Diagnosis Of Otitis Media Research Articles

Comparative Study between Endoscopic Transcanal Myringoplasty Versus Microscopic Myringoplasty in middle age group (20-40 years)

Background: The surgical goals of myringoplasty are the closure of the tympanic membrane perforation and improvement of the hearing levels. Aim of the work: To compare the results, advantages and disadvantages between endoscope and microscope in myringoplasty. PATIENTS AND METHODS: This study was carried out in the Otorhinolaryngology Department at Alhussin and Bab-Alsharia University Hospitals. The study included 40 patients with a diagnosis of chronic suppurative otitis media of tubo-tympanic type, divided into two groups and each group contained 20 patients. All patients were operated by one surgeon. Results: The difference in age, sex, side of diseased ear and size of perforation between the two groups was not significant. In group (A) the circumference of the perforation was clearly visualized in all patients (100%). While, in group (B) the circumference of the perforation could not be visualized in 7 patients (35%), 5 patients (25%) required external auditory canal curettage and 2 patients (10%) required endoscope-assisted microscopic myringoplasty to evaluate the ossicular chain. The difference between the 2 groups was significant (P.value = 0.004). In group (A) the graft was uptaken in 85% of patients while in group (B) the graft was uptaken in 80% of patients with no significant difference between the two groups (p = 0.677). Conclusion: The ability to easily negotiate through EAC, Panoramic, wide angle, and magnified view provided by the endoscope and uninterrupted picture overcomes most of the disadvantage of the microscope.

Clinical techniques in Veterinary Dermatology: Regional anaesthesia of the canine ear.

Video otoscopy is a valuable tool for the diagnosis and treatment of otitis externa (OE) and otitis media (OM) in dogs. Procedures performed by video otoscopy often are painful and it can be challenging to maintain steady anaesthetic depth and provide smooth anaesthetic recovery. A multimodal approach to analgesia and anaesthesia is ideal to minimize complications associated with high doses of anaesthetic drugs while providing the patient with adequate analgesia. To describe a technique for regional anaesthesia of the canine ear. One canine cadaver, obtained as part of a teaching laboratory class for other clinical techniques, with institutional approval, was used for illustration purposes. Clinical technique for regional anaesthesia of the canine ear. Nerve blocks for regional anaesthesia are an important aspect of a multimodal anaesthetic approach. A technique for blocking the two major sensory nerves to the canine ear is described.

Ossiculoplasty using Autologous Reshaped Incus and Teflon PORP: A Comparative Study

Introduction
 Autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) are commonly used for ossicular chain reconstruction. The present study attempts to assess the post-operative outcome with these two prostheses.
 Materials and Methods 
 A Randomized prospective study was conducted in Tertiary referral care hospital to determine which material, among autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) gives better postoperative hearing result in Ossiculoplasty.
 Patients presenting at outpatients’ department with the clinical diagnosis of chronic otitis media with perforation or retraction. The study population consisted of a total of 50 patients. Ossiculoplasty with reshaped Incus or PORP was performed after Canal Wall Up mastoidectomy. Hearing results were measured by Air-Bone gap in PTA after 6 months of surgery.
 Results 
 Selecting the criteria <20 dB ABG as success when Stapes superstructure is present, Incus has 64.29% success rate, whereas PORP has 31.81% success. Extrusion rate of different prosthesis shows PORP has 18.18% extrusion whereas autologous Incus has lower (7.14%) extrusion rate.
 Conclusion 
 Among these two ossiculoplasty materials, autologous Incus gives better postoperative hearing gain and lower extrusion rate.

Diagnosis of unsafe chronic suppurative otitis media using computed tomography through predictive value assessments

Background: Chronic Suppurative Otitis Media (CSOM) is a significant cause of preventable hearing loss. Global emergence of resistant strains is of great concern. The aim of the present study was to assess the accuracy and predictive value of computed tomography in diagnosis of unsafe chronic suppurative otitis media. Methods: Aprospective, analytical study was conducted among 90 patients with complaint of unsafe chronic suppurative otitis media which were randomly selected from outpatient Department of Otorhinolaryngology at Subharti Medical College, Dehradun, Uttarakhand. The patients comprised of both males as well as females and also of different age groups. Results: Out of 90 patients, 61(67.22%) were males followed by 29 (32.22%) females. The minimum age of patient in the study was of 8years and the maximum age of patient in study of 50 years. Maximum number of patients belonged to the age group of 11-20 (50%). The mean age in this study was 23 years. Among study subjects, 32 (35.55%) cases had conductive hearing loss, 11 (12.22%) cases had sensorineural type, 40(44.44%) had mixed type and 7 (7.77%) had no response. In this study, sensitivity, specificity, positive predictive value, negative predictive value was calculated of computed tomography findings as compared to preoperative findings. The sensitivity of HRCT for mastoid was 100%, visualization malleus was 94.11%, incus was also 62.31%, stapes was 47.22% and facial N dehiscent and intact was 44.82%. Similarly, the specificity of CT scan for mastoid was 83.33%, malleus was 92.85%, incus was 61.90%, stapes erosion was 37.03% and facial N dehiscent was 96.72%. Conclusion:The present study was concluded that computed tomography can accurately image the findings in unsafe chronic suppurative otitis media and represents a major advance in the diagnostic imaging of this disease.

Role of rapid diagnostics for viral respiratory infections in antibiotic prescribing decision in the emergency department.

To describe the frequency of antibiotic prescriptions in patients with known viral respiratory infections (VRIs) diagnosed by polymerase chain reaction (PCR) in 3 emergency departments (EDs) and to identify patient characteristics that influence the prescribing of antibiotics by ED physicians despite PCR confirmation of viral cause. Retrospective, observational analysis of patients with PCR-diagnosed VRI discharged from 3 acute-care hospital EDs within 1 health system. In total, 323 patients were discharged from the ED with a VRI diagnosis, of whom 68 were prescribed antibiotics (21.1%). These patients were older (median, 59.5 vs 43 years; P = .04), experienced symptoms longer (median, 4 vs 2 days; P = .002), were more likely to have received antibiotics in the preceding 7 days (27.9% vs 9.8%; P < .001), and had higher proportions of abnormal chest X-rays (64.5% vs 28.4%; P < .001). Patients were more likely to receive antibiotics for a diagnosis of pneumonia (39.7% vs 1.6%; P < .001) or otitis media (7.4% vs 0.4%; P = .002), and were less likely with diagnosis of upper respiratory infection (2.9% vs 13.7%; P = .02) or influenza (20.6% vs 44.3%; P < .001). Despite a diagnosis of VRI, one-fifth of ED patients were prescribed antibiotics. Patient characteristics including age, duration of symptoms, abnormal chest X-rays, and specific diagnosis may increase provider concern for concurrent bacterial infections. Opportunities exist for antimicrobial stewardship strategies to incorporate rapid diagnostics in promoting judicious antibiotic usage in the ED.

The “TIP algorithm” for the accurate diagnosis of pediatric otitis media

ObjectivesThe authors studied the correlation between the grading TIP which evaluates three otoendoscopic characteristics of the tympanic membrane (TM) (transparency, integrity and position) with the gold standard represented by the impedenzometry. Methods and materialsCross-sectional studies with independent and blind comparison with the gold standard diagnostic. The setting was primary care and ambulatory. 115 TMs were examined (57 right and 58 left) of 60 children (36 males and 24 females) and classified according to the TIP grading (transparency, integrity, position). Each patient underwent otoendoscopy to obtain TIP grading and subsequently to tympanometry, which was considered the gold standard for diagnosis. The Transparency is the condition in which at least one or more structures behind the TM are visible: promontory, incudo-malleolar and incudo-stapedial articulations. The Integrity is such when no holes in the TM are visible. The TM must be displayed up to the anulus. The position of the TM is evaluated according to the handle and the short apophysis of the malleus. The correlation between TIP grade and tympanometry was measured by the “Chi Square” test. ResultsThe method showed an average sensitivity and specificity of the three TIP parameters (TIP1 TIP2, TIP 4) versus tympanometry of 95.6% (I.C. 90.1–98.5); PPV and PPN 95.6 (I.C 90.3%–98.1%) Positive Likelihood Ratio 22,000 (I.C. 9.327 to 51.894) Negative Likelihood Ratio 0.045 0.019 to 0.107. ConclusionGrading TIP is a valid method for accurate diagnosis of pediatric otitis media and can predict the tympanometry result with high statistical significance.

Otitis Media with Effusion in Aircrew Members.

BACKGROUND: Middle-ear barotrauma is a common problem reported by aircrew members and passengers. Studies have shown that 20-50% of passengers report ear complaints during the flight or after landing. The aim of this study is to determine the prevalence of otitis media with effusion in aircrew members and describe the time to resolution of the condition.METHODS: All aircrew members presenting at Civil Aviation Center at Congonhas Airport at São Paulo for annual flight medical examinations from September 2014 to May 2015 were reviewed retrospectively for the presence of otologic disorders. Eligible participants were all pilots, copilots, and flight attendants with a diagnosis of otitis media with effusion confirmed by immittance testing.RESULTS: Of 1607 aircrew members, 155 (9.65%) were diagnosed as having otitis media with effusion. Most participants were men (51.6%). Regarding aircrew position, 81.9% were flight attendants, 11.6% were copilots, and 6.5% were pilots. The mean time to resolution of the otitis media was 8.23 (± 3.02) days.DISCUSSION: Otolaryngologists must be aware of the effects of gas expansion in the middle ear at higher altitudes for the appropriate treatment of diseases related to pressure changes. The recommendation for an aircrew member to return to flying duties should occur only after the individual has been treated and complete resolution, confirmed by immittance testing, has been documented.Pinto JA, dos Santos Sobreira Nunes H, dos Santos RS, Cavallini A, Freitas G, Knoll D, Duarte C. Otitis media with effusion in aircrew members. Aerosp Med Hum Perform. 2019; 90(5):462-465.

Central auditory processing in teenagers with non-cholesteatomatous chronic otitis media

IntroductionEvidences of possible effects of early age otitis media with effusion in the central auditory processing, emphasize the need to consider such effects also in subjects with chronic otitis media. AimTo investigate and analyze the impact of non-cholesteatomatous chronic otitis media on central auditory processing in teenagers. MethodsThis is a study in which 68 teenagers were recruited, 34 with a diagnosis of non-cholesteatomatous chronic otitis media (study group) and 34 without otological disease history (control group). The evaluation of the subjects consisted of: anamnesis, pure-tone threshold audiometry, speech audiometry and a behavioral test battery for assessment of central auditory processing. ResultsA statistically significant difference was found between the means observed in the study and control groups in all tests performed. An association was found between the control group and subgroups of the study group with unilateral alterations in all tests. An association was shown between the results for the control group and study group for family income, with a greater impact on subjects with a lower income. ConclusionsNon-cholesteatomatous chronic otitis media affects the central auditory processing in teenagers suffering from the disorder, and monaural low-redundancy hearing is the most affected auditory mechanism. Unilateral conductive changes cause more damage than bilateral ones, and lower family income seems to lead to more changes to the central auditory processing of subjects with non-cholesteatomatous chronic otitis media.

Outcome of Myringoplasty with Temporalis Fascia and Perichondrial-Cartilage Composite Graft in High Risk Perforations

The objective of this study was to compare the graft uptake results and postoperative hearing of myringoplasty with temporalis fascia and cartilage-perichondrial composite graft in high risk perforations. Patients of age 13 years and above with diagnosis of chronic otitis media – mucosal type with high risk perforation that is >50% perforation of tympanic membrane, revision cases, absent/ eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal involvement cases were included for myringoplasty. Pure Tone Audiometry was done within 1 week before surgery. 80 cases were included for myringoplasty which were randomly allocated by lottery method with 40 cases each in temporalis fascia group and cartilage perichondrial composite graft group. Graft uptake results were assessed after 6 weeks and postoperative hearing was evaluated and compared within and between the groups. Graft uptake rate in temporalis fascia group and cartilage perichondrial composite graft group was 90% and 92.5%, respectively with no significance difference in the graft uptake rate (p = 0.692) between the groups. The mean pre and post-operative air bone gap in temporalis fascia group and cartilage perichondrial composite group were 30.69dB±10.19,16.36±8.37dB and 33.73±8.07dB, 20.76±9.47dB, respectively with highly significant difference in both groups (p < 0.001) showing improvement in the hearing after surgery in both groups. The mean air bone gain were 14.33dB and 12.97dB in temporalis fascia and cartilage perichondrial composite group respectively with no significant difference between the groups (p=0.469). The graft uptake rate and hearing results after cartilage perichondrial composite graft are comparable to those of temporalis fascia graft. Furthermore, the cartilage perichondrial composite graft is more rigid and thick so it is more resistant than fascia to anatomic deformation and necrosis. Therefore, we recommend the use of cartilage perichondrial composite graft for tympanic membrane reconstruction in high risk perforation without concern about affecting audiometric results.

Automated classification platform for the identification of otitis media using optical coherence tomography

The diagnosis and treatment of otitis media (OM), a common childhood infection, is a significant burden on the healthcare system. Diagnosis relies on observer experience via otoscopy, although for non-specialists or inexperienced users, accurate diagnosis can be difficult. In past studies, optical coherence tomography (OCT) has been used to quantitatively characterize disease states of OM, although with the involvement of experts to interpret and correlate image-based indicators of infection with clinical information. In this paper, a flexible and comprehensive framework is presented that automatically extracts features from OCT images, classifies data, and presents clinically relevant results in a user-friendly platform suitable for point-of-care and primary care settings. This framework was used to test the discrimination between OCT images of normal controls, ears with biofilms, and ears with biofilms and middle ear fluid (effusion). Predicted future performance of this classification platform returned promising results (90%+ accuracy) in various initial tests. With integration into patient healthcare workflow, users of all levels of medical experience may be able to collect OCT data and accurately identify the presence of middle ear fluid and/or biofilms.

Increase in tympanostomy tube placements despite pneumococcal vaccination, a population-based study.

AimThe aim was to estimate the impact of the 10‐valent pneumococcal vaccine (PHiD‐CV) on tympanostomy tube placements (TTP) in children under five years of age in Iceland.MethodsThis population‐based observational cohort study followed 11 consecutive birth‐cohorts 2005–2015 from birth until their fifth birthday. Population registries were merged using national identification numbers. The risk of TTP was compared between birth‐cohorts adjusted for the number of previous otitis media diagnoses and antimicrobial prescriptions. A Cox regression model was applied and the hazard ratio (HR) of TTP was estimated between each birth‐cohort and the last vaccine non‐eligible birth‐cohort. The vaccine impact of PHiD‐CV10 on TTP was estimated as 1‐HR ×100%.ResultsIn total, 51 247 children were followed for 210 724 person‐years, of which 14 351 underwent 20 373 procedures. The estimated vaccine impact on TTP was −6% (95% CI −16% to 2.7%). Children in the vaccine‐eligible cohorts had fewer previous otitis media diagnoses and had been prescribed fewer antimicrobials prior to the procedure than children in the vaccine non‐eligible cohorts.ConclusionDespite high uptake of PHiD‐CV10, tympanostomy procedures increased in Iceland during the study period. Vaccine‐eligible children had milder disease prior to the procedure. The reason underlying these findings are speculative.

Clinical diagnosis and treatment of eosinophilic otitis media

Objective: Eosinophilic otitis media(EOM) is a rare,refractory otitis media.This article summarizes the clinical manifestations and diagnosis and treatment experience of EOM. Method: Retrospective analysis of 3 cases of EOM patients with medical history, clinical manifestations, and related auxiliary examinations.Discuss the EOM clinical features,diagnosis and treatment in conjunction with the literature. Result: The clinical features of 3 patients with EOM were summarized as: a large amount of yellowish white secretions or polyps formation, obvious itching symptoms; polyp biopsy showed a large amount of eosinophil infiltration;topical use of hormone-containing ear drops treatment is effective.Conclusion: EOM is a new type of chronic otitis media.It has characteristic clinical manifestations,a comprehensive treatment based on glucocorticoids should be given..

Improving the methods of diagnosis and treatment of otitis media with effusion

The study involved 172 patients with otitis media with effusion. All patients as a method of early diagnosis of otitis media with effusion conducted multislice computer tomography (MSCT). This made it possible to check the effectiveness of conservative treatment and timely perform surgical treatment, including sanitizing intervention on the middle ear with the erased clinical picture of acute mastoiditis, and to avoid complications. With the help of MSCT of the temporal bones with the dynamic observation of patients with high accuracy, you can confirm the full restoration of pneumatization of the middle ear cavities or identify possible recurrences of exudate accumulation. Patients who underwent surgery were randomly divided into 2 groups, depending on the duration of the laser myringotomy: on the 3rd day of hospital treatment (first group) or on the 7th day of hospital treatment (second group). Absence of otorrhea from the tympanic cavity and return of hearing in patients of the first group was significantly in a shorter period (p<0.05). CO2-laser myringotomy for patients with otitis media with effusion without positive dynamic by conservative therapy is most effectively in the early stages of the disease.

Emerging Technologies for the Diagnosis of Otitis Media.

To review new experimental techniques for the diagnosis of otitis media (OM). Literature search in English in the following databases: MEDLINE (via PubMed), Ovid Medline, Google Scholar, and Clinical Evidence (BMJ Publishing) between January 1, 2005, and April 30, 2018. Subsequently, articles were reviewed and included only if relevant. MeSH terms: ["diagnosis"] AND [all forms of OM] AND ["human"] AND ["ear"] and ["tympanic membrane"]. The retrieved innovative diagnostic techniques rely on and take advantage of the physical properties of the tympanomastoid cavity components: tympanic membrane (TM) thickness, its translucency and compliance; middle ear fluid characteristics; biofilm presence; increased tissue metabolic activity in OM states; and fluid presence in the mastoid cavity. These parameters are taken into account to establish OM diagnosis objectively. We review spectral gradient acoustic reflectometry, digital otoscopy, TM image analysis, multicolor reflectance imaging, anticonfocal middle ear assessment, optical coherence tomography, quantitative pneumatic otoscopy, transmastoid ultrasound, wideband measurements, TM thickness mapping, shortwave infrared imaging, and wideband acoustic transfer functions. New experimental techniques are gradually introduced to overcome the limitations of standard otoscopy. The aforementioned techniques are still under investigation and are pending widespread clinical use. The implementation of these techniques in the market is dependent on their success in clinical trials, as well as on their future cost. New techniques for the diagnosis of OM can objectively evaluate the morphology of the TM, determine the presence of middle ear fluid and evaluate its content, and thus potentially replace standard otoscopy.

OTIC AND NASAL POLYPS WITH PERIPHERAL EOSINOPHILIA AND BILATERAL HEARING LOSS

Introduction Refractory otitis media (OM) in adults is challenging as misdiagnosis can lead to permanent sensorineural hearing loss. OM in the presence of peripheral eosinophilia and atopic history should warrant alternative treatment rather than antibiotics and topical steroids. Case Description A 71-year-old female with asthma, nasal polyps and allergic rhinitis presented with two years of bilateral hearing loss. She had multiple episodes of recurrent otitis media treated with topical and systemic steroids along with antibiotics without improvement. Physical exam was significant for hypertrophied turbinates and anterior rhinoscopy showed a large polyp in the right middle meatus. Otoendoscopy showed a right tympanic membrane with chronic myringitis, central perforation with polypoid changes to the middle ear mucosa. Left tympanic membrane had central perforation and polypoid tissue (Figure 1). Labs were significant for peripheral eosinophilia of 1.3 × 103 eosinophils/μL (16.7%) and IgE level of 1065 IU/mL. A diagnosis of presumed eosinophilic otitis media was made. Discussion Eosinophilic otitis media (EOM) is a rare disorder of intractable bilateral otitis media. Diagnosis can be made using the major criteria of eosinophils in the middle ear mucosa or its effusion, along with two or more items of the minor criteria (association with asthma, nasal polyposis, chronic rhinosinusitis, resistance to conventional treatment for otitis media, and a highly viscous middle ear effusion). The differential should exclude disorders such as eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. Treatment of EOM includes removal of eosinophilic middle ear effusion and suppression with steroids.

Diagnosis and management of otitis media with effusion in a tertiary hospital in Kano: a best practice implementation project.

To implement the best available practice to improve the diagnosis and management of OME according to best available evidence at the Aminu Kano Teaching Hospital, Kano, Nigeria. Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear, without signs and symptoms of an acute infection. It has high rates of physician visits and is a common cause of hearing impairment in affected children. In Nigeria, the prevalence is estimated to range from 8% to 25.2%. The current quality improvement project was conducted using the Joanna Briggs Institute approach for clinical audits, involving a baseline audit, an implementation of change phase and a follow-up audit, using Practical Application of Clinical Evidence System software. Eleven evidence-based audit criteria were used for this project. The same audit criteria were used for the baseline and follow-up audit. The sample size was 20 for both the baseline and follow-up. Implemented change involved the introduction of pneumatic otoscope use in the department and educational sessions with clinicians and caregivers. The project was conducted from July to November 2017. Implementation of strategies to improve practice led to large increases in compliance with audit criteria, particularly Criteria 1, 6, 9 and 10 (from 0-25% to 70-100%). Paradoxically, a decrease in compliance was observed for two criteria. The current project succeeded in increasing clinician compliance with best available evidence. The most significant evidence-based change seen was in the use of pneumatic otoscope, whereas the most difficult barrier to overcome was resistance to change.

Otitis media, antibiotics, and risk of autism spectrum disorder.

Otitis media infections and antibiotic treatment have been linked to the risk of developing autism spectrum disorder. Broad-spectrum antibiotics may alter the composition of the gut flora microbiota, which is hypothesized to be involved in the regulation of the immune system. This study examines the interplay among otitis media, antibiotics, and the subsequent risk of developing autism. Based on the entire Danish population, 780,547 children were followed from birth (January 1, 1997 to December 31, 2008) until December 31, 2012. We calculated adjusted hazard ratios and absolute risks of autism with 95% confidence intervals (CIs) related to previous otitis media diagnoses and antibiotic prescriptions redeemed at Danish pharmacies. The absolute risk of autism before age 10 was increased among children with otitis media (1.2% for females and 3.3% for males) and in children who had redeemed an antibiotic prescription (0.6% and 2.7% for females and males) compared to children without a history of otitis media and antibiotics usage (0.4% for females and 1.9% for males). Similarly, we found an increased hazard ratio of autism associated with otitis media (1.83 95% CI 1.71-1.95) and antibiotics usage (1.29 95% CI 1.17-1.43). A history of both otitis media and antibiotic treatment did not further increase the risk of autism. Although the risk of autism was associated with otitis media and treatment with antibiotics, we found little evidence of a synergistic effect between otitis media infections and treatment with antibiotics. Autism Res 2018, 11: 1432-1440. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We investigated whether otitis media ear infections and antibiotic treatment were associated with autism spectrum disorder. Autism was more common in children who had had an otitis media infection or who had been treated with antibiotics. Given the observational nature of our data, our study cannot be used to conclude that otitis media or use of antibiotics cause autism, as our findings may be subject to unobserved confounding.

Effect of Prenatal Exposure to Perfluoroalkyl Substances (PFASs) on Childhood Infectious Diseases up to 7 Years of Age: The Hokkaido Study

Background/Aim: Perfluoroalkyl substances (PFASs) are persistent industrial chemicals that have possible effects on the immune system. We have reported the possible impact up to 4 years of age, however, effects on childhood infectious disease at later age is still unclear. We aimed to investigate the association between prenatal PFASs exposure and infectious diseases up to 7 years.Methods: A total of 2689 mother-child pairs, who were enrolled in the Hokkaido Study, were included in this data analysis. Eleven PFASs in 3rd trimester plasma were measured using UPLC-MSMS. Doctor diagnosis of otitis media, chicken pox, pneumonia, and respiratory syncytial virus (RSV), up to 7 years were extracted from the mother-reported questionnaires at 2, 4, 7 years of age. The odds ratio (OR) of log[e] transformed PFASs levels, as well as categorical values were calculated by logistic regression models adjusted for potential confounders such as infant sex, maternal age at delivery, gestational week, parity, household income, any allergies at 7y, and duration nursing.Results: Prevalence of otitis media, chicken pox, pneumonia, and RSV were 55.7%, 61.5%, 30.6%, and 16.8%, respectively. After stratified by siblings with (n&amp;#61;2309) and without (n&amp;#61;379), the increased the adjusted ORs (95% confidential interval) of pneumonia were found with PFOS (1.60, 0.94-2.71 p-value for trend in quartile model&amp;#61;0.039), PFDA (1.66, 1.03-2.66, p trend&amp;#61;0.004), and PFDoDA (1.61, 1.04-2.49, p trend&amp;#61;0.624) and increased the adjusted ORs of RSV were found with PFOA (1.91, 1.07-3.42, p trend&amp;#61;0.005) among children without any siblings. However, any of such associations were not found among children with siblings.Conclusion: Prenatal exposure to PFASs were associated with increased risk of pneumonia and RSV up to 7 years of age only among children without any siblings, however, not among children with siblings.

Do demographic disparities exist in the diagnosis and surgical management of otitis media?

Determine if demographic disparities exist between the diagnosis of otitis media (OM) and the provision of myringotomy and tubes in children. Cross-sectional analysis of a national database. The National Ambulatory Medical Care Survey 2010 and the National Hospital Ambulatory Medical Care Survey-Ambulatory Surgery 2010 were abstracted for cases with a diagnosis of OM and myringotomy and tube (MT) procedures in children, respectively. Sex, race, ethnic, and insurance distributions were computed for OM and MT and then compared for healthcare disparities between rates of OM diagnoses and MT procedures. A total of 13.6 million ambulatory pediatric OM diagnoses were identified in 2010 (55.9% male; 82.4% white, 11.3% black, and 6.3% other; 14.3% Hispanic, 85.7% non-Hispanic). A total of 413 thousand ambulatory myringotomy procedures were identified (59.6% male; 86.0% white, 11.0% black, and 3.0% other; 13.0% Hispanic, 87.0% non-Hispanic). There was no statistically significant difference in the provision of MT versus OM diagnosis according to sex (P = 0.400), race (P = 0.313), or ethnicity (P = 0.228). There was also no statistically significant difference in the percentage of Medicaid coverage for OM children (37.0%) versus those undergoing MT (31.1%; P = 0.376). There does, however, appear to be a statistically higher percentage of non-Hispanic children being diagnosed with otitis media than Hispanic children (P = 0.049). There were no significant demographic differences in the incidence of children with OM undergoing MT with respect to sex, race, ethnicity, or insurance status. As a specialty, otolaryngology does not appear to exhibit any disparate healthcare access bias in providing MT to children with OM. NA Laryngoscope, 128:2898-2901, 2018.

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.