Diagnosis Of Otitis Media Research Articles

Development of an Algorithm for the Diagnosis of Otitis Media

Looking back 100 years from now, how will you judge the professional integrity of medicine in the second decade of the 21st century, more than 8 decades after Fleming discovered penicillin? Among young children, acute otitis media (AOM) has been the most frequent diagnosis for which antibiotics are prescribed.1,2 The diagnosis and management of AOM should provide a telling case study. You assume medicine had long ago mastered the treatment of AOM and persistent middle ear effusion, two of the most common acute and chronic conditions encountered in primary care settings.

Development of an Algorithm for the Diagnosis of Otitis Media

BackgroundThe relative importance of signs and symptoms in the diagnosis of otitis media has not been adequately evaluated. This has led to a large degree of variation in the criteria used to diagnose otitis media, which has resulted in inconsistencies in clinical care and discrepant research findings. MethodsA group of experienced otoscopists examined children presenting for primary care. We investigated the signs and symptoms that these otoscopists used to distinguish acute otitis media (AOM), otitis media with effusion (OME), and no effusion. We used recursive partitioning to develop a diagnostic algorithm. To assess the algorithm, we validated it in an independent dataset. ResultsBulging of the tympanic membrane (TM) was the main finding that otoscopists used to discriminate AOM from OME; information regarding the presence or absence of other signs and symptoms added little to the diagnostic process. Overall, 92% of children with AOM had a bulging TM compared with 0% of children with OME. Opacification and/or an air-fluid level was the main finding that the otoscopists used to discriminate OME from no effusion; 97% of children diagnosed with OME had an opaque TM compared with 5% of children diagnosed with no effusion. An algorithm that used bulging and opacification of the TM correctly classified 99% of ears in an independent dataset. ConclusionsBulging of the TM was the finding that best discriminated AOM from OME. The algorithm developed here may prove to be useful in clinical care, research, and education concerning otitis media.

Pseudo—Sudden Deafness

We describe the symptom complex and management of a clinical entity we refer to as "pseudo-sudden deafness," which is an episode of acute otitis media that leads to sensorineural hearing loss with reduced speech discrimination. We included 8 adult patients with audiometrically confirmed, asymmetric sensorineural hearing loss with decreased speech discrimination that presented after an episode of acute otitis media. Magnetic resonance imaging ruled out retrocochlear disease. Both physical examination and myringotomy helped confirm the diagnosis of serous otitis media (SOM). Myringotomy, tympanostomy tubes, oral antibiotics, and otic antibiotic-steroid drops were used to treat the SOM. Oral steroids were used to treat the sensorineural component. Pretreatment and posttreatment audiograms showed an improvement in speech discrimination score, pure tone thresholds, or both after treatment for underlying SOM and sensorineural hearing loss in 6 of the 8 patients. Patients who present with an acute onset of unilateral sensorineural hearing loss with decreased speech discrimination may be mistakenly thought to have idiopathic sudden sensorineural hearing loss when, in fact, they may have an SOM-induced phenomenon that is potentially reversible. The distinguishing feature is a preexisting otitis media, which must be treated first, before the administration of steroids.

A Case of Severe Asthma with Eosinophilic Otitis Media Successfully Treated with Anti-IgE Monoclonal Antibody Omalizumab

A 51-year-old woman had been receiving medical treatment for asthma since she was 21 years old. However, her asthma was poorly controlled despite treatment involving combination inhalation of high-dose corticosteroid and long-acting β 2-aderenergic agonist (LABA) and regularly taking oral steroids. Hearing loss and otorrhea appeared at the age of 44, and she was given a diagnosis of eosinophilic otitis media (EOM) and received medical treatment. In 2007, symptoms of asthma and otitis media deteriorated. In December 2009, omalizumab therapy was started for refractory asthma. After 2 months of omalizumab treatment, not only asthma, but also hearing loss improved. It is suggested that early initiation of omalizumab therapy may inhibit the progression of progressive EOM.

Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children: A Systematic Review

Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children: A Systematic Review

Does Early Otitis Media Lead to IBD

Rates of inflammatory bowel disease (IBD) in children are rising. One etiologic hypothesis is that early use of antibiotics causes alterations in gastrointestinal flora that contribute to the development of IBD (JW Pediatr Adolesc Med Oct 31 2012). Researchers examined the association between an early diagnosis of otitis media (by age 5 years) — the most common diagnosis …

Transiently Evoked Otoacoustic Emissions in Children with Otitis Media with Effusion

Introduction. Otitis media with effusion is a common pediatric disease whose diagnosis is based on pneumatic otoscopy, pure-tone audiometry, and tympanometry. The aim of this study was to evaluate transiently evoked otoacoustic emissions in the diagnosis of otitis media with effusion as compared to tympanometry. Patients and Methods. 38 children with bilateral otitis media with effusion were studied. 40 normal children of similar age and sex were used as controls. All subjects underwent pneumatic otoscopy, standard pure-tone audiometry, tympanometry, and transiently evoked otoacoustic emissions. Results. In the group of children with bilateral otitis media, transiently evoked otoacoustic emissions were absent in 51 ears (67%). In the remaining 25 ears (33%) the mean emission amplitude was reduced, as compared to the mean value of the control group. Conclusions. Transiently evoked otoacoustic emissions should be included in the diagnostic workup of otitis media with effusion because it is a fast, reliable, and objective test. Transiently evoked otoacoustic emissions should always be used in conjunction with tympanometry, because a more meaningful interpretation of transiently evoked otoacoustic emissions measures is possible.

A Case of Cerebral Venous Thrombosis in a 77-Year-Old White Man

A Case of Cerebral Venous Thrombosis in a 77-Year-Old White Man

Breastfeeding and Otitis Media: A Review of Recent Evidence

Human milk provides infants with antimicrobial, anti-inflammatory, and immunomodulatory agents that contribute to optimal immune system function. The act of breastfeeding allows important bacterial and hormonal interactions between the mother and baby and impacts the mouth, tongue, swallow, and eustachian tubes. Previous meta-analyses have shown that lack of breastfeeding and less intensive patterns of breastfeeding are associated with increased risk of acute otitis media, one of the most common infections of childhood. A review of epidemiologic studies indicates that the introduction of infant formula in the first 6months of life is associated with increased incidence of acute otitis media in early-childhood. More recent research raises the issues of how long this increased risk persists, and whether lack of breastfeeding is associated with diagnosis of otitis media with effusion. However, many studies suffer from lack of study of younger populations and imprecise definitions of infant feeding patterns. These findings suggest that measures of the association between breastfeeding history and otitis media risk are sensitive to the definition of breastfeeding used; future research is needed with more precise and consistent definitions of feeding, with attention to distinctions between direct breastfeeding and human milk feeding by bottle.

Concept and Diagnosis of Eosinophilic Otitis Media

Concept and Diagnosis of Eosinophilic Otitis Media

Otoscopic Findings Accurately Diagnose Otitis Media

Otoscopic Findings Accurately Diagnose Otitis Media

Challenges encountered in the diagnosis of tuberculous otitis media: case report and literature review

To report a rare case of tuberculous otitis media, and to highlight barriers to clinical and microbiological diagnosis. Case report and literature review. Tuberculous otitis media is a rare cause of chronic ear infection in the UK. Its symptoms may mimic a range of other otological conditions, including otitis media, chronic suppurative otitis media, cholesteatoma and necrotising otitis media. This case report highlights the challenges of obtaining a clinical diagnosis of tuberculous otitis media, and emphasises the fact that screening for acid-fast bacilli is not sufficient, in isolation, to rule out mycobacterial infection.

Efficacy of high-resolution CT in differential diagnosis of chronic suppurative otitis media and cholesteatoma otitis media by soft-tissue shadows

To evalute the efficacy of high-resolution CT(HRCT) in differential diagnosis and treatment of chronic suppurative otitis media and cholesteatoma otitis media by soft-tissue shadows. HRCT scanning was performed in 120 cases, 153 ears, with chronic otitis suppurative media and cholesteatoma otitis media, of which original data were processed with multi-planar reconstruction (MPR) and maximum intensity projection (MIP), the characteristics of the soft-tissue shadows' growth, window width or window leveling and bony destruction were respectively observed, as well as compared with the surgery findings. In 120 patients (153 ears), 109 ears were diagnosed as cholesteatoma otitis media, and 44 ears were diagnosed as chronic suppurative otitis media, among which 33 ears had granulation tissue and 11 ears had secretion. One hundred and seven ears were postoperatively diagnosed as cholesteatoma otitis media, among which 25 ears had granulation tissue. Among 46 ears of chronic suppurative otitis media, 35 ears had granulation tissue, and only 11 ears had secretion. A 98.6% diagnostic accuracy can be reached with HRCT in diagnosing cholesteatoma otitis media and chronic suppurative otitis media. The Youden's index was 0.98, 0.98 and 1.00 respectively with HRCT in diagnosing cholesteatoma, granulation tissue and secretion. Combination of the three different imaging methods, axial images, coronal MPR images and MIP images, can improve the efficacy of the HRCT diagnosis and definite chronic otitis media, which can be routinely used for surgery plan.

Early Diagnosis of Otitis Media is Associated With Childhood IBD Risk: A Population-Based Analysis

Early Diagnosis of Otitis Media is Associated With Childhood IBD Risk: A Population-Based Analysis

Tuberculous Otitis Media and Lupus Vulgaris of Face: An Unusual Association

Tuberculous otitis media is a rare extra-pulmonary presentation of tuberculosis. Tuberculous otitis media is usually associated with pulmonary tuberculosis or tuberculosis involving nasopharynx and oropharynx. Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. The disease often affects the face and may be associated with nasal or nasopharyngeal tuberculosis. Lupus vulgaris associated with tuberculous otitis media is not reported in English literature. We report a case of 40year old female patient who presented with symptoms of chronic suppurative otitis media and non-healing skin lesion of face. The biopsy of skin lesion showed granulomatous pathology and helped us to reach a diagnosis of tuberculous otitis media.

Societal costs and burden of otitis media in Portugal

This study aimed to estimate the resource consumption and societal impact of otitis media (OM) in children younger than five years of age in Portugal. An Internet survey on generic childhood symptoms and diseases was administered to a sample of parents. This self-report survey had been previously implemented in other European countries. Medically confirmed OM was defined as symptoms of earache or “running ear” and/or a diagnosis of OM provided by a medical doctor. Direct medical, nonmedical, and indirect nonmedical costs were calculated for individual cases. Mean total costs per OM episode were estimated at €334. This corresponds to an estimated societal impact of 72 million €/year, of which 39% were indirect nonmedical costs. An epidemiological study should help to confirm the results of this study, and evaluate whether an intervention to reduce the occurrence and/or duration of OM may have an impact on societal costs and quality of life for affected families.

Use of medical resources and indirect costs of otitis media in Sweden

To estimate the use of medical resources and the societal impact of otitis media (OM) in children less than five years of age in Sweden. An internet survey questionnaire was administered to a sample of parents with children <5 years of age. The survey covered socio-demographic data, characteristics of the OM episode, use of medical resources, productivity loss by the caregivers, and travel-related costs. Medical doctor confirmed OM (MD-OM) was defined as symptoms of earache or ''running'' ear, and/or a diagnosis of OM provided by a medical doctor. Of all MD-OM episodes (n = 91), in 47% a general practitioner had been consulted, in 21% a paediatrician, and in 23% an emergency department had been visited. Hospital admission occurred in one case. The MD prescribed antibiotics in 85% and over the counter drugs were bought in 69% of the episodes. In 57% of the MD-OM episodes the caregivers lost days from a paid job (mean 30.3 hours per episode, SD 19.6). In 30% of the episodes, parents reported productivity loss at work during their child's illness (mean 9.0 hours per episode, SD 12.4). The mean costs were estimated to be 6,385 SEK (575) per episode of MD-OM resulting in an economic burden to Sweden of 743,570,000 SEK (66,920,866). Fifty eight per cent of the costs were indirect non-medical costs. The medical and economic burden of OM is considerable to individual families as well as to society in Sweden. This study has filled a gap in the knowledge base on the impact of OM on society.

Assessment of middle ear function in patients with cleft palate treated under "Smile Train Project"

Objective: To evaluate the middle ear function in patients of cleft palate treated under Smile Train Project. Materials and Methods: Sixty patients (120 ears; 32 male and 28 female) of cleft palate with or without cleft lip were evaluated in pediatrics and ENT OPD in preoperative period. A general medical check up was performed in pediatrics OPD to evaluate the associated craniofacial anomalies. Middle ear function was evaluated in ENT OPD. Otoscopy was done in all patients. Cases under five years of age were evaluated for middle ear function by tympanometry and cases with more than five years of age were evaluated by tympanometry for middle ear function and pure tone audiometry to establish the type of hearing loss. The results are presented as number of ears. Results: A total of 50% of the patients in the study group were in zero- to two-year age group. Otoscopy findings in 120 ears showed that 66.66% of the patients had dull tympanic membrane suggesting a diagnosis of otitis media with effusion. Tympanometry was done in 110 ears, of which, 72.72% of ears had type B tympanogram suggesting otitis media with effusion. Pure tone audiometry in more than five years age group showed that 81.25% ears had conductive hearing loss. Conclusion: This study suggests the need of preoperative ENT check up and audiological assessment in patients of cleft palate undergoing palatal surgery under Smile Train Project. The association of otitis media with effusion in patients with cleft palate appears strong and a high degree of suspicion for the disease should be kept in them. The anatomical defect and possible causative pathophysiology also supports the inference. Otitis media with effusion causing hearing loss in these patients causes speech delay and unfavorable outcome despite aggressive speech therapy in postoperative period. A co-ordinate team approach of concerned specialists involved in managing these patients would definitely improve their outcome.

Comparison of Computed Tomography and Routine Radiography of the Tympanic Bullae in the Diagnosis of Otitis Media in the Calf

Otitis media is difficult to diagnose antemortem. Case reports have described computed tomography (CT) in the diagnosis, but not all cases were confirmed. CT is a sensitive and specific imaging modality of the tympanic bullae and can be used as the gold standard for the diagnosis of otitis media. Sixteen Holstein calves 5-7 weeks of age were included. Prospective study. All calves were sedated with i.v. xylazine (0.05-0.15 mg/kg) for routine radiography (3 views) and CT of the tympanic bullae followed by necropsy. Based upon necropsy findings, 10 of 16 calves were affected with otitis media, 4 unilaterally and 6 bilaterally. Imaging changes associated with otitis media included increased soft tissue opacity within the bulla, thickening of the bulla wall, enlarged bulla, and osteolysis of the bulla wall and trabeculations. The most frequent radiographic changes were lysis of trabeculations and increased soft tissue opacity, which were present in 56.3% of affected bullae. On CT, increased soft tissue opacity within the bulla was present in 93.8% of affected bullae. Sensitivity of radiography and CT was 68.8 and 93.8% and specificity was 50 and 100%, respectively. The κ value between radiography and CT with necropsy diagnosis was 0.19 for radiography, indicating poor agreement, and 0.94 for CT, indicating excellent agreement. CT is more specific, more sensitive, and easier to interpret than radiography and can be used as the gold standard in the diagnosis of otitis media in the calf.

A histological examination in the cases of initial diagnosis as chronic otitis media with a polypoid mass in the external ear canal

Objective to analyse a large series of patients with initial diagnosis of chronic otitis media (COM) with a polypoid mass in the external ear canal (EAC). Material and methods 185 consecutive patients with COM were evaluated; 75 showed a polypoid mass in the EAC. Results In 65 out of the 75 (86.7%) patients, histological examination after mastoidectomy revealed cholesteatoma. In the remaining 10 (13.3%) cases, the histological diagnosis was: glomus tumor, melanoma, mucosal adenoma, fibrous dysplasia, squamous cell carcinoma, adenoma of the endolymphatic sac, encephalocele, and tuberculosis. One patient (glomus tumor) had undergone biopsy of the polypoid mass twice preoperatively and the initial histological diagnosis was “inflammatory polyp”. Therefore, we examined the temporal bones with a glomus tumor diagnosis from the temporal bone collection of the House Ear Institute. In 1560 temporal bones, a glomus tympanicum was found in 6. In four cases, the tumor extended to the EAC mimicking a polyp covered by squamous epithelium. Conclusion A significant percentage of polyps in COM maybe the tip of an ‘iceberg’. CT-scan and MRI techniques may be helpful but not always accurate, and biopsies have certain risks. Increased clinical suspicion may limit misdiagnosis and inappropriate management.