Episodes Of Otorrhea Research Articles

Otorhinolaryngological findings and hearing in HIV-positive and HIV-negative children in a developing country

The otorhinolaryngological (ORL) manifestations of Human Immunodeficiency virus (HIV) are common, but remain poorly characterized among children of Sub-Saharan Africa, where 90% of new pediatric infections occur. Our objective was to compare ORL findings and hearing in HIV-positive and -negative children of Luanda, Angola, using a comparative study of 78 outpatients from the HIV polyclinic and of 78 age- and sex-matched controls in a pediatric hospital with interview, general and ORL examination, brainstem auditory evoked potentials, and at age >5years pure tone open-air audiometry. ORL pathology emerged in 92% of HIV-positive and 78% (p=0.02) of control children. HIV-associated ORL findings comprised dental caries (56 vs. 32%; p=0.0009), cervical lymphadenopathy >1cm (45 vs. 10%; p<0.0001), facial skin lesions (32 vs. 5.1%; p<0.0001), chronic suppurative otitis media (26 vs. 3.8%; p=0.0002), dry tympanic membrane perforations (9 vs. 1%; p=0.03), tonsils of Mallampati score 0-1 (87 vs. 64%; p=0.0009), and bilateral hearing loss of >25dB (13 vs. 1%; p=0.009). Other HIV-associated characteristics included ear pain (44 vs. 27%; p=0.006), earlier otorrhea episodes (34 vs. 17%; p=0.004), tuberculosis (29 vs. 2.6%; p<0.0001), and pneumonia (22 vs. 2.6%; p=0.0003). ORL pathology appeared usual in both HIV-positive and -negative children. However, the overall high frequency and severity of the findings among the HIV-positive children require regular inclusion of the ORL area in these children's clinical evaluation.

Posterior cranial fossa extension of congenital cholesteatoma in children: Report of two cases

Abstract Objectives : To present the results of surgical treatment and long term follow-up of two cases of congenital cholesteatoma in young children extending into the posterior cranial fossa. Method : A retrospective review of 264 children, surgically treated for cholesteatoma of the temporal bone between 1999 and 2008 was performed. The presenting symptoms, tympanic membrane findings, surgical findings, methods, and results were investigated retrospectively. Results : 30 cases satisfied the criteria of congenital cholesteatoma. Two patients presented radiological and surgical evidence of extension of the cholesteatoma in the posterior cranial fossa. Post-operative air-bone gap changes were not significant. No recurrence is observed to date. Conclusion : Congenital cholesteatoma is a different disease entity from acquired cholesteatomas, no previous otorrhea episodes are described and the tympanic membrane appears to be intact; the first symptom is usually hearing loss, but in very young children, one side hearing loss may be misdiagnosed, therefore CC may have severe intracranial complications as onset symptomatology. Pre-operative CT imaging is useful for the evaluation of the extension of the disease and planning the appropriate surgical technique.

Otorrhea in Infants With Tympanostomy Tubes Before and After Surgical Repair of a Cleft Palate

To compare the incidence of otorrhea in a group of infants with cleft palate (CP) and tympanostomy tubes before and after surgical repair of the CP. Prospective observational study. Otolaryngology clinic at a tertiary care children's hospital. Thirty-three infants with CP and middle ear effusions who underwent tympanostomy tube placement. Subjects were observed from the time of tube placement until 6 months after CP repair. Incidence of otorrhea before and after CP repair. Subjects were observed a mean of 6.3 months before CP repair and 6 months after CP repair. Before CP repair, 11 of 33 infants (33%) had no episodes of otorrhea, compared with 22 of 33 (67%) after CP repair (P = .007). Fourteen infants (43%) had 2 or more episodes of otorrhea before CP repair compared with 2 (6%) after CP repair (P = .001). Before CP repair, significantly fewer tubes were patent at the time of the audiologic evaluation compared with after CP repair (39 of 62 [63%] vs 52 of 66 [79%]; P = .048). Average speech reception threshold for the infants with tympanostomy tubes before CP repair was 18.1 dB compared with 12.6 dB after CP repair (P = .01). The incidence of otorrhea after tympanostomy tube placement before CP repair is higher than the incidence after CP repair, although more than half of all infants (19 [58%]) had either 1 or no episodes of otorrhea before CP repair.

Morphological evidence of biofilm formation in Greenlanders with chronic suppurative otitis media

Biofilm may explain the recurrences and recalcitrant episodes of otorrhea in chronic suppurative otitis media (CSOM). This study investigates bacterial biofilm in Greenlanders with CSOM and chronic otitis media with effusion (COME). The study is partly blinded, prospective and retrospective. Six children with CSOM, four children with COME and ten adults with CSOM were included in this study. Cultures were obtained and examined by standard methods. Otorrhea or glue was collected from the children and smears were prepared. Middle ear mucosa biopsies were obtained from the adults. Smears and biopsies were analyzed with microscopy and peptide nucleic acid fluorescence in situ hybridization (PNA-FISH). Biofilm was confirmed in 83% of CSOM smears but in none of the COME smears. Mucosal biofilm was confirmed in 80% of the biopsies from adults with CSOM. This study provides direct morphological evidence of biofilm in samples from human CSOM. This may help to explain the microbiological mechanisms of the disease and alter the treatment strategy in the future.

Tube associated otorrhea in children with recurrent acute otitis media; results of a prospective randomized study on bacteriology and topical treatment with or without systemic antibiotics

To establish if otorrhea associated to tympanostomy tubes in infants suffering from recurrent acute otitis media is similar to acute otitis media, and if topical treatment alone is sufficient or if addition of systemic antibiotics is required. Children under 3 years of age with tympanostomy tubes due to recurrent acute otitis media were recruited to the study. The study design was open label randomized and prospective. Fifty patients were allocated to either of two treatment groups and were monitored for 6 months. Group I received only topical treatment (commercially available ear drops and saline solution) in case of otorrhea. Group II was treated with topical treatment together with systemic antibiotics. All episodes of acute otorrhea were registered. Main outcome measure was duration of otorrhea in days. Bacterial samples from the ear discharge were taken. Forty-one episodes were treated according to protocol. The bacteriological testing mainly showed bacteria typical of acute otitis media. A majority of episodes were cured within 7 days in both groups, and statistical analysis showed no significant difference between the treatment groups in duration of otorrhea. In Group I systemic antibiotics were added in one-third (7/21) of the episodes due to signs of affected general condition such as high fever and severe earache. The otorrhea episodes in the study were similar to acute otitis media based on the bacteriological results. Topical treatment alone might be used as first treatment of choice. Although systemic antibiotics were added in several cases in the topical treatment group, the findings of the study do not support use of systemic antibiotics for tube associated otorrhea in RAOM children in general.

Seqüelas de tubos de ventilação em crianças com otite média com efusão: um seguimento de três anos

A inserção de tubos de ventilação (TV) é um dos procedimentos mais comuns em otorrinolaringologia. Otorréia, timpanoesclerose, retração, perfuração e colesteatoma após a colocação de tubos de ventilação são complicações citadas na literatura. OBJETIVOS: Determinar o tipo e a incidência de seqüelas/complicações de TV em crianças com otite média recorrente e otite média com efusão crônica que foram submetidas a miringotomia com colocação de TV. FORMA DE ESTUDO: Estudo de coorte, longitudinal prospectivo. MATERIAL E MÉTODO: Setenta e cinco crianças (150 orelhas) entre 11 meses e 10 anos de idade foram monitoradas regularmente durante até 38 meses após a colocação de TV. RESULTADOS: Incidência de seqüelas/complicações: otorréia - 47,3% das orelhas; perfuração - 2,1%; retração do tímpano - 39,7%; timpanoesclerose - 23,3%. Tempo médio de permanência do TV: 12,13 meses. Idade média na primeira cirurgia de quem não foi re-operado = 35,9 meses e idade média na primeira cirurgia de quem sofreu re-inserção = 25,6 meses (P=0,04). O TV permaneceu mais tempo nas orelhas com mais episódios de otorréia (P=0,01). A colocação de TV com adenoidectomia associou-se a uma freqüência menor de otorréias (P=0,02). CONCLUSÕES: Otorréia foi a complicação de colocação de TV mais incidente. A colocação de TV com adenoidectomia associou-se a um menor número de otorréias. O TV permaneceu mais tempo nas orelhas com maior freqüência de otorréias. Pouca idade na ocasião da primeira colocação de TV está associada a uma incidência maior de re-inserção de TV. Um em cada seis pacientes provavelmente necessitará uma segunda inserção de TV.

Tympanostomy tube sequelae in children with otitis media with effusion: a three-year follow-up study

SummaryTympanostomy tube (TT) insertion is one of the most frequently performed procedures in otolaryngology. Otorrhea, tympanosclerosis, retraction, perforation, and cholesteatoma are complications reported in the literature after its application. Aim: To determine the incidence and the type of TT insertion sequelae/complications in children presenting with recurrent otitis media and chronic otitis media with effusion undergoing myringotomy and tube placement. Study Design: prospective cohort study. Material and Method: A total of 75 children (150 ears) aged 11 months to 10 years were regularly followed up for up to 38 months after TT insertion. Results: Incidence of sequelae/complications: otorrhea - 47.3% of the ears; perforation - 2.1%; retractions - 39.7%; tympanosclerosis - 23.3%. Average length of stay: 12.13 months. Mean age at initial tube placement of children not requiring a second set of tubes = 35.9 months and mean age at initial tube insertion of children requiring an additional set of tubes = 25.6 months (P=0.04). TT stayed longer in the ears that had more episodes of otorrhea (P=0.01). TT insertion with adenoidectomy was associated with a smaller number of otorrhea episodes (P=0.02) Conclusions: Otorrhea was the most frequently found complication. TT placement with adenoidectomy was associated with fewer otorrhea episodes. TT extruded later in those ears that had more episodes of otorrhea. Younger age at the time of the initial tube placement is associated with higher incidence of additional tube placement. One in six patients will probably require a second set of ventilation tubes.

Water Precautions and Tympanostomy Tubes: A Randomized, Controlled Trial

The objective was to determine whether there is an increased incidence of otorrhea in young children with tympanostomy tubes who swim and bathe without water precautions as compared with children who use water precautions in the form of ear plugs. Prospective, randomized, investigator-blinded, controlled trial. Two hundred one children (age range, 6 mo-6 y) who had undergone bilateral myringotomy and tube insertion were randomly assigned into one of two groups: swimming and bathing with or without ear plugs. Children were seen monthly for 1 year and whenever there was intercurrent otorrhea. Ninety children with and 82 children without ear plugs returned for at least one follow-up visit. Mean (SD) duration of follow-up was 9.4 (4.1) months for the children with ear plugs and 9.1 (4.4) months for the children without ear plugs. Forty-two children (47%) who wore ear plugs developed at least one episode of otorrhea, as compared with 46 (56%) who did not use ear plugs (logistic regression adjusting for stratification variables, P = .21). The mean (SD) rate of otorrhea per month was 0.07 (0.31) for the children who wore ear plugs as compared with 0.10 (0.31) for the children who did not wear ear plugs (Poisson regression adjusting for stratification variables, P = .05). There is a small but statistically significant increase in the rate of otorrhea in young children who swim and bathe without the use of ear plugs as compared with children who use ear plugs. Because the clinical impact of using ear plugs is small, their routine use may be unnecessary.

Long-term results of Armstrong beveled grommet tympanostomy tubes in children.

Many different tympanostomy tubes have been developed with different sizes, shapes, compositions, and coatings. Despite the frequency of ventilation tube placement, very few large studies have examined the outcomes of patients receiving this procedure. An ideal tube would be easy to insert and would extrude at a predictable interval without complications. This study was performed to assess outcome measures and complication rates of the Armstrong beveled grommet tube. A retrospective case series of patients who had Armstrong beveled grommet tympanostomy tubes placed over a 3 year period by two Children's Hospital of Wisconsin pediatric Otolaryngology staff. Patient age, diagnosis, operative findings, and time to tube extrusion were reviewed. Otorrhea, perforation, and cholesteatoma rates were also assessed. Five hundred seven consecutive patients who had Armstrong tubes placed were reviewed. One thousand ninety-six Armstrong tubes were placed in these patients. Follow-up to extrusion rates were available for 756 tubes. The mean patient age at tube placement was 33.3 months, and the median age was 23 months. Mean and median times to extrusion were 16.5 and 15.5 months. One hundred sixty episodes of otorrhea were noted in 148 patients. Four patients had histories of cholesteatoma, none of which developed in conjunction with Armstrong tubes. Ten (1.32%) perforations that have not resolved over time were noted after Armstrong tube placement. Armstrong beveled grommet tympanostomy tubes have complication rates comparable with those reported for Armstrong or other short-acting tubes in smaller series.

Effect of N-acetylcysteine on the Incidence of Recurrence of Otitis Media with Effusion and Re-insertion of Ventilation Tubes

Previous studies have demonstrated the anti-inflammatory, anti-oxidant, and mucolytic nature of N-acetylcysteine (NAC). Theoretically, these properties make the substance ideal for therapeutic use against otitis media with effusion (OME). The disease is characterized as a sustained non-specific inflammation of the middle ear mucosa with secretory transformation of the epithelium resulting in accumulation of fluid in the middle ear space. To investigate the effects of instillation of NAC in the middle ear, a double-blind, placebo-controlled, randomized trial was carried out. A total of 75 children who were undergoing their first bilateral insertion of ventilation tubes (VT) due to OME were randomized to Mucomyst (NAC) or placebo (the vehicle) on one ear in relation to the VT insertion. The contralateral ear underwent VT insertion exclusively. Instillation of Mucomyst or placebo was repeated 3 and 7 days afterwards. The children were followed regularily for 11-39 months. Episodes of otorrhea, recurrence of OME after VT extrusion and re-insertion of VTs were registered as primary outcome parameters. The results demonstrated that Mucomyst significantly reduced the recurrence of OME and re-insertion of VTs ( p <0.025) and significantly increased the time until VT extrusion ( p <0.0167). In addition, the number of episodes of ear problems and visits at the ENT clinic were reduced significantly by NAC ( p <0.0383).

Efficacy of tympanostomy tube insertion for otitis media with effusion in children with Down syndrome

Objective: Although the insertion of tympanostomy tubes is regarded as an effective treatment for otitis media with effusion in the general population, it remains to be determined whether tympanostomy tube insertion is also effective for otitis media with effusion in children with Down syndrome. The present study was carried out to determine the efficacy of tympanostomy tube insertion in children with Down syndrome. Patients and methods: We studied 28 children (18 males and ten females) with Down syndrome and 28 age-matched control children who underwent tympanostomy tube insertion and were followed up for more than 2 years, up to 7 years of age or older. The children were followed up every month for 6 months after the operation and every 2 months thereafter. The tympanostomy tubes were not removed unless granulation tissue appeared around the ventilation tubes. Results: The cure rate for otitis media with effusion was lower in the children with Down syndrome than in the age-matched control children. Sequelae of otitis media with effusion (atelectatic eardrum, permanent perforation of the eardrum and middle ear cholesteatoma) were significantly often encountered in the former group. The children with Down syndrome had more frequent episodes of otorrhea from the tympanostomy tubes than the control children and antibiotic-resistant-bacteria were frequently isolated. Moreover, improvement in hearing acuity after the placement of tympanostomy tubes was not always achieved in children with Down syndrome. Conclusion: The efficacy of the tympanostomy tube insertion for children with Down syndrome was much lower than in control children. We propose that in children with Down syndrome conservative management should be the treatment of first choice and that the insertion of tympanostomy tubes should be indicated only when hearing loss due to middle ear effusion is in a severe degree and when pathological changes of the eardrum, such as adhesion and deep retraction pocket formation, are going to occur.

Prevalence, Incidence, and Duration of Otorrhea in Young Children with Tympanostomy Tubes for Persistent Otitis Media with Effusion. † 519

No data have been reported, to our knowledge, on the duration of episodes of otorrhea in children with tympanostomy tubes. In a prospective study of child development in relation to early-life otitis media (OM) we monitor a diverse (low-SES urban, mixed-SES small town/rural, middle-class suburban) cohort of children closely for OM from age ≤2 mo. Those who develop specified minimum cumulative durations of OM within the first 3 yr of life are randomized, subject to consent, to receive tube placement either promptly or after a defined extended period if OM persists. Episodes of tube otorrhea are treated with systemic and/or topical antimicrobials, and aural toilet as feasible. We report here data on otorrhea following initial tube placement(176 bilateral; 3 unilateral) at ages 6 to 49 mo in 179 randomized children followed for ≥6 mo without intervals >90 days between visits. Tube tenure and durations of episodes of otorrhea were estimated from (usually) monthly scheduled visits and interpolations for intervals between visits. The mean (SD) tenure of individual tubes was 13.9 (6.9) mo. Proportions of children with tubes who developed ≥1 episode of otorrhea, according to study site grouping and time frame after tube placement, were:Table Maximum numbers of episodes of otorrhea/child were 4 in 6 mo, 6 in 12 mo, and 7 in 24 mo. Mean duration of episodes was 16.2 days, median was 10 days, and range was 3 to 131 days. Duration was >30 days in 12.9% of 295 episodes. We conclude that tube otorrhea develops commonly in young children, that its prevalence varies inversely with SES; and that it often persists for lengthy periods despite treatment.

1. Total ear reconstruction

Objective: Although the insertion of tympanostomy tubes is regarded as an effective treatment for otitis media with effusion in the general population, it remains to be determined whether tympanostomy tube insertion is also effective for otitis media with effusion in children with Down syndrome. The present study was carried out to determine the efficacy of tympanostomy tube insertion in children with Down syndrome. Patients and methods: We studied 28 children (18 males and ten females) with Down syndrome and 28 age-matched control children who underwent tympanostomy tube insertion and were followed up for more than 2 years, up to 7 years of age or older. The children were followed up every month for 6 months after the operation and every 2 months thereafter. The tympanostomy tubes were not removed unless granulation tissue appeared around the ventilation tubes. Results: The cure rate for otitis media with effusion was lower in the children with Down syndrome than in the age-matched control children. Sequelae of otitis media with effusion (atelectatic eardrum, permanent perforation of the eardrum and middle ear cholesteatoma) were significantly often encountered in the former group. The children with Down syndrome had more frequent episodes of otorrhea from the tympanostomy tubes than the control children and antibiotic-resistant-bacteria were frequently isolated. Moreover, improvement in hearing acuity after the placement of tympanostomy tubes was not always achieved in children with Down syndrome. Conclusion: The efficacy of the tympanostomy tube insertion for children with Down syndrome was much lower than in control children. We propose that in children with Down syndrome conservative management should be the treatment of first choice and that the insertion of tympanostomy tubes should be indicated only when hearing loss due to middle ear effusion is in a severe degree and when pathological changes of the eardrum, such as adhesion and deep retraction pocket formation, are going to occur.

The effect of water exposure after tympanostomy tube insertion

Introduction: Unprotected water exposure as a cause of otorrhea in patients with tympanostomy tubes remains controversial. Although most otolaryngologists continue to recommend either the avoidance of swimming or the use of water precautions during swimming, evidence indicates that the infection rate may not be affected by this practice. This study prospectively evaluates the possible role of unprotected water exposure in the occurrence of post-tympanostomy-tube ostorrhea. Materlals and Methods: Two hundred twelve consecutive patients undergoing tympanostomy tube placement were randomized into swimming and nonswimming groups. No special precautions (eg, ear plugs, canal occlusion, antibiotic drugs) were used in either group. This incidence of otorrhea was then compared between these groups. Results: One-year follow-up was obtained in 107 patients. There was no significant difference in the incidence of otorrhea or the number of otorrhea episodes between the two groups. Conclusions: Swimming is not contraindicated in patients with tympanostomy tubes, and water precautions do not decrease the incidence of otorrhea. This is a US government work. There are no restrictions on its use.

One-year follow-up after tympanostomy tube insertion for recurrent acute otitis media.

In a prospective study, 126 children were followed for 1 year after the placement of tympanostomy tubes especially for recurrent acute otitis media. About 7 in 10 children remained free of middle ear infection and 1 in 10 showed frequent (i.e. 3 or more) episodes of otorrhea during the follow-up period. However, the most conclusive observation was that the otorrhea episodes were not equally distributed over the different ages: they were markedly more frequent in the group younger then 2 years old, although the prestudy infection rate was similar in all age groups. Furthermore, the incidence of middle ear infection was positively correlated with upper respiratory infection but not with other variables such as prestudy spontaneous perforations, contents of the middle ear, presence of the tube at the end of the study, and swimming habits. It seems that middle ear infection with ventilation tubes in place is influenced by age and upper respiratory infection as it is for acute otitis media in the population as a whole.

Treatment Failure in Otitis-prone Children with Prophylactic Tympanostomy Tubes Is Correlated with NasopharyngealHaemophilus influenzaeColonization

Tympanostomy tubes are used to prevent recurrent otitis media among otitis-prone children. However, not all children benefit from this treatment. In the present study 28 children (19 boys, 9 girls) were given bilateral tympanostomy tubes at age 9-22 months (mean 14 months). They were observed 6 months before and after tube insertion. The treatment was considered successful for 20 children. Among these, 16 completely lacked or had one episode of middle ear discharge and 4 had otorrhea on two occasions. A total of 8 children suffered from three or more episodes of otorrhea and were considered as treatment failures. In the failure group, the nasopharyngeal average carrier rate of H. influenzae 6 months before and after tube insertion was 64% vs. 29% in the group responding well to the treatment (p less than 0.001). Nonencapsulated forms of H. influenzae were in a great majority. In the failure group 7 out of 8 presented middle ear discharge as soon as within 2 weeks after tube insertion whereas this occurred in only 3 out of 20 in the responding group. IgG, IgG1 and IgG2 antibody response to pneumococcal polysaccharide (6A, 19F) were equally distributed in the two groups. The present data suggest that one reason for an unsatisfactory response to treatment with prophylactic tympanostomy tubes is nasopharyngeal colonization and subsequent middle ear infections caused by H. influenzae.

A prospective study of titanium ventilation tubes

A prospective controlled study was undertaken in which in 100 children a titanium ventilation tube was inserted in one ear, and a Paparella silicone tube was inserted in the contralateral ear as a control. The tubes were evaluated with respect to length of time of intubation, episodes of otorrhea, and early occlusion. Sixty-five patients were followed for at least one year, or until both tubes had extruded. Long-term follow-up of these patients has revealed little difference in the incidence of tube occlusion, early extrusion, or infection with otorrhea. Since the titanium tube is more than twice as expensive and has no proven advantages over a silicone tube of similar design, we have no reason to recommend its use over the less costly, standard silicon ventilation tube.

The Draining Ear: Otitis Media and Externa

Otorrhea, or discharge from the ear, may be associated with otitis media or otitis externa. Each episode of otorrhea requires examination of the external ear canal and middle ear to determine the origin and extent of disease, a complete understanding of the pathogenesis, and a therapeutic approach that considers the microbiology and the extent of tissue invasion. This review focuses on infections of the middle ear and external ear commonly associated with otorrhea. The pathogenesis, clinical manifestations, methods of diagnosis, and medical and surgical therapies are presented.

Delayed onset post-tympanotomy otorrhea.

Otorrhea is the most frequent complication of the use of tympanostomy tubes. When it occurs after the immediate postoperative period, otorrhea is probably the result of external contamination of the middle ear or acute otitis media. We analyzed data from 627 operations upon 1248 ears of 491 children with chronic secretory otitis media and found that delayed onset (longer than 7 weeks) postoperative otorrhea occurred after 26.4 percent of the 382 operations in which tympanostomy tubes were used. The average number of episodes of otorrhea per case was 1.46 and ranged from 1 to 9. The rate of otorrhea occurrence in patients with tubes in place was significantly higher in the summer months. Otorrhea also occurred after 9.0 percent of 245 myringotomy procedures. The average number of episodes was 1.32 and ranged from 1 to 3. Treatment of postoperative otorrhea increases the health care costs of surgical treatment of chronic otitis media with effusion; this problem should be included in the calculation of cost-effectiveness.

A controlled study of a ‘new’ ventilating tube. The gold standard?

A prospective controlled study of a gold ventilation tube was undertaken in which a gold tube was inserted in one ear of 88 children and a Paparella silicone tube was inserted in the contralateral ear as a control. The tubes were evaluated with respect to length of time of intubation, episodes of otorrhea and early occlusion. Sixty-three patients were available for a follow-up of at least 6 months. The gold tube remained in place for a shorter period of time when compared to the control tube. Episodes of otorrhea were infrequent and there was not any significant difference between the two types of tubes. The gold tube became occluded more frequently than the control tube. Since the gold tube is approximately 3 times more expensive and has no proven advantages over our conventional silicone tube, we have no reason to recommend its use in preference to any other available tube.