Otitis Research Articles

Clotrimazole drops or miconazole cream which is better for fungal ear infection

Abstract Background: Otomycosis is a common condition that the otolaryngologist faces in the clinic; proper treatment and follow-up are necessary for the complete resolution of the disease. Objectives: To compare the efficacy of topical Miconazole cream against clotrimazole drops in the treatment of otomycosis. Materials and Methods: In this prospective study, 200 patients are included, and they are divided into two groups randomly. In total, 100 patients are treated with clotrimazole drops, and the other 100 are treated with miconazole cream. They are assessed after 4 days and after 14 days of treatment to evaluate the improvement of the three main symptoms aural fullness, otalgia, and itching. Results: After assessment of the symptomatic improvement on Day 4 and Day 14, we can see that the improvement is better with cream usage, especially in the 1st few days, while no difference can be seen after finishing the whole course of treatment. Conclusion: For early clinical improvement and good patient preference, we advise the usage of creams over drops due to their easy application and acceptable regimen.

The Compatibility of Preoperative Temporal Bone CT Scan Interpretation and Intraoperative Findings in Chronic Suppurative Otitis Media at Dr. Zainoel Abidin Hospital Banda Aceh

Introduction: Chronic suppurative otitis media (CSOM) is middle ear and mastoid infection that causes hearing loss globally. Computed Tomography (CT)-Scan of the temporal bone is useful for assessing the pathogenesis of the disease and estimating the prognosis. In addition, evaluation of CT-Scan in patients with CSOM is useful for selecting the appropriate surgical procedure to minimize post-surgical complications. This study aims to assess the suitability of temporal CT-Scan interpretation to intraoperatif findings in CSOM patients. Methods: This is an observational study with cross-sectional design conducted at the dr. Zainoel Abidin General Hospital, Banda Aceh. The components of suitability evaluation include cholesteatoma, scutum erosion, ossicles, tegmen tympani, facial canal, posterior wall and sigmoid sinus wall. The interpretation suitability of temporal CT-Scan and intraoperatif findings was performed using the Kappa test. Results: A total of 18 CSOM patients were involved in this study with a mean age of 32.44 years and dominated by the safe type with a percentage of 55.6%. Interpretation of ossicular erosion based on temporal CT scan has very strong suitability with the intraoperatif findings with k=0.88 followed by posterior wall erosion (k=0.684), scutum erosion (k=0.679), tympanic tegmen erosion (k=0.455) and facial canal erosion (k=0.341). The findings of cholesteatoma and erosion of the sigmoid sinus wall had a very low suitability (k<0.001). Conclusion: Temporal CT scan in CSOM patients has relatively good suitability with intraoperatif findings in evaluating erosion of the ossicles, posterior wall, and scutum. Another examination modality is necessary to assess and improve the accuracy of disease pathogenesis.

Management of Cleft Lip and Palate: A Narrative Review

Cleft of lip and palate are the most common serial congenital anomalies to affect the orofacial region. Its occurrence can be isolated or together in various combination and/or along with other congenital deformities. In addition to aesthetic disfigurement, a child with cleft lip and/or palate suffers functional morbidity such as restricted maxillofacial growth, speech anomalies, swallowing and feeding difficulties, hearing loss and/or recurrent ear infections. Although not generally life-threatening, living with a cleft evoke a significant health burden. The management of patients with cleft lip and cleft palate is very complex and requires a multidisciplinary team with several treatment interventions This article aims to review the primary care physicians in literature knowledge about cleft lip and palate.

Efficacy of combination of acetic acid and ciprofloxacin eardrops versus only ciprofloxacin eardrops in achieving dry ears in chronic suppurative otitis media

BackgroundAs per WHO, the chronic inflammatory condition involving the middle ear and mastoid cavity, resulting in recurrent ear discharge, otherwise known as otorrhoea, through perforation of the eardrum or tympanic membrane, is known as chronic suppurative otitis media (CSOM). Recurrent middle ear infections are known to produce a myriad of intracranial and extracranial complications. CSOM is considered a biofilm disease, wherein biofilms are found to be the most prevalent microbial form, playing a crucial role in the chronicity of the infections and observed resistance to antibiotics. Thus disruption of the biofilm layer is necessary for the management of CSOM. This can be achieved by aural toileting and topical 2% acetic ear drops.AimTo study the efficacy of the combination of acetic acid and ciprofloxacin eardrops versus only ciprofloxacin ear drops in achieving dry ears in chronic suppurative otitis media.Materials and methodsSixty-three patients diagnosed with CSOM (mucosal type) were randomly divided into two groups: Group A — who received both 2% acetic acid and ciprofloxacin ear drops and Group B — who received only Ciprofloxacin ear drops; thrice daily. Additionally, both groups received systemic oral antibiotic being tab. ciprofloxacin 500 mg twice daily for 14 days. Weekly follow-up was done for 2 weeks and compared on the basis of otological symptom score.ResultsBoth combination of acetic acid with ciprofloxacin and only ciprofloxacin ear drops significantly reduced the amount of ear discharge (P < 0.001) by the second visit, but the reduction in the amount of otorrhoea in Group A was found to be more significant than in Group B (P = 0.014). Also, the former was significantly more effective in achieving and maintaining dry ears by the third visit (P < 0.001).ConclusionCombination of acetic acid and ciprofloxacin ear drops was found to be more effective than only ciprofloxacin ear drops in achieving and maintaining dry ears while treating CSOM.

Factors Leading to Conductive Hearing Loss among Children Living in Delhi Slum Areas

Background: Middle-ear diseases in children pose a significant burden to the healthcare system. Recurrent upper respiratory tract infections, cold, and cough often initiate middle ear disease. It results in mild to moderate hearing impairment that can be detrimental to the child's linguistic development. It can further lead to behavioural and cognitive problems. The study was designed to establish a relationship between common middle pathologies like CSOM and OME with hearing loss in children.&#x0D; Objective: To determine the prevalence of middle ear pathology and its association with hearing loss in slum children of Delhi.&#x0D; Methods: A study was conducted with 269 children aged five to ten years. The children were screened by otoscopic examination, followed by Tympanometry and then by Pure Tone Audiometry.&#x0D; Results: The prevalence of middle ear problems was 24.2%, out of which the prevalence of Chronic Suppurative Otitis Media (CSOM) was 10.8%, Otitis media with effusion (OME) was 12.3% and Acute Otitis Media (AOM) was 1.1%. A significant correlation (p&lt; 0.005) was found between hearing loss and middle ear pathology like CSOM and OME. Out of the 65 children with ear pathology, hearing loss was detected in 55 children, out of which 29 children with CSOM, moderated conductive hearing loss was detected in 28 children and out of 33 OME children, mild to moderate conductive hearing loss was detected in 26 children.&#x0D; Conclusion: The article highlights the high prevalence of middle ear pathology in underprivileged children. The study also concludes the high probability of conductive hearing loss in these children. It is recommended that there is more need for awareness for early detection and treatment of middle ear infection to avoid any language and behavioural problems in the future. Also, the disparity between children living in urban and rural areas needs to be bridged.

Vibrio Cholerae Colonisation in a Case of Bilateral Cystic Bronchiectasis in an Immunocompetent Male

Non O1 and non O139 strains of Vibrio cholerae are often nontoxigenic and tend to cause extraintestinal infections such as wound infections, external ear infection, sepsis, epidural and subdural abbesses. We herein describe an unusual presentation where there is colonisation of Vibrio cholerae in a case of bilateral cystic bronchiectasis in an immunocompetent male.

Assessment of ear infection in children attending Dalhatu Araf specialist Hospital, Lafia

Bacterial infection of the ear, especially amongst children from low-income countries, is a major cause of hospitalization, presenting in different forms and severity. The prevalence and antibiotic profile of bacteria associated with ear infection amongst children between the ages 0–10years presenting with symptoms was determined using standard microbiological procedures and Kirby-Bauer disk diffusion methods. The results showed an 89.6% prevalence rate of bacterial ear infections, with males and children aged 0–1 years accounting for 53.7% and 28.9% of cases respectively. Pseudomonas spp. was the most prevalent (32.6%) bacteria isolated, while Klebsiella spp. was the least prevalent (8.9%). Male children had higher distribution and presence of bacterial growths than their female counterparts. Antimicrobial assay revealed high susceptibility rates as well as multidrug resistance of the bacterial isolates to the antibiotics tested. Cefuroxime and Augmentin were most effective against all isolates. This study showed a high prevalence of bacterial-associated ear infections dominated by Pseudomonas spp. and more prevalent in males and children between 0 and 3 years old. This calls for improved postnatal care education and child hygiene by nursing mothers, midwives and nannies to forestall and prevent any public health challenge that might arise from the uncontrolled spread and increase in pathogenicity of infections caused by the isolates.

Hearing loss and respiratory health symptoms among large-scale sawmill workers of the timber processing factories within the Gert Sibande District Municipality: a comparative cross-sectional study

BackgroundOccupational exposure to wood dust may cause respiratory illnesses, while prolonged exposure to loud noise may cause noise-induced hearing loss.ObjectiveThe objective of the study was to assess the prevalence of hearing loss and respiratory symptoms among large-scale sawmill workers within the Gert Sibande Municipality in Mpumalanga Province, South Africa.MethodsA comparative cross-sectional study consisting of 137 exposed and 20 unexposed randomly selected workers was undertaken from January to March 2021. The respondents completed a semi-structured questionnaire on hearing loss and respiratory health symptoms.Data analyseThe data was analysed using Statistical Package for Social Sciences (SPSS) version 21 (Chicago II, USA). The statistical analysis of the difference between the two proportions was done using an independent student t-test. The level of significance was set at p < 0.05.ResultsThere was a statistically significant difference between the exposed and unexposed workers on the prevalence of respiratory symptoms like phlegm (51.8 vs. 0.0%) and shortness of breath (chest pain) (48.2 vs. 50%). There was also a statistically significant difference between the exposed and unexposed workers on the signs and symptoms of hearing loss like tinnitus (ringing in the ears) (50 vs. 33.3%), ear infections (21.4 vs. 66.7%), ruptured ear drums (16.7 vs. 0.0%), and ear injuries (11.9 vs. 0.0%). The exposed workers reported always wearing personal protective equipment (PPE) (86.9%) compared to the unexposed workers (75%). The reason for not wearing PPE consistently by the exposed workers was due to not being available (48.5%), compared to the unexposed workers who reported other reasons (100%).ConclusionThe prevalence of respiratory symptoms among the exposed workers was higher than that of the unexposed workers, except for chest pains (shortness of breath). The prevalence of symptoms of hearing loss among the exposed workers was higher than the unexposed workers, except for ear infections. The results suggest that measures should be implemented at the sawmill to help protect workers’ health.

A Comparative Study to Determine Hearing Outcome in Type 1 Tympanoplasty With and Without Canaloplasty in Tubotympanic Type of Chronic Suppurative Otitis Media.

Chronic suppurative Otitis Media is a common ear infection in India. Canaloplasty done with tympanoplasty helps to remove bony overhangs and provide complete visibility of fibrous annulus of tympanic membrane. 1. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty with canaloplasty. 2. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty without canaloplasty. 3. To compare the hearing outcome in the above mentioned 2 groups of patients. 56 patients of 15-60 years of age with mucosal type of Chronic otitis media, with central dry perforation and intact ossicles were included in our study. They were divided into group 1 (type 1 tympanoplasty + canaloplasty) and group 2 (type 1 tympanoplasty without canaloplasty), on alternate basis. AC, BC, Air bone gap avg was assessed via pure tone audiometry at 4 frequencies preoperatively and postoperatively at 3rd and 6th month, % closure of ABG average was calculated. Type 1 tympanoplasty along with canaloplasty has better hearing improvement in pure tone audiometry compared to type 1 tympanoplasty alone, as % closure of ABG at postoperative 3rd and 6th month holds significant. The canaloplasty provides better surgical exposure via removing bony overhangs, aids in excellent functional outcome in the form of % closure of ABG. Hence canaloplasty is added as an adjunct to routinely performed aural surgeries to enhance hearing outcome.

Non-rigid point cloud registration for middle ear diagnostics with endoscopic optical coherence tomography

PurposeMiddle ear infection is the most prevalent inflammatory disease, especially among the pediatric population. Current diagnostic methods are subjective and depend on visual cues from an otoscope, which is limited for otologists to identify pathology. To address this shortcoming, endoscopic optical coherence tomography (OCT) provides both morphological and functional in vivo measurements of the middle ear. However, due to the shadow of prior structures, interpretation of OCT images is challenging and time-consuming. To facilitate fast diagnosis and measurement, improvement in the readability of OCT data is achieved by merging morphological knowledge from ex vivo middle ear models with OCT volumetric data, so that OCT applications can be further promoted in daily clinical settings.MethodsWe propose C2P-Net: a two-staged non-rigid registration pipeline for complete to partial point clouds, which are sampled from ex vivo and in vivo OCT models, respectively. To overcome the lack of labeled training data, a fast and effective generation pipeline in Blender3D is designed to simulate middle ear shapes and extract in vivo noisy and partial point clouds.ResultsWe evaluate the performance of C2P-Net through experiments on both synthetic and real OCT datasets. The results demonstrate that C2P-Net is generalized to unseen middle ear point clouds and capable of handling realistic noise and incompleteness in synthetic and real OCT data.ConclusionsIn this work, we aim to enable diagnosis of middle ear structures with the assistance of OCT images. We propose C2P-Net: a two-staged non-rigid registration pipeline for point clouds to support the interpretation of in vivo noisy and partial OCT images for the first time. Code is available at: https://gitlab.com/nct_tso_public/c2p-net.

Myringotomy tube placement: understanding the impact of the coronavirus disease 2019 pandemic.

Otolaryngologists perform bilateral myringotomy and tube placement for surgical management for otitis media with effusion. This retrospective study aimed to address the extent to which the coronavirus disease 2019 pandemic and season impact the number of bilateral myringotomy and tube placement procedures performed at a tertiary care centre. A total of 1248 charts of children who underwent bilateral myringotomy and tube placement from January 2018 through February 2021 were reviewed. The cohort included 41.6 per cent females and 58.4 per cent males, with 63.7 per cent having private insurance. The median age at surgery was 2.6 years. The spring season had the most bilateral myringotomy and tube placement procedures per week. The number of bilateral myringotomy and tube placement procedures performed per week after the onset of the coronavirus disease 2019 pandemic was significantly lower compared to the years prior. There was no difference in number of intra-operative effusions pre-pandemic versus after the pandemic onset. This study sheds light on the impact of the coronavirus disease 2019 pandemic and seasonality on the rates of tympanostomy tube procedures, vital for understanding the temporality of ear infections.

Factors associated with heartworm preventative use in the golden retriever lifetime study.

Heartworm disease is preventable with use of heartworm preventatives, but the reported prevalence of heartworm preventative use in the United States is low, some estimates falling around 50% of dogs. However, there are very few estimates of prevalence and its associated factors. We aimed to estimate prevalence and evaluate factors, including vaccination status, demographics, lifestyle, physical conditions, medications and supplements, and environment and living conditions, for their association with heartworm preventative use in a large dataset from the Golden Retriever Lifetime Study (N = 2,998). Due to the large number of predictors evaluated, we built a bootstrapped elastic net logistic regression model, which is robust to overfitting and multicollinearity. Variables were evaluated by calculating covariate stability (>80%) and statistical significance (p<0.02). In our sample, the prevalence of heartworm use was 39.5%. In our elastic net model, receiving vaccinations (rabies, Bordetella, or any other vaccine), being located in the Southern U.S., being altered, having an infectious disease or ear/ nose/throat system disease diagnosis, being on heartworm preventatives in the past, currently being on tick preventative, having sun exposure in an area with concrete flooring, living in a house with more rooms with carpeted floors, and spending time on hardwood flooring inside were associated with greater odds of heartworm preventative use. Supplementation use and being in the top quartile of height were associated with lower odds of heartworm preventative use. The explanatory factors we identified can be used to improve client communication. In addition, target populations for educational interventions and outreach can be identified. Future studies can validate the findings in a more diverse population of dogs.

Nanocatalysts as fast and powerful medical intervention: Bridging cochlear implant therapies and advanced modelling using Hidden Markov Models (HMMs) for effective treatment of inner ear infections

As human population growth and waste from technologically advanced industries threaten to destabilise our delicate ecological equilibrium, the global spotlight intensifies on environmental contamination and climate-related changes. These challenges extend beyond our external environment and have significant effects on our internal ecosystems. The inner ear, which is responsible for balance and auditory perception, is a prime example. When these sensory mechanisms are impaired, disorders such as deafness can develop. Traditional treatment methods, including systemic antibiotics, are frequently ineffective due to inadequate inner ear penetration. Conventional techniques for administering substances to the inner ear fail to obtain adequate concentrations as well. In this context, cochlear implants laden with nanocatalysts emerge as a promising strategy for the targeted treatment of inner ear infections. Coated with biocompatible nanoparticles containing specific nanocatalysts, these implants can degrade or neutralise contaminants linked to inner ear infections. This method enables the controlled release of nanocatalysts directly at the infection site, thereby maximising therapeutic efficacy and minimising adverse effects. In vivo and in vitro studies have demonstrated that these implants are effective at eliminating infections, reducing inflammation, and fostering tissue regeneration in the ear. This study investigates the application of hidden Markov models (HMMs) to nanocatalyst-loaded cochlear implants. The HMM is trained on surgical phases in order to accurately identify the various phases associated with implant utilisation. This facilitates the precision placement of surgical instruments within the ear, with a location accuracy between 91% and 95% and a standard deviation between 1% and 5% for both sites. In conclusion, nanocatalysts serve as potent medicinal instruments, bridging cochlear implant therapies and advanced modelling utilising hidden Markov models for the effective treatment of inner ear infections. Cochlear implants loaded with nanocatalysts offer a promising method to combat inner ear infections and enhance patient outcomes by addressing the limitations of conventional treatments.

Comparison of acidifying agents and clotrimazole for treatment of otomycosis: a comprehensive one-way mini-review.

This review aimed to compare the efficacy of acidifying agents and clotrimazole in the treatment of patients with otomycosis. The databases, including Research Gate, Google Scholar, ScienceDirect, Embase, Medline, Scopus, Cochrane, and library databases of clinical trials were searched in this study. The keywords were "Fungal Ear Infection" and "Otitis External" for otomycosis, "Clotrimazole", Lotrimin", "Mycelex", "Desenex", and "Clotrimaderm Mycoderm" for clotrimazole, and "Boric Acid Alcohol", "Alcohol-vinegar solution", Burow solution (Domeboro), "Isopropyl Alcohol", "VoSol" and "Acetic Acid" for acidifying agents. Regarding search strategy, a total of 53 studies were collected, 11 of which were maintained for assessment. Almost all studies were published after 1990. These articles discussed the role of clotrimazole and acidifying compounds in the treatment of otomycosis. Moreover, the route of administration, dosage, and side effects of these medications were highlighted. Eight studies had similar results and claimed that clotrimazole has the best or most significant effect on the treatment of otomycosis for patients suffering from pain, itching, swelling, and hearing loss. Although all medications appear effective, there is a paucity of evidence to fully support the decision to choose between clotrimazole or acidifying agents for the treatment of otomycosis in terms of both efficacy and safety. However, in the biomedical field, the re-emerging investigation attention is due to the statements of a number of mechanisms defending the use of acidifying agents to treat mycosis (of antifungal-resistant species).

Managing recurrent otitis externa in dogs: what have we learned and what can we do better?

Recurrent otitis externa is a common problem in dogs. Topical treatment for each flare is successful in the short term, but repeated cycles of inflammation and infection lead to chronic inflammatory changes, pain and aversion, and antimicrobial resistance. These make the flares more frequent and harder to control. Eventually, the changes become irreversible and require a total ear canal ablation/lateral bulla osteotomy or ablative laser surgery. Most ear canal surgery is avoidable if recurrent otitis is properly managed at an earlier stage. This requires a different mindset and approach to these cases, taking advantage of recent research and clinical findings. Most importantly, clinicians must appreciate that all recurrent ear infections in dogs are secondary. To achieve a good long-term outcome, it is essential that all the underlying factors in each case are diagnosed and managed using the primary, secondary, predisposing, and perpetuating framework. This means that the primary condition must be diagnosed and managed, the secondary infection treated, predisposing risks identified and corrected, and the perpetuating factors reversed. Treatment is in 2 phases: induction to get the ears in remission and then long-term maintenance therapy to prevent relapses. Treatment should be appropriate to each dog but will typically involve ear cleaning, topical antimicrobial therapy, and topical or systemic glucocorticoids. Novel treatments for infection and inflammation will offer additional options in the future. Understanding the triggers for recurrent otitis in dogs will help clinicians plan effective management regimens that will make a huge difference to the quality of life of their patients and their owners.

Tackling acne vulgaris by fabrication of tazarotene-loaded essential oil-based microemulsion: In vitro and in vivo evaluation

This study aimed to formulate and optimize an anti-acne drug namely tazarotene (TZR) in essential oil-based microemulsion (ME) using either Jasmine oil (Jas) or Jojoba oil (Joj). TZR-MEs were prepared using two experimental designs (Simplex Lattice Design®) and characterized for droplet size, polydispersity index, and viscosity. Further in vitro, ex vivo, and in vivo investigations were performed for the selected formulations. Results revealed that TZR-selected MEs exhibited suitable droplet size, homogenous dispersions, and acceptable viscosity, in addition to spherical-shaped particles in morphology. The ex vivo skin deposition study showed a significant TZR accumulation in all skin layers for the Jas-selected ME over the Joj one. Further, TZR didn't show any antimicrobial activity against P. acnes, however, it was boosted when it was incorporated into the selected MEs. The in vivo study results of the infected mice ears induced by P. acnes revealed that our selected MEs successfully reached a high level of ear thickness reduction of 67.1% and 47.4% for Jas and Joj selected MEs, respectively, versus only 4% for the market product. Finally, the findings confirmed the ability to use essential oil-based ME, particularly with Jas, as a promising carrier for topical TZR delivery in the treatment of acne vulgaris.

Clinical Spectrum and Treatment Response of Malignant Otitis Externa Patients: A Rural Tertiary Care Centre Experience.

Malignant otitis externa (MOE) is an invasive external ear infection that has a tendency to spread throughthe temporal bone and can further progress to involve intracranial structures. Though the prevalence of MOE is rare, high morbidity and mortality are often associated. Complications of advanced MOE include cranial nerve involvement, most commonly facial nerve, and intracranial infections such as abscesses and meningitis. In this retrospective case series of nine patients diagnosed with MOE, demographic data, clinical presentations, laboratory data, and radiological findings were reviewed. All patients were followed up for a minimum period of three months after discharge. Outcomes were measured in terms of reduction in obnoxious ear pain (Visual Analogue Scale), ear discharge, tinnitus, need for re-hospitalization, recurrence of disease, and overall survival. In our case series of nine patients (seven males and two females), six underwent surgery, and three patients were managed with a medical line of treatment. All patients had a significant reduction in otorrhea, otalgia, random venous blood sugars, and improvement of facial palsy implicating good response to treatment. Prompt diagnosis of MOE warrants clinical expertise and aids in preventing complications. A prolonged course of intravenous anti-microbial agents is the mainstay of treatment, but timely surgical interventions in treatment-resistant cases can prevent complications.

Characteristics of Poly ENT HN Patients at Umbu Rara Meha Hospital and Physical Examination Features Obtained in Cases of Chronic Suppurative Otitis Media (CSOM) Benign Type and Malignant Type

Introduction: Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear which has been in the process for more than 2 months, which is characterized by a perforation of the tympanic membrane and continuous or intermittent discharge from the ear canal. In developing countries like Indonesia, the incidence of CSOM is quite high. Objective: to find out the characteristics of patient visits to the ENT polyclinic at Umbu Rara Meha Hospital and to find differences in the results of physical examinations for the Benign/ Benign type CSOM and the Danger/Malignant type of CSOM. Method: The type of research used is observational analytics with a cross sectional design. Results and Discussion: based on the characteristics of patients visiting the ENT HN polyclinic, it was found that the dominant patients visiting the ENT HN polyclinic were male patients 50.7%, the age group 21-30 years 23% and ages 0-10 years 18.4%, most residents in cities who visiting Kambajawa 16.2%, high school education level 34.6%, Christianity 62.5%, using BPJS payments 51.5% and coming from the Sumba tribe 54.4%. The top 3 diseases in the ENT HN field are obturan cerumen 18.36%, rhinosinusitis 13.97% and cases of CSOM 12.2%. Conclusion: CSOM is included in the top three lists of the ten most common diseases at Umbu Rara Meha Hospital, determining the type of CSOM including the Benign or benign type or the malignant or malignant type will determine the appropriate therapeutic action and the prognosis of the patient's disease.

Impact of Habitual Yogurt Intake in Mother-Child Dyads on Incidence of Childhood Otitis Media: The Japan Environment and Children's Study (JECS).

Otitis media, one of the most common childhood diseases, is characterized by inflammation or infection of the middle ear. Due to their ease of access, daily probiotics are recommended for the prevention of early childhood otitis media. This study aimed to assess the impact of probiotics on the incidence of otitis media using a dataset (n = 95,380) from the Japan Environment and Children's Study, a nationwide birth cohort study. After multiple imputations, the association between the incidence of otitis media in early childhood and the daily frequency of yogurt intake in children and mothers was examined using a generalized linear model after adjusting for several confounders. Repeated incidence of otitis media during the 2years after birth was found in 14,874 participants (15.6%). Based on participants with the lowest frequency of yogurt intake ("almost never") as the reference group, risk ratios for otitis media incidence decreased with higher frequencies of yogurt intake in children at one year of age, but also independently in mothers during pregnancy. The lowest risk ratio (95% confidence interval) for otitis media incidence at six months of age was observed with the most frequent yogurt intake (once/day or more) (0.54 [0.46-0.63]). Additionally, although a similar association was observed in the subgroup of those with cleft lip and/or palate (CL/P), a high-risk group for severe recurrent otitis media, no statistical significance was observed. Thus, increased regular yogurt intake in both children and mothers was associated with a decrease of otitis media during early childhood.

Mechanics of removing water from the ear canal: Rayleigh–Taylor instability

Water stuck in the ear is a common problem during showering, swimming or other water activities. Having water trapped in the ear canal for a long time can lead to ear infections and possibly result in hearing loss. A common strategy for emptying water from the ear canal is to shake the head, where high acceleration helps remove the water. In this present study, we rationalize the underlying mechanism of water ejection/removal from the ear canal by performing experiments and developing a stability theory. From the experiments, we measure the critical acceleration to remove the trapped water inside different sizes of canals. Our theoretical model, modified from the Rayleigh–Taylor instability, can explain the critical acceleration observed in experiments, which strongly depends on the radius of the ear canal. The resulting critical acceleration tends to increase, especially in smaller ear canals, which indicates that shaking heads for water removal can be more laborious and potentially threatening to children due to their small size of the ear canal compared with adults.