Appearance Of Tympanic Membrane Research Articles

Integrated Health Solutions: Addressing the Co-occurrence of Otitis Media With Effusion and Early Childhood Caries in Preschool Children.

Introduction: Otitis media with effusion (OME) is a common middle ear condition, which frequently affects children and can lead to hearing impairment, speech delays, and developmental issues. Early childhood caries (ECC) is another prevalent pediatric condition defined by the presence of decayed, missing, or filled tooth surfaces in children under six years old. Objectives: This study aims to determine the prevalence of OME and ECC, the association between these two conditions, and the risk and severity of ECC among preschool children with OME. Methodology: A prospective cross-sectional study was conducted at a single tertiary center. A total of 206 preschool children aged six and below with hearing impairment or speech delay were recruited. They were grouped as follows: with OME (n= 129) and without OME (n = 77). Demographic and socioeconomic data were obtained, followed by otoscopy, anterior rhinoscopy, and tympanometric assessment. The subjects were further stratified into having ECC or not by conducting a dental examination for caries detection, whose findings were documented using Dental Charting and Caries Risk Assessment (CRA). Tympanometric width (TW) was also analyzed to measure its association with tympanic membrane appearance. Results: 51.5% (n=106) of children with OME were found to have ECC. They predominantly had mild ECC (49.1%), and most (51%) were at moderate risk for caries based on the CRA (P < 0.001). A significant association between OME and ECC was observed (p < 0.001). Tympanometry results documented a strong correlation between TW greater than 200 daPa and abnormal tympanic membrane findings in OME (P< 0.001). Conclusions: The association between OME and ECC in preschool children necessitates integrated healthcare approaches for early detection and management. Reliable diagnostic tools, such as tympanic width measurement for OME and CRA for ECC, are crucial in addressing these health issues. Early intervention and comprehensive care can mitigate the risks and improve health outcomes for affected children.

Managing Eustachian Tube Dysfunction with Balloon Catheterization

Objective: Eustachian tube dysfunction (ETD) is not commonly acknowledged until it leads to sequelae within the middle ear. Thus, treatments are focusing on treating active middle ear diseases repetitively rather than identifying possible fundamental causes. This study aims to report a preliminary local experience in treating ETD using balloon dilatation. Methods: This prospective, randomized controlled study was conducted in a tertiary academic center. Sixteen patients who were identified with symptoms of ETD were recruited. Six who had failed initial medical therapy underwent balloon dilatation of Eustachian tube (BDET); meanwhile, ten subjects were recruited into the medical treatment group. The primary efficacy endpoint was the comparison of reduction from baseline in overall 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Added endpoints were normalization of tympanogram and improvement of tympanic membrane appearance at 2 weeks, 6 weeks, and 3 months after intervention. Results: The median in reduction of overall ETDQ-7 score for the interventional group was 2.93 (2.14, 3.14) versus 0.43 (0, 0.86) for the control group. Reduction in overall ETDQ-7 score showed a significant improvement at 6 weeks which was persistent at 3 months post balloon dilatation (P &lt; 0.05). Similarly, the BDET group demonstrated changes in tympanogram at 6 weeks and 3 months post balloon dilatation (P &lt; 0.05). Tympanic membrane appearances were similar at the end of the study in both the groups. Conclusion: BDET is a promising precise treatment for patients who present with symptoms of ETD. The improvement of symptoms it provides may increase the readiness for it to be introduced as a standard practice in local settings and beyond.

Balloon Eustachian Tuboplasty (BET) in Children: A Retrospective Multicenter Analysis.

Generation of pilot data for planning of prospective BET-studies for treatment of dilatory Eustachian tube (ET) dysfunction in children. Retrospective multicenter analysis. Nine ENT departments at tertiary care teaching hospitals. 4-12-year-old children with chronic otitis media with effusion (COME) for more than 3 months or more than 3 episodes of acute otitis media during the last year, having failed standard surgical therapy at least once. BET with or without paracentesis, ventilation tube insertion, or tympanoplasty. Tympanic membrane appearance, tympanometry, and hearing threshold. Two hundred ninety-nine ETs of 167 children were treated. Mean age was 9.1 years (95% confidence interval [95% CI]: 8.7-9.4 yr). In 249 ears (83.3%), COME and/or retraction of the tympanic membrane were the indication for BET. Median hearing threshold was 20 dB HL (95% CI: 0-46 dB). One hundred fifty-five ears (51.8%, 95% CI: 46.1-57.4%) showed a tympanogram type B. Treatment consisted of BET without other interventions ("BET-only") in 70 children, 128 ears. Median length of follow-up for 158 (94.6%) children was 2.6 months (95% CI: 0.3-16.1 mo). After treatment, the tympanic membrane appeared normal in 196 ears (65.6%, 95% CI: 60.0-70.8%, p < 0.001). Median hearing threshold improved to 10 dB HL (95% CI: 0-45 dB, p < 0.001). Tympanograms shifted toward type A and C (type A: 39.1%, 95% CI: 33.7-44.7, p < 0.001). These improvements were also observed in subgroup analyses of "BET-only" treatment and the indication of "COME" respectively. BET is improving a variety of dilatory ET dysfunction-related ear diseases in children. This study provides detailed data for design and planning of prospective studies on BET in children.

Diagnostic accuracy of a general practitioner with video-otoscopy collected by a health care facilitator compared to traditional otoscopy

ObjectiveVideo-otoscopy is rapidly developing as a new method to diagnose common ear disease and can be performed by trained health care facilitators as well as by clinicians. This study aimed to compare remote asynchronous assessments of video-otoscopy with otoscopy performed by a general practitioner. MethodChildren, aged 2–16 years, attending a health center in Johannesburg, South Africa, were examined. An otologist performed otomicroscopy and a general practitioner performed otoscopy. Video-otoscopy was performed by a health care facilitator and video sequences were stored on a server for assessment by the same general practitioner 4 and 8 weeks later. At all examinations, a diagnosis was set and the tympanic membrane appearance was graded using the OMgrade-scale. The otologist's otomicroscopic diagnosis was set as reference standard to compare the accuracy of the two otoscopic methods. ResultsDiagnostic agreement between otologist's otomicroscopic examination and the general practitioner's otoscopic examination was substantial (kappa 0.66). Agreement between onsite otomicroscopy and the general practitioners asynchronous video assessments were also substantial (kappa 0.70 and 0.80). ConclusionVideo-otoscopy performed by a health care facilitator and assessed asynchronously by a general practitioner had similar or better accuracy compared to face-to-face otoscopy performed by a general practitioner.

Clinico-audio-radiological and operative evaluation of otitis media with effusion

Aims: Otitis media with effusion (OME) is a common cause of hearing and speech impairment in children. The correlation of the clinical, audiological, radiological, and intraoperative findings was carried out so as to make a protocol for early diagnosis and management of OME. It will help prevent the more serious sequelae of OME such as tympanosclerosis, chronic adhesive otitis media, and even chronic suppurative otitis media. Methods: 300 clinically diagnosed patients of OME were studied prospectively. Thereafter, patients underwent impedance audiometry, pure tone audiometry, and X-ray soft tissue nasopharynx for adenoids. The patients were given adequate medical treatment for 3 to 6 months, and the patients who did not respond to the treatment were subjected to adenoidectomy with ear examination under magnification and myringotomy with or without grommet insertion. Results: The mean age at presentation was 5.96 years. Only 32% patients gave a history of hearing loss. About 90% patients had mouth breathing, followed by snoring (84%). About 79% ears had abnormal tympanic membrane appearance and mobility; 65.5% had an abnormality on impedance audiometry; and 69.75% had an air condition threshold level of >20 dB. About 78% patients had either Grade III or Grade IV Adenoid hypertrophy. Adenoidectomy was done in all 300 patients with myringotomy in 472 ears. Grommets were inserted in 365 ears. There was a significant reduction in mean air conduction threshold with an improvement of 8.0 dB and 7.5 dB in right and left ears, respectively at 2 months postoperatively. At 6 th month postoperative, the average improvement from baseline dropped to 6.0 dB in right ear and 5.5 dB in the left ear. Conclusion: OME is the most frequent causes of silent hearing impairment in young children which needs a close vigil. All suspected children (on clinical and otoscopic findings) must be subjected to impedance audiometry and X-ray soft tissue nasopharynx for adenoids. After the failure of medical treatment for 3-6 months, the child should be subjected to myringotomy with adenoidectomy in the same sitting. Whenever a child is planned for tonsil or adenoid surgery, he/she must undergo evaluation for OME beforehand so that the child's hearing risk can be simultaneously taken care of in the same sitting.

Structured clinical assessment of the ear, nose and throat in patients with granulomatosis with polyangiitis (Wegener’s)

The objective of this prospective cross-sectional study is to describe the clinical otorhinolaryngological manifestations of granulomatosis with polyangiitis (Wegener's) (GPA) in a prospective cohort. All patients suffering from GPA seen in a tertiary centre between March 2007 and November 2008 had a detailed clinical assessment by an ENT surgeon of their ear, nose and head and neck complaints. An evaluation of whether there was disease activity and/or infection in each ENT area was made using the European Vasculitis Study Group guidelines. The number of patients assessed was 144. The proportion of female patients was 47 % (n = 69) and the median age was 57.7 years (IQ range 42.5-68.5). The prevalence of ENT involvement was 87 % (125/144). Hearing loss and abnormal tympanic membrane appearance were more common in patients with active disease and no infection (7/8 and 6/8, respectively, in active disease cf. 59/131 and 52/131, respectively, in remission). Nasal crusting was the most common nasal complaint recorded (52/144, 36 %) and bloody rhinorrhoea was the most common symptom in patients with disease activity. Rhinoscopy was highly sensitive in diagnosing disease activity (100 %). Subglottic stenosis was the most common head and neck manifestation (27/121, 22 %) and 74 % were symptomatic. In conclusion, the pattern and frequency of clinical ENT manifestations in GPA have been described in a large patient cohort. The use of tools readily available in the ENT clinic was essential to assess these patients accurately. This dataset will form the basis of an objective scoring system to measure disease activity in the ENT system.

Perlak pierwotny ucha środkowego i szczytu piramidy

Petrosal cholesteatomas are rare lesions, which may be primary or acquired in nature. We report a case of primary cholesteatoma in petrous bone occurring in 51-year old woman who presented with a unilateral facial nerve palsy and conductive hearing loss, despite normal tympanic membrane appearance. Early diagnosis was facilitated by computed tomography scanning and magnetic resonance imaging. Complete cholesteatoma removal was accomplished using a transtemporal supralabyrinthine approach, which allowed hearing preservation. Facial nerve function is the main complication of these lesion. We suggest that use of CT scanning and MRI in unilateral conductive hearing loss may allow the earlier detection of the most cases of petrosal cholesteatomas.

The Mechanical Reduction of Early Acquired Cholesteatomas in Children: Indications and Limitations

The standard treatment for acquired cholesteatoma involves surgical removal of the lesion and reconstruction of the tympanic membrane. In some children, these lesions can be treated more conservatively. We conducted a retrospective study of 29 ears in 24 children who had been treated for early acquired cholesteatoma with mechanical reduction and a tympanostomy tube. Outcomes measures included hearing status, the postoperative appearance of the tympanic membrane, and the need for additional surgery. We found that anterior and inferior pars tensa lesions, with or without squamous debris, can be successfully reduced, but that posterosuperior retractions respond less well when the ossicular chain has been eroded. None of the children who responded to mechanical reduction required major reconstructive surgery later. We conclude that mechanical reduction of retraction pocket cholesteatomas with tympanostomy tube placement is sufficient to restore normal hearing and a normal tympanic membrane appearance in selected children with early lesions. We also identified several important prognostic features, including the patient's age, the specific location of the retraction pocket on the tympanic membrane, the extent of the pocket, ossicular chain involvement, and the patient's adenoid status.

Laser-Assisted Tympanostomy in Pediatric Patients with Serous Otitis Media

To evaluate prognostic factors related with cure rate, in pediatric patients with serous otitis media treated with laser-assisted tympanostomy without ventilation tubes, in a single institution. The procedure was performed on 124 ears in 88 individuals, from 3 to 14 years old. External auditory canal anatomy, type of anesthesia, tympanic membrane and middle ear fluid characteristics, myringotomy size, and laser parameters, in relation to cure rate, were accordingly studied. The overall cure rate by ear at the end of the 2-month follow-up period was 54.83%, whereas 45.17% still suffered from otitis media. Multivariate statistical analysis demonstrated that the presence of a thick tympanic membrane is significantly correlated with pure outcome in children with serous otitis media, when laser-assisted tympanostomy without ventilation tubes is performed favoring a worse cure rate (P < 0.023). Other parameters did not statistically correlate with the outcome. A 41% parental dissatisfaction rate was noticed. This study addresses selection bias for children with serous otitis media, candidates for laser-assisted tympanostomy. These are related to the duration of serous otitis media, the condition of middle ear mucosa, the thickness of the tympanic membrane, the type of anesthesia, and the cost of laser apparatus. There is likely to be a causal relationship between outcome and tympanic membrane appearance in children undergoing laser-assisted tympanostomy.

Tympanic membrane changes following paediatric cochlear implantation

Objectives: To investigate the effects of cochlear implantation on the tympanic membrane in children.Design: Cross-sectional study.Methods: Eighty-four cochlear implant recipients were recruited at a vaccination clinic. The implanted ear was examined and the appearance of the external auditory canal and tympanic membrane documented. Demographic and clinical data such as age at implantation, duration of implantation, preoperative tympanic membrane appearance and preoperative middle-ear function were obtained retrospectively from hospital charts.Results: Thirty-eight patients (46.9%) were found to have abnormal tympanic membrane findings. The most common abnormality was scarring of the tympanic membrane in the vicinity of the electrode array. No statistically significant association was found between the tympanic membrane findings and demographic and clinical variables.Conclusions: Cochlear implantation may cause tympanic membrane scarring. The significance of the scarring is unclear. Dehiscence of the posterior wall of the external auditory canal should be avoided to prevent retraction pocket formation of the tympanic membrane.

Long-term otological outcome of hamular fracture during palatoplasty

Objective It has been suggested that fracture of the hamulus during palatoplasty in children with cleft palate may lead to adverse otological sequelae, however, there is little evidence to support this. Study design and setting The otological records of 42 children with repaired cleft palate (excluding submucous cleft palate) aged 8 years old or older were examined. A questionnaire regarding the incidence, treatment, and outcome of middle ear problems was completed by the parents of 68 children with repaired cleft palate, aged 9 years old or older. Results There was no significant difference between children who did and did not undergo hamular fracture with regard to tympanic membrane appearance, audiometry, history of ear problems ( P = 1.000), ear infections ( P = 0.622), ventilation tube insertion ( P = 0.532), or surgery for chronic otitis media ( P = 1.000). Parents of children not undergoing hamular fracture reported a higher incidence of below normal hearing ( P = 0.023). Conclusion and significance There is no evidence that hamular fracture during palatoplasty affects long-term otological outcome in cleft palate.

Otitis media: the chinchilla model.

Streptococcus pneumoniae infection and disease have been modeled in several animal species including infant and adult mice, infant and adult rats, infant Rhesus monkeys, and adolescent and adult chinchillas. Most are models of sepsis arising from intravenous or intraperitoneal inoculation of bacteria, and a few were designed to study disease arising from intranasal infection. Chinchillas provide the only animal model of middle ear pneumococcal infection in which the disease can be produced by very small inocula injected into the middle ear (ME) or intranasally, and in which the disease remains localized to the ME in most cases. This model, developed at the University of Minnesota in 1975, has been used to study pneumococcal pathogenesis at a mucosal site, immunogenicity and efficacy of pneumococcal capsular polysaccharide (PS) vaccine antigens, and the kinetics and efficacy of antimicrobial drugs. Pathogenesis experiments in the chinchilla model have revealed variation in ME virulence among different pneumococcal serotypes, enhancement of ME infection during concurrent intranasal influenza A virus infections, and natural resolution of pneumococcal otitis media (OM) without intervention. Research has explored the relative contribution of pneumococcal and host products to ME inflammation. Pneumococcal cell wall components and pneumolysin have been studied in the model. Host inflammatory responses studied in the chinchilla ME include polymorphonuclear leukocyte oxidative products, hydrolytic enzymes, cytokine and eicosanoid metabolites, and ME epithelial cell adhesion and mucous glycoprotein production. Both clinical (tympanic membrane appearance) and histopathology (ME, Eustachian tube, inner ear) endpoints can be quantified. Immunologic and inflammatory studies have been facilitated by the production of affinity-purified antichinchilla immunoglobulin G (IgG), IgM, and secretory IgA polyclonal antibody reagents, and the identification of cross-reactivity between human and chinchilla cytokines, and between guinea pig and chinchilla C3. Alteration of ME mucosa by pneumococcal neuraminidase and alteration of ME epithelial cell (MEEC) surface carbohydrates during intranasal pneumococcal infection have been demonstrated. Pathogenesis studies have been aided by cultured chinchilla MEEC systems, in which the ability of platelet activating factor and interleukin (IL)-1 beta to stimulate epithelial mucous glycoprotein synthesis has recently been demonstrated. Because chronic OM with effusion is characterized by presence of large amounts of mucous glycoprotein in the ME, pneumococcus may have an important role in both acute and chronic ME disease. Both unconjugated PS and PS-protein-conjugated vaccines are immunogenic after intramuscular administration without adjuvant in chinchillas. Passive protection studies with human hyperimmune immunoglobulin demonstrated that anti-PS IgG alone is capable of protecting the chinchilla ME from direct ME challenge with pneumococci. Active PS immunization studies demonstrated protection following direct ME and intranasal pneumococcal challenge with and without concurrent influenza A virus infection. An attenuated influenza A virus vaccine also showed protection for pneumococcal OM. Antimicrobial treatment of acute OM has been based almost exclusively on empirical drug use and clinical trials without a foundation of ME pharmacokinetics. Studies in the chinchilla model have started to bring a rational basis to drug selection and dosing. Microassays have been developed using high-pressure liquid chromatography for many relevant drugs. Studies have explored the in vivo ME response in pneumococcal OM to antimicrobial drugs at supra- and sub-minimum inhibitory concentration (MIC), the effect of concurrent influenza A virus infection on ME drug penetration, and the effect of treatment on sensorineural hearing loss produced by pneumococcal OM.

Association of abnormal appearance of tympanic membrane with minimal temporal bone pneumatization. A cadaver study.

The association of abnormal tympanic membrane appearance with minimal pneumatization of the temporal bone was studied in 28 unilateral formalin-fixed cadaver specimens. The photographic appearance of each tympanic membrane was judged by seven otolaryngologists, and a normalcy score determined. The normalcy score of the tympanic membranes had a weak association (tau = 0.27, p less than 0.05) with pneumatization volume, as determined by computed tomography. The same trend, though not statistically significant, was found with pneumatization area determined by lateral radiographs. For cross-sectional surveys, the otitis media condition is probably best identified by a combination of indicators: bilateral extent of pneumatization as assessed by computed tomography, bilateral appearance of the tympanic membranes, and a history of otitis media.

The relationship between acoustic reflex threshold and air-bone gap.

Neither air-bone gap nor acoustic reflex presence/absence gives an unequivocal indication of abnormality in middle-ear sound transmission. In the present study, a stratified population sample was investigated to examine the interrelationships between these and other parameters of middle-ear status. Of a total of 1725 ears, 1450 had both normal acoustic reflex threshold (ART less than or equal to 100 dB; see text) and air-bone gap (ABG less than or equal to 15 dB); 70 had both abnormal ART and ABG; 160 had abnormal ART but normal ABG; 45 had abnormal ABG but normal ART. Examination of data on tympanic membrane appearance and middle-ear pressure in the latter two groups suggests that ART is a considerably more sensitive indicator than ABG of hearing loss involving middle-ear abnormality, with only a marginally higher rate of false positives. However, a more comprehensive clinical picture is obtained when both ART and ABG are measured.