Development Of Middle Ear Effusion Research Articles

Post-radiation middle ear effusion in NPC patients: Analysis of patient, tumour, and radiation factors.

The purpose of this study was to investigate whether patient, tumour and radiation therapy factors are associated with development of middle ear effusion (MEE) in nasopharyngeal carcinoma (NPC) patients. A retrospective review of NPC patients treated between January 2000 and June 2018 at Rabin Medical Center. Patient factors, tumour factors, radiation doses, and radiation fields were collected and outlined if needed (middle ear, eustachian tube [ET], tensor veli palatini [TVP], and levator palatini [LVP] muscles), then analysed and compared between patients with MEE and those without and between sides in patients with unilateral MEE. Seventy-three patients were enrolled. Most were males (71.2%) with advanced-stage diseases (78%). At the time of diagnosis 14 patients (19.2%) presented with MEE. Following radiation, 18 patients, with no evidence of MEE at presentation, developed MEE. Tumour stage, histology, and laterality were not associated with development of MEE. Comparison of mean radiation field dosages including-gross target volume, clinical target volume, and patient target volume showed no association with post-radiation MEE. In addition, no difference was found in the radiation doses to the middle ear, ET or the LVP nor the TVP between ears with and without MEE. Post-irradiation MEE remains a common adverse effect in NPC patients. Surprisingly, tumour stage, tumour laterality, and histology were not associated with MEE. Similar findings were observed for total radiation doses and specific doses to the middle ear, ET, and ET muscles.

Effect of adenoidal enlargement on development of otitis media with effusion

Background Adenoid hypertrophy has a major effect on development of middle ear effusion not due to the large volume but through combination of factors including local immune regulation, biofilm, and immunoglobulin E allergic reaction. Aim To assess the correlation between adenoid tissue volume and development of middle ear effusion. Patients and methods This was a sequential analysis study including a sample size of 195 patients from 4 to 12 years. They were diagnosed with adenoid hypertrophy, confirmed by flexible nasopharyngeal endoscopy (FNE) and lateral neck radiographs. They were evaluated by tympanometry to assess otitis media with effusion. Results We found that 59 (29.2%) patients had FNE grade 1, 68 (35.4%) patients had FNE grade 2, 68 (35.4%) patients had FNE grade 3, and no patients had grade 4. A total of 101 (52.6%) patients had a tympanogram type A and 94 (47.4%) patients had a tympanogram type B. There was no statistically significant correlation between tympanogram groups in relation to the FNE (P=0.762). Conclusion We suggested that there was no valuable correlation between change in size or volume of adenoid tissue and development of middle ear effusion.

Effect of head and neck radiotherapy on the Eustachian tube functions

BackgroundNowadays, radiotherapy is widely used in management of many types of tumors including head and neck tumors; in this study, we concerned with its reverse effects on the Eustachian tube functions and if this effect is temporary or permanent.ResultsThe whole (30) patients have tympanogram at both ears before starting radiotherapy; all patients (100%) were normal. In the immediate post radiotherapy tympanogram at the contralateral side, 6.7% of patients had effusion, and 20% had Eustachian tube dysfunction, while at the ipsilateral side, 20% of patients had effusion, and 33.3% had ET dysfunction. In the follow-up tympanogram 12 weeks post radiotherapy, we found that 6.7% of patients had effusion, and (10%) had Eustachian tube dysfunction at the contralateral side, while 6.7% of patients had effusion, and only 20% had Eustachian tube dysfunction at the ipsilateral side.ConclusionFrom this study, we concluded that patients with head and neck tumors treated by radiotherapy (apart from the nasopharynx) have a high incidence of affection of Eustachian tube function namely middle ear effusion and Eustachian tube dysfunction. The possibility for development of middle ear effusion and Eustachian tube dysfunction increases with increased tumor stage. Eustachian tube functions immediately post radiotherapy and after 12 weeks of the end of radiotherapy was affected by different effects according to the tumor site. The Eustachian tube functions significantly improved within 12 weeks after the last dose of radiotherapy, and we recommend audiological follow-up for patients with head and neck tumors treated with radiotherapy.

Evaluation of Prevalence and Factors Affecting the Development of Middle Ear Effusion in Patients with Prolonged Intubation in Intensive Care Unit

Objective: Monitorization of patients in intensive care units requires a multidisciplinary approach. As cooperation with unconscious or intubated patients is often not possible, some conditions may be overlooked. The aim of this study is to reveal the incidence and factors affecting otitis media with effusion in ICU patients intubated longer than 7 days. Methods: Twenty patients hospitalized in the intensive care unit of the Gaziosmanpasa Taksim Training and Research Hospital from March to December 2014 were included in the study. The Gaziosmanpasa Taksim Training and Research Hospital Ethics Committee approved the study according to the Declaration of Helsinki and Good Clinical Practices guidelines. All of the patients included in the study were aged ≥18 years. Patients intubated because of traffic accidents or trauma, patients with a history of chronic otitis media or ear, nose, and throat operations, patients with head and neck tumors, and patients with tympanic membrane perforation, external auditory canal pathology, nasopharyngeal mass, and chronic sinusitis as well as patients with a pathology leading to nasal obstruction, such as nasal polyposis or severe septal deviation, were excluded. After a detailed history by patients’ relatives, an otoscopic examination, nasal examination, tympanometry, and acoustic reflex measurements were performed. Ear examination was performed using a conventional portable otoscope. Results: Among 20 patients, 12 had bilateral effusion (24 out of 40 ears, 60%). In two patients, a type C tympanogram was obtained (four out of 40 ears, 10%), and the remaining 12 ears of six patients were normal (30%). When intubation time is evaluated, among 13 patients intubated longer than 14 days, 11 had effusion (84%). A significant correlation was found between the duration of intubation and effusion development. Assessing the state of consciousness, 11 of 12 unconscious patients (91%) were found to have effusion. There was a significant correlation between effusion development and state of consciousness. Conclusion: In unconscious patients intubated longer than 14 days, the risk of having middle ear effusion is demonstrated to be higher. Consequently, in the periodic follow-up of intensive care patients with prolonged intubation, a routine otoscopic examination has to be considered. (JAREM 2015; 5: 64-7)

Re-evaluation of CO 2 laser myringotomy for managing children with persistent acute otitis media

Background This study aimed to re-evaluate the utility of CO 2 laser myringotomy in children with persistent acute otitis media (PAOM). Methods From September 2002 to April 2008, 40 children with PAOM received CO 2 laser myringotomy. PAOM was defined as continuing symptoms and signs after systemic antibiotic treatment. Before laser myringotomy, the eardrums were checked under videotelescopy, pure tone audiometry or behavior audiometry and tympanometry. Middle ear effusions were collected using our own designed bottle culture device after laser myringotomy. The patients were followed up at outpatient clinics for 3 months. Cultured middle ear pathogens, healing time of the eardrums, hospital course (for admitted patients), and the development of middle ear effusions were recorded. Results Forty children with 53 ears with PAOM were enrolled. Eight patients (20%) had bilateral disease and underwent bilateral laser myringotomy. The overall culture rate was 28.3%, and Streptococcus pneumoniae was the most common pathogen. Eight patients (20%) were admitted for intravenous antibiotics. The average eardrum healing time was 22 days in those with positive cultures, and 16.4 days in those with negative cultures ( p = 0.125). All eardrums healed in 1 month. The resolution rate was 62.5% at 1 month. Patients with bilateral PAOM were prone to have positive middle ear culture (5/8) compared with those with unilateral PAOM (8/32) ( p = 0.086). Conclusion CO 2 laser myringotomy is an applicable means of treating PAOM. S pneumoniae is the most common pathogen in PAOM. CO 2 laser myringotomy allows for the drainage and culture sampling of middle ear effusion, relieving the need of taking prolonged medication.

Antibiotic Therapy to Prevent the Development of Asymptomatic Middle Ear Effusion in Children With Acute Otitis Media

To determine predictors of the development of asymptomatic middle ear effusion (MEE) in children with acute otitis media (AOM) and to assess the effect of antibiotic therapy in preventing the development of MEE in these children. A systematic literature search was performed using PubMed, EMBASE, the Cochrane databases, and the proceedings of international otitis media symposia. A trial was selected if the allocation of participants to treatment was randomized, children aged 0 to 12 years with AOM were included, the comparison was between antibiotic therapy and placebo or no (antibiotic) treatment, and MEE at 1 month was measured. Data from 5 randomized controlled trials were included in the meta-analysis of individual patient data (1328 children aged 6 months to 12 years). We identified independent predictors of the development of asymptomatic MEE and studied whether these children benefited more from antibiotic therapy than children with a lower risk. The primary outcome was MEE (defined as a type B tympanogram) at 1 month. The overall relative risk of antibiotic therapy in preventing the development of asymptomatic MEE after 1 month was 0.9 (95% confidence interval, 0.8-1.0; P =.19). Independent predictors of the development of asymptomatic MEE were age younger than 2 years and recurrent AOM. No statistically significant interaction effects with treatment were found. Because of a marginal effect of antibiotic therapy on the development of asymptomatic MEE and the known negative effects of prescribing antibiotics, including the development of antibiotic resistance and adverse effects, we do not recommend prescribing antibiotics to prevent MEE.

Do Tympanostomy Tubes Improve Developmental Outcomes

After development of middle-ear effusion, many children have tympanostomy tubes inserted to improve hearing and possibly to improve long-term

Similar allergic inflammation in the middle ear and the upper airway: Evidence linking otitis media with effusion to the united airways concept

Otitis media with effusion (OME) is a chronic inflammatory disease of the middle ear space characterized by the accumulation of fluid. Previous investigations have suggested that the immunopathologic mechanism underlying the development of middle ear effusion in patients with allergy is largely due to the effects of T(H)2 mediators. The composition of the inflammatory substrate in the effusions of allergic otitis media is similar to the late-phase allergic response seen elsewhere in the respiratory tract, such as in asthma and in allergic rhinitis. To determine whether the middle ear compartment may be a component of the united airways in allergic disease by comparing the inflammatory profiles of the middle ear to the upper airway. Middle ear effusions, torus tubaris (Eustachian tube mucosa at the nasopharyngeal orifice), and adenoidal tissue biopsies were obtained from 45 patients undergoing simultaneous tympanostomy tube placement for OME and adenoidectomy for adenoid hypertrophy. The cellular and cytokine profiles of each site were investigated by using immunocytochemistry (elastase, CD3, major basic protein) and in situ hybridization (IL-4, IL-5, IFN-gamma mRNA). Atopic status was determined for each patient by using skin prick testing. Eleven of the 45 patients with OME (24%) were atopic. The middle ear effusions of atopic patients had significantly higher levels of eosinophils, T lymphocytes, and IL-4 mRNA + cells ( P < .01) and significantly lower levels of neutrophils and IFN-gamma mRNA + cells ( P < .01) compared with nonatopic patients. The nasopharyngeal tissue biopsies revealed similar cellular and cytokine profiles. In atopic patients with OME, the allergic inflammation occurs on both sides of the Eustachian tube, both in the middle ear and in the nasopharynx. The results of this study support the concept that the middle ear may be part of the united airway in atopic individuals.

Effect of round window membrane application of nitric oxide on hearing and nitric oxide concentration in perilymph

Nitric oxide (NO), a free radical, has been found to be important in the development of middle ear effusions. However, the effect of NO in the middle ear effusion on cochlear function and on perilymph concentrations of NO has not been reported. We placed S-nitroso- N-acetylpenicillamine (SNAP), a NO donor compound, on the round window membrane (RWM) of adult chinchillas. Auditory brainstem response (ABR) thresholds were measured before and after the placement of SNAP on the RWM and hourly for 8 h after SNAP placement. Samples of perilymph were collected 2 h after application of SNAP and were assayed for total nitrate and nitrite, the end products of NO. Experimental ears demonstrated significant ABR threshold elevations after 5 h and elevated nitrate/nitrite in the perilymph. These findings suggest that NO present in the middle ear passes through the RWM into the inner ear and can cause significant hearing loss.

Effect of intranasal histamine challenge on Eustachian tube function

Objective: To show a relationship between intranasal histamine challenge, the development of middle ear effusion and Eustachian tube (ET) dysfunction in a rat model. Methods: Non-allergic Sprague–Dawley rats weighing between 450–600 g were randomly assigned to receive an intranasal infusion of 16 μl of 10% histamine or normal saline. ET function was assessed by using the forced-response test to measure passive and active opening and closing pressures at time intervals of 6, 10, 14, 18, 22, and 26 min and 24 h post-infusion. Mucociliary clearance times (MCCTs) of the tubotympanum at 18 min post-infusion were measured by timing the transit of dye from the middle ear to the nasopharynx. Outcome measures were ET dysfunction and evidence of clinical effusion. Results: Intranasal histamine caused acute ET dysfunction when introduced into the nasopharynx demonstrated by significant elevations in passive and active opening and closing pressures ( P⩽0.001) compared to controls. The largest difference was seen at 26 min post-infusion. Furthermore, MCCTs were 2.4 times longer after infusing intranasal histamine than after saline infusion. No clinically significant effusions were evident in either group at any time interval. Conclusion: These data demonstrate a successful development of an intranasal histamine rat model, in addition to a relationship between intranasal histamine challenge and development of acute ET dysfunction.

Induction of mucin and adhesion molecules in middle ear mucosa.

We hypothesized that inflammation molecules induce the secretory hyperplasia characteristic of otitis media with effusion (OME). The purpose of the present study was to compare the location of inflammation molecules and mucin in the middle ear mucosa of both normal and OME ears. OME was created by bisection of the tensor veli palatini muscle in germ-free rabbits, and the development of middle ear effusion was confirmed by otomicroscopy and tympanometry. Ventilation tubes (VTs) were inserted in half of the ears. The animals were decapitated after 8 weeks, and serial sections of the middle ear mucosae were either periodic acid-Schiff (PAS)-stained or stained immunohistochemically for inflammation molecules or mucins. The length of stained epithelium was measured and related to the total epithelial length. There was a striking resemblance between mucin-type MUC5B- and PAS-positive epithelium and areas positive for the chemoattractant inflammation molecules intercellular adhesion molecule-1 (ICAM-1) and RANTES (reacted upon activation, normal T expressed and secreted). The percentages of ICAM-1- and PAS-stained epithelium were significantly higher in OME ears than in normal ears. OME ears treated with VTs also contained significantly more PAS-positive epithelium than normal ears, but less than OME ears. Based on the spatial and temporal coincidence between ICAM-1 and mucin, it is suggested that: (i) inflammation may initiate and maintain the hypersecretory state of the middle ear mucosa which is presumably responsible for the chronicity of OME; and (ii) that MUC5B is a major mucin component of OME effusions.

Induction of Mucin and Adhesion Molecules in Middle Ear Mucosa

We hypothesized that inflammation molecules induce the secretory hyperplasia characteristic of otitis media with effusion (OME). The purpose of the present study was to compare the location of inflammation molecules and mucin in the middle ear mucosa of both normal and OME ears. OME was created by bisection of the tensor veli palatini muscle in germ-free rabbits, and the development of middle ear effusion was confirmed by otomicroscopy and tympanometry. Ventilation tubes (VTs) were inserted in half of the ears. The animals were decapitated after 8 weeks, and serial sections of the middle ear mucosae were either periodic acid-Schiff (PAS)-stained or stained immunohistochemically for inflammation molecules or mucins. The length of stained epithelium was measured and related to the total epithelial length. There was a striking resemblance between mucin-type MUC5B- and PAS-positive epithelium and areas positive for the chemoattractant inflammation molecules intercellular adhesion molecule-1 (ICAM-1) and RANTES (reacted upon activation, normal T expressed and secreted). The percentages of ICAM-1- and PAS-stained epithelium were significantly higher in OME ears than in normal ears. OME ears treated with VTs also contained significantly more PAS-positive epithelium than normal ears, but less than OME ears. Based on the spatial and temporal coincidence between ICAM-1 and mucin, it is suggested that: (i) inflammation may initiate and maintain the hypersecretory state of the middle ear mucosa which is presumably responsible for the chronicity of OME; and (ii) that MUC5B is a major mucin component of OME effusions.

Repeated inflation does not prevent otitis media with effusion in a monkey model.

Investigate the efficacy of repeated middle ear inflation with an inert gas (argon) for preventing the development of middle ear effusion in monkeys with functional eustachian tube obstruction. Prospective controlled trial of daily middle ear inflation with five monkeys assigned to the inflation group and four to the control group. The right tensor veli palatini muscle of nine monkeys was paralyzed with botulinum toxin. Tympanometry was done before the procedure and then daily for 21 days. Presence and distribution of effusion were assessed before paralysis and on day 15 using magnetic resonance imaging (MRI). In five right ears inflation was done beginning at the first observation of negative middle ear pressure of < or =200 mm H2O and repeated on all days with pressures < or =-100 mm H2O. Four right ears served as uninflated controls. Right middle ear pressure decreased in all animals over the course of the study. Pressure returned to near-ambient levels immediately following the argon inflation but was decreased to control levels at the subsequent observation on the following day. MRI at day 15 documented effusion in all right ears with no quantifiable differences in amount or distribution between ears that were and were not inflated with argon. Repeated inflation with an inert gas does not prevent middle ear effusion in monkeys with functional eustachian tube obstruction.

Trans-mucosal inert gas exchange constants for the monkey middle ear

Objective: The purpose of the study was to estimate the exchange constants for Argon and N 2 across the middle ear mucosa of monkeys for use in mathematical models of middle ear pressure regulation. Methods: In five anesthetized monkeys, the tympanic membrane was perforated and, with the animal breathing room air, a 13-ml probe attached to an Argon gas source and to a pressure transducer was introduced into the ear canal and sealed. The probe and middle ear volume was washed with Argon and then closed to the gas source. Gas samples were withdrawn from the probe at 15-min intervals for composition analysis using an online mass spectrometer. Probe partial pressures of Argon and N 2 were regressed on time and the slopes of those functions were divided by the respective average partial pressure gradient for the interval to estimate the exchange constants. Results: The average trans-mucosal exchange constants for Argon and N 2 were 0.0007±0.0001 and 0.0003±0.0001/min, respectively. The average ratio of the two constants was 2.60±0.36 which is not different from the value of 2.3 predicted for perfusion limited gas exchange. Conclusion: These results confirm a very slow, perfusion limited trans-mucosal exchange of N 2 and other inert gases across the middle ear mucosa. They infer that the required frequency of Eustachian tube openings to prevent the development of middle ear effusion is low and on the order of one/day.

In vivo observation with magnetic resonance imaging of middle ear effusion in response to experimental underpressures.

In this study, magnetic resonance imaging (MRI) was used to define, in vivo, the effect of acute middle ear (ME) underpressures on vascular permeability and the development of effusion. The MEs of four cynomolgus monkeys were unilaterally inflated with oxygen and carbon dioxide on different occasions and followed for a period of approximately 4 hours by tympanometry and MRI scanning. Carbon dioxide inflations caused the rapid development of ME underpressures of less than -600 mm H2O by 10 minutes. The MRI scans showed a progressive brightening of the ME and all associated air cells, indicative of the accumulation of effusion in three of the four experiments. An MRI contrast agent was administered to the vascular compartment during the course of the experiment and was rapidly transferred to the ME space, indicating vascular permeability to the agent. The contralateral, control side did not develop significant underpressures, effusion, or increased vascular permeability. Inflation with oxygen caused lesser underpressures and no accompanying changes in the MRI scans. These data support the hydrops ex vacuo theory and confirm the usefulness of MRI for in vivo documentation of the development of ME effusions and changes in vascular permeability of the mucosa in the experimental setting.

Comparison of sonotubometry with tympanometry to assess eustachian tube function in adults.

Eustachian tube dysfunction is thought to be one of the most important factors in the development of middle ear effusions. Direct measurement of Eustachian tube opening is not widespread in clinical practice. Evaluation of a new, small and cheap sonotubometer was carried out on 50 volunteers. The results were compared with the measurement of Eustachian tube function by tympanometry and show a high degree of correlation (P less than 0.001).

Evacuation of the middle ear by sniffing: a cause of high negative pressure and development of middle ear disease.

Previous research on eustachian tube function has been devoted mainly to the study of the tubal opening ability and pressure equalization. This article summarizes a series of experimental studies focusing on the closing ability of the tube. Results support the belief that the purpose of the tube should be seen primarily as protecting the middle ear from the extensive pressure variations that physiologically take place in the nasopharynx. A number of studies of diseased ears have shown that tubal malfunction was characterized mainly by a reduced ability to withstand negative pressure in the nasopharynx. Sniffing can evacuate the middle ear, causing high negative intratympanic pressure. It seems likely that this mechanism is involved in the development of middle ear effusion and manifest retraction-type middle ear disease.

Sniff-induced Negative Middle Ear Pressure: Study of a consecutive series of children with otitis media with effusion

Sniff-induced negative pressure in the middle ear space has recently been demonstrated in patients with the retraction type of middle ear disease. In the present study pressure recordings were performed in a consecutive series of 50 children treated with ventilating tubes for otitis media with effusion. It was found that a majority of the patients were able to induce negative pressure in the middle ear by sniffing. The ability to equalize negative pressure was found to be poor. These findings suggest a causal relationship between sniff-induced negative pressure in the middle ear space and the development of middle ear effusion.

980 INFECTIOUS DISEASES: THE ROLE OF INFLUENZA INDUCED POLYMORPHONUCLEAR LEUKOCYTE (PMN) DYSFUNCTION IN THE PATHOGENESIS OF PNEUMOCOCCAL OTITIS MEDIA

Viral upper respiratory infection is often associated with acute otitis media suggesting that some respiratory virus compromise host defenses. We have shown that chinchillas inoculated intranasally with influenza A virus (INF) have subsequent depression of their PMN function. The role of PMN dysfunction in the pathogenesis of pneumococcal otitis media (PnOM) was studied using different intervals between intranasal pneumococcal (Pn) and INF inoculation. The incidence of PnOM was greatest when Pn was inoculated just prior to PMN dysfunction. Inoculation with Pn two days after INF produced PnOM in 7/10 chinchillas. Inoculation of Pn two days before INF, concurrent with INF and 12 days after INF caused PnOM in 12/36, 3/8 and 1/10 chinchillas, respectively. PnOM developed in 6/26 and 0/25 chinchillas inoculated with Pn or INF alone, respectively. Four through six days after INF inoculation, 13 chinchillas receiving either INF or INF + Pn had markedly depressed PMN chemiluminescence and chemotactic activity, while seven chinchillas receiving Pn alone had normal PMN function. PMN depression always preceeded clinical illness. Tympanoplasty tubes were placed in one ear of 38 chinchillas, and no difference was found in the incidence of PnOM in ventilated and non-ventilated ears. While eustachian tube obstruction contributes to the development of middle ear effusion, these results suggest that viral induced PMN dysfunction may also be important in the pathogenesis of PnOM.

Otitis media with effusion: Specific antibody activities against exotoxins in middle ear effusions

Findings of recent immunologic studies on otitis media with effusion indicate that antibodies in middle ear effusions can either originate from serum and/or from local production in the middle ear cavity and Eustachian tube. Determination of specific antibody activity of different immunoglobulin classes in effusions and sera against certain bacterial antigens may aid in a better understanding of the pathogenesis of otitis media with effusion. A radioimmunosorbent assay was employed in the present study to determine specific antibody activity against streptolysin or staphylolysin. Although these antibody activities were mainly limited to IgG and IgA class antibodies in effusion as well as in serum, it was also found that SIgA of various types of the effusion possesses the antibody activity against these exotoxins. Findings of this study suggest that a local immunity functions in the middle ear cavity of patients with otitis media with effusions and that bacterial infection may contribute to the development of middle ear effusion in certain cases.