as a single-group pre-test/post-test was conducted on 40 girls and 40 boys between 18 months and 5 years old. Tympanometry normalization was the main test to control the benefit of diet. Clinical and therapeutic variables were studied through evaluation questionnaires, a quality test of the diet, as well as various anthropometric parameters. RESULTS At the end of one year, tympanometry had normalized in 85% of patients. The remaining 15% had normal audiometry and/or associated symptoms had decreased. Likewise, episodes of recurrent colds decreased from 5.96 ± 1.41 to 2.55 ± 0.37; bacterial complications of 3.09 ± 0.75 to 0.61 ± 0.06 and persistent nasal obstruction of 1.92 ± 0.27 to 0.26 ± 0.05. The degree of satisfaction of the families with the program was very high. CONCLUSIONS The application of the Traditional Mediterranean Diet could have promising effects in the prevention and treatment of otitis media with effusion.
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14
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Imöhl M, Perniciaro S, Busse A, van der Linden M. Bacterial Spectrum of Spontaneously Ruptured Otitis Media in a 7-Year, Longitudinal, Multicenter, Epidemiological Cross-Sectional Study in Germany. Front Med (Lausanne) 2021; 8:675225. [PMID: 34095179 PMCID: PMC8172772 DOI: 10.3389/fmed.2021.675225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
We analyzed middle ear fluid (MEF) and nasopharyngeal swabs (NPS) from spontaneously ruptured acute otitis media (AOM) cases occurring in children under 5 years in Germany. The aim of the study was the assessment of disease burden and bacterial etiology in the era of routine pneumococcal vaccination. Furthermore, we aimed to compare isolates from MEF with isolates from NPS and to analyze the Streptococcus pneumoniae serotype distribution. We analyzed MEF and NPS samples in children 2 months to 5 years for vaccination status, frequency of bacterial strains, serotype/emm-type distribution of S. pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes; and intraindividual correlation between MEF and NPS. From 2008 to 2014, MEF samples were collected from 2,138 subjects of which 2,001 (93.6%) also provided an NPS sample. In 851 of 2,138 MEF samples (39.8%), we identified organisms with confirmed pathogenic potential—S. pyogenes: 315 (14.7%), S. pneumoniae: 170 (8.0%), Staphylococcus aureus: 168 (7.9%), H. influenzae: 133 (6.2%), and Moraxella catarrhalis. Among NPS samples, 1,018 (50.9%) contained S. pneumoniae, 775 (38.7%) H. influenzae, 648 (32.4%) M. catarrhalis, and 344 (17.2%) S. pyogenes. Over the seven study years, the number of AOM patients steadily decreased, while the recruiting base remained constant. S. pneumoniae MEF isolates decreased by 86%, with serotype 3 being the most prevalent (25.7–42.9%). PCV13-non-PCV7-non-3 serotypes reduced to 0%. Among NPS, PCV7 serotypes decreased from 14.1 to 3.7%, PCV10: 17.6 to 3.7%, and PCV13: 55.3 to 25.7%. PCV13-non-PCV7-non-3 serotypes increased in the first 3 years of the study (17.1–22.9%), then decreased to 4.6% in year 7. Non-typeable H. influenzae reduced from 87.1 to 41.7% in MEF and from 91.4 to 54.2% in NPS. MEF and NPS isolates from the same subject were identical for 91.9% of S. pneumoniae, 99.0% of S. pyogenes, and 83.3% of H. influenzae. Among PCV7-vaccinated children, 5.6% had a PCV7 vaccine type in the MEF sample, and among PCV13-vaccinated children, 51.7% had a PCV13 serotype. Among non-vaccinated children, the percentages were 14.8 and 70.4. Pneumococcal conjugate vaccination has impacted the prevalence and etiology of spontaneously ruptured otitis media among children in Germany. Overall case numbers and pneumococcal vaccine type cases have strongly decreased.
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Affiliation(s)
- Matthias Imöhl
- National Reference Center for Streptococci, Department of Medical Microbiology, Aachen University Hospital, RWTH Aachen University, Aachen, Germany.,Laboratory Diagnostic Center, Aachen University Hospital, RWTH Aachen University, Aachen, Germany
| | - Stephanie Perniciaro
- National Reference Center for Streptococci, Department of Medical Microbiology, Aachen University Hospital, RWTH Aachen University, Aachen, Germany
| | | | - Mark van der Linden
- National Reference Center for Streptococci, Department of Medical Microbiology, Aachen University Hospital, RWTH Aachen University, Aachen, Germany
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15
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McCoy JL, Dixit R, Lin RJ, Belsky MA, Shaffer AD, Chi D, Jabbour N. Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement. THE ANNALS OF OTOLOGY, RHINOLOGY, AND LARYNGOLOGY 2021:34894211015741. [PMID: 33978498 DOI: 10.1177/00034894211015741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). METHODS A retrospective cohort study was performed at a tertiary children's hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. RESULTS A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance (P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). CONCLUSIONS Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jennifer L McCoy
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, USA
| | - Ronak Dixit
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Jun Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael A Belsky
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, USA
| | - David Chi
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, USA.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Noel Jabbour
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, USA.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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16
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Elbeltagy R, Abdelhafeez M. Outcome of Gastroesophageal Reflux Therapy in Children with Persistent Otitis Media with Effusion. Int Arch Otorhinolaryngol 2021; 26:e058-e062. [PMID: 35096159 PMCID: PMC8789499 DOI: 10.1055/s-0040-1718958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/23/2020] [Indexed: 10/27/2022] Open
Abstract
Abstract
Introduction Otitis media with effusion (OME) is considered one of the most common disorders that affect children during the first years of life. There are many risk factors of persistent middle ear effusion; one of these risk factors is gastroesophageal reflux. Association between persistent OME and gastroesophageal reflux diseases (GERDs) could be explained by respiratory tract infections, insufficient ciliary clearance, and poor drainage of the Eustachian tube.
Objective To investigate whether the control of gastroesophageal reflux plays a role in the management of persistent OME and decreases tympanostomy tube insertion
Method A cross-sectional study was conducted on 50 children complaining of persistent OME. Their ages ranged between 5 and 12 years old. All children were subjected to full history taking, audiological assessment and 24-hour esophageal pH monitoring. The study group was divided according to pH results into two groups: GERD positives and GERD negatives.
Result The prevalence of GERD in persistent OME was 58%. There were statistically significant differences in the hearing levels and middle ear condition before and after the treatment (p < 0.05). The percentage of improvement of children complaining of persistent OME after antireflux treatment was 52%.
Conclusion Gastroesophageal reflux disease should be considered in patients with persistent OME. The administration of proton pump inhibitor (PPI) can set aside superfluous surgical treatment (such as tympanostomy).
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Affiliation(s)
- Reem Elbeltagy
- Department of Otorhinolaryngology, Audio-Vestibular Medicine, Faculty of Medicine, Zagazig University, El Sharkia, Egypt
| | - Marwa Abdelhafeez
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Minia, Egypt
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17
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Wassef DW, Dhaduk N, Roy SC, Barinsky GL, Kalyoussef E. Helping Children with Special Needs: Who Receives Tympanostomy Tubes? Ann Otol Rhinol Laryngol 2021; 130:954-960. [PMID: 33455429 DOI: 10.1177/0003489420987425] [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: 11/17/2022]
Abstract
OBJECTIVES Tympanostomy tubes can prevent sequelae of otitis media that adversely affect long term hearing and language development in children. These negative outcomes compound the existing difficulties faced by children who are already diagnosed with developmental disorders. This study aims to characterize this subset of children with developmental disorders undergoing myringotomy and tympanostomy tube insertion. METHODS A retrospective review using the Kids' Inpatient Database (KID) was conducted, with codes from International Classification of Diseases, Ninth Revision used to query data from the years 2003 to 2012 to determine a study group of children with a diagnosis of a developmental disorder undergoing myringotomy and tympanostomy insertion. This group was compared statistically to patients undergoing these procedures who did not have a diagnosed developmental disorder. RESULTS In total, 21 945 cases of patients with myringotomy with or without tympanostomy tube insertion were identified, of which 1200 (5.5%) had a diagnosis of a developmental disorder. Children with developmental disorders had a higher mean age (3.3 years vs 2.9 years, P = .002) and higher mean hospital charges ($43 704.77 vs $32 764.22, P = .003). This cohort also had higher proportions of black (17.6% vs 12.3%, P < .001) and Hispanic (23.9% vs 20.6%, P = .014) patients, and had lower rates of private insurance coverage (39.6% vs 49%, P < .001). CONCLUSION The population of children with developmental disorders undergoing myringotomy or tympanostomy tube placement has a different demographic composition than the general population and faces distinct financial and insurance coverage burdens. Further study should be done to assess if these differences impact long term outcomes.
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Affiliation(s)
- David W Wassef
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nehal Dhaduk
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Savannah C Roy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Evelyne Kalyoussef
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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18
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Stephens JH, O’Keefe M, Schembri M, Baghurst PA. Parents Need More Support: A Qualitative Study of the Experiences of Australian Parents Who Are Waiting for Surgical Intervention for Their Children With Otitis Media. J Patient Exp 2020; 7:717-725. [PMID: 33294607 PMCID: PMC7705822 DOI: 10.1177/2374373519883495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the experiences, expectations, and motivations of parents/caregivers of children with otitis media who were booked to undergo tympanostomy tube insertion. METHOD A cross-sectional cohort study was conducted using semistructured interviews with 39 parents. Interviews were conducted via telephone and analyzed for key themes. RESULTS Three themes emerged that incorporated a range of subthemes: (1) the impact of the child's underlying condition on the family, (2) the cues and prompts that influenced parents to seek intervention, and (3) the parents' expectations of the health-care system. The child's otitis media disrupted the day-to-day functioning of the family and the child's well-being, but despite this, the families found ways to adapt and cope. Parents were influenced by their friends, family, and medical practitioners when making treatment decisions and had differing expectations of the health-care system. CONCLUSION Parents need support during their child's illness to help with pressures placed on the family and also in making health-care decisions for their child. Clinicians should consider these issues when discussing treatment options with parents.
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Affiliation(s)
- Jacqueline H Stephens
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maree O’Keefe
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Schembri
- Ear, Nose and Throat Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Peter A Baghurst
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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19
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Noel J, Suzukawa K, Chavez E, Pak K, Wasserman SI, Kurabi A, Ryan AF. A kinase inhibitor screen identifies signaling pathways regulating mucosal growth during otitis media. PLoS One 2020; 15:e0235634. [PMID: 32760078 PMCID: PMC7410257 DOI: 10.1371/journal.pone.0235634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022] Open
Abstract
Otitis media, the most common disease of childhood, is characterized by extensive changes in the morphology of the middle ear cavity. This includes hyperplasia of the mucosa that lines the tympanic cavity, from a simple monolayer of squamous epithelium into a greatly thickened, respiratory-type mucosa. The processes that control this response, which is critical to otitis media pathogenesis and recovery, are incompletely understood. Given the central role of protein phosphorylation in most intracellular processes, including cell proliferation and differentiation, we screened a library of kinase inhibitors targeting members of all the major families in the kinome for their ability to influence the growth of middle ear mucosal explants in vitro. Of the 160 inhibitors, 30 were found to inhibit mucosal growth, while two inhibitors enhanced tissue proliferation. The results suggest that the regulation of infection-mediated tissue growth in the ME mucosa involves multiple cellular processes that span the kinome. While some of the pathways and processes identified have been previously implicated in mucosa hyperplasia others are novel. The results were used to generate a global model of growth regulation by kinase pathways. The potential for therapeutic applications of the results are discussed.
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Affiliation(s)
- Julia Noel
- Department of Surgery/Otolaryngology, UC San Diego, San Diego, CA, United States of America
| | - Keigo Suzukawa
- Department of Surgery/Otolaryngology, UC San Diego, San Diego, CA, United States of America
| | - Eduardo Chavez
- Department of Surgery/Otolaryngology, UC San Diego, San Diego, CA, United States of America
| | - Kwang Pak
- Department of Surgery/Otolaryngology, UC San Diego, San Diego, CA, United States of America
| | | | - Arwa Kurabi
- Department of Surgery/Otolaryngology, UC San Diego, San Diego, CA, United States of America
| | - Allen F. Ryan
- Department of Surgery/Otolaryngology, UC San Diego, San Diego, CA, United States of America
- San Diego VA Healthcare System, San Diego, CA, United States of America
- * E-mail:
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20
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Herzog C, Homøe P, Koch A, Niclasen J, Dammeyer J, Lous J, Kørvel-Hanquist A. Effects of early childhood otitis media and ventilation tubes on psychosocial wellbeing - A prospective cohort study within the Danish National Birth Cohort. Int J Pediatr Otorhinolaryngol 2020; 133:109961. [PMID: 32169775 DOI: 10.1016/j.ijporl.2020.109961] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Otitis Media (OM) is one of the most common infections among children in developed countries and may result in temporary conductive hearing loss (HL) if accompanied by middle ear effusion (MEE). Ventilation tube insertion (VTI) is recommended as treatment for recurrent acute OM or chronic MEE with HL. HL may lead to impaired development of psychosocial skills. However, evidence for the developmental consequences of OM and the effect of VTI is inconsistent. The objectives of this study were to investigate 1) whether OM in early childhood is associated with long-term consequences of psychosocial development and 2) if VTI prevents the possible negative consequences of OM. METHODS This study examined prospectively collected data from 52.877 children registered in the Danish National Birth Cohort (DNBC). Information about previous OM-episodes and VTI was obtained through systematic follow-up interviews at seven years, and The Strength and Difficulties Questionnaire (SDQ) containing questions about psychological wellbeing was completed. Five groups were defined based on OM-exposure and the presence of VTI. Baseline characteristics were analysed, and comparison of mean SDQ-scores for the five exposure groups was conducted. Means were adjusted for à priori defined confounding factors. RESULTS Data from 52,877 children in the DNBC showed an association between OM and poorer SDQ-scores. VTI was associated with an additional increase, i.e. worsening, of the SDQ-score for boys, and only a slight beneficial effect on the girls' outcome. The groups differed in their baseline characteristics in e.g. maternal education, socio-economic status, breastfeeding, and prematurity. CONCLUSION Significant associations between parent-reported OM in early childhood and later psychosocial health difficulties were found. VTI did not resolve this association.
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Affiliation(s)
- C Herzog
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - A Koch
- Center for Infectious Disease Epidemiology, Statens Serum Institute, Copenhagen, Denmark
| | - J Niclasen
- Steno Diabetes Center, Copenhagen, Denmark
| | - J Dammeyer
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - J Lous
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Kørvel-Hanquist
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
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21
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Giese APJ, Ali S, Isaiah A, Aziz I, Riazuddin S, Ahmed ZM. Genomics of Otitis Media (OM): Molecular Genetics Approaches to Characterize Disease Pathophysiology. Front Genet 2020; 11:313. [PMID: 32391049 PMCID: PMC7191070 DOI: 10.3389/fgene.2020.00313] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/16/2020] [Indexed: 12/21/2022] Open
Abstract
Otitis media (OM) is an infective and inflammatory disorder known to be a major cause of hearing impairment across all age groups. Both acute and chronic OM result in substantial healthcare utilization related to antibiotic prescription and surgical procedures necessary for its management. Although several studies provided evidence of genetics playing a significant role in the susceptibility to OM, we had limited knowledge about the genes associated with OM until recently. Here we have summarized the known genetic factors that confer susceptibility to various forms of OM in mice and in humans and their genetic load, along with associated cellular signaling pathways. Spotlighted in this review are fucosyltransferase (FUT) enzymes, which have been implicated in the pathogenesis of OM. A comprehensive understanding of the functions of OM-associated genes may provide potential opportunities for its diagnosis and treatment.
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Affiliation(s)
- Arnaud P J Giese
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Saadat Ali
- The Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ishrat Aziz
- Department of Biotechnology, Virtual University of Pakistan, Lahore, Pakistan
| | - Saima Riazuddin
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Zubair M Ahmed
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
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22
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Clay-Williams R, Stephens JH, Williams H, Hallahan A, Dalton C, Hibbert P, Ting HP, Arnolda G, Wiles L, Braithwaite J. Assessing the appropriateness of the management of otitis media in Australia: A population-based sample survey. J Paediatr Child Health 2020; 56:215-223. [PMID: 31317635 DOI: 10.1111/jpc.14560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 02/05/2023]
Abstract
AIM Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. METHODS We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health-care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children. RESULTS We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health-care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. CONCLUSIONS Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME.
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Affiliation(s)
- Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jacqueline H Stephens
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Helena Williams
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Andrew Hallahan
- Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | | | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Hsuen P Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise Wiles
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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23
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Vijayakumar A, Pugazhenthan T, Sathish Babu M, Sajitha V. Ophthalmology and Otorhinolaryngology. TOXICOLOGICAL ASPECTS OF MEDICAL DEVICE IMPLANTS 2020:33-66. [DOI: 10.1016/b978-0-12-820728-4.00003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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24
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Aural Fullness, Hearing Loss, and Tinnitus. Surgery 2020. [DOI: 10.1007/978-3-030-05387-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Lee HH, Chin A, Pak K, Wasserman SI, Kurabi A, Ryan AF. Role of the PI3K/AKT pathway and PTEN in otitis media. Exp Cell Res 2019; 387:111758. [PMID: 31837294 DOI: 10.1016/j.yexcr.2019.111758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
Mucosal hyperplasia is common sequela of otitis media (OM), leading to the secretion of mucus and the recruitment of leukocytes. However, the pathogenic mechanisms underlying hyperplasia are not well defined. Here, we investigated the role of the AKT pathway in the development of middle mucosal hyperplasia using in vitro mucosal explants cultures and an in vivo rat model. The Akt inhibitor MK2206 treatment inhibited the growth of middle ear mucosal explants in a dose-dependent manner. In vivo, MK2206 also reduced mucosal hyperplasia. Unexpectedly, while PTEN is generally thought to act in opposition to AKT, the PTEN inhibitor BPV reduced mucosal explant growth in vitro. The results indicate that both AKT and PTEN are mediators of mucosal growth during OM, and could be potential therapeutic targets.
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Affiliation(s)
- Hwan Ho Lee
- Division of Otolaryngology, Department of Surgery, University of California, San Diego and San Diego VA Healthcare System, La Jolla, CA, 92093, USA
| | - Anthony Chin
- Division of Otolaryngology, Department of Surgery, University of California, San Diego and San Diego VA Healthcare System, La Jolla, CA, 92093, USA
| | - Kwang Pak
- Division of Otolaryngology, Department of Surgery, University of California, San Diego and San Diego VA Healthcare System, La Jolla, CA, 92093, USA
| | - Stephen I Wasserman
- Division of Otolaryngology, Department of Surgery, University of California, San Diego and San Diego VA Healthcare System, La Jolla, CA, 92093, USA
| | - Arwa Kurabi
- Division of Otolaryngology, Department of Surgery, University of California, San Diego and San Diego VA Healthcare System, La Jolla, CA, 92093, USA
| | - Allen F Ryan
- Division of Otolaryngology, Department of Surgery, University of California, San Diego and San Diego VA Healthcare System, La Jolla, CA, 92093, USA.
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26
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Genetically Diversity of Pseudomonas aeruginosa Isolated from Chronic Suppurative Otitis Media with Respect to Their Antibiotic Sensitivity Pattern. Indian J Otolaryngol Head Neck Surg 2019; 71:1300-1308. [PMID: 31750169 DOI: 10.1007/s12070-018-1358-8] [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: 02/13/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022] Open
Abstract
Pseudomonas aeruginosa is an important chronic suppurative otitis media (CSOM) pathogen that exhibits multiple resistances to antibiotics with increasing frequency, making patient treatment more difficult. The aim of the study is to ascertain the genetically diversity of this clinically isolated P. aeruginosa with inter simple sequence repeat (ISSR) markers. All 25 P. aeruginosa were isolated from CSOM patients by taking their ear swabs and culturing on blood agar and MacConkey agar. All strains were identified with morphological characters and biochemical testing. The antimicrobial susceptibility testing was carried out according to National Committee for Clinical Laboratory Standards. ISSR was used to study the genetic diversity of P. aeruginosa. Clinically CSOM isolated 25 P. aeruginosa were 88% Ciprofloxacin resistant and similarly resistant to other antibiotics were documented. The study has been made using ISSR marker to find out the genomic relation among the strains/populations of P. aeruginosa. The result was shown that maximum similarity (80%) was between S-11 and S-13 and minimum (28.2%) was between S-4 and S-16 with an average similarity of 53.2%. The dendogram showed a distinct separation in between all the strains/populations of P. aeruginosa. The strains/populations were broken up into two main clusters in which small one bear two strains/populations (S-4 and S-9) and another cluster have another 23 strains/populations. These 23 strains were also separated to form subcluster by having different range of small clades. The genetically diversity of pathogenic P. aeruginosa present in CSOM at our hospital indicates the coexistence different strains due to different antibiotic sensitivity patterns. The conventional culture and sensitivity methods are time consuming whereas in PCR, it will detect within 4-6 h for effective antibiotic. Basing upon the banding pattern with ISSR primers, clinicians can prescribe the effective antibiotics accordingly for CSOM patients in the same day.
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27
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Harrison A, Hardison RL, Wallace RM, Fitch J, Heimlich DR, Bryan MO, Dubois L, John-Williams LS, Sebra RP, White P, Moseley MA, Thompson JW, Justice SS, Mason KM. Reprioritization of biofilm metabolism is associated with nutrient adaptation and long-term survival of Haemophilus influenzae. NPJ Biofilms Microbiomes 2019; 5:33. [PMID: 31700653 PMCID: PMC6831627 DOI: 10.1038/s41522-019-0105-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/03/2019] [Indexed: 01/14/2023] Open
Abstract
Nontypeable Haemophilus influenzae (NTHI) is a human-restricted pathogen with an essential requirement for heme-iron acquisition. We previously demonstrated that microevolution of NTHI promotes stationary phase survival in response to transient heme-iron restriction. In this study, we examine the metabolic contributions to biofilm formation using this evolved NTHI strain, RM33. Quantitative analyses identified 29 proteins, 55 transcripts, and 31 metabolites that significantly changed within in vitro biofilms formed by RM33. The synthesis of all enzymes within the tryptophan and glycogen pathways was significantly increased in biofilms formed by RM33 compared with the parental strain. In addition, increases were observed in metabolite transport, adhesin production, and DNA metabolism. Furthermore, we observed pyruvate as a pivotal point in the metabolic pathways associated with changes in cAMP phosphodiesterase activity during biofilm formation. Taken together, changes in central metabolism combined with increased stores of nutrients may serve to counterbalance nutrient sequestration.
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Affiliation(s)
- Alistair Harrison
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Rachael L. Hardison
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Rachel M. Wallace
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - James Fitch
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Steve and Cindy Rasmussen Institute for Genomic Medicine, 575 Children’s Crossroad, Columbus, OH 43215 USA
| | - Derek R. Heimlich
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Meghan O’ Bryan
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Laura Dubois
- Duke Proteomics and Metabolomics Core Facility, Duke Center for Genomic and Computational Biology, Duke University, 701 West Main Street, Durham, NC 27701 USA
| | - Lisa St. John-Williams
- Duke Proteomics and Metabolomics Core Facility, Duke Center for Genomic and Computational Biology, Duke University, 701 West Main Street, Durham, NC 27701 USA
| | - Robert P. Sebra
- Icahn School of Medicine at Mount Sinai, Icahn Institute and Department of Genetics & Genomic Sciences, 1 Gustave L. Levy Place, New York, NY 10029 USA
| | - Peter White
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Steve and Cindy Rasmussen Institute for Genomic Medicine, 575 Children’s Crossroad, Columbus, OH 43215 USA
| | - M. Arthur Moseley
- Duke Proteomics and Metabolomics Core Facility, Duke Center for Genomic and Computational Biology, Duke University, 701 West Main Street, Durham, NC 27701 USA
| | - J. Will Thompson
- Duke Proteomics and Metabolomics Core Facility, Duke Center for Genomic and Computational Biology, Duke University, 701 West Main Street, Durham, NC 27701 USA
| | - Sheryl S. Justice
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
- Infectious Diseases Institute, The Ohio State University College of Medicine, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Kevin M. Mason
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis, 700 Children’s Drive, Columbus, OH 43205 USA
- Infectious Diseases Institute, The Ohio State University College of Medicine, 700 Children’s Drive, Columbus, OH 43205 USA
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28
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Saraca LM, Di Giuli C, Sicari F, Priante G, Lavagna F, Francisci D. Use of Ceftolozane-Tazobactam in Patient with Severe Medium Chronic Purulent Otitis by XDR Pseudomonas aeruginosa. Case Rep Infect Dis 2019; 2019:2683701. [PMID: 31687233 PMCID: PMC6803738 DOI: 10.1155/2019/2683701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 02/01/2023] Open
Abstract
We present a case of a male Italian patient of 66 years with a history of kidney transplantation in treatment with cyclosporine and methylprednisolone. He visited an ENT clinic and was diagnosed as chronic left purulent otitis media. He began at-home antibiotic therapy with poor benefit. On 09/13/18, he was admitted to the hospital "S. Maria "of Terni for persistence of left ear pain and complete hearing loss. Magnetic resonance imaging (MRI) of the brain showed "in correspondence of the petrous rock and the mastoid…presence of flogistic tissue." Auricular swabs and later surgical drainage of the purulent material were performed and both were positive for extensively drug-resistant (XDR) Pseudomonas aeruginosa sensitive only to colistin in absence of synergism with rifampin. The patient underwent antibiotic therapy with ceftolozane-tazobactam, a new generation cephalosporin with anti-Pseudomonas activity and a β-lactamase inhibitor, that currently is indicated for the treatment of complicated urinary tract infections and complicated intra-abdominal infections, with complete healing. In literature, it is described a series of 12 patients with severe MDR (multidrug-resistant) Pseudomonas aeruginosa infections (6 pneumonia) who received salvage therapy with ceftolozane-tazobactam after inappropriate empirical and/or suboptimal treatment. This study included a case of a male patient of 45 years, affected by Burkitt lymphoma and severe neutropenia, who presented with otitis and mastoiditis, and isolation of Pseudomonas aeruginosa in surgical drainage of the purulent material of the ear (blood cultures were negative). He underwent antibiotic therapy with ceftolozane-tazobactam at a dosage of 3 g/8 h for 21.3 days. The patient was healed, but a late recurrence was described because of isolation of ceftolozane-tazobactam-resistant Pseudomonas after therapy. The possibility of acquiring resistance to ceftolozane-tazobactam should be considered in patients with previous exposure to beta-lactams and with poor response to these antibiotics.
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Affiliation(s)
- L. M. Saraca
- Clinica di Malattie Infettive, Università degli Studi di Perugia, A. O. “S. Maria”, Terni, Italy
| | - C. Di Giuli
- Clinica di Malattie Infettive, A. O. “S. Maria”, Terni, Italy
| | - F. Sicari
- Clinica di Malattie Infettive, Università degli Studi di Perugia, A. O. “S. Maria”, Terni, Italy
| | - G. Priante
- Clinica di Malattie Infettive, Università degli Studi di Perugia, A. O. “S. Maria”, Terni, Italy
| | - F. Lavagna
- Struttura Complessa di Radiologia, A. O. “S. Maria”, Terni, Italy
| | - D. Francisci
- Clinica di Malattie Infettive, Università degli Studi di Perugia, A. O. “S. Maria”, Terni, Italy
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29
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Thom RP, Keary CJ, Palumbo ML, Ravichandran CT, Mullett JE, Hazen EP, Neumeyer AM, McDougle CJ. Beyond the brain: A multi-system inflammatory subtype of autism spectrum disorder. Psychopharmacology (Berl) 2019; 236:3045-3061. [PMID: 31139876 DOI: 10.1007/s00213-019-05280-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022]
Abstract
An immune-mediated subtype of autism spectrum disorder (ASD) has long been hypothesized. This article reviews evidence from family history studies of autoimmunity, immunogenetics, maternal immune activation, neuroinflammation, and systemic inflammation, which suggests immune dysfunction in ASD. Individuals with ASD have higher rates of co-morbid medical illness than the general population. Major medical co-morbidities associated with ASD are discussed by body system. Mechanisms by which FDA-approved and emerging treatments for ASD act upon the immune system are then reviewed. We conclude by proposing the hypothesis of an immune-mediated subtype of ASD which is characterized by systemic, multi-organ inflammation or immune dysregulation with shared mechanisms that drive both the behavioral and physical illnesses associated with ASD. Although gaps in evidence supporting this hypothesis remain, benefits of this conceptualization include framing future research questions that will help define a clinically meaningful subset of patients and focusing clinical interactions on early detection and treatment of high-risk medical illnesses as well as interfering behavioral signs and symptoms across the lifespan.
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Affiliation(s)
- Robyn P Thom
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Christopher J Keary
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Michelle L Palumbo
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Caitlin T Ravichandran
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jennifer E Mullett
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Eric P Hazen
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Ann M Neumeyer
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Department of Neurology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Christopher J McDougle
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. .,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. .,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.
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30
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Silva MD, Sillankorva S. Otitis media pathogens – A life entrapped in biofilm communities. Crit Rev Microbiol 2019; 45:595-612. [DOI: 10.1080/1040841x.2019.1660616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Maria Daniela Silva
- CEB – Centre of Biological Engineering, LIBRO – Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Braga, Portugal
| | - Sanna Sillankorva
- CEB – Centre of Biological Engineering, LIBRO – Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Braga, Portugal
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31
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Hussain A, Bangash WU, Khan MI, Ali MA, Khan A, Ibrahim M. FREQUENCY OF OTITIS MEDIA WITH EFFUSION IN CLEFT PALATE CHILDREN. GOMAL JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.46903/gjms/17.02.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Children with cleft palate oftenly present with otitis media with effusion. The objective of this study was to determine the frequency of otitis media with effusion among cleft palate children. Material & Methods: This cross-sectional study was carried out in the Department of ENT, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from June 2017 to December 2018. Ninety patients were selected through consecutive sampling technique. All children 3-10 years of age with cleft palate were included. Patients with combined cleft palate and cleft lip were excluded. All patients underwent otoscopy and tympanometry. Type B tympanogram was considered as evidence of fluid in the middle ear. Later on patients with only Type B tympanogram underwent myringotomies. Results: Out of 90 (180 ears) patients 61 (67.78%) were males and 29 (32.22%) females. Mean age of the sample was 6.15±2.226 years (3-10, range 7 years). On otoscopic examination, 107/180 (59.45%) ears were suspected to have fluid in the middle ear. Type B tympanogram was detected in 125/180 (69.45%) ears. Only 38/90 (42.20%) patients (76/180 ears), underwent pure tone audiometry. Based on otoscopic, tympanometric and audiometric findings, myringotomies were performed in 125/180 (69.45%) ears. At myringotomy fluid was present in middle ear space of 98/180 (78.4%) ears. Out of total 180 ears the true frequency of otitis media with effusion was 98/180 (54.45%). Conclusions: The frequency of otitis media with effusion in patients with cleft palate is high. Tympanometry is fairly sensitive in diagnosing this condition in these patients.
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32
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Bongiovanni A, Parisi GF, Scuderi MG, Licari A, Brambilla I, Marseglia GL, Leonardi S. Gastroesophageal reflux and respiratory diseases: does a real link exist? Minerva Pediatr 2019; 71:515-523. [PMID: 31129955 DOI: 10.23736/s0026-4946.19.05531-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gastro-esophageal reflux disease (GERD) indicates a gastroesophageal reflux that causes symptoms such as pain, and needs medical therapy, and may result in complications such as erosive esophagitis, aspiration pneumonia. Here, we review if it exists a real link between clinical presentation of some respiratory diseases such as asthma, chronic cough, cystic fibrosis and laryngopharyngitis and GERD. EVIDENCE ACQUISITION This review was conducted employing 2 databases: PubMed and Science Direct. EVIDENCE SYNTHESIS Asthma may lead to reflux, and reflux could exacerbate asthma or cause asthma-like symptoms. Prevalence of GERD in children with asthma ranged from as low 32% to as high 80%. There are several studies where the use of proton pump inhibitors (PPIs) and histamine H2 receptor antagonists lead to inconclusive results. The relation of chronic unexplained cough to GERD remains controversial in children and pediatric guidelines do not currently recommend empirical GERD treatment trials for pediatric chronic cough. Gastroesophageal reflux is more frequent in patients with cystic fibrosis (CF) than general population. Although PPIs are regularly prescribed in approximately half of the patients with CF, there are no specific guidelines for treatment of reflux in CF and it was shown that chronic treatment with PPIs was correlated to possible increased risk of exacerbations. CONCLUSIONS The pathogenesis of GER-related respiratory symptoms is multifactorial. The causal relationship between these two conditions may be difficult to prove also with the aid of supporting tests. Multichannel intraluminal impedance associated with pH-metry (pH/MII) detect all gastroesophageal reflux episodes accompanied with a bolus movement and classify GER episodes according to their content (liquid, gas and mixed), pH value and proximal extension. There are no consistent evidences confirming the validity of medical therapy in reflux with respiratory symptoms.
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Affiliation(s)
- Annarita Bongiovanni
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe F Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
| | - Maria G Scuderi
- Department of Medical, Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Amelia Licari
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Ilaria Brambilla
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Gian L Marseglia
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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33
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Torretta S, Drago L, Marchisio P, Ibba T, Pignataro L. Role of Biofilms in Children with Chronic Adenoiditis and Middle Ear Disease. J Clin Med 2019; 8:jcm8050671. [PMID: 31086039 PMCID: PMC6571864 DOI: 10.3390/jcm8050671] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/26/2019] [Accepted: 05/10/2019] [Indexed: 01/31/2023] Open
Abstract
Chronic adenoiditis occurs frequently in children, and it is complicated by the subsequent development of recurrent or chronic middle ear diseases, such as recurrent acute otitis media, persistent otitis media with effusion and chronic otitis media, which may predispose a child to long-term functional sequalae and auditory impairment. Children with chronic adenoidal disease who fail to respond to traditional antibiotic therapy are usually candidates for surgery under general anaesthesia. It has been suggested that the ineffectiveness of antibiotic therapy in children with chronic adenoiditis is partially related to nasopharyngeal bacterial biofilms, which play a role in the development of chronic nasopharyngeal inflammation due to chronic adenoiditis, which is possibly associated with chronic or recurrent middle ear disease. This paper reviews the current evidence concerning the involvement of bacterial biofilms in the development of chronic adenoiditis and related middle ear infections in children.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Policlinico of Milan, Via Francesco Sforza, 35, 20122 Milano, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
| | - Lorenzo Drago
- Clinical Chemistry and Microbiology Laboratory, IRCCS Galeazzi Institute and LITA Clinical Microbiology Laboratory, 20161 Milano, Italy.
- Department of Clinical Science, University of Milan, 20122 Milan, Italy.
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Policlinico of Milan, Via Francesco Sforza, 35, 20122 Milano, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
| | - Tullio Ibba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Policlinico of Milan, Via Francesco Sforza, 35, 20122 Milano, Italy.
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Policlinico of Milan, Via Francesco Sforza, 35, 20122 Milano, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
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34
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Francis NA, Waldron CA, Cannings-John R, Thomas-Jones E, Winfield T, Shepherd V, Harris D, Hood K, Fitzsimmons D, Roberts A, Powell CV, Gal M, Jones S, Butler CC. Oral steroids for hearing loss associated with otitis media with effusion in children aged 2-8 years: the OSTRICH RCT. Health Technol Assess 2019; 22:1-114. [PMID: 30407151 DOI: 10.3310/hta22610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Children with hearing loss associated with otitis media with effusion (OME) are commonly managed through surgical intervention, hearing aids or watchful waiting. A safe, inexpensive, effective medical treatment would enhance treatment options. Small, poorly conducted trials have found a short-term benefit from oral steroids. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of a 7-day course of oral steroids in improving hearing at 5 weeks in children with persistent OME symptoms and current bilateral OME and hearing loss demonstrated by audiometry. DESIGN Double-blind, individually randomised, placebo-controlled trial. SETTING Ear, nose and throat outpatient or paediatric audiology and audiovestibular medicine clinics in Wales and England. PARTICIPANTS Children aged 2-8 years, with symptoms of hearing loss attributable to OME for at least 3 months, a diagnosis of bilateral OME made on the day of recruitment and audiometry-confirmed hearing loss. INTERVENTIONS A 7-day course of oral soluble prednisolone, as a single daily dose of 20 mg for children aged 2-5 years or 30 mg for 6- to 8-year-olds, or matched placebo. MAIN OUTCOME MEASURES Acceptable hearing at 5 weeks from randomisation. Secondary outcomes comprised acceptable hearing at 6 and 12 months, tympanometry, otoscopic findings, health-care consultations related to OME and other resource use, proportion of children who had ventilation tube (grommet) surgery at 6 and 12 months, adverse effects, symptoms, functional health status, health-related quality of life, short- and longer-term cost-effectiveness. RESULTS A total of 389 children were randomised. Satisfactory hearing at 5 weeks was achieved by 39.9% and 32.8% in the oral steroid and placebo groups, respectively (absolute difference of 7.1%, 95% confidence interval -2.8% to 16.8%; number needed to treat = 14). This difference was not statistically significant. The secondary outcomes were consistent with the picture of a small or no benefit, and we found no subgroups that achieved a meaningful benefit from oral steroids. The economic analysis showed that treatment with oral steroids was more expensive and accrued fewer quality-adjusted life-years than treatment as usual. However, the differences were small and not statistically significant, and the sensitivity analyses demonstrated large variation in the results. CONCLUSIONS OME in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. Discussions about watchful waiting and other interventions will be enhanced by this evidence. The findings of this study suggest that any benefit from a short course of oral steroids for OME is likely to be small and of questionable clinical significance, and that the treatment is unlikely to be cost-effective and, therefore, their use cannot be recommended. FUTURE WORK Studies exploring optimal approaches to sharing natural history data and enhancing shared decision-making are needed for this condition. TRIAL REGISTRATION Current Controlled Trials ISRCTN49798431 and EudraCT 2012-005123-32. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 61. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nick A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Thomas Winfield
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Amanda Roberts
- Cardiff & Vale University Health Board, Child Health Directorate, St David's Children Centre, Cardiff, UK
| | - Colin Ve Powell
- Department of General Paediatrics, Children's Hospital for Wales, Cardiff, UK
| | - Micaela Gal
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Sarah Jones
- Involving People Network, Health and Care Research Wales, Cardiff, UK
| | - Christopher C Butler
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Novotny LA, Brockman KL, Mokrzan EM, Jurcisek JA, Bakaletz LO. Biofilm biology and vaccine strategies for otitis media due to nontypeable Haemophilus influenzae. J PEDIAT INF DIS-GER 2019; 14:69-77. [PMID: 30853830 PMCID: PMC6402341 DOI: 10.1055/s-0038-1660818] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Otitis media (OM) is one of the most common diseases of childhood, and nontypeable Haemophilus influenzae (NTHI) is the predominant causative agent of chronic and recurrent OM, as well as OM for which treatment has failed. Moreover, NTHI is now as important a causative agent of acute OM as the pneumococcus. NTHI colonizes the human nasopharynx asymptomatically. However, upon perturbation of the innate and physical defenses of the airway by upper respiratory tract viral infection, NTHI can replicate, ascend the Eustachian tube, gain access to the normally sterile middle ear space, and cause disease. Bacterial biofilms within the middle ear, including those formed by NTHI, contribute to the chronic and recurrent nature of this disease. These multicomponent structures are highly resistant to clearance by host defenses and elimination by traditional antimicrobial therapies. Herein, we review several strategies utilized by NTHI in order to persist within the human host and interventions currently under investigation to prevent and/or resolve NTHI-induced diseases of the middle ear and uppermost airway.
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Affiliation(s)
- Laura A Novotny
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kenneth L Brockman
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Elaine M Mokrzan
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph A Jurcisek
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lauren O Bakaletz
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
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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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Kapitanova M, Knebel JF, El Ezzi O, Artaz M, de Buys Roessingh AS, Richard C. Influence of infancy care strategy on hearing in children and adolescents: A longitudinal study of children with unilateral lip and /or cleft palate. Int J Pediatr Otorhinolaryngol 2018; 114:80-86. [PMID: 30262372 DOI: 10.1016/j.ijporl.2018.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/09/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the relation between ventilation tube insertion, otitis media with effusion duration and otologic outcomes in unilateral cleft lip and/or cleft palate children from infancy to teenage age. DESIGN AND POPULATION Retrospective longitudinal charts review of patients from the multidisciplinary cleft team of the University Hospital of Lausanne over a 30-year period. 146 charts from consecutive patients with non-syndromic unilateral cleft lip and/or cleft palate who were born between January 1986 and January 2003 were included. RESULTS The earlier in life a cleft child experience his first otitis media with effusion (OME), the worse his long-term hearing will be. Along with the age of onset of OME, we disclosed an influence of the duration of OME without ventilation tube (VT) insertion on short and long-term hearing outcomes. Different patterns were observed between cleft palate (CP) and cleft lip palate children (CLP), with a higher incidence of otitis media with effusion for the CLP group than the CP group. Direct positive relationship between VT insertion and hearing were disclosed and evaluation of long-term complications did not reveal significant relation with VT insertion. Of note, OME in CLP children led to a higher rate (but not statistically significant) of chronic ear complications than in the CP group, that may indicate more persistent OME or different adverse effect on the middle ear mucosa between CP and CLP children. CONCLUSIONS Individualized counseling should take into account different factors such as the type of cleft, the age of onset of OME and duration of OME, keeping in mind the adverse effect of persistent middle ear fluid. In the present report, results prone an early ventilation tube insertion to prevent short and long-term injury to the middle ear homeostasis, hearing loss and related issues.
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Affiliation(s)
- Maryna Kapitanova
- ENT, Head and Neck Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean-François Knebel
- Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences University Hospital Center and University of Lausanne, Lausanne, Switzerland; EEG Brain Mapping Core Centre for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Oumama El Ezzi
- Cleft Palate Multidisciplinary Team, University Hospital Center and University of Lausanne, Lausanne, Switzerland; Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Mélody Artaz
- ENT, Head and Neck Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Cleft Palate Multidisciplinary Team, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Anthony S de Buys Roessingh
- Cleft Palate Multidisciplinary Team, University Hospital Center and University of Lausanne, Lausanne, Switzerland; Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Céline Richard
- ENT, Head and Neck Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences University Hospital Center and University of Lausanne, Lausanne, Switzerland; Cleft Palate Multidisciplinary Team, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
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The Influence of Age on the Relationship Between Allergic Rhinitis and Otitis Media. Curr Allergy Asthma Rep 2018; 18:68. [PMID: 30343453 DOI: 10.1007/s11882-018-0826-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To examine the relationship between otitis media, allergic rhinitis, and age. RECENT FINDINGS Otitis media and allergic rhinitis are prevalent conditions with a controversial relationship. Some data suggest that these entities are significantly associated, either through allergic rhinitis inducing Eustachian tube dysfunction or through allergic pathophysiology simultaneously occurring intranasally and in the ear. Other studies, however, have refuted this relationship. For example, treatment with antihistamines does not reliably improve OME, making causation and association challenging to establish. Age may have an effect on the nature of the relationship between allergic rhinitis and otitis media, by impacting both the individual conditions and their association. Epidemiological, immunological, and adenoidal studies have suggested that differences occur with age, and this review encapsulates the related data and publications. We begin by evaluating how allergic rhinitis and otitis media each are affected by age, then evaluate the role that age may have in the relationship between the two conditions. Adult and pediatric literature are evaluated so as to include the full impact of age across patients' lifespan. Age induces changes in immunity, patterns of inflammation, and susceptibility to both allergic rhinitis and otitis media with effusion. Age may also be an effect modifier which impacts the nature of the relationship between these two conditions. The influence of age on the association between these highly prevalent conditions remains a topic of active study.
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Samelli AG, Rabelo CM, Sanches SGG, Martinho AC, Matas CG. Tablet-based tele-audiometry: Automated hearing screening for schoolchildren. J Telemed Telecare 2018; 26:140-149. [PMID: 30269641 DOI: 10.1177/1357633x18800856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction To assess the performance of a tablet-based tele-audiometry method for automated hearing screening of schoolchildren through a comparison of the results of various hearing screening approaches. Methods A total of 244 children were evaluated. Tablet-based screening results were compared with gold-standard pure-tone audiometry. Acoustic immittance measurements were also conducted. To pass the tablet-based screening, the children were required to respond to at least two out of three sounds for all the frequencies in each ear. Several hearing screening methods were analysed: exclusively tablet-based (with and without 500 Hz checked) and combined tests (series and parallel). The sensitivity, specificity, positive and negative predictive values and accuracy were calculated. Results A total of 9.43% of children presented with mild to moderate conductive hearing loss (unilateral or bilateral). Diagnostic values varied among the different hearing screening approaches that were evaluated: sensitivities ranged from 60 to 95%, specificities ranged from 44 to 91%, positive predictive values ranged from 15 to 44%, negative predictive values ranged from 95 to 99%, accuracy values ranged from 49 to 88%, and area under curve values ranged from 0.690 to 0.883. Regarding diagnostic values, the highest results were found for the tablet-based screening method and for the series approach. Discussion Compared with the results obtained by conventional audiometry and considering the diagnostic values of the different hearing screening approaches, the highest diagnostic values were generally obtained using the automated hearing screening method (including 500 Hz). Thus, this application, which was developed for the tablet computer, was shown to be a valuable hearing screening tool for use with schoolchildren. Therefore, we suggest that this hearing screening protocol has the potential to improve asynchronous tele-audiology service delivery.
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Affiliation(s)
| | | | | | - Ana C Martinho
- School of Medicine, University of São Paulo (FMUSP), Brazil
| | - Carla G Matas
- School of Medicine, University of São Paulo (FMUSP), Brazil
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Yazici A, Coskun ME. The effect of ventilation tube insertion to the health-related quality of life in a group of children in Southeast Anatolia. Clin Otolaryngol 2018; 43:1578-1582. [PMID: 30160377 DOI: 10.1111/coa.13220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/20/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To demonstrate the influence of ventilation tube insertion to the quality of life in a group of children in Southeast Anatolia by Otitis Media 6-item (OM6) questionnaire. DESIGN Patients who underwent ventilation tube insertion due to otitis media with effusion (OME) at Otorhinolaryngology Department of Gaziantep University between December 2016 and April 2017 were enrolled in this prospective study. All patients were evaluated with the OM-6 survey before operation and 6 weeks after surgery. RESULTS The mean age of 45 patients out of 50 accounted for 67.64 ± 42.89 months with 27 (60%) males and 18 (40%) females. The numbers of preoperative and postoperative overall OM6 scores represented a significant improvement with 4.34 and 2.16, respectively. Moreover, each domain of OM6 (physical suffering, hearing loss, speech impairment, emotional distress, activity limitations and caregiver concerns) showed statistically significant difference. CONCLUSION Ventilation tube insertion procedure provided a significant improvement in a group of children in Southeast Anatolia suffering from chronic OME in terms of Quality of Life (QOL) assessed by OM6. We believe that OM6 is a useful tool for evaluating the patients' health-related quality of life and for providing additional information to the caregivers' or families' enquiries regarding the consequences of surgical intervention.
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Affiliation(s)
- Alper Yazici
- Department of Otorhinolaryngology, University of Gaziantep, Gaziantep, Turkey
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Streamlining grommet pathways for otitis media with effusion and hearing loss in children: our experience. The Journal of Laryngology & Otology 2018; 132:881-884. [PMID: 30208983 DOI: 10.1017/s0022215118001603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Grommet insertion is a common surgical procedure in children. Long waiting times for grommet insertion are not unusual. This project aimed to streamline the process by introducing a pathway for audiologists to directly schedule children meeting National Institute for Health and Care Excellence Clinical Guideline 60 ('CG60') for grommet insertion.Method and resultsA period from June to November 2014 was retrospectively audited. Mean duration between the first audiology appointment and grommet insertion was 294.5 days (median = 310 days). Implementing the direct-listing pathway reduced the duration between first audiology appointment and grommet insertion (mean = 232 days; median = 231 days). There has been a reduction in the time between the first audiology appointment and surgery (mean difference of 62.5 days; p = 0.024), and a reduction in the time between second audiology appointment and surgery (28 days; p = 0.009). CONCLUSION Direct-listing pathways for grommet insertion can reduce waiting times and expedite surgery. Implementation involves a simple alteration of current practice, adhering to National Institute for Health and Care Excellence Clinical Guideline 60. The ultimate decision regarding surgery still rests with ENT specialists.
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Cullas Ilarslan NE, Gunay F, Topcu S, Ciftci E. Evaluation of clinical approaches and physician adherence to guidelines for otitis media with effusion. Int J Pediatr Otorhinolaryngol 2018; 112:97-103. [PMID: 30055748 DOI: 10.1016/j.ijporl.2018.06.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/09/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Otitis media with effusion (OME) is an important clinical entity because of its high prevalence, difficulties in diagnosis, complications and diversities in management. Herein, we aimed to evaluate current physician approaches on OME and determine clinical adherence to current guidelines. METHODS AND MATERIALS A total of 370 physicians [Group 1: pediatricians (n = 256, 69.2%), Group 2: otorhinolarynologists (n = 114, 30.8%)] completed a survey instrument addressing demographic data and clinical practice parameters on OME in children. We also compared clinical approaches of Group 1 and Group 2. In addition, multiple logistic regression analysis was performed to evaluate factors which may effect correct approaches. RESULTS The mean period of clinical experience was 9.30 ± 8.35 [median 6 (1-40)] years. A total of 311 (84%) respondents reported satisfactory level of self-confidence as regards of clinical approaches to OME. Reduced mobility of the tympanic membrane and preference of pneumatic otoscopy was signified by 107 (28.9%) and 64 (17.3%) respondents, respectively. Fifty-six (15.1%) physicians identified "watchful waiting" for 3 months for children who are not at risk while 314 (84.9%) reported preference of medications, with antibiotics the most preferred prescription (n = 223, 63%). Comparison of Group 1 and Group 2 indicated similar results except better, yet insufficient, characterization of physical examination findings of OME by Group 2 (p < 0.001, for each parameter). Group 2 preferred tympanometry more in uncertain cases (p < 0.001) and handled chronic cases better (p < 0.001). Multiple logistic regression analysis revealed lower signification of reduced mobility of the tympanic membrane for respondents who denoted depending on personal experience ([OR] = 3.077 [95% CI 1.042-9.09]) or following clinical guidelines ([OR] = 3.365 [95% CI 1.38-8.20]) rather than combining them both. Rate of antibiotic avoidance was lowest in physicians with a period of clinical experience<5 years ([OR] = 2.14 [95% CI 1.32-3.48]). CONCLUSIONS Despite notifying high self-confidence and adherence to current guidelines on OME, both pediatricians and otorhinolaryngologists lacked to exhibit proper approaches. Further research is warranted to evaluate the causes of poor adherence to current guidelines and bring suggestions for the maintenance of consistent and correct clinical approaches to OME.
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Affiliation(s)
- Nisa Eda Cullas Ilarslan
- Attending Physician, Department of Pediatrics, Ankara University School of Medicine, Cebeci Hospital, 06590 Ankara, Turkey.
| | - Fatih Gunay
- Attending Physician, Department of Pediatrics, Ankara University School of Medicine, Cebeci Hospital, 06590 Ankara, Turkey
| | - Seda Topcu
- Attending Physician, Department of Pediatrics, Ankara University School of Medicine, Cebeci Hospital, 06590 Ankara, Turkey
| | - Ergin Ciftci
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Ankara University School of Medicine, Cebeci Hospital, 06590 Ankara, Turkey
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Kurabi A, Schaerer D, Noack V, Bernhardt M, Pak K, Alexander T, Husseman J, Nguyen Q, Harris JP, Ryan AF. Active Transport of Peptides Across the Intact Human Tympanic Membrane. Sci Rep 2018; 8:11815. [PMID: 30087425 PMCID: PMC6081404 DOI: 10.1038/s41598-018-30031-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/02/2018] [Indexed: 12/17/2022] Open
Abstract
We previously identified peptides that are actively transported across the intact tympanic membrane (TM) of rats with infected middle ears. To assess the possibility that this transport would also occur across the human TM, we first developed and validated an assay to evaluate transport in vitro using fragments of the TM. Using this assay, we demonstrated the ability of phage bearing a TM-transiting peptide to cross freshly dissected TM fragments from infected rats or from uninfected rats, guinea pigs and rabbits. We then evaluated transport across fragments of the human TM that were discarded during otologic surgery. Human trans-TM transport was similar to that seen in the animal species. Finally, we found that free peptide, unconnected to phage, was transported across the TM at a rate comparable to that seen for peptide-bearing phage. These studies provide evidence supporting the concept of peptide-mediated drug delivery across the intact TM and into the middle ears of patients.
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Affiliation(s)
- Arwa Kurabi
- University of California, San Diego, Division of Otolaryngology, Department of Surgery, La Jolla, CA, 92093, USA.
- San Diego Veterans Affairs Healthcare System, Research Department, San Diego, CA, 92130, USA.
| | - Daniel Schaerer
- University of California, San Diego, Division of Otolaryngology, Department of Surgery, La Jolla, CA, 92093, USA
| | - Volker Noack
- Ruhr-Universitat Bochum, Department of ENT, Bochum, NRW, Germany
| | - Marlen Bernhardt
- Universitätsklinik Würzburg, Department of ENT, Würzburg, 97070, Germany
| | - Kwang Pak
- University of California, San Diego, Division of Otolaryngology, Department of Surgery, La Jolla, CA, 92093, USA
- San Diego Veterans Affairs Healthcare System, Research Department, San Diego, CA, 92130, USA
| | - Thomas Alexander
- University of California, San Diego, Division of Otolaryngology, Department of Surgery, La Jolla, CA, 92093, USA
| | - Jacob Husseman
- University of California, San Diego, Division of Otolaryngology, Department of Surgery, La Jolla, CA, 92093, USA
| | - Quyen Nguyen
- University of California, San Diego, Division of Otolaryngology, Department of Surgery, La Jolla, CA, 92093, USA
| | - Jeffrey P Harris
- University of California, San Diego, Division of Otolaryngology, Department of Surgery, La Jolla, CA, 92093, USA
| | - Allen F Ryan
- University of California, San Diego, Division of Otolaryngology, Department of Surgery, La Jolla, CA, 92093, USA
- San Diego Veterans Affairs Healthcare System, Research Department, San Diego, CA, 92130, USA
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Indius JH, Alqaderi SK, Kjeldsen AD, Heidemann CH. Middle ear disease in Danish toddlers attending nursery day-care - Applicability of OM-6, disease specific quality of life and predictors for middle ear symptoms. Int J Pediatr Otorhinolaryngol 2018; 110:130-134. [PMID: 29859574 DOI: 10.1016/j.ijporl.2018.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Otitis media (OM) is a very common childhood disease and impacts child quality of life (QoL) to different extends. The aim of this study was to investigate the difference in quality of life between three groups of children; Children with symptoms of ear disease within the last 4 weeks, children without any ear disease and children scheduled for ventilating tube treatment. Furthermore, we investigated predictors for experiencing middle ear symptoms. Lastly, we assessed psychometric properties of OM-6 used to assess QoL. METHODS Four hundred ninety-four children attending nursery day-care aged 6-36 months were enrolled in the study. Caregivers were asked to recall the child's history of symptoms related to middle ear infection. The Danish version of otitis media-6 questionnaire was used to measure the children's quality of life. Data from children treated with ventilating tubes were included from a previously published study. Logistic regression was applied for determining possible predictors for experiencing ear related symptoms. RESULTS The study had an 87% response rate, with a total of 342 children included. At the inclusion 32 (9%) children were included in the 4-week group and, while 307 children were allocated to the non-4 week group. The children in the 4-week group were significantly younger and were more likely to have siblings with a history of middle ear infection than the non-4week group. Furthermore, QoL was significantly worse in the 4-week group compared to the non-4week group. Only subtle differences were found between children with acute symptoms compared to children scheduled for tube treatment. CONCLUSIONS As expected, children with acute symptoms of OM experience lowered QoL compared to children with no symptoms and young age as well as having siblings with a history of middle ear problems were found to be possible predictors for experiencing middle ear symptoms. Children with acute symptoms differed from children scheduled for ventilating tubes on domains related to long-term problems from OM. OM-6 has shown to be a valid instrument for assessing disease specific QoL in children with OM, however a more large-scale instrument might be necessary for detecting subtle differences between subgroups of children with OM.
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Affiliation(s)
- J H Indius
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark.
| | - S K Alqaderi
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark
| | - A D Kjeldsen
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark
| | - C H Heidemann
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark
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Ungar OJ, Cavel O, Golan GS, Oron Y, Wasserzug O, Handzel O. The Hebrew version of the Eustachian tube dysfunction questionnaire-7. HEARING BALANCE AND COMMUNICATION 2018. [DOI: 10.1080/21695717.2018.1463756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Omer J. Ungar
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Cavel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad S. Golan
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oshri Wasserzug
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Blioskas S, Karkos P, Psillas G, Dova S, Stavrakas M, Markou K. Factors affecting the outcome of adenoidectomy in children treated for chronic otitis media with effusion. Auris Nasus Larynx 2018; 45:952-958. [PMID: 29426724 DOI: 10.1016/j.anl.2018.01.003] [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: 01/22/2017] [Revised: 11/08/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this cohort was to determine potential risk factors, concerning the effectiveness of adenoidectomy in the treatment of chronic otitis media with effusion in children. METHODS Ninety six children with chronic otitis media with effusion treated with adenoidectomy were enrolled in this study. A thorough medical history was taken, including family history of otologic disease, parental smoking habits and breast feeding history. Radiographic palatal airway size was measured preoperatively, whereas the presence of allergy was also investigated. All patients were, postoperatively, followed up for a period of two years, in three month intervals. Disease course was classified as "complete remission", "improvement" or "consistence", in every postoperative evaluation, according to strictly established criteria. RESULTS Children's age proved to be a significant factor in the postoperative outcome of adenoidectomy, as a treatment of chronic otitis media with effusion, especially when comparing patients being over and under the fifth year of age. Also, the presence of allergy, family history of otologic disease and palatal airway size, all proved to influence postoperative outcome in a statistical significant way (p<0.05). On the other hand, child's sex, passive smoking, breast feeding and previous acute otitis media infections did not seem to alter the efficacy of adenoidectomy. CONCLUSION Adenoidectomy remains a cornerstone in the treatment of chronic otitis media with effusion in children. Results document that young age, presence of allergy predisposition, otologic family history and small palatal airway can be important drawbacks and should be intensively sought for and taken into account, during treatment planning.
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Affiliation(s)
- Sarantis Blioskas
- 1st Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece
| | - Petros Karkos
- 1st Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece
| | - George Psillas
- 1st Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece
| | - Stamatia Dova
- 1st Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece
| | - Marios Stavrakas
- 1st Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Efkarpia, 56403 Thessaloniki, Greece.
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Kurabi A, Schaerer D, Chang L, Pak K, Ryan AF. Optimisation of peptides that actively cross the tympanic membrane by random amino acid extension: a phage display study. J Drug Target 2018; 26:127-134. [PMID: 28658990 PMCID: PMC6223256 DOI: 10.1080/1061186x.2017.1347791] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
Abstract
Local treatment of middle ear (ME) disease currently requires surgical penetration of the tympanic membrane (TM). We previously discovered 12-mer peptides that are actively transported across the intact TM, a process that could be used for non-invasive drug delivery into the ME. To optimise transport and provide further understanding of the peptides transport mechanism, we extended two of the candidate peptides by six additional amino acids at random, and screened the resulting 18-mers libraries on TMs of rats with active bacterial otitis media (OM) for transport efficiency using phage display. Six identified peptides were individually tested in vivo for trans-TM transport to verify the tissue specificity. Three exhibited enhanced transport compared to their parent 12-mer scaffold, with the best showing an approximately nine-fold increase. Sequence analysis revealed anchor residues and structural features associated with enhanced transport. This included the prominent display of conserved sequence motifs at the extended free ends of the predicted peptide structures.
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Affiliation(s)
- Arwa Kurabi
- a Department of Surgery, Division of Otolaryngology , School of Medicine, University of California , La Jolla , CA , USA
- b San Diego VA Healthcare System , San Diego , CA , USA
| | - Daniel Schaerer
- a Department of Surgery, Division of Otolaryngology , School of Medicine, University of California , La Jolla , CA , USA
| | - Lisa Chang
- a Department of Surgery, Division of Otolaryngology , School of Medicine, University of California , La Jolla , CA , USA
| | - Kwang Pak
- a Department of Surgery, Division of Otolaryngology , School of Medicine, University of California , La Jolla , CA , USA
- b San Diego VA Healthcare System , San Diego , CA , USA
| | - Allen F Ryan
- a Department of Surgery, Division of Otolaryngology , School of Medicine, University of California , La Jolla , CA , USA
- b San Diego VA Healthcare System , San Diego , CA , USA
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Patient, Provider, and Practice Characteristics Associated with Inappropriate Antimicrobial Prescribing in Ambulatory Practices. Infect Control Hosp Epidemiol 2018; 39:307-315. [DOI: 10.1017/ice.2017.263] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVETo reduce inappropriate antimicrobial prescribing across ambulatory care, understanding the patient-, provider-, and practice-level characteristics associated with antibiotic prescribing is essential. In this study, we aimed to elucidate factors associated with inappropriate antimicrobial prescribing across urgent care, family medicine, and pediatric and internal medicine ambulatory practices.DESIGN, SETTING, AND PARTICIPANTSData for this retrospective cohort study were collected from outpatient visits for common upper respiratory conditions that should not require antibiotics. The cohort included 448,990 visits between January 2014 and May 2016. Carolinas HealthCare System urgent care, family medicine, internal medicine and pediatric practices were included across 898 providers and 246 practices.METHODSPrescribing rates were reported per 1,000 visits. Indications were defined using the International Classification of Disease, Ninth and Tenth Revisions, Clinical Modification (ICD-9/10-CM) criteria. In multivariable models, the risk of receiving an antibiotic prescription was reported with adjustment for practice, provider, and patient characteristics.RESULTSThe overall prescribing rate in the study cohort was 407 per 1,000 visits (95% confidence interval [CI], 405–408). After adjustment, adult patients seen by an advanced practice practitioner were 15% more likely to receive an antimicrobial than those seen by a physician provider (incident risk ratio [IRR], 1.15; 95% CI, 1.03–1.29). In the pediatric sample, older providers were 4 times more likely to prescribe an antimicrobial than providers aged ≤30 years (IRR, 4.21; 95% CI, 2.96–5.97).CONCLUSIONSOur results suggest that patient, practice, and provider characteristics are associated with inappropriate antimicrobial prescribing. Future research should target antibiotic stewardship programs to specific patient and provider populations to reduce inappropriate prescribing compared to a “one size fits all” approach.Infect Control Hosp Epidemiol 2018;39:307–315
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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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Wouters I, Van Heirstraeten L, Desmet S, Blaizot S, Verhaegen J, Goossens H, Van Damme P, Malhotra-Kumar S, Theeten H. Nasopharyngeal s. pneumoniae carriage and density in Belgian infants after 9 years of pneumococcal conjugate vaccine programme. Vaccine 2017; 36:15-22. [PMID: 29180027 DOI: 10.1016/j.vaccine.2017.11.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/06/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In Belgium, the infant pneumococcal conjugate vaccine (PCV) programme changed from PCV7 (2007-2011) to PCV13 (2011-2015) and to PCV10 (2015-2016). A 3-year nasopharyngeal carriage study was initiated during the programme switch in 2016. Main objective of the year 1 assessment was to obtain a baseline measurement of pneumococcal carriage prevalence, carriage density, serotype distribution and antibiotic resistance. MATERIALS/METHODS Two infant populations aged 6-30 months and without use of antibiotics in the seven days prior to sampling were approached: (1) attending one of 85 randomly selected day-care centres (DCC); (2) presenting with AOM at study-trained general practitioners and paediatricians. Demographic and clinical characteristics were documented and a single nasopharyngeal swab was taken. S. pneumoniae were cultured, screened for antibiotic resistance and serotyped, and quantitative Taqman real-time PCR (qRT-PCR) targeting LytA was performed. RESULTS Culture-based (DCC: 462/760; 60.8% - AOM: 27/39; 69.2%) and LytA-based (DCC: 603/753; 80.1% - AOM: 32/39; 82.1%) carriage prevalence was high. Average pneumococcal DNA load in LytA-positive day-care samples was 6.5 × 106 copies/µl (95%CI = 3.9-9.2 × 106, median = 3.5 × 105); DNA load was positively associated with signs of common cold and negatively with previous antibiotic use. Culture-based frequency of 13 pneumococcal vaccine (PCV) serotypes was 5.4% in DCC and 7.7% in AOM, with 19F and 14 being most frequent, and frequencies below 0.5% for serotypes 3, 6A, 19A in both populations. Predominant non-PCV serotypes were 23B and 23A in day-care and 11A in infants with AOM. In day-care, resistance to penicillin was rare (<0.5%) and absent against levofloxacin; 32.7% and 16.9% isolates were cotrimoxazole- and erythromycin-resistant respectively. CONCLUSION Four years after PCV13 introduction in the vaccination programme, PCV13 serotype carriage was rare in infants throughout Belgium and penicillin resistance was rare. Continued surveillance in the context of a PCV programme switch is necessary.
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Affiliation(s)
- Ine Wouters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Liesbet Van Heirstraeten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Stefanie Desmet
- Reference Centre for Pneumococci, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Stéphanie Blaizot
- Centre for Health Economics Research and Modelling Infectious Diseases, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jan Verhaegen
- Reference Centre for Pneumococci, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
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