Chronic Middle Ear Inflammation Research Articles

Effect of diesel exhaust particles on RANK/RANKL expression in in vivo and in vitro models of middle ear inflammation

ObjectiveIncreasing evidence suggests a link between middle ear inflammation and the development of diesel exhaust particles (DEPs). Chronic middle ear inflammation can lead to bone damage and remodeling. This study aimed to explore the impact of DEPs on the expression of interleukin (IL)-6 and RANKL under conditions of middle ear inflammation. MethodsDEPs were collected by burning fuel in a diesel engine at the Gwangju Institute of Science and Technology. Human middle ear epithelial cells were cultured to 70–80% confluence in culture plates and then treated with DEPs at concentrations of 0, 5, 10, 20, 40, and 80 μg/mL for 24 h. Cell viability was assessed manually. B6.SJL mice, aged 9 weeks, were exposed to DEPs at a concentration of 200 μg/m3 for 1 h daily over a period of 28 days. The expression levels of IL-6, tumor necrosis factor α, RANKL, and RANK were evaluated using hematoxylin and eosin staining and western blot analysis of the harvested middle ear samples. ResultsThe viability of human middle ear epithelial cells was found to decrease in a dose-dependent manner after 24 h. The mRNA expression level of IL-6 exhibited the most significant increase at the 48-h mark. In contrast, the mRNA expression levels of RANKL and RANK showed a marked increase as early as 6 h post-exposure, with both genes subsequently displaying a time-dependent decrease. Histological analysis revealed that the middle ear mucosa was thicker in the group exposed to DEPs compared to the control group. Additionally, the protein expression levels of IL-6 and RANKL were elevated in the DEP-exposed group relative to the normal control group. ConclusionsWe confirmed the expression of osteoclast-related proteins in the mouse middle ear. These results imply that air pollutants might affect RANKL/RANK signaling, which is associated with bone remodeling.

Subtotal Petrosectomy with Cochlear Implantation or Osseointegrated Hearing Rehabilitation: A Single Institutional Study.

To examine audiologic outcomes and operative considerations for patients undergoing subtotal petrosectomy (STP) followed by implantable hearing restoration. Retrospective review. Tertiary academic referral hospital. All patients who underwent STP and implantable hearing restoration from 2014 to 2020. Single or staged STP with cochlear implantation (CI) or placement of an osseointegrated hearing implant (OHI). Indications for STP and CI or OHI; postoperative complication and reoperation rates; audiologic outcomes through speech recognition thresholds, AzBio sentence scores, and consonant-nucleus-consonant scores. Twenty-six adults (age 33-85) and six children (age 1-17) underwent 37 STP procedures with 33 CIs and four OHI. Thirty-one cases were planned single-stage, but six (16%) cases required revision surgery postoperatively due to refractory postauricular infection and breakdown of wound closure. Therefore, 25 cases were single procedures and 12 were staged. Indications for staged procedures included extensive cholesteatoma (n = 5, 42%), chronic middle ear inflammation (n = 5, 42%), and osteoradionecrosis (n = 2, 17%). No patients with OHI required revision surgery. For patients undergoing CI, the mean speech recognition thresholds improved from 80 ± 21 dB to 31 ± 9 dB (p < 0.001), mean aided AzBio scores improved from 11% to 43% (p = 0.002) and aided consonant-nucleus-consonant word scores improved from 6% to 47% (p < 0.001) in quiet. Subtotal petrosectomy is effective for creating a safe, dry ear in patients with chronic inflammation or anatomically challenging ears. Rehabilitative hearing options following STP can be achieved safely, restoring hearing to an acceptable level with CI. Careful consideration should be undertaken to approach as a single or staged procedure.

Clinico-Mycological Profile of Otomycosis in Chronic Suppurative Otitis Media Patients Attending a Tertiary Care Teaching Hospital

Chronic Suppurative Otitis Media (CSOM) is commonly encountered chronic inflammation of middle ear as well as the mastoid cavity due to dysfunction of Eustachian tube followed by microbial infection. Fungal infection in CSOM is now a major otolarynological problem in India not only in children but in adults too. Excessive use of steroids, antibiotics, cytotoxic chemotherapies and immunosuppressive diseases has increased the incidence of otomycosis in recent years. To define the aetiology of clinically diagnosed otomycosis. To isolate and identify fungal agents and their association with different factors(age, sex, predisposing factors). A total of 100 clinically diagnosed patients of CSOM with suspicion of otomycosis were included in the study. Patients where passing swab is difficult as with canal stenosis were excluded. Samples were taken using sterile swabs and studied for microbial profile. Male to female ratio in study was 1.6:1. The most common fungi isolated in CSOM cases was Aspergillus fumigatus followed by Aspergillus niger. Other fungus isolated were Aspergillus flavus, Penicillium species, Mucor species and Candida species. 04 samples showed mixed growth of Aspergillus species and Candida species. In our study we concluded that Aspergillus complex was most commonly isolated fungi in CSOM cases.

Sectra 3 D Human Body Visualization Table Use in Brain Abscess Diagnostics in a Child: A Case Report

Summary Brain abscess in children is a rare and particularly severe complication of acute otitis media/Chronic suppurative otitis media (CSOM). Presenting a child with brain abscess, which was developed as a pre-surgical complication of CSOM with cholesteatoma. Visualization of the abscess on a 3-D Sectra Visualization table was performed. An 8-year-old child who often suffered from untreated runny ear was admitted in a critical state. The history and clinical and laboratory data suggested severe chronic inflammation of the right middle ear. The examination did not reveal signs of meningeal irritation, increased intracranial pressure, excitation, sensory disorders, or focal symptoms. Surgical treatment was performed as a radical mastoidectomy with the removal of a cholesteatoma. After a three-day uneventful postoperative period, the patient worsened. A CT scan visualized a brain abscess in the right temporal lobe. A craniotomy was performed by opening the brain abscess, with an aspiration of pus, and lavage of the cavity. After surgical and conservative treatment, the child was discharged clinically healthy on the fourteenth day. Processing the image check-ups on a Sectra 3-D visualization table helped determine the size and localization of the abscess and the choice of surgical access.

Patterns of Bone Damage in Patients With Chronic Middle Ear Inflammation.

Despite different etiologies, chronic otitis media involves the damaging and restructuring of bone tissue. The inflammatory process destroys elements of the ossicular chain, and bone lesions may appear that allow the development of otogenous complications. A correlation between the degree of damage to the ossicular chain as well as the bony walls of the middle ear and the type of chronic inflammatory lesions was sought. Destructive changes to bones were observed using scanning microscopy. The removed damaged fragments of the ossicles were prepared for evaluation with a scanning microscope. Preparations were sputter-coated with a thin layer of gold and subsequently evaluated. Of 220 surgeries carried out in the discussed period, destruction of the middle ear bone walls, opening the way for the development of intracranial complications, was found in 27 patients. Most of them had ongoing chronic otitis media with granulation. (1) Bone loss of the skull base was observed more frequently in patients with chronic otitis media with granulation than with cholesteatoma. (2) In chronic otitis media with cholesteatoma, damage to the ossicular chain was observed significantly more frequently than in the case of otitis media with granulation.

Study of bacterial pathogens causing chronic suppurative otitis media and the antibiotic susceptibility pattern of the isolates at a tertiary care centre in Kochi

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of middle ear and mastoid cavity presenting with recurrent ear discharges through a tympanic membrane perforation. Complications of CSOM were frequent in pre-antibiotic era. Injudicious use of antibiotics led to the emergence of multi-drug resistant strains and complications in return. To isolate the organisms associated with CSOM in a tertiary care centre and to detect their antibiogram.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this clinical, prospective, cross sectional study, a total of 100 patients clinically diagnosed with CSOM were enrolled from January to December 2019 (1 year). &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 100 samples collected, predominant bacteria were isolated in 58 patients (58%). The most common isolate was &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; (29 isolates) followed by &lt;em&gt;Staphylococcus aureus&lt;/em&gt; (24), &lt;em&gt;Klebsiella&lt;/em&gt; species (3) and 1 isolate each of &lt;em&gt;Pneumococci&lt;/em&gt; and &lt;em&gt;Acinetobacter&lt;/em&gt; species. Among the 29 isolates of &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt;, 8 (28%) were multidrug resistant. Sensitivity was 100% to imipenem followed by 97% to meropenem,79% to gentamicin, 76% to amikacin, 66% to ciprofloxacin, 41% to piperacillin tazobactam and 17% to ceftazidime. Of the 24 isolates of &lt;em&gt;Staphylococcus aureus&lt;/em&gt;, 4 (16%) were methicillin resistant &lt;em&gt;Staphylococcus aureus&lt;/em&gt; (MRSA).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Pseudomonas aeruginosa was the most common isolate, of which 28% were multi drug resistant. This calls for the judicious use of antibiotics and alternative measures for treatment of drug resistant strains. Formulating an antibiotic policy based on the local antibiogram can help in preventing the emergence and spread of resistant pathogens.&lt;/p&gt;

Middle-ear cholesteatoma co-existing with labyrinthine fistula and vestibular schwannoma

BackgroundMany conditions, among them vestibular schwannoma and middle ear cholesteatoma with lateral semicircular canal destruction, may be associated with asymmetrical sensorineural hearing loss (SNHL) and vertigo. However, the probability that these two distinct disease entities causing the same symptoms occur in a single patient is very low, approximately 1 per 28 billion per 1 year.MethodsWe present the case of a 40-year-old male admitted to our clinic because of chronic middle ear inflammation with concomitant tinnitus vertigo, and deafness in the right ear. The patient was diagnosed with lateral semicircular canal fistula caused by middle-ear cholesteatoma and concomitant vestibular schwannoma. Canal wall-down surgery was carried out to remove the cholesteatoma, followed by gamma knife radiosurgery for the vestibular schwannoma.ResultsVertigo and tinnitus resolved within 3 days after the ear surgery, and gamma knife treatment resulted in the complete involution of the vestibular schwannoma. The patient presented with completely dry middle-ear cavity and no recurrence of the cholesteatoma was observed during a 3-year follow-up.ConclusionAs the hereby reported condition is very rare, the results cannot be compared with any similar report published previously. Nevertheless, based on the outcome, the treatment strategy seems to be both reasonable and effective.

Isolation and Identification of Bacteria Causing Chronic Suppurative Otitis Media and Its Antibiogram

Background: Chronic Suppurative Otitis Media (CSOM) is defined as chronic inflammation of middle ear and mastoid cavity, which presents with recurrent ear discharge or otorrhoea through a tympanic perforation. According to WHO, the prevalence of CSOM in India is more than 4% and it falls among those countries where urgent attention is needed. It can be caused by various bacteria, fungus and viruses. Bacterial origin of CSOM is more common than other etiologies. Aims and Objectives: The present study is aimed to detect common organisms which are responsible for CSOM, most common organism responsible for the complications and to determine the antibiotic sensitivity pattern of the organisms isolated from CSOM. Results: Ear swabs were taken from 100 clinically diagnosed cases of CSOM attending department of ear, nose and throat, MBS hospital and NMCH and were subjected to culture and antibiotic susceptibility. 104 (88.13%) among 118 ear swabs from total 100 patients were culture positive and 14 (11.87%) were culture negative. The most frequently isolated organisms in CSOM patients were Pseudomonas aeruginosa (42 (40.38%)), followed by Staphylococcus aureus (36 (34.6%)), Klebsiella pneumoniae (12 (11.53%)), Escherichia coli (08 (7.69%)) and Proteus mirabilis (06 (5.76%)). Most effective and favorable drug in our study for Pseudomonas aeruginosa was piperacillin-tazobactum, followed by cefepime. Staphylococcus aureus were 100% sensitive to Vancomycin and Linezolid, and 61.11% were MRSA. Conclusion: This study highlights the need for active diagnosis and management of CSOM. Judicious use of antibiotics is recommended and also the patient must complete a course of treatment as prescribed, because inadequate treatment may cause the emergence of resistant microorganisms. Keywords: CSOM, bacterial, gram positive, gram negative Cite this Article Anita E. Chand, Charu Sharma. Isolation and Identification of Bacteria Causing Chronic Suppurative Otitis Media and Its Antibiogram. Research & Reviews: A Journal of Microbiology and Virology. 2019; 9(3): 1–5p.

Sphenoid sinus development in patients with acquired middle ear cholesteatoma

ObjectiveIn this study, we examine the relationship between developmental insufficiency of mastoid air cells and abnormal morphology of the paranasal sinuses in patients with chronic otitis media (COM) and acquired middle ear cholesteatoma (AMEC) using precise image assessment, in order to evaluate whether the anatomical features of paranasal sinuses has any impact on the pathogenesis in COM and AMEC. MethodsA total of 127 patients, including 45 COM patients and 82 AMEC patients, were enrolled for this study. The existence of nasal septal deviation, the existence of paranasal sinus opacification, the modified Lund–Mackay score, the diameters of the paranasal sinuses, the Vidic classification, mastoid development, and cranial size were assessed by CT examination. A further 76 adult patients who underwent high-resolution CT imaging of their skull bone for other diseases were enrolled as the control. ResultsThe AMEC group showed a significantly shorter sphenoid length (P < 0.01) and lower Vidic classification score (P < 0.01) compared to the control group in this study. In addition, we observed that patients with AMEC had less pneumatization of the mastoid air cells compared to the control individuals, and that the sphenoid length of the poor MC score group was significantly shorter than that of the good MC score group. ConclusionOur results suggested that the developmental deficiency in sphenoid length caused by long-standing pediatric rhinosinusitis might indicate the potential of chronic middle ear inflammation in childhood and impact the pneumatization of mastoid air cells. Therefore, chronic rhinosinusitis during the childhood and adolescence might play a role in the pathophysiology of AMEC.

EVALUATION OF ANTIBIOTIC SENSITIVITY PATTERN IN CHRONIC OTITIS MEDIA

Background: Chronic otitis media (COM) is defined as chronic inflammation of middle ear and mastoid cavity that may present with recurrent ear discharges or otorrhoea through a tympanic perforation.&#x0D; Methods: A prospective cross sectional analysis was performed using antibiotic susceptibility test.&#x0D; Results: Antibiotic resistance was seen in case of the commonly used antibiotics like ampicillin, amoxicillin, Amoxicillin+Clavulanic acid. Cephalosporins were less commonly used antibiotics and showed resistance in 40.00% cases. Cotrimoxazole showed about 50.00% resistant cases. The less commonly used antibiotic was vancomycin however, showed high sensitivity (100%) followed by Linezolid (92.00%).&#x0D; Conclusion: Atibiotic sensitivity has been changing over time with high levels of resistance to commonly used antibiotics.&#x0D; Keywords: Antibiotic sensitivity, Chronic otitis media, Ear discharge

Middle Ear Osteoma Causing Mixed Hearing Loss: A Case Report

Osteomas of the middle ear are rare benign tumors. Their consequences and symptoms are due to their specific location, such as the promontory or the epitympanum and their contact with the facial nerve, the semicircular canal, the ossicles, and the oval or round windows. We report a very unusual case of middle ear osteoma (MEO) in a 23-year-old male patient causing a right mixed hearing loss by contacting and overwhelming the incus and stapes. The lesion was also closely attached to the tympanic portion of the fallopian canal. Since the stapes was not clearly visible behind the lesion, careful observation was preferred to surgery owing to the high risk of inner ear damage and facial palsy with removal of the lesion. MEOs are rarely situated at this critical site. Regular clinical and computerized tomography monitoring is warranted to check their growth. This case also supports the etiological theory of chronic middle ear inflammation causing osteomas.

Bacteriological study and antibiotic sensitivity profile in patients with ear discharge visiting ENT OPD at tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Otitis media (OM) is a big menace in countries like India. Chronic suppurative otitis media (CSOM) is chronic inflammation of middle ear, which affects the tympanic membrane, middle ear mucosa and other middle ear structures characterised by the presence of persistent perforation or persistent mucoid or muco-purulent discharge for at least 8 weeks. Variety of organisms founds in patients suffering from chronic otitis media like, &lt;em&gt;Pseudomonas&lt;/em&gt;, &lt;em&gt;Staphylococcus aureus&lt;/em&gt;, &lt;em&gt;Proteus mirabilis&lt;/em&gt;, &lt;em&gt;Klebsiella pneumonia&lt;/em&gt; and &lt;em&gt;Escherichia coli&lt;/em&gt; found. The pattern of organisms varies in different geographical areas. The objectives of the study were to isolate bacteria from patients with ear discharge, to find out antibiotic sensitivity of isolated organisms&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is an observational cross sectional study done in the OPD department of otorhinolaryngology, at P.D.U medical college and hospital, Rajkot, for a period of six months from January 2017 to June 2017. A total number 200 patients of both gender between 5 to 74 years who visited the OPD department of otorhinolaryngology with chronic ear discharge taken for study. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Out of 200 patients of 5-74 years with chronic suppurative otitis media were examined and out of this Hundred and twelve (54%) of the patients were males with mean age of 33.44. &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; was the commonest identified organisms the sensitivity pattern highly favoured Pipercillin, Amikacin and Polymyxin B, Cefoparazone. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Chronic otitis media is more prevalent in males than females. Commonest organisms found were &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; followed by &lt;em&gt;Staphylococcus aureus. &lt;/em&gt;Piperacillin, Amikacin, Gentamicin, Polymyxin B and Cefoperazone were found most effective agents against &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt;.&lt;/span&gt;&lt;/p&gt;

A mouse-to-man candidate gene study identifies association of chronic otitis media with the loci TGIF1 and FBXO11

Chronic otitis media with effusion (COME) is the most common cause of hearing loss in children, and known to have high heritability. Mutant mouse models have identified Fbxo11, Evi1, Tgif1, and Nisch as potential risk loci. We recruited children aged 10 and under undergoing surgical treatment for COME from 35 hospitals in the UK, and their nuclear family. We performed association testing with the loci FBXO11, EVI1, TGIF1 and NISCH and sought to replicate significant results in a case-control cohort from Finland. We tested 1296 families (3828 individuals), and found strength of association with the T allele at rs881835 (p = 0.006, OR 1.39) and the G allele at rs1962914 (p = 0.007, OR 1.58) at TGIF1, and the A allele at rs10490302 (p = 0.016, OR 1.17) and the G allele at rs2537742 (p = 0.038, OR 1.16) at FBXO11. Results were not replicated. This study supports smaller studies that have also suggested association of otitis media with polymorphism at FBX011, but this is the first study to report association with the locus TGIF1. Both FBX011 and TGIF1 are involved in TGF-β signalling, suggesting this pathway may be important in the transition from acute to chronic middle ear inflammation, and a potential molecular target.

Long-term Follow up and patient satisfaction after tympanoplasty with Titanium Clip-Prothesis

Aim of the present study is to evaluate the long term results of ossiculoplasty using titanium clip prosthesis. A retrospective analysis with prospective follow-up has been done including for all patients who had a Clip-PORP implanted between the years 2002-2013. Following this, audiometric hearing results were measured with clinical examination including otoscopy and quality of life evaluation using Glasgow benefit inventory. 48 patients (51 ears, 29 men, 19 women, average age 44.1 years) received followed up after an average duration of 6.3 years. The overall air-bone-gap (0.5-4 kHz) decreased from 22.8 dB preoperatively to 14.6 dB postoperatively (p≤0.001). The most frequent indication for surgical treatment were cholesteatomas and recurrent cholesteatomas (52%), chronic inflammation of middle ear (12%), revision of radical mastoidectomy (8%) and disturbance in sound conduction after previous operation (14%). Tympanic membrane was closed in 47 times (92,2%), 4 times (7,8%) there was a defect. Clip-PORP was in situ 39 times (75%), protrusion and disposal were detected 6 times (11,8%) and 2 times (4%), respectively. However, 1 time (2%) the prothesis was lost or evaluation was not possible (3 times, 5,9%). The overall patient satisfaction and general subscale score after the treatment was beneficially evaluated. There was no change in social support score nore the physical health score. In summary, the ossicular chain reconstruction using titan Clip-PORP is safe and well established. Also in long-term analysis stable hearing results due to reduction of air bone gap are represented. The subjective quality of life is sustainable improved.

Long-term Follow up and patient satisfaction after tympanoplasty with Titanium Clip-Prothesis

Aim of the present study is to evaluate the long term results of ossiculoplasty using titanium clip prosthesis. A retrospective analysis with prospective follow-up has been done including for all patients who had a Clip-PORP implanted between the years 2002-2013. Following this, audiometric hearing results were measured with clinical examination including otoscopy and quality of life evaluation using Glasgow benefit inventory. 48 patients (51 ears, 29 men, 19 women, average age 44.1 years) received followed up after an average duration of 6.3 years. The overall air-bone-gap (0.5-4 kHz) decreased from 22.8 dB preoperatively to 14.6 dB postoperatively (p≤0.001). The most frequent indication for surgical treatment were cholesteatomas and recurrent cholesteatomas (52%), chronic inflammation of middle ear (12%), revision of radical mastoidectomy (8%) and disturbance in sound conduction after previous operation (14%). Tympanic membrane was closed in 47 times (92,2%), 4 times (7,8%) there was a defect. Clip-PORP was in situ 39 times (75%), protrusion and disposal were detected 6 times (11,8%) and 2 times (4%), respectively. However, 1 time (2%) the prothesis was lost or evaluation was not possible (3 times, 5,9%). The overall patient satisfaction and general subscale score after the treatment was beneficially evaluated. There was no change in social support score nore the physical health score. In summary, the ossicular chain reconstruction using titan Clip-PORP is safe and well established. Also in long-term analysis stable hearing results due to reduction of air bone gap are represented. The subjective quality of life is sustainable improved.

Bacteriological profile and antibiotic sensitivity in Chronic Suppurative Otitis Media

Chronic Suppurative Otitis Media is a chronic inflammation of middle ear presents with recurrent otorrhoea through a tympanic perforation, usually occurs after upper respiratory viral infections followed by invasion of pyogenic organisms. Our prospective study, conducted over a period of 10 months, includes ear discharge from 100 patients with chronic suppurative ottis media. Discharge collected in sterile swabs were sent immediately to microbiology laboratory and processed. Bacterial isolates were identified by standard methods and antibiotic susceptibility testing was done. Staphylococcus was the predominant organism followed by Pseudomonas sps., and Escherichia Coli. Most of the organisms were sensitive to Cefotaxime followed by Amikacin. The aim of the study on aerobic microbes and their anti-biogram pattern was to prepare a protocol for empirical antibiotic therapy based on the study to shorten the period of infection. Keywords: Chronic suppurative otitis media, Bacterial isolates, Anti-boigram, Anti-biotic resistance

Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies

Objective: To investigate and establish the use of tympanometry in conscious sheep to provide a means of objective assessment of tympanic membrane integrity, middle ear ventilation and functioning of the Eustachian tube (ET). Design: After conditioning the sheep for four weeks, tympanometric measurements at 226 Hz were carried out weekly for 13 weeks. Before measurements, the external ear canal had been cleaned. Resultant curves were classified according to human reference values. Study Sample: Tests were performed on 12 female blackface sheep. Results: After cleaning of the external ear canal under otoscopic control, tympanic membranes were intact with no evidence of acute or chronic middle ear inflammation, middle ear effusion or retraction. Cleaning ensured valid, objective and reproducible measurements. As the majority of normal tympanograms were notched without the appearance of any malformation, an additional tympanogram type (AN) was introduced. The notched appearance can most likely be explained by the anatomy of the middle ear of the sheep and the test frequency that was used. Conclusion: The current study demonstrated how tympanometry can be used to evaluate treatment modalities for middle ear and ET function in conscious sheep. This provided a large animal model for further human research in otology.

A new model for non-typeable Haemophilus influenzae middle ear infection in the Junbo mutant mouse.

ABSTRACTAcute otitis media, inflammation of the middle ear, is the most common bacterial infection in children and, as a consequence, is the most common reason for antimicrobial prescription to this age group. There is currently no effective vaccine for the principal pathogen involved, non-typeable Haemophilus influenzae (NTHi). The most frequently used and widely accepted experimental animal model of middle ear infection is in chinchillas, but mice and gerbils have also been used. We have established a robust model of middle ear infection by NTHi in the Junbo mouse, a mutant mouse line that spontaneously develops chronic middle ear inflammation in specific pathogen-free conditions. The heterozygote Junbo mouse (Jbo/+) bears a mutation in a gene (Evi1, also known as Mecom) that plays a role in host innate immune regulation; pre-existing middle ear inflammation promotes NTHi middle ear infection. A single intranasal inoculation with NTHi produces high rates (up to 90%) of middle ear infection and bacterial titres (104-105 colony-forming units/µl) in bulla fluids. Bacteria are cleared from the majority of middle ears between day 21 and 35 post-inoculation but remain in approximately 20% of middle ears at least up to day 56 post-infection. The expression of Toll-like receptor-dependent response cytokine genes is elevated in the middle ear of the Jbo/+ mouse following NTHi infection. The translational potential of the Junbo model for studying antimicrobial intervention regimens was shown using a 3 day course of azithromycin to clear NTHi infection, and its potential use in vaccine development studies was shown by demonstrating protection in mice immunized with killed homologous, but not heterologous, NTHi bacteria.

Analysis of dynamics of IL-17 in chronic middle ear inflammation induced by nontypeable Haemophilus influenzae in mice model

Analysis of dynamics of IL-17 in chronic middle ear inflammation induced by nontypeable <I>Haemophilus influenzae</I> in mice model

Cholesteatoma ? A Potential Consequence of Chronic Middle Ear Inflammation

The article provides an overview on the current state-of-science of middle ear cholesteatoma, a non-neoplastic, keratinizing lesion that is characterized by the proliferation of epithelium with aberrant micro-architecture. Pathogenetic mechanisms including morphological, immunological, epidemiological and microbiological aspects of the disease are summarized. The importance of penicillinase-expressing anaerobic bacteria and biofilm formation for maintaining the chronic middle ear inflammation is stressed. Nevertheless, the role of the isolated pathogens in the primarily non-sterile compartiment of the middle ear cavity is so far not completely understood and data on the isolated species are contradictious. Heredity was demonstated for some variants of the disease. Therefore, further studies on the etiological role of microbial agents and potential benefits of resistance-adapted antimicrobial therapy seem advisable. Local and systemic complications of the potentially life-threatening disease like conductive and sensorineural hearing loss and cranial abscesses are reported. The prognosis is limited due to frequent recurrence in spite of surgical therapy. Further research is necessary for a better understanding of the pathogenetic mechanisms and to expand the sectrum of therapeutic options.