High Prevalence Of Otitis Media Research Articles

Questionnaire to assess the significance of history taking in assessment of otitis media with effusion in children

Background: There is a high prevalence of Otitis media with effusion (OME) with diagnoses of least 50% of children under the age of one, and 60% of children under the age of two. Complications have a significant impact on a child’s quality of life including hearing impairment, language acquisition delay, declining school performance, and behavioral problems. The objective of the study is to develop and test the reliability of a simple questionnaire based on common complaints given by caregivers of children with OME. Methods: 100 patients were included from the ENT Clinic at King Hamad University Hospital and categorized into preschool age (1-4 years) and School age (5-15 years). A bilingual binary questionnaire was developed (Cronbach’s Alpha: 0.89). Results: There were 22 preschool age patients, and 78 school age patients. Six complaints were significant where the child does not respond to name calling (p=0.031), needs to raise the TV volume (p=0.000), occasionally talks loudly (p=0.003), uses verbal communication for their needs (p=0.000), has episodes of clumsiness and dizziness (p=0.000), and doesn’t pronounce words correctly according to their age (p=0.008). Conclusions: Questionnaires based on complaints can aid the diagnosis of OME as caregiver’s assessment is often limited.

Immunogenicity, otitis media, hearing impairment, and nasopharyngeal carriage 6-months after 13-valent or ten-valent booster pneumococcal conjugate vaccines, stratified by mixed priming schedules: PREVIX_COMBO and PREVIX_BOOST randomised controlled trials

Australian First Nations children are at very high risk of early, recurrent, and persistent bacterial otitis media and respiratory tract infection. With the PREVIX randomised controlled trials, we aimed to evaluate the immunogenicity of novel pneumococcal conjugate vaccine (PCV) schedules. PREVIX_BOOST was a parallel, open-label, outcome-assessor-blinded, randomised controlled trial. Aboriginal children living in remote communities of the Northern Territory of Australia were eligible if they had previously completed the three-arm PREVIX_COMBO randomised controlled trial of the following vaccine schedules: three doses of a 13-valent PCV (PCV13; PPP) or a ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10; SSS) given at 2, 4, and 6 months, or SSS given at 1, 2, and 4 months followed by PCV13 at 6 months (SSSP). At age 12 months, eligible children were randomly assigned by a computer-generated random sequence (1:1, stratified by primary group allocation) to receive either a PCV13 booster or a PHiD-CV10 booster. Analyses used intention-to-treat principles. Co-primary outcomes were immunogenicity against protein D and serotypes 3, 6A, and 19A. Immunogenicity measures were geometric mean concentrations (GMC) and proportion of children with IgG concentrations of 0·35 μg/mL or higher (threshold for invasive pneumococcal disease), and GMCs and proportion of children with antibody levels of 100 EU/mL or higher against protein D. Standardised assessments of otitis media, hearing impairment, nasopharyngeal carriage, and developmental outcomes are reported. These trials are registered with ClinicalTrials.gov (NCT01735084 and NCT01174849). Between April 10, 2013, and Sept 4, 2018, 261 children were randomly allocated to receive a PCV13 booster (n=131) or PHiD-CV10 booster (n=130). Adequate serum samples for pneumococcal serology were obtained from 127 (95%) children in the PCV13 booster group and 126 (97%) in the PHiD-CV10 booster group; for protein D, adequate samples were obtained from 126 (96%) children in the PCV13 booster group and 123 (95%) in the PHiD-CV10 booster group. The proportions of children with IgG concentrations above standard thresholds in PCV13 booster versus PHiD-CV10 booster groups were the following: 71 (56%) of 126 versus 81 (66%) of 123 against protein D (difference 10%, 95% CI -2 to 22), 85 (67%) of 127 versus 59 (47%) of 126 against serotype 3 (-20%, -32 to -8), 119 (94%) of 127 versus 91 (72%) of 126 against serotype 6A (-22%, -31 to -13), and 116 (91%) of 127 versus 108 (86%) of 126 against serotype 19A (-5%, -13 to 3). Infant PCV13 priming mitigated differences between PCV13 and PHiD-CV10 boosters. In both groups, we observed a high prevalence of otitis media (about 90%), hearing impairment (about 75%), nasopharyngeal carriage of pneumococcus (about 66%), and non-typeable H influenzae (about 57%). Of 66 serious adverse events, none were vaccine related. Low antibody concentrations 6 months post-booster might indicate increased risk of pneumococcal infection. The preferred booster was PCV13 if priming did not have PCV13, otherwise either PCV13 or PHiD-CV10 boosters provided similar immunogenicity. Mixed schedules offer flexibility to regional priorities. Non-PCV13 serotypes and non-typeable H influenzae continue to cause substantial disease and disability in Australian First Nation's children. National Health and Medical Research Council (NHMRC).

What does microbiology have to do with the Hearing for Learning Initiative (HfLI)?

Where would we be without microbiology in tackling the high prevalence of otitis media (OM; middle ear infection) and disabling hearing loss that disadvantage Australian First Nations children living in remote communities? Understanding the microbiology of OM in this population has been critical in directing innovative clinical trials research and developing appropriate evidence-based practice guidelines. While these processes are critical to reducing disadvantage associated with OM and disabling hearing loss, a remaining seemingly insurmountable gap has remained, threatening progress in improving the lives of children with ear and hearing problems. That gap is created by the crisis in primary health care workforce in remote communities. Short stay health professionals and fly-in fly-out specialist services are under-resourced to manage the complex needs of the community, including prevention and treatment of otitis media and hearing loss rehabilitation. Hence the rationale for the Hearing for Learning Initiative – a workforce enhancement model to improve sustainability, cultural appropriateness, and effectiveness of evidence-based ear and hearing health care for young children in remote settings. This paper summarises the role of microbiology in the pathway to the Hearing for Learning Initiative.

Association of Passive Smoking with Otitis Media among School Children of Eastern Nepal

Abstract Introduction Otitis media (OM) and otitis media with effusion are commonly presenting conditions in an otolaryngology clinic. Exposure to passive smoking is thought to increase the risk of OM through an effect on mucociliary clearance, decreased ciliary beat frequency, or mucous hypersecretion. Awareness among parents plays a key role in the primary prevention of the disease. Objective We aimed to identify the association of passive smoking with OM among school-going children of the eastern region of Nepal. Methods A community-based cross-sectional study was done among 663 school-going children, selected by stratified random sampling using a questionnaire. Data regarding age, gender, type of school, otological symptoms, smoking status of parents and family members, otoscopic findings, pure tone audiometry, and impedance audiometry were recorded. Results Six-hundred and sixty-three students were included in the study. OM was confirmed in 103 students (15.5%). Smoking history was present in at least one of the family members in 177 out of 663 students (26.69%) and with positive smoking history in any member of the family, OM was seen in 65 (36.7%) students (p ≤ 0.001), which suggested significant association. OM was seen in 38 students (7.8%) when there was no exposure to passive smoking. Conclusions There is a high prevalence of OM (15.5%) in school-going children. The study shows significant association between passive smoking and OM in children.

Evaluation of Eustachian tube function in patients of cleft palate and effects of palatoplasty on these findings

<p class="abstract"><strong>Background:</strong> Isolated cleft palate and cleft palate and cleft lip patients have poor Eustachian tube function which results in hearing impairment that too in the speech formative years. Aim of study was to evaluate tympanometric findings in patient of cleft palate and effect of palatoplasty on both short term and long term postoperatively.</p><p class="abstract"><strong>Methods:</strong> The subjects consisted of patients attending the cleft lip and palate clinic. This was a combined clinic consisting of department of plastic surgery, department of ENT and department of dental surgery held every month at a tertiary care hospital in Delhi. Study consisted of three groups of patients namely preoperative group, postoperative group and pre-postoperative group.</p><p class="abstract"><strong>Results:</strong> No significant difference was observed in tympanometric abnormalities in cases of combined cleft lip and palate as compared to isolated cleft palate. After age of 5 months once changes of OME has set in there was no significant change in middle ear findings irrespective of palatal repair.</p><p class="abstract"><strong>Conclusions:</strong> There is a very high prevalence of otitis media with effusion in these patients. The changes do resolve spontaneously after age of seven, this perhaps is due to combined effect, growth, development and l maturity of Eustachian tube and palatal surgery rather than palatal surgery alone.</p><p> </p>

Allied health students as service providers in Aboriginal and Torres Strait Islander early childhood education programs: Perceptions of parents and educators

Early childhood education programs contribute significantly to children’s health and educational outcomes. Responsive service delivery approaches that support Aboriginal and Torres Strait Islander children and families to access allied health services in the early years are needed to reduce the health/education equity gap in Australia, particularly given the high prevalence of otitis media in this population. This study investigated perspectives of parents and early childhood educators regarding speech pathology and occupational therapy student-delivered services in Aboriginal and Torres Strait Islander early childhood settings. Thirteen early childhood educators and nine parents participated in focus groups or interviews following delivery of interprofessional services. Data were analysed using descriptive qualitative analysis. Findings suggest parents and early childhood educators perceived allied health student-delivered services to be effective, and enabled conceptualisation of a community-centred model for allied health service delivery in Aboriginal and Torres Strait Islander early childhood settings. This model supports communities to directly and collaboratively influence the provision of allied health services, and highlights approaches that involve relationship-building and respectful collaboration.

Evaluating the Frequency of Ear Problems in Patients with Cleft Lip and Palate

Background: Orofacial cleft is one of the most common congenital malformations of craniofacial region. Otitis media with effusion causing conductive hearing loss is a considerable challenge for many children with cleft lip and palate. The aim of this study was to evaluate the prevalence of hearing disorders and associated malformations in these patients. Methods: The research population consisted of patients with cleft palate, between years 2012 and 2014, who were referred to Children’s Medical Center and Vali-e-Asr hospital in Tehran, Iran. Otoscopic examination, tympanometry, pure tone audiometry and echocardiography were performed for each patient. Results: Among patients with cleft palate, 73% suffered from hearing disorders. There was no relationship between prevalence of hearing loss and sex, presence of other congenital anomalies and degree of cleft, but middle ear diseases were significantly higher in children younger than 2 years. Among patients with cleft lip or palate, 10% suffered from cleft lip, 63% suffered from cleft palate and 27% suffered from cleft lip and palate. There was at least one congenital anomaly in 53% of patients. Conclusion: This study demonstrates high prevalence of otitis media with effusion and conductive hearing loss in patients with cleft. However, audiologic problems are alleviated when patients become older.

Клиническая характеристика острых средних отитов и мастоидитов у детей

Objectves. To study the prevalence of acuta otitis media and mastoiditis in children according to data from the pediatric otolaryngology department of state budgetary health care institution “Regional Clinical Hospital No 2”. Tyumen city. Materials and methods. A retrospective analysis of the case histories of children who were hospitalized in the period from 2009 to 2017, the prevalence of various forms of otitis media and mastoiditis was studied. Results and discussion. The article analyzes the prevalence of clinical forms of otitis and mastoiditis in children. The number of children with otitis was 33% (4984 /15,087), of wich 68% with nonperforated form, 32% with perforated form, 6% complicated forms. Boys are more often sick, the younger and preschool age groups of children is the main risk group (85%) for the development of otitis media and mastoiditis. Conclusions. The high prevalence of otitis media and mastoiditis, their steady growth testifies to the urgency of the problem in pediatric practice.

Follow up of a birth cohort to identify prevalence and risk factors for otitis media among Indian children in the eighth year of life

BackgroundOtitis media, a disease highly prevalent among children worldwide, manifests clinically in both acute and chronic forms. The manner and time at which chronicity develops among Indian children is unknown. AimTo study the prevalence, manifestations and risk factors for otitis media in a birth cohort aged 8 years. MethodsA birth cohort of 107 babies was followed up at 8 years of age and ENT evaluation with nasopharyngeal swabbing for detecting Streptococcus pneumoniae and Hemophilus influenzae was performed. ResultsThe overall prevalence of otitis media was 14%, almost half the prevalence in the first 2 years of life. Eight children (7.5%) with congested, bulging eardrums and no systemic symptoms had asymptomatic acute otitis media. Another five (4.7%) children had otitis media with effusion and 2 (1.9%) had chronic suppurative otitis media. Although 10/15 (66.7%) children with otitis media had positive swabs at 8 years age, only 2 were pneumococcal vaccine (PCV-13) serotypes. Risk factor analysis showed that passive smoking was the only significant parameter associated with otitis media (p = 0.029).Nasopharyngeal swabbing showed that 51/105 (48.6%) children had positive swabs for S. pneumoniae and 5/105 (4.8%) for S.pneumoniae with non-type b H. influenzae. The ten most commonly encountered pneumococcal serotypes were 6A,4,8,16F,33B,35A,35B, 18C, 19F and 23B which together comprised 29 of the 56 (51.8%) isolates. PCV-13 serotypes formed 19/56 (33.9%) to 21/56 (37.5%) of all pneumococcal isolates. Of 6 children who had received PCV-13, 4 tested positive for S. pneumoniae at 8 years of age too. However, none were vaccine serotypes. Four of those with otitis media who had positive swabs had received no immunisation at all and 3 of them had vaccine serotypes, viz. 4, 6A and 18C respectively. ConclusionIndian children continue to have a high prevalence of otitis media at 8 years age. More than 1/3 of nasopharyngeal isolates at this age are vaccine serotypes. Passive smoking is an important risk factor for childhood otitis media and may contribute to the development of chronicity of the disease.

Hearing Screening in Preschool Children of a Rural Community in Portugal - A 10-year Experience

Abstract Introduction Preschool hearing screening programmes would identify later onset or progressive hearing losses and conductive hearing loss, due to the high prevalence of otitis media with effusion in childhood. Hearing loss associated with otitis media with effusion can have a great impact on reading, writing, central auditory processing and balance. Objectives The present study aims at characterising the audiological alterations found in preschool children screened in a rural community in Portugal, and the correlation between audiological findings and otoscopy. Methodology This is an observational study using the results obtained in a ten year audiological and otological screening of preschool children. Otoscopy, Tympanometry and Audiometry (1, 2 and 4 KHz presented at 40 and 20 dB intensity) were performed at the first stage of the screening and the results were classified as “pass” or “refer”. Every non-normal result of any category would imply a second stage consisting of observation by an ENT specialist at the site and the establishing of a follow-up plan. Written Informed Consent was obtained from the parents prior to initiating the study. Results 595 children aged 5 and 6 years were screened between 2007 and 2017, of whom 192 (32.3%) required referral to the second stage. The most frequent alteration was found in the tympanogram. The tympanograms showed a significant correlation with the otoscopy performed by the ENT doctor, mainly type B tympanograms. The pass/refer audiometry also showed a statistically significant correlation with the medical otoscopy, although weak in all frequencies studied. Conclusion It’s extremely important to perform a hearing screening in the age range of 5-6 years (with a high predisposition to middle ear problems), with the main objective of identifying and referring for treatment children who present alterations in order to reduce the consequences of the hearing impairment.

Otitis media and mastoiditis in temporal bones of prehistoric Chilean populations. A paleopathological and paleoepidemiological study

Background: This study evaluates otitis media in prehistoric populations in northern Chile.Aims/objectives: Determining prevalence of otitis media and diagnostic usefulness of temporal-bone X-rays in skulls.Materials and methods: 444 skulls belonging to three groups: prehistoric-coastal (400–1000 AD), prehistoric-highland (400–1000 AD) and Pisagua-Regional Developments (1000–1450 AD). Skulls were evaluated visually and with Schuller’s view X-rays. Five skulls diagnosed as having had otitis media, five diagnosed as normal, and one with temporal bone fistula also had a computed tomography (CT).Results: Changes suggestive of otitis media were present in Prehistoric-coastal 53.57%; Pisagua-Regional Developments 70.73%; prehistoric-highlands 47.90%. Diagnostic effectiveness of Schuller’s view X-rays for assesing middle ear disease was confirmed by CT studies. The case with temporal bone fistula had changes suggestive of mastoiditis and possible post auricular abscess.Conclusions: There was a high prevalence of otitis media in prehistoric populations in Chile. The higher prevalence in one group was presumably due to racial factors. Temporal-bone X-rays are effective for massive evaluation of ear disease in skulls. A case of mastoiditis with temporal bone fistula and possible post-auricular abscess is documented.Significance: Documenting racial factors in otitis media. Validating X-rays for massive evaluation of otitis media in skulls.

Genetic counseling in an indigenous Filipino community with a high prevalence of A2ML1-related otitis media.

In this report, we describe the knowledge and beliefs on causes and management of otitis media of an indigenous Filipino community with a high prevalence of otitis media that is associated with an A2ML1 variant. Community lectures and individual genetic counseling were provided as intervention. Knowledge, beliefs, and health care-seeking behavior pertaining to otitis media were assessed pre- and post-genetic counseling. Twenty-five heads of households were interviewed. Beliefs regarding etiology of ear discharge varied widely, with swimming in the sea as the most commonly cited cause of ear discharge. During the post-counseling session, poor personal hygiene, dirty environment, and familial inheritance were mentioned as risk factors for otitis media or ear discharge. Knowledge about the genotypes for the A2ML1 variant and otitis media diagnoses within the household influenced beliefs on the role of hygiene and genetic susceptibility to otitis media and attitudes towards health care-seeking behavior. Genetic counseling was associated with variable improvement in knowledge on otitis media and in their understanding of genetic susceptibility to otitis media due to the A2ML1 variant. Language barriers, literacy level, cultural factors, and the complex nature of genetic information made genetic counseling in the particular population a challenge. Insights drawn from this experience recommend follow-up visits in the community.

Tympanometric changes following adenoidectomy in children with adenoid hypertrophy

<p class="abstract"><strong>Background:</strong> Adenoid Hypertrophy is the commonest disorder in children. The size of adenoids varies from child to child and also in the same individual as he grows and attains maximum size between age of 3 to 7 years. Adenoid hypertrophy plays a significant role in the pathogenesis of otitis media with effusion. Our objective was to study the tympanogram changes following adenoidectomy. i.e to find out the effect of adenoidectomy on Otitis Media with Effusion.</p><p class="abstract"><strong>Methods:</strong> Patients showing >50% of airway obstruction by the adenoids were included in the study. 20 patients with adenoid hypertrophy underwent adenoidectomy. Pre-operative and postoperative tympanograms of 40 ears were studied. </p><p class="abstract"><strong>Results:</strong> Type A curve (normal) was found in 12 ears. Type B Flat tympanogram – 12 ears s/o Gross Serous Otitis Media. Type C tympanogram – 8 ears s/o uncomplicated eustachian tube obstruction. 5 ears showed tympanogram s/o Eustachian tube block without significant collection of middle ear fluid. 3 ears showed tympanogram s/o uncomplicated eustachian tube obstruction. Post adenoidectomy, 32 ears showed normal tympanogram. 8 ears showed tympanogram s/o negative middle ear pressure with normal compliance.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows high prevalence of Otitis Media with Effusion in patients with adenoid hypertrophy. Otitis Media with Effusion is treated by adenoidectomy in most of the patients which is confirmed by post adenoidectomy tympanogram. Also, problem of decreased attention in school due to reduced hearing secondary to OME can be corrected by adenoidectomy. Hence, all patients should undergo pre and post-adenoidectomy tympanometry to know the compliance and pressure changes in the middle ear.</p>

Hearing thresholds and ventilation tube treatment in children with unilateral cleft lip and palate

ObjectiveChildren with cleft lip and palate have a high prevalence of otitis media with effusion (OME) which is often associated with a fluctuating, conductive hearing loss in the low and mid-frequencies and a risk for permanent hearing loss in the higher frequencies. Although common, there is no consensus on the treatment of OME with ventilation tubes. The aim of this study is to document if the risk for permanent hearing loss and acquired cholesteatoma increases due to treatment with ventilation tubes (VT treatments) during childhood in a group of children with cleft lip and palate. MethodsA retrospective medical chart review of 33 children (25 boys and 8 girls) born with unilateral cleft lip and palate (UCLP) was completed. Audiological data (results of hearing sensitivity tests, the total number of hearing tests, and number of VT treatments) were extracted from medical records from when the children were 4–7 and >7–10 years of age. ResultsThe hearing thresholds in the speech frequencies improved with age (p < 0,05) but a minority of the children continued to present with elevated hearing thresholds in the higher frequencies at >7–10 years of age. There were no significant correlations between number of VT treatments and hearing thresholds at >7–10 years. Four of the 33 children presented with complications: two children exhibited perforations of the ear drum (6.1%) and two children developed unilateral cholesteatoma (6.1%). ConclusionIn the current study, the hearing sensitivity of children with cleft lip and palate improved with age. However, this improvement was not seen in the higher frequencies. Twelve percent of the children experienced complications following VT treatments. Due to these complications, it is recommended that all children with cleft palate should have routine follow-ups by an ENT doctor and audiologist. As part of the routine follow-up care, hearing assessments should be performed before and after VT treatments.

Does Type of Cleft Palate Repair Influence Postoperative Eustachian Tube Dysfunction?

Otitis media (OM) is a frequent occurrence in the cleft palate population. Palate repair is thought to positively contribute to Eustachian tube function. The purpose of this study is to determine the proportion of cleft patients in our cohort with OM, and if palatoplasty closure technique influences future OM differently. The authors posited that Z-plasty palate repair would result in improved Eustachian tube function, compared with straight-line repair. Patient records were accessed and data was recorded on palatoplasties from 2005 to 2007 as well as from 2012 to 2014. Type of palatoplasty (straight-line vs. Z-plasty) was recorded and compared to prevalence of pressure equalizer tube placement and antibiotic prescriptions in various assessment intervals following repair 1) <6 months, 2) 6 months to 1 year. Statistical analysis included Welch 2 sample t test. The type of cleft palate was similar between the 2 groups. Prior to palate repair, over 30% of subjects in both groups required either tubes or antibiotics for OME. At the time of surgery, over 50% of patients received ear tubes, in both groups. Following repair, for straight versus Z, 0 versus 11%; and, 27.8 versus 20% required ear tubes for intervals 1) and 2), respectively. P values for both intervals are 0.9183 and 0.328, respectively. Antibiotics during interval one were required in 22.2% versus 23.5% of straight-line closures and Z-plasty, respectively. Antibiotics in the second interval were needed for 33.3% and 30% of straight-line closures and Z-plasty closures, respectively. P values for antibiotic use in the first and second intervals were 0.5353 and 0.4316 respectively. Cleft palate patients have a high prevalence of OM. Palatoplasty technique (straight-line and Z-plasty) does not affect Eustachian tube dysfunction differently following repair as measured by pressure equalizer tube placement and antibiotic use.

The microbiome of otitis media with effusion in Indigenous Australian children

IntroductionIndigenous Australian children have a high prevalence of otitis media with effusion (OME) and associated conductive hearing loss. Only three microbiological studies of middle ear fluid (MEF) from Indigenous Australian children with OME have been reported. All of these were reliant on culture or species-specific PCR assays. The aim of this study was to characterise the middle ear fluid (MEF), adenoid and nasopharyngeal (NP) microbiomes of Indigenous Australian children, using culture-independent 16S rRNA gene sequencing. MethodsMEF, NP swabs and adenoid specimens were collected from 11 children in the Alice Springs region of Central Australia. Bacterial communities in these specimens were characterised using 16S rRNA gene sequencing. ResultsThe microbiota in MEF samples were dominated (>50% relative abundance) by operational taxonomic units (OTUs) consistent with Alloiococcus otitidis (6/11), Haemophilus influenzae (3/11) or Streptococcus sp. (specifically, Mitis group streptococci which includes Streptococcus pneumoniae) (1/11). Anatomical site selectivity was indicated by the presence of a single conserved Haemophilus OTU in 7/11 MEF samples. In comparison, there were ten distinct Haemophilus OTUs observed across the NP and adenoid samples. Despite significant differences between the MEF and NP/adenoid microbiomes, Streptococcus sp., H. influenzae and Moraxella catarrhalis OTUs were common to all sample types. Co-occurrence of classical otopathogens in paired MEF and NP/Adenoid samples is consistent with earlier culture-based studies. ConclusionThese data highlight the need to further assess H. influenzae traits important in otitis media and to understand the role of canal flora, especially A. otitidis, in populations with a high prevalence of tympanic membrane perforation.

Sweep frequency impedance measures in Australian Aboriginal and Caucasian neonates

ObjectiveDespite high prevalence of otitis media in Aboriginal children, the acoustic–mechanical properties of their outer and middle ear during the neonatal period remain obscured. The objective of this study was to compare the acoustic–mechanical properties of outer and middle ear using Sweep Frequency Impedance (SFI) measures between Australian Aboriginal and Caucasian neonates. MethodsSFI data from 40 ears of 24 Aboriginal neonates (16 males, 8 females) with mean gestational age of 39.57 weeks (SD=1.25) and 160 ears of 119 Caucasian neonates (57 males, 62 females) with mean gestational age of 39.28 weeks (SD=1.25) serving as controls were analysed. SFI data in terms of resonance frequency (RF) and mobility of the outer and middle ear (ΔSPL) were collected from neonates who passed a test battery that included automated auditory brainstem response, distortion product otoacoustic emissions test and 1000-Hz tympanometry. SFI data were analysed using descriptive statistics and analysis of variance. ResultsThere was no significant difference in mean gestational age, age of testing and birth weight between the Aboriginal and Caucasian neonates. The mean resonance frequencies for the outer ear (mean RF1=264.9Hz, SD=58.6Hz) and middle ear (mean RF2=1144Hz, SD=228.8Hz) for Aboriginal neonates were significantly lower than that of Caucasian neonates (mean RF1=295.3Hz, SD=78.4Hz and mean RF2=1241.8Hz, SD=216.6Hz). However, no significant difference in the mobility of outer ear (ΔSPL1) and middle ear (ΔSPL2) between the two groups was found. Middle ear resonance was absent in 22.5% (9 ears) of Aboriginal ears but present in all Caucasian ears. ConclusionsThis study provided evidence that despite passing the test battery, Aboriginal neonates had significantly lower resonance frequencies of the outer and middle ear than Caucasian neonates. Furthermore, 22.5% of Aboriginal neonates showed no middle ear resonance, indicating the possibility of subtle middle ear issues not detected by the test battery. Reasons for the different acoustic-mechanical properties between the two ethnic groups remain unclear and require further investigation.

Wideband absorbance in Australian Aboriginal and Caucasian neonates.

Despite the high prevalence of otitis media in Australian Aboriginal infants and children, the conductive mechanism of the outer and middle ear of Aboriginal neonates remains unclear. Differences in characteristics of the conductive pathway (outer and middle ear) between Aboriginal and Caucasian neonates have not been systematically investigated by using wideband acoustic immittance measures. The objective of this study was to compare wideband absorbance (WBA) in Australian Aboriginal and Caucasian neonates who passed or failed a screening test battery containing high-frequency tympanometry and distortion product otoacoustic emissions (DPOAEs). A cross-sectional study design was used. The mean WBA as a function of frequency was compared between Aboriginal and non-Aboriginal neonates who passed or failed the test battery. A total of 59 ears from 32 Aboriginal neonates (mean age, 51.9 h; standard deviation [SD], 18.2 h; range, 22-86 h) and 281 ears from 158 Caucasian neonates (mean age, 42.4 h; SD, 23.0 h; range, 8.1-152 h) who passed or failed 1000-Hz tympanometry and DPOAEs were included in the study. WBA results were analyzed by using descriptive statistics and t tests with Bonferroni adjustment. An analysis of variance with repeated measures was applied to the data. Aboriginal and Caucasian neonates had almost identical pass rates of 61%, as determined by the test battery. Despite the apparently equal pass rates, the mean WBA of Aboriginal neonates who passed the test battery was significantly lower than that of their Caucasian counterparts at frequencies between 0.4 and 2 kHz. The mean WBA of Aboriginal neonates who failed the test battery was significantly lower than that of their Caucasian counterparts who also failed the test battery at frequencies between 1.5 and 3 kHz. Both Aboriginal and Caucasian neonates who failed the test battery had significantly lower WBA values than their counterparts who passed the test battery. This study provided convincing evidence that Aboriginal neonates had significantly lower WBA values than their Caucasian counterparts, although both groups had equal pass rates, as determined by the test battery. Although the two ethnic groups showed significant differences in WBA, the factors contributing to such differences remain undetermined. Further research is warranted to determine the factors that might account for the difference in WBA between the two ethnic groups.

Otitis media among high-risk populations: can probiotics inhibit Streptococcus pneumoniae colonisation and the risk of disease?

Otitis media is the second most common infection in children and the leading cause for seeking medical advice. Indigenous populations such as the Inuits, indigenous Australians and American Indians have a very high prevalence of otitis media and are considered to be high-risk populations. Streptococcus pneumoniae, one of the three main bacterial causes of otitis media, colonises the nasopharynx prior to disease development. In high-risk populations, early acquisition of high bacterial loads increases the prevalence of otitis media. In these settings, current treatment strategies are insufficient. Vaccination is effective against invasive pneumococcal infection but has a limited impact on otitis media. Decreasing the bacterial loads of otitis media pathogens and/or colonising the nasopharynx with beneficial bacteria may reduce the prevalence of otitis media. Probiotics are live microorganisms that offer health benefits by modulating the microbial community and enhancing host immunity. The available data suggest that probiotics may be beneficial in otitis media. This review discusses the potential use of probiotics to reduce pathogen colonisation and decrease the prevalence of otitis media, providing justification for further investigation.

Prevalence and risk factors of otitis media with effusion in primary school and kindergarten children in provincial and district centers of Diyarbakır

Objective: The aim of the present study was to determine the prevalence of otitis media with effusion (OME) among primary school and kindergarten children in provincial and district centers of Diyarbakir. Methods: The study was conducted at 4 primary schools and 3 kindergartens in the city center, and at 13 primary schools in district centers. Using the combined physical examination and otoscopic and tympanometric evaluations, 256 children out of 1,763 (14.5%) were diagnosed with OME. Results: Among total OME cases (119 girls, 137 boys) 118 (46.1%) had bilateral while 138 cases (53.9%) had unilateral effusion (89 on left and 49 on right ear). The prevalence of OME among primary school students were 12.6% at the city center, 16.3% at district level schools and 15.2% among kindergarten students. Higher OME prevalence is associated with passive smoking and allergic rhinitis. Age, sex, attending kindergarten and socioeconomic status were not significantly related with OME. Conclusion: In conclusion, because of high prevalence of otitis media and its possible severe complications screening equipment should be ensured at primary level health institutions. Screening for OME should be a part of preventive health services particularly for all kindergarten and early elementary school students; and should be performed by ENT specialist or pediatricians/general practitioners trained in pneumatic otoscopic and tympanometric evaluation.