The Binax NOW test as a tool for diagnosis of severe acute otitis media and associated complications

The diagnosis of acute otitis media (AOM) is often difficult, depending heavily on the experience and skills of the examiner. However, it is important to identify episodes of AOM that involve the risk of complications and to treat these episodes appropriately. The present study was performed in order to evaluate the use of a rapid antigen assay for Streptococcus pneumoniae, the Binax NOW test, as a diagnostic tool in patients with severe AOM and associated complications. The study included 70 patients with 74 episodes of AOM, 18 of them with complications. Cultures, Binax NOW tests, and a PCR assay were performed on nasopharyngeal secretions, middle ear fluid, and in some cases mastoid bone, cerebrospinal fluid, and urine. According to culture and PCR of the middle ear fluid, 30 (41%) of the episodes were caused by S. pneumoniae. The Binax NOW test was positive in 24 of these episodes (80%). It identified pneumococcal AOM independent of antibiotic treatment, and it was easily adapted to bone tissue. The test yielded sensitivity, specificity, and positive and negative predictive values for middle ear specimens of 85%, 100%, 100%, and 89%, respectively. The corresponding positive and negative values for predicting the bacterial etiology with nasopharyngeal secretions were 51% and 75%. This study showed that the Binax NOW test is a useful diagnostic tool for patients with severe AOM with or without complications.

Treatment of non-allergic nasal hypersecretion with ipratropium and beclomethasone

The effect of ipratropium and beclomethasone administered as nasal aerosols was compared in a double-blind, double-dummy, randomized, cross-over designed study. Twenty-four patients with non-allergic, watery hypersecretion participated in the trial. According to the patients' daily registration of nasal symptoms, no significant difference could be found between the two drugs. It was not possible to characterize patients who would benefit from treatment with either ipratropium or beclomethasone.

Upper respiratory tract infection and eustachian tube function in children

The Eustachian tube function was studied in 11 children (3-9 years of age) with and without upper respiratory tract infection ( URTI ). During URTI the active muscular opening function deteriorated and middle ear pressure weakened, whereas the passive pressure opening and closing levels, reflecting tubal closing forces, increased. These findings may explain the high frequency of transient episodes of middle ear underpressure and middle ear effusion (MEE) in children. In children with a primary tubal hypofunction due to poor muscular opening function, URTI may contribute to recurrent or persistent MEE.

Changes in Eustachian tube function with age in children with normal ears. A longitudinal study

A longitudinal study of the Eustachian tube function by different pressure equilibration tests was performed during 11/2-3 years in 44 otologically healthy children, 3-12 years of age. The muscular opening function improved significantly with increasing age. The improvement was most frequent during pre-school ages (3-7 years). Also the tympanometrically measured middle ear pressure, related to the muscular opening function, tended to normalize during the follow-up study. The pressure opening and closing functions, reflecting the tubal closing forces, did not, however, change during the observation time. All the children with poorest muscular opening function at the initial test improved; none developed persistent middle ear disease during the follow-up. Using this standardized exhalation/inhalation test of the pressure equilibrating function of the tube it seems possible to grade the muscular opening function in a valid way. It is argued that the main cause of poor muscular opening function in children is not only due to anatomical differences of the skull base, the tube and peritubal structures but also to the immaturity of the neuromuscular system during childhood.

Pressure opening and closing functions of the Eustachian tube by inflation and deflation in children and adults with normal ears

Different inflationary (e.g. Valsalva's) and deflationary (e.g. sniffing) manoeuvres were studied in 58 children and 61 adults, all otologically healthy, in order to evaluate qualitatively and quantitatively the pressure opening and closing functions of the Eustachian tube. Only 71% of the normal children could voluntarily increase the middle ear pressure compared with 100% of the adults. The corresponding figures for evacuating the middle ear by deflation were 24% and 34%, respectively. The rhinopharyngeal pressure levels during the manoeuvres were age-dependent and decided the response rate in children. Tubal factors also determined the response rate since low pressure opening and closing levels were related to successful deflation. Negative middle ear pressures found in the normal children were due to poor muscular opening function of the tube rather than successful deflation. The pressure closing level seems to be a reliable tool in grading tubal closing ability.

Treatment with sulfur hexafluoride in children with serous otitis media. An alternative to tubulation

In this pilot study, sulfur hexafluoride (SF6), a nontoxic inert gas infused into the ear during myringotomy and acting as a gas cushion behind an intact eardrum, was tested on five children with bilateral serous otitis media. The contralateral ear was treated with air as a control. A significant difference in air-bone gaps (frequencies, 0.5, 1.0, and 2.0 kHz) lasting at least eight weeks was found between the ears treated with SF6 and the air-treated ears. No side effects were noted. Tympanograms showed varying patterns. The long-term effects were also favorable for the SF6-treated ears. In selected cases, eg, ears with thin scars and retractions, this might be a valuable alternative to tubulation. Further studies are being carried out.

High speed tympanometry and ipsilateral middle ear reflex measurements using a computerized impedance meter. A comparison with the results obtained by a conventional impedance meter

By means of a new computerized impedance meter, middle ear pressure, tympanograms and ipsilaterally elicited middle ear reflex can be recorded and presented in 3 sec. Owing to the fast rate of air pressure change in the external ear canal it is not necessary to have a completely airtight seal around the ear probe when recording middle ear pressure, which saves time. Results obtained using the new device and those obtained by a conventional impedance bridge are compared.

Pressure opening and closing functions of the eustachian tube in children and adults with normal ears

Eustachian tube function was studied with the impedance technique and a pressure chamber in 58 children, aged 3-12 years, and 61 adults, aged 17-73 years, all otologically healthy. The pressure opening and closing functions were measured, i.e. the relative overpressure in the middle ear required to force open the tube, and the residual overpressure in the middle ear after pressure opening, respectively. These "passive" functions of the tube, assumed to reflect the closing factors, did not differ significantly between normal children and adults. The muscular opening function, i.e. "active" pressure equilibration capacity, on the other hand, was significantly poorer in children than in adults and poorer in younger children than in older ones. The results can be used as a reference material in investigations of the Eustachian tube in children with middle ear disease.

Eustachian tube function in normal children and adults

Eustachian tubal function was studied in 85 otologically healthy children, 3-12 years of age. Middle ear pressure and muscular opening function was measured by tympanometry performed in a pressure chamber, and the results were compared with those obtained from 92 normal adults. Children were found to have a less good muscular opening function and more negative middle ear pressures within wider ranges, compared with adults. Improvement was also seen in children with increasing age. The results seemed to indicate a relation between muscular opening function and middle ear pressure. Even if it were possible to grade the muscular opening function by means of the test procedure, it would still not be possible to define what should be regarded as normal or abnormal tubal function. This report is the first in a series of tubal function studies in normal children.

Comparison of eustachian tube function in children and adults with normal ears

The eustachian tube function was studied in 53 children and 55 adults, all otologically healthy, by means of typanometry in a pressure chamber. The ability to equilibrate applied overpressures and underpressures in the middle ear by deglutition or jaw movements, ie, muscular opening function was significantly poorer in children than in adults, and also significant poorer in younger children than in older ones. The pressure opening function of the tube was determined during reduction of the pressure in the chamber, ie, deflation test. The relative positive pressure persisting in the middle ear after the deflation test, ie, closing pressure, was also measured. No significant difference was found between children and adults. The ability to create a negative middle ear pressure by sniffing (positive sniffing test) was correlated with low closing pressures of the tube. Children with negative middle ear pressures had poor muscular opening function rather than positive sniffing tests. Judging from serial tympanometric measurements for up to two months, also performed in ten sniffing positive and ten sniffing negative children, it seems that the results obtained in the pressure chamber tests reflect a "mean tubal function."