Diagnosis Of Otitis Media With Effusion Research Articles

The evaluation of auditory processing skills and late latencies in children with ventilation tube history

Objective(s): This study aims to evaluate the changes in temporal auditory processing skills in children who underwent bilateral ventilation tube insertion (VTI) due to Otitis Media with Effusion (OME) and the effect of these changes on speech comprehension in noisy environments. MethodsThis is a case-control study. In total, 60 children were included in the study in two groups. The control group included 30 children aged 11 to 15, who had normal hearing thresholds and normal immitancemetric evaluation, and were not diagnosed with OME. The study group included 30 children, aged 11–15 who underwent bilateral VTI surgery after their diagnosis of OME during the ages of 3–10 and currently had normal hearing thresholds and normal immitancemetric values. Each group underwent the Turkish Matrix Test (TMT), Random Gap Detection Test (RGDT), Frequency Pattern Test (FPT), Duration Pattern Test (DPT), and Cortical Auditory Evoked Potential Test (CAEP). ResultsWhen the temporal processing tests (FPT, DPT, RGDT) were compared, a significant difference was obtained between the study group and the control group (p < 0.05). With the TMT, significantly lower scores were obtained in the study group compared to the control group (p < 0.01). In addition, the latency values in the cortical auditory evoked potential test were longer in the study group compared to the control group, but these results were not statistically significant (p > 0.05). ConclusionAs a result of the study, it is concluded that the central auditory processing skills were affected in children with a history of bilateral VTI due to OME. Temporal processing tests, Turkish Matrix Test and Cortical Auditory Evoked Potential tests can be recommended as reliable and easily applicable tests, together with traditional hearing test methods in children with a history of OME, in order to evaluate comprehension skills in classroom noise.

The use of hearing tests to assess otitis media with effusion in children with Down syndrome

BackgroundDown syndrome is associated with an increased risk for otitis media with effusion (OME), a childhood condition in which fluid accumulates in the middle ear, potentially leading to hearing loss. The American Academy of Pediatrics Down syndrome guidelines and the American Academy of Otolaryngology – Head and Neck Surgery OME guidelines recommend hearing testing to assess the hearing status of children with Down syndrome diagnosed with OME. MethodsThrough an Institutional Review Board approved retrospective chart review at Children's Mercy, this project assessed how clinical factors affect the frequency in which children with Down syndrome receive hearing testing after diagnosis of OME. The study included data from all children with Down syndrome between 1 and 8 years old diagnosed with OME in the Down syndrome, general pediatrics, and otolaryngology clinics between 2018 and 2020. Demographics and clinical factors, including clinic setting, were collected. ResultsOf the 124 patients identified, 91.1 % were diagnosed with OME in the otolaryngology clinic and 33.1 % received hearing testing. While most diagnoses occurred in the otolaryngology clinic, a higher proportion of hearing testing at the time of diagnosis occurred in the Down syndrome clinic. This could be explained by the fact that the Down syndrome clinic is a multidisciplinary clinic, where yearly visits include hearing screening. Bivariate analysis using chi-square or Fisher's tests showed that clinic setting had a significant association (p-value <0.001) with hearing testing. However, logistic regression depicted all clinical factors had an insignificant effect on hearing testing at 5 % significance. ConclusionWhile results indicate hearing testing is largely not performed to assess OME early in otolaryngology clinics, they may be used to assess intervention efficacy post-diagnosis. Results point to the importance of Down syndrome clinics in early diagnosis of hearing loss leading to timely referrals to otolaryngology clinics which diagnose and manage OME in children with Down syndrome.

Improving the Accuracy of Otitis Media with Effusion Diagnosis in Pediatric Patients Using Deep Learning.

Otitis media with effusion (OME), primarily seen in children aged 2 years and younger, is characterized by the presence of fluid in the middle ear, often resulting in hearing loss and aural fullness. While deep learning networks have been explored to aid OME diagnosis, prior work did not often specify if pediatric images were used for training, causing uncertainties about their clinical relevance, especially due to important distinctions between the tympanic membranes of small children and adults. We trained cross-validated ResNet50, DenseNet201, InceptionV3, and InceptionResNetV2 models on 1150 pediatric tympanic membrane images from otoendoscopes to classify OME. When assessed using a separate dataset of 100 pediatric tympanic membrane images, the models achieved mean accuracies of 92.9% (ResNet50), 97.2% (DenseNet201), 96.0% (InceptionV3), and 94.8% (InceptionResNetV2), compared to the seven otolaryngologists that achieved accuracies between 84.0% and 69.0%. The results showed that even the worst-performing model trained on fold 3 of InceptionResNetV2 with an accuracy of 88.0% exceeded the accuracy of the highest-performing otolaryngologist at 84.0%. Our findings suggest that these specifically trained deep learning models can potentially enhance the clinical diagnosis of OME using pediatric otoendoscopic tympanic membrane images.

An advanced machine learning approach for high accuracy automated diagnosis of otitis media with effusion in different age groups using 3D wideband acoustic immittance

Wideband Acoustic Immittance (WAI) is a diagnostic tool for identifying middle ear dysfunction. The challenge to its widespread use is difficulty in interpreting the complex data. This study aimed to develop advanced Machine Learning (ML) tools to automatically diagnose ears with otitis media with effusion (OME) in different age groups from the WAI data. A total of 1177 sets of WAI data were collected from 551 normal middle ears and 626 ears with OME, divided into three age groups. A Titan IMP440 was used to measure wideband absorbance at frequencies from 226 to 8000 Hz, and pressure between +200 daPa and −300 daPa. A two-stage ML approach was used to achieve a highly accurate diagnosis of OME in each age group. In the first stage, a convolutional neural network (CNN) was developed to classify the WAI data set. In the second stage, another neural network with a self-attention mechanism was used to classify the most discriminative regions of the data. These regions were extracted areas that had the top 2.5 % most statistically significant difference between normal and OME ears in the training WAI data. Final classification considered outputs from the two stages. The two-stage ML approach achieved classification accuracy of 96.6 %, 94.1 %, and 90.7 % for the three age groups, respectively. The importance of this research is its contribution to the development of an automated diagnostic tool for OME. This tool will be easy to use, highly accurate, works across age groups and which will support clinicians in their diagnostic decisions.

Questionnaire to assess the significance of history taking in assessment of otitis media with effusion in children

Background: There is a high prevalence of Otitis media with effusion (OME) with diagnoses of least 50% of children under the age of one, and 60% of children under the age of two. Complications have a significant impact on a child’s quality of life including hearing impairment, language acquisition delay, declining school performance, and behavioral problems. The objective of the study is to develop and test the reliability of a simple questionnaire based on common complaints given by caregivers of children with OME. Methods: 100 patients were included from the ENT Clinic at King Hamad University Hospital and categorized into preschool age (1-4 years) and School age (5-15 years). A bilingual binary questionnaire was developed (Cronbach’s Alpha: 0.89). Results: There were 22 preschool age patients, and 78 school age patients. Six complaints were significant where the child does not respond to name calling (p=0.031), needs to raise the TV volume (p=0.000), occasionally talks loudly (p=0.003), uses verbal communication for their needs (p=0.000), has episodes of clumsiness and dizziness (p=0.000), and doesn’t pronounce words correctly according to their age (p=0.008). Conclusions: Questionnaires based on complaints can aid the diagnosis of OME as caregiver’s assessment is often limited.

Appropriateness of Diagnosis and Management for Otitis Media With Effusion in Pediatric Urgent Care Clinics.

Otitis media with effusion (OME)'s clinical presentation is often confused with acute otitis media (AOM) by clinicians. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. The aim of this study was to determine the clinician diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 urgent care clinics within a pediatric health care system. We retrospectively reviewed a random sample of encounters for children aged 0 to 18 years with a billing diagnosis of OME in 2019. We recorded clinical symptoms, antibiotic prescribed, and the clinicians' diagnosis. We used the American Academy of Pediatrics guidelines to assign an AOM diagnosis and compared those with the clinicians' final diagnoses using Pearson χ 2 . Of the 912 eligible charts, clinicians' final diagnoses were as follows: AOM for 271 (29.7%) patients, OME for 638 (70.0%) patients, and no ear pathology for 3 (0.3%) patients. Antibiotics were prescribed for 519 (56.9%) patients; of those, only 242 (46.6%) had a final clinician diagnosis of AOM. Antibiotic prescribing rates were higher when a clinician diagnosed AOM compared with OME (89.3% vs 43.2%; P < 0.001). Per American Academy of Pediatrics guidelines, up to 273 (29.9%) patients qualified for an AOM diagnosis, but those were not the same as those diagnosed with AOM by clinicians ( P < 0.001). When evaluating children with a billing diagnosis of OME, a third fit a diagnosis of AOM. Clinicians commonly misdiagnosed AOM, but also prescribed antibiotics to almost half of those they diagnose with OME.

OTITIS MEDIA WITH EFFUSION AND ITS ASSOCIATED FACTORS AMONG PATIENTS WITH CEREBRAL PALSY: A MULTI-CENTER STUDY

Children with cerebral palsy (CP) are more prone to Otitis media with effusion (OME). We set out to determine the prevalence and factors associated with OME among patients with CPaged 2 to 18 years of age at two tertiary hospitals. Across-sectional study design was used. Diagnosis of OME was made on presence of a type B tympanogram. Of the 151 patients with CPrecruited the median age was 3 years (IQR 2.5-6.9). Majority were males (64.2%), had non-ambulatory CP (78.8%) and had breastfed for over 6 months (74.8%). Allergic rhinitis and nasal regurgitation of feeds were reported in 40.4% and 69.5% respectively. The prevalence of OME was 43.7%. Children who were breastfed for over 6 months (p value = 0.025) were less likely to have OME while presence of allergic rhinitis (p value = 0.016) and nasal regurgitation of feeds (p value = 0.035) increased the odds of presence of OME. The prevalence of OME among patients with CP is high (43.7%). Children with CP should breastfeed for more than 6 months to protect them against OME while timely management of nasal regurgitation of feeds and allergic rhinitis may minimize the risk of OME in these patients

A deep learning approach to the diagnosis of atelectasis and attic retraction pocket in otitis media with effusion using otoscopic images

BackgroundThis study aimed to develop and validate a deep learning (DL) model to identify atelectasis and attic retraction pocket in cases of otitis media with effusion (OME) using multi-center otoscopic images.MethodA total of 6393 OME otoscopic images from three centers were used to develop and validate a DL model for detecting atelectasis and attic retraction pocket. A threefold random cross-validation procedure was adopted to divide the dataset into training validation sets on a patient level. A team of otologists was assigned to diagnose and characterize atelectasis and attic retraction pocket in otoscopic images. Receiver operating characteristic (ROC) curves, including area under the ROC curve (AUC), accuracy, sensitivity, and specificity were used to assess the performance of the DL model. Class Activation Mapping (CAM) illustrated the discriminative regions in the otoscopic images.ResultsAmong all OME otoscopic images, 3564 (55.74%) were identified with attic retraction pocket, and 2460 (38.48%) with atelectasis. The diagnostic DL model of attic retraction pocket and atelectasis achieved a threefold cross-validation accuracy of 89% and 79%, AUC of 0.89 and 0.87, a sensitivity of 0.93 and 0.71, and a specificity of 0.62 and 0.84, respectively. Larger and deeper cases of atelectasis and attic retraction pocket showed greater weight, based on the red color depicted in the heat map of CAM.ConclusionThe DL algorithm could be employed to identify atelectasis and attic retraction pocket in otoscopic images of OME, and as a tool to assist in the accurate diagnosis of OME.

Classification of OME with Eardrum Otoendoscopic Images Using Hybrid-Based Deep Models, NCA, and Gaussian Method

Otitis media with effusion (OME) is defined as a middle ear disease that occurs with the accumulation of fluid in the posterior part of the eardrum, usually without any symptoms. When OME disease is not treated, some negative consequences arise that deeply affect the education, social and cultural life of the patient. OME disease is a difficult issue to diagnose by specialists. In this article, autoendoscopic images of the eardrum have been classified using deep learning methods to help specialists in the diagnosis of OME. In this study, a hybrid deep model based on artificial intelligence is proposed. In the proposed hybrid model, feature maps were obtained using Efficientnetb0 and Densenet201 architectures from both the original dataset and the improved dataset using the gaussian method. Then, the merging process was applied to these feature maps. Unnecessary features are eliminated by applying NCA dimension reduction to the combined feature map. The most valuable features obtained at the end of the optimization process are classified in different machine learning classifiers. The proposed model reached a very competitive accuracy value of 98.20% in the SVM classifier.

Nasal autoinflation devices for middle ear disease in cleft palate children: are they effective?

SUMMARYObjectiveCleft lip palate (CLP) and cleft palate (CP) patients have a higher incidence of otitis media with effusion (OME) and conductive hearing problems. This article aims to evaluate the effectiveness of a 6-month course of self-administered autoinflation therapy in paediatric CP/CLP patients in terms of conductive hearing loss (CHL) and OME prevalence.MethodsFifty-one patients with surgically corrected CP/CLP and diagnosis of OME received indication to 6-months autoinflation therapy with an Otovent® device. Clinical evaluation, tympanogram and pure tone audiometry were carried out at the time of prescription (T0), at the end of treatment (T1) and at 6-month follow-up (T2). Patients were divided in 2 groups based on therapeutic compliance (29 compliant children, group A, vs 22 non-compliant children, group B).ResultsCase series showed better audiological results and tympanometries at both time points (p < 0.001). Group A showed better outcomes at tympanograms and at each frequency, but were statistically significant only in terms of CHL at 250 and 1000 Hz frequencies at T1 (respectively 0.024 and 0.012).ConclusionsNasal autoinflation therapy accelerates improvement of OME and hearing thresholds at short-/mid-term, leading to an earlier improved hearing performance.

Characteristics and clinical significance of wideband tympanometry of otitis media with effusion in young children

Objective: To study the characteristics of wideband tympanometry(WBT) and its application value in the diagnosis of otitis media with effusion(OME) in young children. Methods: We compared wideband acoustic energy absorbance(EA) under peak pressure in young children with OME(190 ears) and healthy control subjects(121 ears) from Ninth People's Hospital of Shanghai Jiaotong University School of Medicine between January 2018 and June 2020. Both groups were divided into three groups, 1-6 months, 7-36 months and 37-72 months. SPSS 20.0 statistical software was used to analyze and compare the EA parameters between OME children of different months and the control group. Receiver operating characteristic (ROC)curve was used to analyze the diagnostic value of WBT in young children with OME. Results: There were significant differences in EA among three OME groups from 500 Hz to 2 000 Hz(P<0.05).Compared with the control groups, EA of 1-6 m OME group decreased significantly below 4 000 Hz(P<0.05), EA of 7-36 m OME group decreased significantly at 545-1 600 Hz(P<0.05), EA of 37-72 m OME group decreased significantly above 545 Hz(P<0.05).ROC curve indicated that EA at 1 000 Hz had the greatest diagnostic value (AUC was 0.890), followed by 1 500 Hz and the range of 500-2 000 Hz (AUC was 0.883 and 0.881, respectively).EA at 1 000 Hz with a cutoff value of 0.55 had the best diagnostic sensitivity of 90.8%, which was higher than conventional tympanometry (85.8%). The maximum AUC (0.932) could be obtained by combining EA, peak pressure and admittance amplitude of 226 Hz tympanometry as predictors. Conclusions: EA is significantly decreased in young children with OME. Compared with the conventional single frequency tympanometry, WBT is more accurate in the diagnosis of OME in young children, and the prediction accuracy would be better if combined with 226 Hz tympanometry.

Exploring the Influence of Age on 3D Wideband Absorbance Immittance and the Automated Diagnosis of&amp;nbsp;Otitis Media With Effusion Using Machine Learning

Background: Wideband Absorbance Immittance (WAI) has great potential as a diagnostic tool for identifying middle ear dysfunction in the ENT/Audiology clinic. The challenge to its widespread use is the limited understanding and interpretation of WAI results by practitioners because the WAI dataset contains thousands of values. This study investigated energy absorbance at varying frequency-pressure domains in normal and ears with otitis media with effusion (OME) in different age groups using machine learning (ML) tools to determine the accuracy of automated diagnosis of OME. Methods: A total of 1178 sets of WAI data (551 normal middle ears and 627 ears with OME) were divided into three age groups for statistical analysis. ML approaches included classification model development and significant region extraction from the frequency-pressure WAI plots. Findings: Significant differences were found across various frequency-pressure regions between normal and OME ears in the three different age groups. Feature selection using ML classifiers identified areas of importance at mid frequencies and pressures between -50 to +150 daPa in age groups over 3 years. More accurate OME classification was seen with the ML models in the groups over the age of 3. Interpretation: The ML approach provides great potential for the automated diagnosis of middle ear diseases using WAI data. The important discriminative regions extracted using the ML tools provide practical guidance to clinicians to decide whether an ear is normal or OME. There were however significant age influences on ML accuracies, particularly in the age group under 3 years. Funding Information: This work is supported by NIHR (AI Award, 02305), Ser Cymru III Enhancing Competitiveness Infrastructure Award (MA/KW/5554/19), Great Britain Sasakawa Foundation (5826), Cardiff Metropolitan University Research Innovation Award and The Global Academies Research and Innovation Development Fund. Declaration of Interests: None declared. Ethics Approval Statement: This study received ethical approval for data collection from Cardiff School of Sport and Health Sciences Ethical Committee under the Cardiff Metropolitan University ethical guidelines and regulations (Ethical reference number: Sta-3013).

Non-contact optical coherence tomography - an effective method for visualizing the exudate of the middle ear

Otitis media with effusion (OME) accounts for 15-17% of the total number of recorded diseases of the middle ear. Surgical methods have become much more common. One of the factors affecting the tactics and effectiveness of treatment OME is the degree of viscosity of the effusion. Modern diagnostic methods do not allow to reliably identify cases of OME with high effusion viscosity. To study the possibilities of optical coherence tomography (OCT) in the diagnosis of OME and a non-invasive study of effusion viscosity. An analysis of the results of the examination of 29 patients who underwent surgical treatment for OME - tympanostomy. A control group of 30 patients without middle ear pathology. The study used a spectral OCT with a non-contact probe designed specifically for studies of the structural middle ear. Quantitative analysis of the results using open source ImageJ. Objectification of the degree of viscosity of the effusion was carried out by means of viscometry. A comparative analysis of the intensity of the optical signal in the external auditory canal (EAC) and in the tympanic cavity (TC) was performed, as well as a comparison of the signal from viscous and fluid effusion. In all patients with OME, during the OCT study, an optical signal with a higher intensity was recorded in TC than in the EAC. In all cases, in the control group in the TC, an optical signal was recorded that was identical in intensity with the signal in the EAC. When measuring the degree of viscosity of the effusion, 17 cases of OME were characterized as effusion of a low degree of viscosity, 12 cases - effusion of extreme viscosity. When comparing the average intensity of the optical signal of the OCT images of viscous and liquid effusion, a statistically significant difference was revealed, p<0.001. OCT makes it possible to detect light scattering from large scatterers - cell structures characteristic of low viscosity effusion. In addition, OCT allows you to register an optical signal from small scatterers - high molecular weight structures that are present in large quantities in viscous effusion. A correlation was found between the intensity of the optical signal in the TC and the degree of viscosity of the middle ear effusion. Based on OCT data, it is possible to determine the indications for surgical treatment of OME by detecting viscous exudate.

Relationship of T lymphocytes, cytokines, immunoglobulin E and nitric oxide with otitis media with effusion in children and their clinical significances.

To investigate the relations of T lymphocytes, cytokines, immunoglobulin E, and nitric oxide with otitis media with effusion (OME) in children and their clinical significances. Fifty children with OME treated in our hospital were enrolled in the study (observation group). Fifty healthy children were selected as control. The percentages of CD4+ and CD8+ T lymphocyte and CD4+/CD8+ ratio in peripheral blood, and the levels of cytokine (IL)-2, IL-4, IL-6, immunoglobulin E (IgE) and nitric oxide (NO) in peripheral blood and middle ear effusion (MEE) in both groups were detected. The correlations of these indexes with OME were analyzed. The percentage of peripheral blood CD4+ and CD8+ levels, CD4+/CD8 ratio, IgE, and NO levels in the observation group were significantly higher than those in the control group (P < 0.01). In the observation group, the IL-2 and IL-6 levels, and IgE and NO levels in the MEE were significantly higher than those in peripheral blood (P < 0.01). In addition, in the observation group, the MEE IL-2 and IL-6 levels were positively correlated with peripheral blood CD4+/CD8+ ratio, respectively r = 0.366, P = 0.009; r = 0.334, P = 0.018. The levels of peripheral blood CD4+ and CD8+ lymphocytes and MEE IL-2, IL-6, IgE, and NO levels are increased in children with OME. These indexes have provided significant clues for the diagnosis of OME in children.

The clinical value of wideband tympanometry in the diagnosis of otitis media with effusion

Objective:To establish normative data for wideband absorbance measurements in Chinese with normal ear and effusion ear using wideband tympanometry(WBT) and determine the WBT curves of normal ears and effusion ears to facilitate the use of it. To investigate whether there are difference between the WBT absorbance in children aged 2-16 and adults above 16. To compare the sensitivity and specificity of WBT and conventional tympanometry tests for diagnosing otitis media with effusion (OME).Method:One hundred and seventy-six patients(342ears) ,from January 2015 to December 2015, were enrolled, including 96 males and 80 females whose ages ranged from 2 to 74 years. All of these patients, who underwent physical examination, ear endoscopy, conventional tympanometry and pure tone audiometry, were divided into three groups, namely normal, negative pressure and effusion according to the clinical diagnosis. WBT was carried out in these patients to analyze whether there are difference in the absorbance between children and adults in normal ears.The absorbance diagram of normal, effusion and negative pressure ears were mapped in Chinese population.The normal WBT curve was named as type N (normal) curve, the middle ear effusion curve as type E (effusion) curve, and the middle ear negative pressure curve as type P (negative pressure) curve. Pairwise comparison was carried out to analyze the difference of the WBT absorbance among these WBT curves. Other 40 patients (66 ears) with clinical diagnosis of middle ear effusion, including 22 males and 18 females with ages ranged from 3 to 36 years old, underwent exploratory tympanotomy. These 40 cases were detected preoperatively by both conventional tympanometry and WBT by which the sensitivity and specificity were compared in the diagnosis of middle ear effusion.Result:The normative data of WBT absorbance in Chinese with normal ear over 2 years old was established. The WBT absorbance at all frequencies between children and subject over 16 years old showed no statistically significant difference except for 10 frequencies in all 31 frequencies detected. The variations in the absorbance were mainly concentrated on the frequencies ranged from 500- 2000 Hz,in patients with OME. In the frequency range of 500-2000 Hz, the absorbance amplitudes in type N curv >type P curve>type E curve. There were significant differences in WBT absorbance at all frequencies between type N and type E between within 500-2000 Hz.The sensitivity and specificity of WBT for middle ear effusion were 94.8% and 87.5%, respectively, which were higher than that of conventional tympanometry with 91.3% of the sensitivity and 62.5% of the specificity.Conclusion:The WBT absorbance is consistent at most of the frequencies in Chinese. The normal ear, effusion and negative pressure in the middle ear can be distinguished by WBT curve. WBT can be useful for clinical diagnosis of OME, which has a higher sensitivity and specificity than conventional tympanometry.

No evidence of cholesteatoma in untreated otitis media with effusion in children with primary ciliary dyskinesia

IntroductionPrimary Ciliary Dyskinesia (PCD) describes a group of inherited disorders that result in abnormal ciliary motion leading to mucous stasis. Clinical features include almost universally otitis media with effusion (OME), particularly in infants. PCD patients provide us with a cohort of patients with OME that is not treated with ventilatory tube (VT) insertion as these have been shown to result in frequent complications including chronic otorrhoea, early extrusion and persistent perforation without significant improvement to hearing in the long term. This cohort was used to investigate whether children with PCD and OME not treated with VT were predisposed to cholesteatoma formation in the setting of a paediatric quaternary referral centre. MethodsA retrospective chart review was performed of all the children attending a multi-disciplinary PCD clinic at a national quaternary referral centre with a diagnosis of OME. We reviewed otoscopic findings, and audiometry and tympanometry results. We assessed the children in four groups: Watchful waiting, hearing aids, VT, and VT and hearing aids. ResultsOne-hundred-and-one of 107 patients included in the study had a diagnosis of otitis media with effusion. No child with OME and PCD was diagnosed with a cholesteatoma during the follow up period. The only children who had insertion of a ventilatory tube were those who had the procedure prior to the formal diagnosis of PCD. We found a significant complication rate in the children with VT insertion. Hearing improved over time. The prevalence of retraction pockets in untreated OME was 1.72% (3 out of 174 ears). ConclusionsIn children with PCD, OME is an almost universal finding in younger children, but not in adolescents. The study supports the current preference to avoid VT insertion in children with PCD as it confers a significantly higher rate of complications. No cases of cholesteatoma were found in this cohort of PCD children with OME managed without VTs.

Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement.

Objectives Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Study Design Cross-sectional analysis of an administrative database. Subjects and Methods National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed. The primary outcome was intranasal steroid administration, and the primary predictor was a diagnosis of OME. The impact of location of service was also analyzed. Results Data representing 1,943,177,903 visits demonstrated that intranasal steroids were administered in 10.0% of visits in which OME was diagnosed, in comparison to 3.5% of visits in which OME was not diagnosed (univariate odds ratio, 3.07; 95% confidence interval [CI], 1.85-5.08; P < .001). After adjusting for age, sex, race/ethnicity, and other confounding conditions, multivariate analysis demonstrated that OME remained associated with an increase in intranasal steroid usage (odds ratio, 3.58; 95% CI, 1.60-8.01; P = .002). This practice pattern was more prevalent in the ambulatory office setting (risk difference 6.6%, P < .001) and less seen in a hospital-based office or emergency department. Conclusion Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.

Oral Steroid Usage for Otitis Media with Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction.

Avoiding oral steroids for otitis media with effusion (OME) is endorsed as a performance measure by the National Quality Foundation, but data regarding current gaps and practice patterns are lacking. Our objectives were to evaluate oral steroid use for OME and the related diagnoses of eustachian tube dysfunction (ETD) and tympanic membrane retraction (TMR), to assess variations by visit setting, and to identify opportunities for measurable performance improvement. Cross-sectional analysis of a national database. Ambulatory visits in the United States. Children and adults in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2005-2010). Data were coded for patient demographic information, potential confounders (eg, concurrent conditions managed by oral steroids), and diagnosis of OME, ETD, or TMR (OME/ETD/TMR). The latter 2 diagnoses were included to meet minimum numbers for reliability of weighted estimates, but OME constituted the majority of cases. Multivariate regression was used to determine the variables associated with oral steroid use. Among 590,772 observations representing 7,191,711,480 visits for OME/ETD/TMR, 3.2% resulted in a new prescription for oral steroid medication (2.3% for children, 7.0% for adults). Adults were more likely to receive steroids (odds ratio = 3.50, P < .001) than those with other diagnoses, but a similar association was not found for children. Patients seen by an otolaryngologist or in the emergency department were less likely to receive steroids than those seen in other settings. OME/ETD/TMR is infrequently treated with oral steroids, particularly in children. Opportunities for performance improvement are limited.

Home Made Pneumatic Otoscopy

The presence of eustachian tube dysfunction may lead to the accumulation of sterile fluid behind the tympanic membrane. The fluid may get infected in the presence of persistent negative middle ear pressure. Decreased mobility of the tympanic membrane may signify the presence of otitis media with effusion (OME). The gold standard for the diagnosis of OME remains to be pneumatic otoscopy [1–3]. Jones and Kaleida demonstrated the accuracy and importance of pneumatic otoscopy, by using a video otoendoscopic test, in the diagnosis of OME [1]. Unfortunately, pneumatic otoscopy is underused by some pediatricians. We improvised a simple replacement for the pneumatic otoscope (Fig. 1). All that is needed is a 10 ml disposable syringe (A), 20–25 cm piece of an intravenous fluid line (B), a plastic adaptor (in our case, it was part of a ball point pen refill), (c) and of course an otoscope (D). Positive and negative pressure may be applied by aspirating and injecting air simultaneously. A good seal is demonstrated by testing for negative pressure against a fingertip. The procedure is safe, and inexpensive. References

Otoscopic Signs of Otitis Media

Lack of agreed-upon diagnostic criteria for acute otitis media (AOM) has led to inconsistencies in clinical care, misleading research results, and misguided educational efforts. The objective of this study was to examine findings that expert otoscopists use when diagnosing AOM. A group of experienced otoscopists examined 783 children presenting for primary care. In addition, endoscopic still images of the tympanic membranes (TMs) were obtained. A random sample of 135 of these images was sent for review to a group of 7 independent physicians who were expert otoscopists. We examined the findings that both groups of observers used to distinguish between AOM, otitis media with effusion (OME), and no effusion. Among both groups of observers, bulging of the TM was the finding judged best to differentiate AOM from OME: 96% of ears and 93% of ear image evaluations assigned a diagnosis of AOM by members of the 2 groups were reported as showing bulging of the TM, compared with 0% and 3%, respectively, of ears and ear image evaluations assigned a diagnosis of OME. Opacification of the TM was the finding that best differentiated OME from no effusion. We describe findings that are used by experienced otoscopists to diagnose AOM and OME. The findings point to the advisability under most circumstances of restricting antimicrobial treatment for AOM to children who have TM bulging, and they call into question clinical trials of the treatment of AOM in which TM bulging has not been a required element for participation.