Chronic Otitis Media In Children Research Articles

The socio-demographic determinants of the outcome of type 1 cartilage tympanoplasty in children: Results from a tertiary-care teaching institute in India.

To explore whether and how the established socio-demographic parameters pertaining to a lower-middle income nation influence the outcome of cartilage tympanoplasty in children with chronic otitis media (COM), inactive mucosal variety. In this prospective cohort study, children aged 5-12 years with COM (dry, large/subtotal perforation) were considered for type 1 cartilage tympanoplasty following definite selection criteria. Relevant socio-demographic parameters were noted for each child. These included parents' education (literate/illiterate), living area (slum/village/others), mothers' occupation (laborer/business/housewife or home-maker), family type (nuclear/joint), and monthly family income. Outcome at 6 months follow-up was interpreted as "success" (favorable; anatomically intact and well-epithelialized neograft and dry ear) and "failure" (unfavorable; residual or recurrent perforation and/or discharging ear). The role of individual socio-demographic factor in determining the outcomes was analyzed with relevant statistical methods. The average age of the 74 children included in the study was 9.30±2.13 years. At six months, 86.5% had a successful outcome, with a statistically significant hearing gain (closure of the air-bone gap) of 17.02±8.96dB (p=.003). Mothers' education had a significant influence on the success rate (Chi: 4.13; significant at p<.05); children of ∼97% of the literate mothers had a successful outcome. Living area was significantly associated with success (Chi: 13.94; significant at p<.01); ∼90% of children living in the slum areas had success, compared to 50% of those residing in villages. The family type also significantly influenced the surgical outcome (Chi: 3.81; significant at p<.05); ∼97% of the children belonging to the joint families encountered success, compared to ∼81% of those brought up in the nuclear families. The success also depended on the mothers' occupation (Chi: 6.47; significant at p<.05); ∼97% of the housewife mothers had children who were successful, against ∼77% of mothers engaged as laborers. Another factor significantly associated with success was the monthly household income. Nearly 97% of the children belonging to families with a monthly household income of >₹3000 (cut-off limit set by the median value) experienced success, in contrast to 79% of those having a monthly family income of <₹3000 (Chi: 4.83; significant at p<.05). Socio-demographic parameters are valuable determinants of the outcome of surgical management of COM in children. For type 1 cartilage tympanoplasty, mothers' education and occupation, family type, living area, and monthly family income significantly influenced the surgical outcome.

A Clinicopathological Study on Chronic Otitis Media in Children at a Tertiary Care Hospital

Introduction: Chronic otitis media (COM) is the commonest disorder in Otorhinolaryngology practice, characterized by chronic inflammation of the middle ear cleft and mastoid cavity which presents with recurrent ear discharge and deafness. It results in considerable morbidity and may even cause extra-cranial and intracranial complications. Infections of the middle ear and complications caused by COM are still major public health problems in developing countries like Bangladesh. It is one of the main causes of preventable hearing loss when treated appropriately. It is important to review the changing trends in the natural history of the disease, and associated clinicopathological findings to understand the pathogenesis &amp; initiate definitive treatment. Aim of the study: The aim of the study was to the clinicopathological outcome of chronic otitis media in children at a tertiary care hospital. Methods: This is an observational prospective study, a total of 80 patients were included and analyzed in this study. The study was done on patients attending the Tairunnessa Memorial Medical College Hospital, Tongi, Gazipur, Bangladesh from January 2020 to July 2021. Result: A total of 80 patients were included in the study, the result is described in two groups. In the safe (mucosal) type, the majority of the patients presented with a profuse, non-smelly mucopurulent discharge followed by hearing loss. The perforations were 63% in the attic while 37% had marginal perforations. The hearing loss was mainly conductive in nature but moderate in degree. There were also associated extracranial complications in this group. In both groups, most patients were female and the majority belongs to the rural population. Conclusion: Chronic otitis media in the pediatric age group is more prevalent in rural populations with otorrhoea being the commonest presenting complaint. Conductive hearing loss of mild to moderate degrees is almost always associated with both mucosal and squamosal .........

Chronic otitis media in children - treatment with an integrative approach

Chronic otitis media in children - treatment with an integrative approach

A clinico-pathological study on chronic otitis media in children

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic suppurative otitis media (CSOM) is the commonest cause of persistent mild to moderate hearing impairment in children and young adults in developing countries and may have prevalence between 2 and 17% amongst children. The aim of this study was to compare clinico-pathological characteristics of safe (mucosal) and unsafe (squamous) diseases in children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An observational prospective study was done at ENT department of Jawaharlal Nehru medical college, AMU, Aligarh from over a period of one and half years. A total of 60 children evaluated as per inclusion and exclusion criteria, 30 in each group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Majority of them belonged to rural background with ear discharge being the predominant complaint in all of them. Children with unsafe disease had more incidences of extracranial complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Keeping in view the detrimental effects of hearing loss on social and educational development of children as the propensity of chronic otitis media to cause life threatening complications, urgent attention to this disease and awareness in public is warranted.&lt;/p&gt;

Does Ostmann's fat pad size correlate with development of chronic otitis media in children?

ObjectiveTo compare Ostmann's fat pad (OFP) size between healthy ears and ears with chronic otitis media with cholesteatoma (COMwC) in children, to assess its role in the disease. MethodsMRI scans of 29 children with unilateral COMwC with conductive hearing loss were used to measure OFP, represented by the maximal diameter of the high intensity area medial to the tensor veli palatini muscle (TVP): M1. A reference diameter was defined from the medial border of OFP reaching the medial border of the medial pterygoid muscle: M2.Values of M1, M2 and the ratio of M1:M2 were compared between the healthy and pathological ear in each patient. ResultsNo difference in OFP size was observed between healthy (H) ears (mean M1H:M2H ratio 0.72 ± 2.28) compared to ears with COMwC pathology (P) (mean M1P:M2P ratio .68 ± 1.57; P = .943) in children, suggesting that OFP size abnormalities do not have a role in pediatric COMwC. ConclusionOFP size was not correlated to the development of unilateral COMwC in children.

Machine Learning for Accurate Intraoperative Pediatric Middle Ear Effusion Diagnosis.

Misdiagnosis of acute and chronic otitis media in children can result in significant consequences from either undertreatment or overtreatment. Our objective was to develop and train an artificial intelligence algorithm to accurately predict the presence of middle ear effusion in pediatric patients presenting to the operating room for myringotomy and tube placement. We trained a neural network to classify images as " normal" (no effusion) or "abnormal" (effusion present) using tympanic membrane images from children taken to the operating room with the intent of performing myringotomy and possible tube placement for recurrent acute otitis media or otitis media with effusion. Model performance was tested on held-out cases and fivefold cross-validation. The mean training time for the neural network model was 76.0 (SD ± 0.01) seconds. Our model approach achieved a mean image classification accuracy of 83.8% (95% confidence interval [CI]: 82.7-84.8). In support of this classification accuracy, the model produced an area under the receiver operating characteristic curve performance of 0.93 (95% CI: 0.91-0.94) and F1-score of 0.80 (95% CI: 0.77-0.82). Artificial intelligence-assisted diagnosis of acute or chronic otitis media in children may generate value for patients, families, and the health care system by improving point-of-care diagnostic accuracy. With a small training data set composed of intraoperative images obtained at time of tympanostomy tube insertion, our neural network was accurate in predicting the presence of a middle ear effusion in pediatric ear cases. This diagnostic accuracy performance is considerably higher than human-expert otoscopy-based diagnostic performance reported in previous studies.

Chronic otitis media and subsequent hearing loss in children from the Himalayan region residing in Buddhist Monastic schools of Nepal

ObjectivesThe main objective of the study was to ascertain the prevalence of chronic otitis media and determine the corresponding hearing loss in children from Nepal’s Himalayan region now residing in Buddhist Monastic schools of Nepal. MethodsThe study was conducted among children at Buddhist monastic school in different parts of Nepal. A total of 3174 children aged between 5 and 15 years, who were originally from the Himalayan region of Nepal and were currently residing in monastic schools, were screened for ear problems and hearing loss. They were examined by otoscope to diagnose chronic otitis media. Hearing was evaluated by pure tone audiometer, and 0.5–4 kHz air conduction hearing threshold was measured and documented. ResultsOf the total of 3174 children who were screened for ear diseases and hearing loss, monks constituted 76.21% (n = 2419) and Nuns 23.78% (n = 755). Chronic otitis media was the most common otoscopic finding during the screening, and it affected a total of 344 (10.83%) children. Out of these 344, hearing loss of varying degrees was observed in 5.42% (n = 172) children. ConclusionThere is high prevalence of chronic otitis media in children belonging to the Himalayan region of Nepal, and it is the main cause of avoidable hearing loss. Timely diagnosis and treatment of chronic otitis media could prevent unnecessary hearing loss in these children.

Otological outcome in cleft lip and palate children with middle ear effusion

ObjectiveTo evaluate the factors contributing to middle ear pathology, hearing and speech development among cleft palate children treated for middle ear effusion. MethodA prospective cross-sectional otoscopic and audiological analysis was conducted on 102 cleft palate children (204 ears) aged 1–18 years old who were treated for middle ear effusion at our centre. Retrospective chart review was done to determine patient characteristics and prior patient management. The aim was to assess the effect of ventilation tube insertion (VTI) on hearing, speech and chronic otitis media; comparing the timing and number of ventilation tubes per ear and determining other factors affecting the short-term and long-term outcome. Results68 children or 130 ears (63% of all cases) were selectively treated with ventilation tube insertion. Repeat procedures (more than 2) were performed in 41 ears. Among children with VTI performed, the incidence of chronic otitis media in children after the age of 4 was 17%. Overall, abnormal tympanic membrane findings and hearing loss were detected in nearly half the cases who were previously treated with VTI. Early ventilation tube insertion at less than 1 year of age, resulted in a better middle ear and hearing outcome in children less than 4 years old (p < 0.05), however there was no significant difference in children more than 4 years old. Early surgical repair of cleft palate prior to the age of one year resulted in favourable results in both age groups (p < 0.05). There was a higher prevalence of chronic otitis media with repeated grommet insertion (3 or more) (p < 0.05). Speech and language milestones were achieved in 94% of all children above the age of four. ConclusionTreatment with early ventilation tube insertion prior to the age of one year provides a hearing benefit in children less than 4 years of age, but no significant difference after 4 years of age. Factors significantly affecting the outcome after 4 years of age was the timing of palatal closure and total number of tube insertions. We recommend a conservative approach especially when considering repeated tube insertions. A long-term follow-up paired with interval hearing assessment is advocated until early adulthood.

Surgical treatment of chronic otitis media in children using three-dimensional imaging

The introduction of three-dimensional exoscopy has opened a new stage in microsurgery in recent years. Researchers from various specialties give mostly positive reviews. There are very few works on the use of three-dimensional imaging in otorhinolaryngology, and there are practically no such works on otosurgery. This article presents a short review of publications and our own clinical examples, which are the first detailed description of VITOM 3D KARL STORZ exoscope use for cholesteatoma surgery in children, published in the available world literature. The first experience allowed us to draw preliminary conclusions about the comparability of this method of intraoperative imaging with a microscope. In addition, we have identified additional benefits of the exoscope. Further research will make it possible to better adapt the technique to the peculiarities of otosurgery, and it should take its place in the arsenal of ENT surgeons, along with microscopy.

Does Physician Ownership of Ambulatory Surgical Centers Influence Use of Tympanostomy Tubes

Significant variation exists in the surgical practice of placing tympanostomy tubes for chronic otitis media in children. In a database review,

Myringoplasty for chronic otitis media in children and strength of the temporal fascia

Myringoplasty for chronic otitis media in children and strength of the temporal fascia

Outcome of Tympanomastoidectomy in Children with Chronic Otitis Media

Objectives: Analyze outcomes of tympanomastoidectomy for chronic otitis media in children at a tertiary care referral center with a high prevalence of patients with genetic syndromes, craniofacial anomalies, and medical comorbidities. Methods: A retrospective review of tympanomastoidectomy performed for chronic otitis media at a single pediatric tertiary care hospital from 1995 through 2013 was performed. Factors evaluated included presence of immunodeficiency or craniofacial anomaly, change in air-bone gap and speech reception threshold, and need for additional otologic procedures. Results: Fifty-six tympanomastoidectomies on 47 patients were evaluated. A total of 25% of the children had a genetic syndrome and 17% had an immunodeficiency. Average age at surgery was 7.5 years with an average duration of follow-up of 2.7 years. Previous treatment included prolonged oral antibiotics (43), prolonged intravenous antibiotics (11), and middle ear irrigation and exchange of tympanostomy tube (7). Twenty-nine ears had undergone 2 or more tympanostomy tube insertion. A total of 28 (50%) ears continued to have some otorrhea postoperatively. Complete audiologic data were available for 23 patients. Improvement in air-bone gap was seen in 87% of cases, with an average improvement of 11.9 dB ( P = .01). Improvement in speech reception threshold was seen in 65%, with an average decrease in threshold of 10 dB ( P = .27). Of the cases, 8.9% required revision tympanoplasty following tympanomastoidectomy. Conclusions: Tympanomastoidectomy in children with severe chronic otitis media improves hearing function and may be beneficial in some patients to cease otorrhea. This should be considered as a treatment option in children that have failed previous conservative management.

Chronic Otitis Media in Children

To provide an easy-to-follow evidence-based diagnostic and therapeutic algorithm for the management of chronic otitis media (COM) in children. Literature review and critical analysis of the available evidence in Medline and other scientific database sources. Otorrhea and hearing loss are the cardinal symptoms of COM, while oto-microscopy and imaging techniques can confirm the diagnosis. Conservative treatment is acceptable to some extent (i.e. mild cases of COM without cholesteatoma). It involves topical drops (quinolones as first choice drugs- strength of recommendation B), as well as performing aural toilet (strength of recommendation B), and avoiding water ingress. Tympanoplasty without mastoidectomy is expected to improve hearing in cases of non-cholesteatomatous COM (strength of recommendation C), and positively affect the children's quality of life (strength of recommendation B). Less experienced surgeons and inflamed, wet middle ear mucosa represent the two most important factors, which could lead to reperforations (strength of recommendation C). The surgical management of COM with cholesteatoma tends to employ the least invasive surgical technique, in order to obtain a small self-cleaning mastoid cavity, as well as good hearing results (strength of recommendation C). The treatment of choice in most cases of pediatric COM is surgery. Figure 1 proposes a detailed and easy-to-follow evidence-based algorithm with regard to the diagnosis and management of COM in children.

CHRONIC SUPPURATIVE OTITIS MEDIA

Objective: The aim of the study was to determine the most prevalent organisms in chronic otitis media in children and their susceptibility to various antibimicrobials so that an appropriate empiric antibiotic can be started promptly while awaiting the results of the culture and sensitivity. Design: Prospective observational study. Place and Duration of Study: The study was conducted at Combined Military Hospital Lahore from Jan 2006 to Dec 2007. Subject and Methods: A total of 156 patients less than 15 years of age who were having discharge from one or both ears for at least 1 week with tympanic membrane perforation were included in the study.A sample of the ear discharge was collected on the swab and cultured on appropriate media. The Gram positive organisms were identified on the basis of Gram staining, catalase and coagulase test, the Gram negative organisms were identified by API 20e. A total of 156 patients were included in the study of which 96(61.5%) were males and 59(37.8%) were females. The organisms isolated were Staphylococcus aureus in 79(50.6%), Pseudomonas aeruginosa in 45 (28.8%) patients and Proteus mirabilis 17 (10.9%), Escherichia coli, Acinetobacter sp and streptocci were isolated in occasional patients. Staphylococcus aureus was the commonest organism isolated followed by Pseudomonas aeruginosa and Proteusmirabilis Fifty four. (34.6%)of Staphylococcus aureus were sensitive to gentamicin, fifty two (33.3%) to ciprofloxacin and 42 (26.9%)% to both ciprofloxacin and gentarnicin. Among the Pseudomonas aeruginosa isolates 40 (25.6%) were sensitive to gentarnicin, 27(17.3%) to ciprofloxacin and 22 (14.1%) to both ciprofloxacin and gentarnicin. Out of 156 patients 91(58.3%) had isolates which were sensitive to ciprofloxacin and 62(39.7%) were resistant to it. One hundred fourteen patients (73.1%)had isolates which were sensitive to gentamicin whereas 33(21.2%) were resistant. Similarly 35 isolates (22.4%) were sensitive to ulphamethoxazole/trimethoprim whereas 66(42.3%) were resistant. Among Proteus mirabilis isolates 12 were sensitive to gentamicin, 11 were sensitive to ciprofloxacin and 11 were sensitive to both ciprofloxacin and gentamicin. Conclusion: Ciprofoxacin ear drops can be recommended to be given empirically in children with chronic discharging ears. The initial therapy can be modified and appropriate therapy started if the result of the culture and sensitivity report shows the isolate to be resistant to the antibiotic started empirically.

Остър серозен отит - лечение и усложнения

Otitis media is the most common diagnosis in children, affecting two thirds of all children by the age of two years. Сhildren with persistent OME have significant hearing loss and structural abnormalities of the eardrum or middle ear. Tympanostomy tubes are an important tool in the treatment of chronic otitis media in children. Successful management requires the use of appropriate indications and the proper selection of tube type. Long term complications are following tympanostomy tube insersion.

Surgical Outcomes In Children With Chronic Otitis Media

We reviewed our surgical techniques and outcomes of children with chronic otitis media (COM) who had underwent surgery. The surgical outcomes and techniques of 51 ear of 49 patients were analyzed retrospectively in the totally of 89 children, aged between 8 to 16 and underwent surgery for COM. On ear examination, 16 children had perforation, 14 children had polyp, 13 children had cholesteatoma. Tympanoplasty was performed in 43% (22 ears), tympanoplasty with mastoidectomy was performed in 56% (29 ears). The canal-wall up mastoidectomy (CWUM) was performed in 25% (13 ears), and canal-wall-down mastoidectomy (CWDM) in the remaining 31% (16 ears). Graft take rate was 76.84 % and hearing gain average was 10.2 dB. In the early period , recurrent and residual diseases are more frequently in the CWUM group than in the CWDM group. In the CWDM group, the mastoid cavity problems occurred more frequently than in the CWUM group. 14 children had polyp, 12 children had cholesteatoma and one child had Langerhans cell histiocytosis (LCH) on hystopathological examination in postoperative period. Not only the hearing loss was lower in children in preoperative period, but also the hearing gain was lower in chidren in postoperative period. The surgical outcomes of tympanoplasty with or without mastoidectomy in children are successful as the results of adults. We should not avoid to perform CWDM for the risks of recurrent and residual disease in children. LCH should be kept in mind for progressive COM in children.

Tympanoplasty, with or without mastoidectomy, is highly effective for treatment of chronic otitis media in children

Conclusion. The overall success rate of tympanoplasty, with or without mastoidectomy, in the treatment of chronic pediatric otitis media, was high and did not depend on patient age, the status of the contralateral ear, the inclusion or absence of surgical mastoidectomy, or the method of mastoidectomy (when this procedure was employed). Tympanoplasty may be expected to improve hearing in cases of chronic otitis media accompanied by perforation, but not in cases of cholesteatoma. Objectives. This study analyzed the clinical features of pediatric patents with chronic otitis media undergoing tympanoplasty, with or without mastoidectomy. Follow-up data were examined to determine the effectiveness of these procedures on the course of the patients' conditions. Subjects and methods. We retrospectively reviewed the medical records of 111 children (a total of 119 ears were treated from this group) aged 15 years or less, who underwent surgical treatment for pediatric chronic otitis media. The subjects were composed of children suffering from chronic otitis media with perforation (COMP) (63 ears), and patients presenting chronic otitis media with cholesteatoma (COMC) (56 ears). The mean follow-up period was 40 months. Preoperative and postoperative (at the final follow-up) audiometry and otologic examinations were performed. Data from postoperative otologic examinations and audiometric measurements were accompanied by examination of both the operative ear and the contralateral ear. Surgical success was defined as the presence of an intact tympanic membrane without perforation, retraction, or evidence of recurring cholesteatoma. Results. The mean ages at the time of operation were 11.1±3.3 years for COMP patients and 9.7±3.0 years for COMC subjects. Surgical treatments for pediatric COMP and COMC patients included tympanoplasty only in 45 ears (38% of ears treated) and tympanoplasty with mastoidectomy in 74 ears (62%). Most of patients with COMC received tympanoplasty with mastoidectomy. No patient with COMP underwent canal wall-down mastoidectomy. Mean pre-operative air-bone gaps (ABGs) and post-operative ABGs were compared. Significant improvement in ABG was evident in the COMP group, but not in the COMC group. Surgical success rates at follow-up after 6 months and 12 months were 97% and 95%, respectively, in the COMP group. In the COMC patients, surgical success rates at follow-up after 6 months and 12 months were 98% and 93%. There were no significant relationships between surgical success rate and patient age, the status of the contralateral ear, or the extent of surgery.

Surgical treatment of chronic otitis media in children

Surgical treatment of chronic otitis media in children

Short ribosomal prophylaxis in the prevention of clinical recurrences of chronic otitis media in children

The aim of this study was to compare the efficacy and the safety of a short oral ribosomal immunotherapy (Immucytal) in the prevention of chronic otitis media in children. Seventy-two patients were enrolled in this study, 41 males and 31 females, aged between 6 and 14 years, with an history of recurrent otitis media. Patients were randomised to receive Immucytal (group A) or placebo (group B) according to the following protocol: one tablet daily in the morning 8 days per month for three consecutive months. Immucytal and placebo were identical in shape and size, in order to maintain double-blind conditions. The efficacy parameters were (evaluated before, at the end and 6 months after the beginning of the therapy): clinical score; changes in immunological parameters; patient’s parents assessment of symptoms on a scale from 0 (much worse) to 4 (much improved) and hearing tests. Patients of group A, had an improvement of clinical items measured, serum concentrations of immunoglobulins, subjective patient’s parents assessment of symptoms and hearing tests. For all evaluations, a significant difference between treatment groups was found. Using this dosage and posology (shorter than others) the beneficial effects of Immucytal were maintained until the end of the 6-month study period.

Incidence and outcome of middle ear disease in cleft lip and/or cleft palate

Objective: Otitis media with effusion is known to be very common among children with cleft palate, however, less is known regarding the natural history and outcome in this group. The purpose of the present study was to examine the incidence, natural history, treatment, and outcome of middle ear disease in children with clefts. Methods: A questionnaire was sent to the parents of all children registered on the cleft lip and palate database at our institution. The medical records of all respondents were also reviewed. Statistical analysis of the results was performed using Fisher's exact test in contingency tables and binary logistic regression analyses, where appropriate. Results: 397 fully completed questionnaires were returned. Ear disease was much more common in children with cleft palate, or cleft lip and palate, than in children with cleft lip. Among children with cleft palate, ear problems (infections and/or hearing loss) were most prevalent in the 4–6-year-old age group. However, ear problems persisted at a substantial level for many years after this; only after the age of 12 years did problems appear to settle. The incidence of below normal current hearing and of surgery for chronic otitis media was significantly related to history of ear infections ( P=0.000 and 0.000, respectively), and to increased number of ventilation tube insertions ( P=0.000 and 0.000, respectively). Conclusions: Middle ear disease is common in children with cleft palate, and, unlike the case for children without clefts, has a prolonged recovery, and a substantial incidence of late sequelae. The higher incidence of below normal hearing and surgery for chronic otitis media in children undergoing a greater number of ventilation tube insertions, although most likely reflecting an increased underlying severity of otitis media in these children, also underlines the lack of long-term benefits of ventilation tubes in this group.