Evidence Of Middle Ear Effusion Research Articles

Post-radiation middle ear effusion in NPC patients: Analysis of patient, tumour, and radiation factors.

The purpose of this study was to investigate whether patient, tumour and radiation therapy factors are associated with development of middle ear effusion (MEE) in nasopharyngeal carcinoma (NPC) patients. A retrospective review of NPC patients treated between January 2000 and June 2018 at Rabin Medical Center. Patient factors, tumour factors, radiation doses, and radiation fields were collected and outlined if needed (middle ear, eustachian tube [ET], tensor veli palatini [TVP], and levator palatini [LVP] muscles), then analysed and compared between patients with MEE and those without and between sides in patients with unilateral MEE. Seventy-three patients were enrolled. Most were males (71.2%) with advanced-stage diseases (78%). At the time of diagnosis 14 patients (19.2%) presented with MEE. Following radiation, 18 patients, with no evidence of MEE at presentation, developed MEE. Tumour stage, histology, and laterality were not associated with development of MEE. Comparison of mean radiation field dosages including-gross target volume, clinical target volume, and patient target volume showed no association with post-radiation MEE. In addition, no difference was found in the radiation doses to the middle ear, ET or the LVP nor the TVP between ears with and without MEE. Post-irradiation MEE remains a common adverse effect in NPC patients. Surprisingly, tumour stage, tumour laterality, and histology were not associated with MEE. Similar findings were observed for total radiation doses and specific doses to the middle ear, ET, and ET muscles.

Concurrent Nasal Surgery with Mastoidectomy in Adults

Objective: To compare our findings with published success rates for mastoidectomy performed withconcurrent nasal surgeryMaterials and Method: The study was conducted from May 2017 – September 2019 in the E.N.T departmentof Saraswathi Institute of Medical Sciences, Hapur. We retrospectively reviewed 35 consecutively presentingpatients who had undergone concurrent septoplasty and mastoidectomy with or without ossicular chainreconstruction. . The study consist of patients ranged in age from 18 to 50 years and were followed up for 1- 24 months. Surgical success was defined as presence of an intact TM graft ,well epithelized mastoid cavitywithout any evidence of middle ear effusion .Results: Our 2 primary finding – graft survival rate of 91.42% and an overall surgical success rate of 77.1% compare favourably with the results of other studies of outcomes of isolated mastoidectomies. Our dataindicates that simultaneous performance of nasal surgery and mastoidectomy is feasible in adults. Nasalpacking has got short term effect on ET dysfunction but rarely severe enough to cause symptoms or middleear effusion. Concurrent approach is useful in TM graft survival or mastoid cavity epithelisation in longterm overall surgical treatment success. The concurrent approach requires only single time administrationof general anaesthesia, cost effective treatment, improved overall symptomatic relief from nasal and earsymptoms.

Language Development, Hearing Loss, and Intracranial Hypertension in Children With TWIST1-Confirmed Saethre-Chotzen Syndrome.

Saethre-Chotzen syndrome (SCS) is an autosomal dominant condition defined by mutations affecting the TWIST1 gene on chromosome 7p21.1. Previous research has identified an elevated prevalence of intracranial hypertension and hearing impairment associated with this syndrome. This study aimed to investigate the influence of hearing history and presence of intracranial hypertension on language development in children with SCS.A retrospective study note analysis was performed for all patients with a confirmed TWIST1 gene abnormality who attended the Oxford Craniofacial Unit and underwent a language assessment over a 22-year period. Intracranial pressure monitoring, hearing status, and language outcomes were examined in detail.Thirty patients with genetically confirmed SCS and language assessment data were identified. Twenty-eight patients underwent surgical intervention; 10 presented with intracranial hypertension (5 prior to, and 5 after primary surgical intervention). Language data coinciding with the presentation of intracranial hypertension were available for 8 children. About 44% of children with intracranial hypertension presented with concurrent receptive and expressive language delay (n = 4/8). For both children (n = 2) with longitudinal language data available, the onset of intracranial hypertension reflected a concurrent decline in language skills. Audiometric data were available for 25 children, 80% (n = 20/25) had a history of hearing loss. About 50% of these had confirmed conductive hearing loss with middle ear effusion and the other 50% had presumed conductive hearing loss with middle ear effusion. About 100% of the children with available hearing data in our study had evidence of middle ear effusion in at least 1 ear. Results also indicated that 43% (n = 13/30) of the children presented with receptive and/or expressive language delay during childhood.Given the importance of hearing for language development and the preliminary findings of a potential decline in language skills in children during periods of intracranial hypertension, regular follow-up of hearing, language, and intracranial hypertension are indicated in children with SCS.

Impedance audiometry in infants with a cleft palate: The standard 226-Hz probe tone has no predictive value for the middle ear condition

Objective Infants with a cleft palate and microscopical evidence for middle ear effusion attracted our attention because of normal tympanometry results and negative otoacoustic emissions. These contradictory findings initiated us to study to what extent high frequency tampynometry is able to supply us with more reliable results. Methods Eighty-three ears of 46 cleft palate babies aged between 2 and 7 months were examined within the pedaudiological screening procedure via tympanometry before their surgical cleft closure. We applied probe tone frequencies of 226 Hz and 678 Hz. A control cohort of 69 ears of 36 babies without cleft palate was established. Results were later compared to the intraoperative findings. Results By tympanometry with a 226-Hz probe tone, the examiners predicted the intraoperative findings correctly in only 29 cases of 83 examined ears (34.9%). However, their interpretation of tympanometry results by means of a 678-Hz probe tone correlated to the intraoperative findings in 96.3% cases. Conclusions In cleft palate babies tympanometry with a 678-Hz probe tone yields clear evidence of middle ear effusion and should therefore serve as an essential instrument before the first surgical step of palate closure. In case of applying the 226-Hz probe tone, we were often confronted with normal function of the Eustachian tube despite of proved existence of middle ear effusion.

Contribution of Vision to Balance in Children Four to Eight Years of Age

The use of sensory feedback for postural control develops throughout childhood. The aim of this study was to determine how children use cues from anterior-posterior optic flow for balance from 4 to 8 years of age. One hundred forty-eight children were enrolled. The subjects had yearly otologic and posturographic examinations between the ages of 4 and 8 years. Balance was assessed only if the subject had no evidence of middle ear effusion. The subject stood for 30 seconds with eyes open without optic flow and for 30 seconds while viewing 0.1, 0.25, and 0.4 Hz anterior-posterior optic flow. The center of pressure (COP) was recorded from the force platform. The root-mean-square of the COP during the periods of quiet stance and with optic flow was computed. The root-mean-square COP was significantly larger during the optic flow stimulation as compared with during quiet stance. The subjects had a significant decrease in COP during optic flow from year 5 to year 6 of life (p = .005). A change in the response to optic flow was seen from age 5 to age 6. This change is consistent with transitional changes in postural responses that have been observed during quiet standing.

Otoscopic and Tympanometric Findings in Acute Otitis Media Yielding Dry Tap at Tympanocentesis

The value of tympanometry in detection of middle ear effusion (MEE) has been widely studied in otitis media with effusion. There has been no direct comparison of tympanometric and tympanocentesis (TAP) findings in acute otitis media (AOM). We compared otoscopic, tympanometric and TAP findings in AOM including cases of AOM without effusion. In a study of AOM treatment of 90 children, a tympanogram was obtained, and TAP was performed before and after 5 days of treatment. Subjects were followed with otoscopy and tympanometry every 2 weeks for 3 months or until the MEE cleared. In 130 AOM ears, otoscopic, tympanometric and TAP findings were available; MEE was obtained from 110 ears. Of 20 ears with a dry tap, 18 had abnormal tympanogram and otoscopic findings. With TAP findings as the standard, sensitivity and positive predictive value of type B tympanogram were 97 and 87%, respectively. Of 18 AOM ears yielding dry tap, 2 yielded MEE 5 days later, and 8 continued with evidence of MEE 5 days-12 weeks later. Five subjects with 8 AOM ears yielding dry tap were lost to follow-up; all had short duration of clinical symptoms. Although otoscopic and tympanometric findings suggested the presence of MEE in AOM, MEE was unobtainable by TAP in 14% of cases. Dry tap cases likely represent early AOM before accumulation of detectable MEE. However, technical difficulty in obtaining small amounts of or highly viscous MEE could not be excluded. Sensitivity and positive predictive value of abnormal tympanograms in detection of MEE in AOM cases are comparable with those in otitis media with effusion.

Effect of nasal packing on Eustachian tube function

Sixty-three patients undergoing surgery to the nasal septum followed by bilateral packing had pre- and post-operative tympanometry in order to determine the effect on eustachian tube function. Fifty-five of the 126 ears tested (46 per cent) developed a reduction in middle ear pressure of at least 50 daPa; 76 per cent became normal within 24 hours of removing the nasal packs. All ears were asymptomatic and no patient had evidence of middle ear effusion. Nasal packing following septal surgery is a frequent cause of short-lasting eustachian tube dysfunction but rarely severe enough to cause symptoms or middle ear effusion. Tubal dysfunction is most likely due to a combination of surgical oedema and a direct effect of the nasal packing.

Nature of spontaneous tympanic membrane perforation in acute otitis media in children.

The study was undertaken to define the characteristics of spontaneous eardrum perforation in acute otitis media. Eighty (29.5 per cent) out of 271 children with acute otitis media had eardrums which perforated. An increased incidence of perforation was associated with a previous history of otitis media. All perforations were small and limited exclusively to the pars tensa. In 85 per cent of the patients, the perforation was located in the anterior-inferior quadrant. It had smooth margins enabling free drainage of pus-and was associated with a favourable clinical course. In the remaining 15 per cent of the cases, the perforation was located in the posterior-superior quadrant. It had a nipple-like shape with a tiny opening that did not allow pus to drain sufficiently from the middle ear. The perforation closed in 94 per cent of the patients within one month. The healing process was gradual and following perforation closure, there was evidence of middle ear effusion for some time before normal aeration was regained.

Eustachian tube dysfunction in children with ragweed hayfever during natural pollen exposure.

The role of upper respiratory allergy in the pathogenesis of otitis media with effusion (OME) is an interesting but still unresolved issue. In order to investigate this further, fifteen children with ragweed hayfever were studied for the development of eustachian tube obstruction (ETO), utilizing the nine-step pressure-swallow test, prior to, during, and after seasonal exposure to ragweed pollen. Daily symptom-medication diaries were maintained and serial physical examinations were performed. ETO was found in 60% of the ragweed sensitive children during natural pollen exposure. The development of ETO was found to correlate with ragweed skin test wheal size and daily patient symptom-medication scores (SMS) during pollen exposure. Treatment of hayfever symptoms with pseudoephedrine and/or chlorpheniramine did not prevent most patients from developing ETO. Despite the prevalence of ETO in the study group, only one child developed evidence of middle ear effusion. These findings suggest that children with ragweed hayfever develop eustachian tube (ET) dysfunction during natural pollen exposure. Seasonal allergy induced ETO is not, however, by itself sufficient to produce middle ear effusion.

Study of middle ear disease using tympanometry in general practice.

Tympanometry was used to provide evidence of middle ear effusions in a prospective study of middle ear disease in 264 children aged 3 months to 6 years in general practice. Adequate measurements on both ears were obtained in 220 children, of whom 68 (31%) had evidence of middle ear effusion in one ear (29 children) or both ears (39 children) at entry to the study. In 28 (42%) of the 68 children persistence of the tympanometric findings was recorded for at least three months. Children of European descent were more likely to have evidence of middle ear effusion at the initial examination compared with African and West Indian children, as were those children whose siblings had a positive history of otitis media compared with those whose siblings had no such history. Children under 3 years were more likely to have evidence of an effusion than older children. Middle ear effusion as shown by tympanometry was not associated with a previous history of otitis media in the child but was associated with recent symptoms of respiratory infection or otalgia. A previous consultation for otitis media was, however, strongly associated with a greater likelihood of a consultation for otitis media during the follow up period. Comparing evidence of effusion by tympanometry with that by pneumatic otoscopy showed that using the appearance of the eardrum alone the sensitivity of otoscopy was 55%; the addition of mobility improved the sensitivity to 76% with little reduction in specificity. Further studies on populations using tympanometry are needed to determine the natural history, aetiology, and indications for referring children with middle ear effusion.

Acoustic impedance and otoscopic findings in young children with Down's syndrome.

This study sought to determine the point incidence of middle ear pathologic conditions and to ascertain the value of acoustic impedance-admittance measurements in detecting otitic pathologic conditions in young children with Down's syndrome. Pneumo-otoscopy and acoustic impedance measures were performed on 38 children (mean age, 3.1 years) with Down's syndrome. Results indicated that more than 60% of the series demonstrated otoscopic and acoustic impedance evidence of middle ear effusion, which is in keeping with results reported previously for older children and young adults with Down's syndrome. Of particular interest was the large number of normal ears that displayed absent crossed and uncrossed acoustic reflexes,which suggested that measurement of the acoustic reflex may be an unreliable parameter for confirming the presence of middle ear effusion in children with Down's syndrome. To maximize the educational potential of these children, a careful examination to detect middle ear effusion must be performed at periodic intervals. If persistent effusion is detected, appropriate surgical management should be instituted without delay.