Clinical Practice Guideline: Tympanostomy Tubes in Children

Executive Summary of Clinical Practice Guideline on Tympanostomy Tubes in Children (Update).

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update).

Microbiology of chronic and recurrent otitis media with effusion in young infants

Can vitamin D supplementation prevent chronic otitis media with effusion?

Does Helicobacter pylori have role in development of otitis media with effusion?

When Should a Retained Tympanostomy Tube be Removed?

Analysis of Paparella Type 1 tympanostomy tubes in pediatric patients: A single-center retrospective review

Hydrolytic activity of cathepsin B-like thiol proteases and collagenolytic proteases was measured in middle ear effusions (MEE) from pediatric patients with acute and chronic otitis media with effusion (OME). Both activities were significantly higher in MEEs from acute OME than those from chronic OME (p less than 0.01). The ratio of hydrolytic activity in the extracellular portion to the total activity in MEEs from chronic OME was also analysed in both proteases. The ratio ranged from 20 to 100% in individual cases, indicating that the degree of the release of lysosomal thiol proteases including collagenolytic proteases from leukocytes is variable in MEEs with chronic OME. The kinetics of lysosomal thiol proteases including collagenolytic proteases in acute OME seems to be much more active than that in chronic OME, and the presence of these thiol proteases appears to be an important factor leading to chronic OME.

Pacific Islands families study: The prevalence of chronic middle ear disease in 2-year-old Pacific children living in New Zealand

Chronic otitis media with effusion (OME) has been observed in 10 to 20% of children following acute, symptomatic otitis media. To determine factors that place children at increased risk of chronic OME, we conducted a 6-week prospective study of 386 children who had 3 or more recent episodes of otitis media and who had middle ear effusion present for at least 2 weeks. Of these children 23% developed chronic OME (i.e. effusion lasting 8 continuous weeks or more), and 26% developed chronic OME complicated by acute, symptomatic otitis media. Predictors for chronic OME were (1) bilateral OME, (2) duration of effusion for greater than 2 weeks at enrollment and (3) day care attendance. Children with these 3 factors had twice the risk of developing chronic OME as children lacking all 3 factors. These risk factors can be used to target children for early, aggressive OME therapy.

Repeat tympanostomy tubes in children with Down syndrome

1. Jack L. Paradise, MD* 2. Charles D. Bluestone, MD† 1. *Professor of Pediatrics and Otolaryngology, University of Pittsburgh School of Medicine; Children’s Hospital of Pittsburgh 2. †Professor of Otolaryngology, University of Pittsburgh School of Medicine; Director, Department of Pediatric Otolaryngology and Eberly Professor of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh, Pittsburgh, Pa After completing this article, readers should be able to: 1. Discuss the advantages of myringotomy and the insertion of tympanostomy tubes for children who have persistent otitis media with effusion (OME) or those who have recurrent acute otitis media (AOM). 2. Explain why myringotomy with tympanostomy tube insertion (M&T) is preferable to antimicrobial prophylaxis to prevent recurrent AOM for children in child care who are at increased risk of colonization with multiple drug-resistant Streptococcus pneumoniae . 3. Describe the possible complications following M&T and their treatments. MT of these, approximately 280,000 were in children younger than 3 years of age. The frequency with which the operation is performed is affected by several circumstances. First, next to the common cold, otitis media (OM), encompassing both AOM and OME, is the most commonly diagnosed and probably the most prevalent illness in United States children. Second, OM often becomes chronic and often recurs. Third, OM usually is accompanied by a variable degree of conductive hearing loss. Fourth, there has been concern that prolonged OME may result in untoward otologic or audiologic sequelae, and that sustained OME-related hearing loss during the first few years after birth, even though limited to that period, might result in later impairments of children’s speech, language, or cognitive skills or their psychosocial adjustment. Fifth, conservative measures often fail to prevent chronicity of OME or recurrences of AOM. Finally, M&T reliably brings about prompt resolution of persistent OME and its attendant hearing loss and usually succeeds in completely or largely preventing AOM recurrences for periods ranging from months to years. A 20-month-old boy presents …

Background: Otitis media with effusion (OME) is the condition in which fluid was presented in the middle ear cavities with absence of signs or symptoms of acute infection. Most episodes of OME resolve within 3 months, without need for surgical intervention. The placement of tympanostomy tubes (TTs) is the treatment for persistent OME. Objective: This study is performed to compare between anterosuperior and anteroinferior insertion of tympanostomy tubes in treatment of otitis media with effusion. Methods: The study included 40 patients with bilateral OME (at least 3 months did not respond to medical treatment) , divided into two groups: Group (I) included 40 patients who had been undergone myringotomy and tympanostomy tubes insertion at antero-superior quadrant of one ear (Right ear). Group (II) included the same 40 patients who had been undergone myringotomy and tympanostomy tubes insertion at antero-inferior quadrant of other ear (left ear). All patients were exposed to complete history taking, ENT examination and audiological investigation (Tympanometry, Pure Tone Audiometry), follow up of cases by clinical and audiological investigations were performed at 1,2 and 6 months.

Conclusions: The high oxidant levels in chronic otitis media with effusion (OME) observed in our research and the improvement seen in children with chronic OME after antioxidant treatment suggest that oxygen-derived free radicals play an important role in chronic OME. Objectives: OME is a common pathologic condition characterized by nonpurulent fluid in the middle ear (ME) that leads to moderate conductive hearing loss and flat tympanogram. During OME inflammatory cells generate large amounts of superoxide radicals to improve bactericidal activity. Overproduction of oxygen-derived free radicals induces oxidative damage in humans. Glutathione (GSH) is one of the major components of the antioxidant system that protects cells from oxidative stress. The aim of the study was to evaluate oxidative stress in chronic OME by investigation of ME fluids collected during myringotomy. Methods: During myringotomy, fluid was collected from the ME to evaluate lipid peroxide levels in the effusion. Fifty-nine children with ME effusion without any resolution after repeated medical treatments were enrolled in the study. Results: Lipid peroxide levels in all samples were high (mean 11.5 nmole/million cells), similar to the values found in other chronic diseases. GSH might be employed during surgery while applying ventilation tubes and after surgery to prevent oxidative stress.

There are conflicting views concerning middle ear infections due to Chlamydia trachomatis. To ascertain the etiological role of this agent in otitis media with effusion, middle ear effusions were cultured for C. trachomatis and other bacterial flora. A total of 102 patients with otitis media with effusion (OME) were recruited for this study. The study population included 66 patients with acute OME (AOME) and 36 patients with chronic OME (COME). As Chlamydia pneumoniae, the third species of Chlamydia, is also known to be isolated from middle ear effusion of OME, the fluorescent-antibody technique using anti-C. pneumoniae or anti-C. trachomatis antibodies was employed in order to identify the inclusion bodies isolated on HeLa 229 cells as C. trachomatis. C. trachomatis was recovered from 7 patients (10.6%) with AOME and from 8 (22.2%) patients with COME. Bacteria were cultured from 20 of 63 patients with AOME and from 13 of 28 patients with COME. Pathological bacteria were cultured from only 2 patients with C. trachomatis infection in the middle ear. Only normal skin flora, no bacterial pathogens, were isolated from the remainder. Antibodies to C. trachomatis in serum were measured by a microimmunofluorescent method in 13 patients with C. trachomatis infection in the middle ear. Antichlamydial antibody of the IgG type was detected in 84.6% (11/13) of these patients. These results suggest that C. trachomatis causes middle ear infections and plays an etiological role in the pathogenesis of otitis media with effusion.