Chronic Serous Otitis Media Research Articles

A RARE CASE REPORT OF MOYAMOYA DISEASE WITH OCULAR ISCHAEMIC SYNDROME IN A 34 YEARS OLD INDIAN WOMAN.

A case of 34 years old Indian female with ocular ischaemic syndrome in both eyes with Moyamoya Disease reported as unusual presentation with its clinical diagnosis management and result. Came with a complain of Giddiness headache which were on and off for 4-6 months and did not relieve on routine medical therapy. The patient was investigated with CT Angiogram, diagnosed as Moyamoya disease and HRCT (Highresolution computed tomography) temporal bone and diagnosed as a chronic serous otitis media. Ocular ischemic syndrome is extremely rare in young patient with moyamoya disease may be particularly susceptible to the development of ocular ischemia due to the associated carotid occlusion. This rare instance of young female ocular ischemia in conjunction with moyamoya disease demonstrates the serious ocular and systemic sequelae of occlusive vascular disease.

Ear Abnormalities Among Children with Fetal Alcohol Spectrum Disorder: A Systematic Review and Meta-Analysis

To systematically review and conduct meta-analysis on studies that report the type and prevalence of functional and structural ear abnormalities among children with prenatal alcohol exposure and/or fetal alcohol spectrum disorder (FASD). MEDLINE, PubMed, Embase, Web of Science, PsycINFO, ERIC, CINAHL, and Maternity and Infant Care were searched from 1806 through March 2021. Reference lists of relevant articles were manually searched. Studies reporting on functional and/or structural ear abnormalities among children (<18years) with prenatal alcohol exposure and/or FASD were eligible. Data extraction and quality assessment were performed by one reviewer and independently checked by another. A random effects meta-analysis was conducted. A total of 31 studies met the inclusion criteria and 25 were included in the meta-analyses, representing a total of 843 children with prenatal alcohol exposure and 1653 children with FASD. Functional ear abnormalities with the highest pooled prevalence were chronic serous otitis media (88.5%; 95% CI, 70.4%-99.3%), abnormal auditory filtering (80.1%; 95% CI, 76.5%-84.3%), and unspecified conductive hearing loss (68.0%; 95% CI, 51.9%-82.2%). Structural ear abnormalities with the highest pooled prevalence were microtia (42.9%; 95% CI, 26.8%-59.7%), railroad track ear (16.8%; 95% CI, 8.1%-27.7%), and misplaced ear (12.3%; 95% CI, 7.6%-17.9%). Our findings highlight the importance of examining the ears during assessment for FASD, and the need for public health messaging regarding the harms of prenatal alcohol exposure.

The role of thymic stromal lymphopoietin in the development of chronic otitis media with effusion.

To investigate the effect of thymic stromal lymphopoietin on the development of chronic otitis media with effusion MATERIALS AND METHODS: This study was conducted on 40 patients who had adenoidectomy operation. The objects were divided into two groups. Group 1; adenoidectomy with chronic serous otitis media, group 2; adenoidectomy without chronic serous otitis media. Serum and tissue thymic stromal lymphopoietin levels were measured by ELISA. Serum and tissue TLSP levels, mast cell count, adenoid size were compared between the groups. Twenty-four (60%) of patients were female and 16 (40%) were male. Twenty patients (55%) had adenoid hypertrophy with chronic serous otitis media, and 18 (45%) had adenoid hypertrophy without chronic serous otitis media. The mean age of the patients was 6.21 ± 2.31years. The mean mast cell count was significantly higher in group 1 compared with group 2 (p = 0.017). The mean tissue thymic stromal lymphopoietin measurement was also significantly higher in group 1 than group 2 (p = 0.023). However, there was no significant difference in regards to serum levels between the groups (p = 0.480). The number of mast cells as well as thymic stromal lymphopoietin levels in the adenoids of children was significantly high in the chronic serous otitis media patients. The release of thymic stromal lymphopoietin from the adenoid tissue plays a role in initiating and maintaining a local inflammatory reaction in the eustachian tube that may lead eventually to middle ear effusion in non-atopic patients.

Оториноларингологична находка при пациенти с бета-таласемия

ENT finding by patients with P- thalassemia; Polina Nencheva, Petar Rouev, Mirela Rangelova, Denka Stoyanova, Dimitar Mihailov Introduction: The thalassemic syndromes are heterogeneous group of diseases. By this kind of haematological disorders the synthesis of p-polypeptid chains is decreased or missing. Except the thalassemic face and other symptoms of the P-thalassemia there are also some kinds of otorhinolaringological symptoms. Objective: The aim of this study is to determine the ENT status by patients with P-thalassemia under regular haemotransfusions and chelating therapy. Study design: Multicentre prospective research - ENT Clinic, Paediatric Clinic, Therapeutic Clinic, Medicine Faculty, Stara Zagora; 6-th Therapeutic Department, District Hospital "Prof. S. Kirkovich", Stara Zagora; Sector of Thalassemia, Paediatric Hospital, Sofia; Sector of Thalassemia, National Centre of Transfusiology, Sofia. Material and Methods: 63 patients with P-thalassemia under regular haemotransfusions and chelating therapy were examinated; ENT examination and audiometry. Results: I patient with chronic serous otitis media and hearing loss; 3 patients with hypertrophy of the pharyngeal tonsils; 16 patients with hypertrophy of the tonsils; 5 patients with septum deviation; 60 patients of the patients with hypohromic nasal mucosa.

Myringotomy with versus without grommet tube insertion in chronic serous otitis media with effusion : Southern Oman experience

Objective: Otitis media with effusion (OME) can lead to hearing loss and delayed speech. Adenoidectomy with myringotomy and ventilation tube insertion are used in the management of OME. This study aimed to compare outcomes of myringotomy with versus without grommet tube insertion in children with OME in Southern Oman.Patients and Methods: A prospective randomized study of 74 patients with serous OME, divided into 2 equal groups, was conducted over 2 years. Group A patients underwent adenoidectomy with myringotomy and grommet tube insertion, while only adenoidectomy and myringotomy were performed on patients in group B. Average age, gender, preoperative hearing loss and postoperative hearing gain, tympanometry 9 months after the operation, and incidence of otorrhoea and myringosclerosis were compared.Results: All the parameters showed a nonsignificant statistical difference. Otorrhoea and myringosclerosis incidence was higher in group A, with a significant statistical difference.Conclusion: Myringotomy alone showed favourable results with fewer complications in treatment of serous OME

Same‐Day Evaluation and Surgery for Otitis Media and Tympanostomy Tube Placement

To determine the feasibility of providing streamlined same-day evaluation and surgical management of children with recurrent otitis media or chronic serous otitis media who meet criteria for tympanostomy tube (TT) placement. Retrospective matched case series. Tertiary care children's hospital. A comparison group (age, sex, insurance product) was utilized to determine if the same-day process decreased facility time and surgical time for the care episode. A parent satisfaction survey was administered. Thirty children, with a median age of 16 months (range, 12-22 months), participated in the same-day surgery process for TT. Twenty-one patients (70.0%) were male, and these patients were matched to a comparison group (similar age, sex, and insurance product) having non-same-day (routine) TT placement. The same-day patients spent significantly less time in clinic for the preoperative physician visit (average, 15 minutes) when compared with the non-same-day patients (average, 51.5 minutes; P < .001). The operative experience for the same-day patients was similar to the non-same-day patients (average, 145 vs 137 minutes, respectively; P = .35), but the overall experience was significantly shorter for the same-day patients (average, 151 vs 196 minutes for comparisons; P < .001). All parents surveyed in the same-day group were satisfied with the efficiency of the experience. The same-day surgery process for management of children who meet the criteria for TT placement is a model of improved efficiency of care for children who suffer from otitis media.

Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis

Fetal alcohol spectrum disorder (FASD) is related to many comorbidities because of the permanent effects of prenatal alcohol exposure on the fetus. We aimed to identify the comorbid conditions that co-occur in individuals with FASD and estimate the pooled prevalence of comorbid conditions occurring in individuals with fetal alcohol syndrome (FAS). We did a systematic literature search of studies reporting on the comorbidity and cause of death in individuals with FASD using multiple electronic bibliographic databases, searching for studies published up to July, 2012. We included original research published in a peer-reviewed journal in the English language. We used the following criteria for determining study quality: use of an established FASD diagnostic guideline, study setting, method of data collection, and sample size. All comorbid disease conditions were coded according to the International Classification of Diseases, tenth revision (ICD-10). To estimate the pooled prevalence of comorbid conditions found to co-occur in individuals with FAS, we did meta-analyses assuming a random-effects model. Of 5068 studies found, 127 met eligibility criteria for data extraction. From those studies, we identified 428 comorbid conditions co-occurring in individuals with FASD, spanning across 18 of 22 chapters of the ICD-10. The most prevalent disease conditions were within the sections of congenital malformations, deformities, and chromosomal abnormalities, and mental and behavioural disorders. 33 studies reported data for frequency in a total of 1728 participants with FAS. The five comorbid conditions with the highest pooled prevalence (between 50% and 91%) included abnormal results of function studies of peripheral nervous system and special senses, conduct disorder, receptive language disorder, chronic serous otitis media, and expressive language disorder. The high prevalence of comorbid conditions in individuals with FASD highlights the importance of assessing prenatal alcohol exposure as a substantial clinical risk factor for comorbidity. The harmful effects of alcohol on a developing fetus represent many cases of preventable disability, and thus, alcohol use during pregnancy should be recognised as a public health problem globally. Public Health Agency of Canada.

Prevalence and characteristics of gastroesophageal reflux in children with otitis media in Isfahan, Iran.

Background:Otitis media (OM) is the most common cause of childhood hearing loss and reason to visit the pediatrician. Furthermore, gastroesophageal reflux (GER) has been associated with a variety of upper aerodigestive tract symptoms or diseases, such as sinusitis, laryngitis, and otits. The objective of the present study was to determine the frequency of GER in children, aged 3 months to 7 years, with OM.Materials and Methods:This retrospective case-control study was conducted on 50 children with OM and 50 healthy children. Presence of GER as the main variables was diagnosed by clinical examination in all studied children using the questionnaires with 2 age-stratified versions of the pediatric GER disease symptoms for children 2 years old and younger, and children 3–7 years old.Results:The prevalence of GER in children with OM and controls was 58% and 22% respectively (P = 0.0005). The frequency of irritability, congestion, and feeding complex in children with OM were significantly more than in control groups. Among children with recurrent acute OM (AOM), and chronic serous OM (CSOM) the prevalence of GER was significantly more than controls (61.1%, vs. 22% for AOM, P = 0.004, and 72.7% vs. 22%, P= 0.003). In children with AOM, regurgitation, vomiting, irritability and congestion were significantly higher than controls included. In children with CSOM, regurgitation, vomiting, and congestion were significantly higher than controls.Conclusion:Results show a significant association between GER and OM, AOM and CSOM in children with OM compares to healthy children. This shows that looking for GER in children with OM may help improving treatments outcomes.

Triune Tube Outcomes

Objectives: (1) Determine complication rates of Triune tubes. (2) Compare complication rates of the Triune tubes with rates cited previously in the literature. (3) Compare complication rates of Triune tubes with T-tubes and grommet tubes. Methods: A retrospective chart review was conducted on myringotomy tubes placed from 2002 to 2011 by a single surgeon in a university hospital setting. Medical records were reviewed for the following data: type of myringotomy tube placed, duration of time the tube remained situated in the tympanic membrane, complications related to the tube placement (persistent tympanic membrane perforation, tube obstruction, granuloma formation, or reoperation), and procedures performed to remediate any encountered complications. Results: A total of 1216 tubes were placed in 565 patients (250 female). Average patient age was 6.8 years (range, 3.7 months to 95.6 years). The primary indication for myringotomy with tube placement was chronic serous otitis media (n = 1062, 87.2%). Other indications included recurrent acute otitis media (n = 12, 1.0%), removal and replacement of nonfunctioning tubes (n = 132, 10.8%), and barotrauma (n = 11, 0.9%). The indication was not specified for 1 tube (0.1%). During the study period, 459 (37.7%) of the tubes placed were Triune, 650 (53.5%) were T-tubes, 88 (7.2%) were grommets, and 19 (1.6%) were not specified. Overall, complications occurred in 96 (20.9%) Triune tubes, 134 (20.6%) T-tubes, and 9 (10.2%) grommet tubes. However, these differences were not statistically significant (chi-square 4.797; P = .187). Conclusions: Triune tubes are safe when myringotomy tube placement is indicated. Complication rates with Triune tubes are comparable with both grommet tubes and T-tubes.

Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients

The aim of this study was to report the results in a consecutive series of patients who had undergone an endoscopic endonasal approach (EEA) for drainage of a petrous apex cholesterol granuloma (CG). Seventeen cases with a confirmed diagnosis of petrous apex CG were identified from a database of more than 1600 patients who had undergone an EEA to skull base lesions at the authors' institution in the period from 1998 to 2011. Clinical outcomes were reviewed and compared with those in previous studies of open approaches. Nine patients underwent a transclival approach and 8 patients underwent a combined transclival and infrapetrous approach. A Silastic stent was used in 11 patients (65%), a miniflap in 4 (24%), and a simple marsupialization of the cyst in 3 (18%). All symptomatic patients had partial or complete improvement of their symptoms postoperatively and at the follow-up (mean follow-up 20 months, range 3-67 months). Complications developed in 3 patients (18%) including epistaxis, chronic serous otitis media, eye dryness, and a transient sixth cranial nerve palsy. Two patients (12%) had a symptomatic recurrence of the cyst requiring repeat endoscopic endonasal drainage. There were no instances of internal carotid artery injuries, CSF leaks, or new hearing loss. The mean postoperative hospital stay was 2 days (range 0.7-4.6 days). These results were comparable with those in previous studies of open approaches to petrous apex CGs. There was a strong correlation between the size of the cyst and the type of approach chosen (Rpb [point biserial correlation coefficient] = +0.67, p = 0.003359) and a very strong correlation between the degree of medial extension (defined by the V-angle) and the choice of approach (Rpb = +0.81, p < 0.0001). Based on these observations, the authors developed an algorithm for guiding the choice of the most appropriate route of drainage. The EEA is a safe and effective alternative to traditional open approaches to petrous apex CGs.

Food Allergy 2011: State of the Science

Program Description: Food allergies are difficult for the patient to understand and challenging for the clinician to treat. The CDC has recently reported that the prevalence of reported food allergies increased 18% over the past 10 years in children under 18. In addition, children with food allergies are 2 to 4 times more likely to suffer from asthma and other allergies. Allergic reactions to foods can produce life-threatening anaphylaxis, but have also been associated with other head and neck problems such as Meniere’s disease, migraine headache, chronic rhinitis, and chronic serous otitis media. There is a wide range of symptoms attributed to food allergies, such as nausea, cramping, diarrhea, dermatitis, urticaria, asthma, and joint pain. However, despite the fact that otolaryngologists see a large number of patients with food allergies, diagnosis and treatment strategies still remain controversial. The first part of the miniseminar will focus on the scientific basis of food allergies by taking a critical look at the latest scientific evidence available in the literature. A basic review of the relevant immunology will be provided along with a comparison of IgE-mediated food reactions versus non-IgE-mediated food reactions. The impact that food preparation and food spoiling has on allergic pathways will also be examined. In the second part of the miniseminar, the manifestations of food allergies will be discussed. The recent literature concerning the rise in prevalence of food allergies will be analyzed and the impact of food allergies on the head and neck and airway will be reviewed. We will examine the role of oral tolerance in human evolution and the relationship of failure to achieve oral tolerance on the health of the individual. The next section will be devoted to the current diagnostic modalities available for the diagnosis of food allergies. The use of structured patient-completed surveys to maximize thoroughness and efficiency will be discussed. We will compare the performance and accuracy of the different methods of food allergy testing, including skin and in vitro methods vs. the traditional gold standard of double-blind, placebo-controlled food challenge. The final part of the presentation will be devoted to treatment strategies for food allergies. Traditional methods, such as elimination diets and recognizing emergencies will be reviewed, as well as more cutting-edge techniques, such as oral and sublingual desensitization and genetically modified foods, will also be discussed. Audio-visual materials will be used to help present this information to the audience. Educational Objectives: 1) Analyze the literature comparing different methods for diagnosing food allergy. 2) Evaluate the scientific basis of IgE and non-IgE mediated food allergy. 3) Understand the currently available treatments for food allergy as well as future directions.

The Otologic Microbiome&lt;subtitle&gt;A Study of the Bacterial Microbiota in a Pediatric Patient With Chronic Serous Otitis Media Using &lt;emph type="ital"&gt;16SrRNA&lt;/emph&gt; Gene-Based Pyrosequencing&lt;/subtitle&gt;

To characterize bacterial microbiota in middle ear, adenoid, and tonsil specimens using 16SrRNA gene-based pyrosequencing analysis. Cross-sectional study of bacterial microbiota in middle ear, adenoid, and tonsil specimens from a pediatric patient with chronic serous otitis media. Middle ear, adenoid, and tonsil specimens from a pediatric patient were collected and underwent cell lysis and DNA isolation. Pyrosequencing was performed on the 454 Life Sciences GS FLX platform (Roche Diagnostics Corp, Branford, Connecticut). Pyrosequencing data were processed, quality-checked, and taxonomically classified to generate an abundance-based matrix. Ecological analyses were performed. Academic, tertiary referral center. Comparative microbiome analysis. We detected a total of 17 unique bacterial families, with 9, 9, and 12 bacterial families from the middle ear, tonsil, and adenoid specimens, respectively. Pseudomonadaceae dominated the middle ear microbiota at 82.7% relative abundance, whereas Streptococcaceae dominated the tonsil microbiota at 69.2%. Multiple bacteria, including Pseudomonadaceae, Streptococcaceae, Fusobacteriaceae, and Pasteurellaceae, dominated the adenoid microbiota. Overlap between the middle ear and the tonsil microbiota was minimal. In contrast, the adenoid microbiota encompassed bacteria detected from middle ear and tonsil. Bacterial community analysis using pyrosequencing analysis revealed diverse, previously unknown bacterial communities in a set of pediatric middle ear, tonsil, and adenoid specimens. Our findings suggest that the adenoid may be a source site for both the middle ear and tonsil microbiota. An ecological framework is appropriate in comparative analysis of microbiota from nonsterile body sites.

Cleft Palate

Cleft Palate

Management of otitis media

Although ear care is not as high on the health agenda as asthma or diabetes, ear infections can be just as dangerous. The World Health Organization (WHO) attributes 51 000 deaths each year to otitis media in children under 5 years. In terms of disability-adjusted life years, otitis media compares with meningitis, polio and trachoma (WHO, 1993). Although the aetiology of acute otitis media is similar in both developed and developing countries, the complication rates of chronic serous otitis media and mastoiditis in developing countries are comparable to those in Europe and the USA in the pre-antibiotic 1930s and 1940s (Crosby et al, 2004). Treatment of otitis media can be confusing and it is important to have clear guidelines in order to decide which children should be treated and for which children a watchful waiting approach may be preferred.

Assessment of childhood allergy for the primary care practitioner

To update the primary care practitioner on the assessment of common childhood allergic illnesses. Relevant scientific literature and published clinical practice guidelines. Atopic children often develop symptoms that occur in a predictable progression from atopic dermatitis to gastrointestinal disturbances, chronic serous otitis media, rhinitis, and asthma. Evaluation of allergic symptoms should be based on their chronicity, family history of atopy, and knowledge of how the information will change patient management. Both skin and blood testing are accurate and useful tools in establishing a diagnosis of allergic disease. Management includes avoidance/environmental control, medications, and, when necessary, referral to specialists. As the incidence of allergic disease increases, the human and monetary costs associated with allergies place a major burden on our healthcare system. Early identification of allergies and appropriate intervention are important to prevent progression to more significant disease. The use of objective diagnostic testing aids in implementing appropriate evidence-based medical management.

Death following tonsillectomy in a child with Williams syndrome

Williams syndrome (WS) is an uncommon genetic syndrome due to a deletion of several genes on chromosome 7. The syndrome is associated with dysmorphic facies, neurological manifestations, idiopathic hypercalcemia, and cardiac abnormalities, particularly supravalvular aortic stenosis (SVAS). Children with Williams syndrome may have chronic serous otitis media and/or obstructive sleep apnea. Hyperacusis is also commonly seen in these children. We report a case of sudden death at the time of tonsillectomy/adenoidectomy and bilateral tympanostomy tube placement in a child with Williams syndrome. All children with Williams syndrome should have a thorough cardiac evaluation before undergoing general anesthesia for any otolaryngologic procedure.

Phenol as a topical anaesthetic agent for myringotomy

Sir, Myringotomy and grommet insertion is a commonly performed procedure for the treatment of chronic serous otitis media. Although this procedure is most often performed under general anaesthetic ...

Anesthetic management of a patient with asymptomatic ventricular tachycardia

There are many causes of ventricular arrhythmias in pediatric patients, even those with structurally normal hearts. However, in young patients with 'normal' hearts, sustained ventricular arrhythmias are relatively rare. The primary concern of the physician is to identify which patients have benign ventricular arrhythmia patterns and which are at risk for sudden cardiac death. Even in asymptomatic patients, the choice of anesthetic agents may be important to minimize precipitation of episodes of tachyarrhythmias. This clinical report describes the anesthetic considerations for an asymptomatic child with a history of sustained premature ventricular contractions, ventricular tachycardia, and bigeminy. This child had chronic serous otitis media requiring repeat tympanostomy and tube replacement. This case report outlines the initial cancellation of anesthesia because of sustained arrhythmias, and subsequent conduct of the anesthesia for the case, as well as the considerations in the selection of the drugs when a child presents with significant ventricular arrhythmia.

The role of laser assisted tympanostomy (LAT) in treating allergic children with chronic serous otitis media

Objectives: To assess various prognostic factors influencing the outcome in paediatric patients with serous otitis media, who have undergone laser assisted tympanostomy without ventilation tube placement. Emphasis is given to children with allergies who underwent the procedure. Method: Laser assisted tympanostomy was performed on a total of 130 ears (92 individuals) with chronic otitis media with effusion. To determine the quality of patient outcome, the following parameters were evaluated: external auditory canal anatomy, type of anaesthesia used, tympanic membrane and middle ear fluid characteristics, myringotomy size, a history of allergies and the laser device parameters. Results: Multivariable statistical analysis demonstrated that the presence of allergies in children with chronic serous otitis media is significantly correlated with a poor outcome ( P<0.0047). Moreover, the presence of a thick tympanic membrane and/or high viscosity (glue) fluid in the middle ear cavity can also independently influence patient outcome ( P<0.025). Simultaneous adenoidectomy and/or tonsillectomy, type of anaesthesia (general versus local), external canal anatomy (wide or narrow) and sex, were not statistically important prognostic factors. The type of anaesthesia used, myringotomy size and the laser device parameters were not found to be associated with patient outcome. Conclusion: A history of allergies, the presence of a thick tympanic membrane and/or high viscosity fluid in the middle ear cavity are all contraindications for laser assisted tympanostomy without tympanostomy tubes, in children who suffer from chronic serous otitis media. The selection criteria for this procedure in the paediatric population are addressed in detail.

Serous otitis media (S.O.M.). A bacteriological study of the ear canal and the middle ear

A bacteriological study of the middle-ear effusions and the ear canals in children with chronic serous otitis media (S.O.M.) was performed. Sixty-eight children (127 ears) were investigated. From this study it appeared that cleansing of the ear canal with 0.5% chlorhexidine in 70% ethanol for 30 s is partially effective; micro-organisms (diptheroids, Staphylococcus epidermidis) could still be isolated in 29%. Cleansing of the ear canal decreases the incidence of middle-ear fluid contamination by nonpathogenic ear canal organisms (diptheroids, Staphylococcus epidermidis, Aerococcus), but after cleansing, ‘non-pathogenic’ micro-organisms could still be isolated in 33% of the effusions (diptheroids, Staphylococcus epidermidis). From 12% of the middle-ear effusions pathogenic micro-organisms (Hemophilus influenzae, Staphylococcus pneumoniae) were isolated; cleansing of the ear canal did not influence this percentage. Anaerobics were not isolated from the middle-ear effusions.