History Of Recurrent Otitis Media Research Articles

Masked speech recognition by 6–13-year-olds with early-childhood otitis media: effects of acoustic condition and otologic history

Objective To investigate speech recognition in school-age children with early-childhood otitis media (OM) in conditions with noise or speech maskers with or without interaural differences. To also investigate the effects of three otologic history factors. Design Using headphone presentation, speech recognition thresholds (SRTs) were measured with simple sentences. As maskers, stationary speech-shaped noise (SSN) or two-talker running speech (TTS) were used. The stimuli were presented in a monaural and binaural condition (SSN) or a co-located and spatially separated condition (TTS). Based on the available medical records, overall OM duration, OM onset age, and time since the last OM episode were estimated. Study sample 6–13-year-olds with a history of recurrent OM (N = 42) or without any ear diseases (N = 20) with normal tympanograms and audiograms at the time of testing. Results Mixed-model regression analyses that controlled for age showed poorer SRTs for the OM group (Δ-value = 0.84 dB, p = 0.009). These appeared driven by the spatially separated, binaural, and monaural conditions. The OM group showed large inter-individual differences, which were unrelated to the otologic history factors. Conclusions Early-childhood OM can affect speech recognition in different acoustic conditions. The effects of the otologic history warrant further investigation.

Recurrent otitis media and behaviour problems in middle childhood: A longitudinal cohort study.

To investigate the long-term effects of early-life recurrent otitis media (OM) and subsequent behavioural problems in children at the age of 10 years. Data from the Raine Study, a longitudinal pregnancy cohort, were used to categorise children into those with three or more episodes of OM (rOM group) and those without a history of recurrent OM in the first 3 years of life (reference group). The parent report Strengths and Difficulties Questionnaire was used to assess child behaviour at the age of 10 years. Parental questionnaires were used to report past and present diagnoses of various mental health and developmental conditions, including attention, anxiety, depression, learning, and speech-language problems. Multiple linear and logistic models were used to analyse the data and were adjusted for a fixed set of key confounding variables. The linear regression analysis revealed significant, independent associations between a history of recurrent OM and higher Strengths and Difficulties Questionnaire scores, including total, internalising, externalising, emotional, attention/hyperactivity and peer problems subscales. Logistic regression analyses revealed an independent increased likelihood for children in the rOM group to have a diagnosis of attention, anxiety, learning and speech-language problems. Children at 10 years of age with an early history of recurrent OM are more likely to exhibit attentional and behavioural problems when compared to children without a history of recurrent OM. These findings highlight the association between early-life recurrent OM and later behavioural problems that may require professional allied health-care interventions.

Impact of ventilation tube insertion on long-term language outcomes at 6 and 10 years of age: A prospective pregnancy cohort study.

Investigating the impact of early childhood ventilation tube insertion (VTI) on long-term language outcomes. Longitudinal cohort study. A total of 2900 pregnant women participated in the Raine Study between 1989 and 1991 in Western Australia, and 2868 children have been followed up. Based on parental reports, 314 children had a history of recurrent otitis media but did not undergo VTI (rOM group); another 94 received VTI (VTI group); while 1735 had no history of rOM (reference group) in the first 3 years of childhood. Children with data on outcomes and confounders were included in analyses of PPVT-R at ages 6 (n = 1567) and 10 years (n = 1313) and CELF-III at 10 years (n = 1410) (approximately 5% in the VTI group and 15% in the rOM group). Peabody Picture Vocabulary Test-Revised edition and Clinical Evaluation of Language Fundamentals® Preschool-3. At 6 years, mean PPVT-R scores were significantly lower in the VTI group than the reference group (β = -3.3; 95% CI [-6.5 to -0.04], p = .047). At 10 years, while the difference between the VTI and reference groups was less pronounced for PPVT-R scores, there was a small but consistent trend of lower measures, on average, across CELF-III scores (expressive: β = -3.4 [-7.1 to 0.27], p = .069; receptive: β = -4.1 [-7.9 to -0.34], p = .033; total: β = -3.9 [-7.5 to -0.21], p = .038). There was no evidence to suggest that language outcomes in the rOM group differed from the reference group. Lower scores of language outcomes in school-aged children who received VTI in early childhood may suggest a long-term risk which should be considered alongside the potential benefits of VTI.

The Impact of Early-Life Recurrent Otitis Media in Children on the Psychological Well-Being of Caregivers.

Children with early-life recurrent otitis media (OM) will often endure pain, sleep disturbances, and other developmental setbacks that impact the surrounding family system. The aim of this study was to investigate the psychological well-being and family functioning of caregivers of children with early-life recurrent OM (rOM). Data from a longitudinal pregnancy cohort were used to categorize children into two groups: those with a history of recurrent OM (rOM group) and those without a history of rOM (reference group) by the age of 3 years. The psychological well-being of caregivers and the family functioning status were assessed using the Affect Balance Scale and the General Functioning Scale of the McMaster Family Assessment Device (FAD-GF), respectively, at the three-, five-, and eight-year follow-up appointments. Multiple linear regression models were used to analyze the data and were adjusted for potential confounding variables. There were significant associations between having a child with an early history of rOM and the Affect Balance Scale of caregivers for the negative affects subscale at the three- (p < 0.001) and five- (p = 0.018) year follow-ups, and the Affect Balance subscale at the three-year (p = 0.007) and the five-year follow-ups (p = 0.047). There were no significant associations measured during the 8-year follow-up period for the FAD-GF. The findings of this study further highlight the impact of caring for a child with rOM in early childhood on caregivers' psychological well-being in the first five years of a child's life. The impact, however, did not appear to influence the longer-term functioning of the family as a whole. 3 Laryngoscope, 134:1445-1449, 2024.

The association between otitis media in early childhood with later behaviour and attention problems: A longitudinal pregnancy cohort

The present study aims to investigate the association between an early history of recurrent otitis media (OM) with or without ventilation tube insertion (VTI) and later behavioural problems in childhood and adolescence. Parental reports in a longitudinal pregnancy cohort were used to classify children into three groups; recurrent OM without VTI (rOM group; n=276), recurrent OM with VTI (VTI group; n=62), and no history of early-life recurrent OM as a reference group (n=1485). The Child Behaviour Checklist (CBCL) was administered at ages 5, 8, 10, and 13 years and data were analysed for psychological wellbeing. Mixed-effects regression modelling was used to investigate the associations between a history of rOM and CBCL T-scores across all ages for rOM and VTI groups compared to the reference group. All analyses were controlled for a wide range of confounding variables. The analyses revealed a significant association between recurrent OM and behavioural problems. While there was a general decline in scores (i.e. improvement) observed over the duration of the follow-up period, children in the rOM group displayed significantly higher scores for internalising and externalising behaviours at ages five, eight and 10 years. Attention scores were significantly higher across all ages in the rOM group. A transient increase in internalising behaviour was observed in the VTI group at ages eight and 10 years. Logistic regression models showed an increased overall likelihood for the rOM group only to fall within the abnormal clinical range for internalising and externalising behaviours. Early-life recurrent OM with and without VTI was associated with increased behavioural and attention problems in early and late childhood. This suggests that recurrent OM can have a significant impact on children's behaviour and attention that can persist into early adolescence.

Delayed onset ADA-SCID presenting as secondary HLH in a patient with normal newborn screening

Severe combined immunodeficiency (SCID) is a rare genetic syndrome caused by aberrant immune cell development or function and is fatal without early identification and treatment. The Centers for Disease Control estimates the annual incidence of SCID to be one case per 40,000 to 100,000 live births. Newborn screening using T-cell receptor excision circles (TREC) allows for early detection and timely treatment of SCID. Adenosine deaminase (ADA) is a vital enzyme in the purine salvage pathway, and its deficiency results in disruption of T, B and NK cell development, accounting for 10–20% of SCID cases. The timing of ADA-SCID presentation ranges from birth to delayed onset disease. Importantly, without early recognition and treatment, delayed onset ADA-SCID results in accumulation of toxic metabolites causing immune dysfunction, recurrent infections, and subsequent organ damage. Recently, some groups have questioned whether traditional TREC newborn screening adequately identifies ADA-SCID, especially those cases with delayed onset. We present the case of a 2-year-old male with normal newborn screening but a history of recurrent otitis media and respiratory infections who developed multisystem organ failure and septicemia with Escherichia coli, candida, adenovirus and enterovirus despite broad-spectrum antimicrobials. The patient also had features of a hyperinflammatory syndrome with fever, pancytopenia, hypertriglyceridemia, and hyperferritinemia and was treated for hemophagocytic lymphohistiocytosis (HLH) with dexamethasone and plasma exchange followed by anakinra, etoposide, and emapalumab. The patient was maximally supported with mechanical ventilation, extracorporeal membrane oxygenation, and renal replacement therapy but had progressive clinical deterioration and ultimately expired. Autopsy was notable for thymic aplasia and erythrophagocytosis in the bone marrow and lymph nodes. Genetic testing revealed a heterozygous missense pathogenic variant in exon 7 in the ADA gene as well as novel heterozygous intronic variant of unknown significance in the ADA gene. Postmortem data suggests this patient had ADA-SCID with multi-pathogen infections and secondary HLH. This case potentially identifies a novel pathogenic variant in ADA missed by traditional TREC newborn screening and highlights the need to retain a high clinical suspicion of SCID in patients with a history of recurrent infections despite normal TREC screening.

Nasopharyngeal cysts in children

Background. Nasopharyngeal cysts are mostly congenital malformations. However, their clinical manifestation can also occur in adolescence, depending on their severity, size and location. Nasopharyngeal cysts are rare in the practice of an otolaryngologist, but can be found in nasal obstruction. The article presents the literature data on the theories of the origin, clinical manifestations, peculiarities of the diagnostics and surgical treatment of the nasopharyngeal cysts.&#x0D; Aim. To increase the efficiency of diagnostics and treatment of nasopharyngeal cysts in children on the basis of a differentiated approach to the manifestation of the disease symptoms.&#x0D; Materials and methods. 29 patients aged from 1 to 8 years (mean age 4.210.39 years) with nasopharyngeal cysts and cyst-like neoplasms were treated at the clinical sites of the Department of Otorhinolaryngology and Pediatric Department of Pirogov Russian National Research Medical University (Moscow) from 2009 to 2022.&#x0D; Results. On admission all 29 (100%) children complained of an increasing nasal obstruction, anterior and posterior purulent rhinorrhea, snoring, decreased hearing, and epiphora. 18 patients (62.1%) had a history of recurrent otitis media and were diagnosed with bilateral exudative otitis media on examination. Transnasal or transoroepipharyngeal endoscopic marsupialization and cyst coagulation with an electrosurgical complex were performed in 28 (96.5%) children. In 19 (65.5%) cases the operation was performed with a single-stage adenotomy and in 8 (27.6%) cases with tubal valvular plasty, partial destruction of the tubal tonsils.&#x0D; Conclusion. Improvement of diagnostics quality due to modern imaging technologies leads to detection of a greater number of accidental findings of nasopharyngeal cysts and requires systematization and detailed elaboration of the accumulated knowledge in the work of the pediatric otorhinolaryngologist.

Comparative study on adhesive otitis media and pars tensa cholesteatoma in children

Objective: Recurrent otitis media and persistent otitis media with effusion in early childhood may cause an atelectatic eardrum and adhesive otitis media, which sometimes progress to pars tensa cholesteatoma. When and how children with adhesive otitis media should be operated on remain controversial. Therefore, this study aimed to analyze the clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma, and to determine the risk factors of progression to cholesteatoma.Methods: Seventeen ears of 15 children with adhesive otitis media (adhesive group) and 14 ears of 13 children with pars tensa cholesteatoma (tensa cholesteatoma group) who underwent tympanoplasty were included in this study. We analyzed the following clinical characteristics of children in both groups: medical and life history, associated diseases, sites of the adhesion, and development and aeration of mastoid air cells as shown by temporal bone computed tomography.Results: Most of the children in both groups had a history of recurrent otitis media and/or persistent otitis media with effusion. They showed a male predominance and a frequent association of allergic rhinitis. The number of ears showing undeveloped mastoid air cells in the tensa cholesteatoma group was significantly larger than that in the adhesive otitis media group (P=0.0068). A lack of aeration of the middle ear, including the eustachian tube, was more frequently found in ears with pars tensa cholesteatoma than in ears with adhesive otitis media (P=0.0012). Using multivariate logistic regression, the presence of otorrhea (odds ratio [OR], 14.847; 95% confidence interval [CI], 0.834–264.184), total adhesion (OR, 28.550; 95% CI, 0.962–847.508), and undeveloped mastoid air cells (OR, 19.357; 95% CI, 1.022–366.589) were related to pars tensa cholesteatoma.Conclusion: Children with adhesive otitis media should be carefully followed up in the outpatient setting. Ears with poor mastoid development may develop pars tensa cholesteatoma. Additionally, ears with middle ear effusion, total adhesion, and the presence of otorrhea tend to be at risk of pars tensa cholesteatoma. Tympanoplasty or tympanostomy tube insertion should be considered for children with adhesive otitis media who have these risk factors to prevent progression to pars tensa cholesteatoma.

Auditory temporal processinzg in children with history of recurrent otitis media with effusion

Objective Several studies report that a history of recurrent otitis media with effusion (OME) can affect the development of the central auditory system and its processing. The aim of the present study was to determine the effects of recurrent OME on the auditory temporal processing using the Gap-In-Noise (GIN) test in children with a positive history in their first five years. Materials and methods In this study, 12 children between 8 and 10 years old were selected. The control group was matched according to the age of study cohort. The GIN test was conducted to assess temporal processing and the approximate threshold and percentage of correct responses were calculated for all participants. Nonparametric test was used to analyze the data. Result Results of the GIN test showed significant differences between the OME and control group (p < .001). Children with recurrent OME performed worse than the control group in this test. No significant difference was observed between the right and left ear performance in both groups (p > .05). Conclusion The study results indicate that, children with recurrent OME suffer from auditory temporal processing to some degree.

Monaural and binaural phase sensitivity in school-age children with early-childhood otitis media

Objective Previous research has linked recurrent otitis media (OM) during early childhood to reduced binaural masking level differences (BMLDs) in school-age children. How this finding relates to monaural processing abilities and the individual otologic history has not been investigated systematically. The current study, therefore, addressed these issues. Design Sensitivity to monaural and binaural phase information was assessed using a common test paradigm. To evaluate the influence of the otologic history, overall OM duration, OM onset age, and the time since the last OM episode were considered in the analyses. Study sample Children aged 6–13 years with a history of recurrent OM (N = 42) or without any previous ear diseases (N = 20). Results Compared to the controls, the OM children showed smaller BMLDs (p < 0.05) whereas their monaural and binaural detection thresholds were comparable (p > 0.05). After controlling for age, the otologic history factors failed to predict the BMLDs of the OM children. Their monaural detection thresholds were correlated with the binaural detection thresholds (r = ∼0.5, p < 0.05) but not the BMLDs. Conclusions The current study suggests that early-childhood OM can impair binaural processing abilities in school-age children.

A study on the efficacy of prophylactic antibiotics in recurrent acute otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To study the efficacy of broad spectrum antibiotics in the prophylaxis of recurrent acute otitis media.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 86 patients of age group between 2 and 15 years with history of recurrent otitis media were enrolled to study the efficacy of the prophylactic antibiotics used in this condition. The children were treated with amoxicillin or azithromycin during the acute episode. Then they were divided equally into two groups and assigned to receive amoxicillin in one group and azithromycin in the other group at one third the therapeutic dose as prophylaxis for 6 months. The children were evaluated at the end of every month and recurrent episodes if any, was documented. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At the end of 6 months it was observed that prophylactic antibiotics were more effective in the younger age group of 2-7 years. Efficacy rates of 87.5% with azithromycin and 77.4% with amoxicillin were noted.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; As azithromycin is given once a week compared to amoxicillin which is given daily and was found to be equally effective as a prophylactic drug in recurrent acute otitis media with a better compliance, it is a good alternative to amoxicillin as a prophylactic antibiotic. Proper dosage goes a long way in bringing down resistance to the therapeutic agents.&lt;/p&gt;

The Effect of Age and History of Recurrent Otitis Media on Dichotic Listening and Verbal Memory in Children

To explore the possible effects of recurrent otitis media (ROM) in early childhood on binaural processing and verbal memory in school-aged children. Two hundred eleven children, including 31 children with and 180 children without a history of ROM, were examined. A dichotic digit test (DDT) and a forward and backward digit memory span test (DMST) were administered. A significant difference was observed between age groups among ROM-free children. The ROM-positive group earned significantly poorer results than the ROM-free group in all measurements, except for the right DDT (rDDT) score. Furthermore, a significant correlation was found between the DDT and EA scores with both DMST scores in the ROM-free group. The correlation between the rDDT and forward DMST scores was not significant in the ROM-positive group, and no significant correlation was observed between the EA score and either DMST score. Our findings support that a history of OM in early childhood based on a parental survey of children is associated with differences in DDT and DMST outcomes.

Malignant Otitis Externa and Stroke.

Malignant otitis externa (MOE) is an aggressive but benign entity which evolves into skull base osteomyelitis. An 81-year-old female patient was admitted for left hemiparesis and homonymous hemianopia. She complained of headache radiating to the right cervical area. A recent history of recurrent otitis media was present. Head and neck imaging showed an ischemic infarction (right temporo-occipital) and a parapharyngeal soft tissue mass originating in an external and medial ear infection. Culture samples revealed Pseudomonas aeruginosa infection leading to the diagnosis of Malignant otitis externa (MOE). Parenteral antibacterial therapy and hyperbaric oxygen therapy resulted in improvement.LEARNING POINTSMalignant otitis externa is an aggressive and life-threatening disease which must be identified early and treated promptly for therapeutic success.Although starting as an outer ear infection (typically caused by Pseudomonas aeruginosa) local spread can involve noble head and neck structures leading to variable signs and symptoms.Modern imaging techniques can help define structure involvement (MRI) and may help identify disease activity and prognosis (nuclear medicine).

Childhood otitis media is associated with dizziness in adulthood: the HUNT cohort study.

The objective of the study was to examine the association between otitis media in childhood and dizziness in adulthood. Longitudinal, population-based cohort study of 21,962 adults (aged 20-59years, mean 40) who completed a health questionnaire in the Nord-Trøndelag Hearing Loss Study was conducted. At 7, 10 and 13years of age, the same individuals underwent screening audiometry in a longitudinal school hearing investigation. Children found with hearing loss underwent an ear, nose and throat specialist examination. Adults diagnosed with childhood chronic suppurative otitis media (n=102) and childhood hearing loss after recurrent acute otitis media (n=590) were significantly more likely to have increased risk of reported dizziness when compared to adults with normal hearing as children at the school investigation and also a negative history of recurrent otitis media (n=21,270), p<0.05. After adjusting for adult age, sex and socio-economic status, the odds ratios were 2.1 [95% confidence interval (CI): 1.4-3.3] and 1.3 (95% CI: 1.0-1.5), respectively. This longitudinal cohort study suggests that childhood chronic suppurative otitis media and childhood hearing loss after recurrent acute otitis media are associated with increased risk of dizziness in adulthood. This might reflect a permanent effect of inflammatory mediators or toxins on the vestibular system. The new finding stresses the importance of treatment and prevention of these otitis media conditions.

Colonization, safety, and tolerability study of the Streptococcus salivarius 24SMBc nasal spray for its application in upper respiratory tract infections.

Streptococcus salivarius, a non-pathogenic species and the predominant colonizer of the oral microbiota, finds a wide application in the prevention of upper respiratory tract infections, also reducing the frequency of their main pathogens. In this pilot study, the primary objective was to evaluate the safety and tolerability of a nasal spray, S. salivarius 24SMBc, as a medical device in a clinical study involving 20 healthy adult subjects. The secondary aim was to determine the ability of colonization assessed by molecular fingerprinting. Twenty healthy adult subjects, aged between 30 and 54 years, without a medical history of recurrent otitis media, were enrolled. All patient characteristics fulfilled the inclusion criteria. All subjects were treated daily for 3 days with the nasal spray containing S. salivarius 24SMBc at a concentration of 5 × 10(9) colony-forming units (CFU)/ml. The persistence of S. salivarius in the nasopharynx was investigated by the antagonism test and random amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). The tolerability and safety were clinically assessed by clinical examinations during treatment. Our results demonstrate the capability of S. salivarius 24SMBc to colonize the rhinopharynx tissues in 95% of subjects and persist in 55% of them after 6 days from the last dose of the formulation, maintaining a concentration of 10(5) CFU/ml. The treatment was well tolerated by all healthy patients and no adverse effects were found. The topical application of streptococcal probiotics is a relatively undeveloped field but is becoming an attractive approach for both prevention and therapy, especially for pediatric age patients. S. salivarius 24SMBc possess characteristics making this strain suitable for use in bacteriotherapy.

DOCK8 deficiency and guillain-barre syndrome

Results R. I. M., 10 year-old-boy that was referred to us with history of recurrent otitis media, sinusitis, and multiple episodes of pneumonia, palmo-plantar warts, and severe contagious molusco. He also has history of severe atopic dermatitis, asthma and food allergies. On evaluation he was noted to have persistent eosinophilia, lymphopenia, normal IgG levels, absent specific antibody response and decreased CD4 and CD8 T cells. Based on history of severe atopy, sinopulmonary infections, recurrent staphylococcal and viral skin infections DOCK8 deficiency was suspected. Since the suspicious, he started the use of daily cotrimazol and monthly immunoglobulin (500 mg/kg). DOCK8 gene sequencing and duplications/deletions analysis was done and there were found deletions in compound heterozygosis (Alelle 1: deletion of exons 3 to 33; Alelle 2: deletion of exons 16 and 20-24). The diagnosis was confirmed. At age 11 year, 2 weeks after a viral disease, he started a weakness involving the arms, legs, and truncal muscles, which had a rapid progression (less than 24 h). He performed an investigation with a normal magnetic resonance and the study of nerve conduction showed specific findings consistent with demyelination characteristic for classic Guilain-Barre Syndrome. He received immunoglobulin in a dose of 2g/kg and evaluated with resolution of the neurologic symptoms. Currently, he keeps receiving monthly immunoglobulin and prophylactic cotrimazol daily and showed no new serious infections. It was found a compatible bone marrow donor and he is being prepared to transplantation.

Auditory temporal abilities in children with history of recurrent otitis media in the first years of life and persistent in preschool and school ages

To study the temporal auditory ordering and resolution abilities in children with and without a history of early OME and ROME, as well as to study the responses according to age. A total of 59 children were evaluated, and all of them presented pure tone thresholds within the normal range at the time of the conduction of the hearing tests. The children were divided into two groups according to the occurrence of episodes of recurrent otitis media. Then, each group was divided into two subgroups according to age: 7- and 8-year olds, and 9- and 10-year olds. All children were assessed with standard tests of temporal frequency (ordination) and gaps-in-noise (resolution). For the temporal abilities studied, children with a history of otitis media presented significantly lower results compared to the control group. In the frequency pattern test, the correct answers increased with age in both groups. In the identification of silence intervals, the control group showed no change in threshold regarding to age, but this change was present in the group with a history of otitis media. Episodes of otitis media with effusion in the first year of life, recurrent and persistent in preschool and school ages, negatively influence the temporal ordering and resolution abilities.

Karyotype-specific ear and hearing problems in young adults with Turner syndrome and the effect of oxandrolone treatment.

To evaluate karyotype-specific ear and hearing problems in young-adult patients with Turner syndrome (TS) and assess the effects of previous treatment with oxandrolone (Ox). Double-blind follow-up study. University hospital. Sixty-five TS patients (mean age, 24.3 yr) previously treated with growth hormone combined with placebo, Ox 0.03 mg/kg per day, or Ox 0.06 mg/kg per day from the age of 8 years and estrogen from the age of 12 years. Ear examination was performed according to standard clinical practice. Air- and bone conduction thresholds were measured in decibel hearing level. We compared patients with total monosomy of the short arm of the X chromosome (Xp), monosomy 45,X and isochromosome 46,X,i(Xq), with patients with a partial monosomy Xp, mosaicism or other structural X chromosomal anomalies. We assessed the effect of previous Ox treatment. Sixty-six percent of the patients had a history of recurrent otitis media. We found hearing loss in 66% of the ears, including pure sensorineural hearing loss in 32%. Hearing thresholds in patients with a complete monosomy Xp were about 10 dB worse compared with those in patients with a partial monosomy Xp. Air- and bone conduction thresholds were not different between the placebo and Ox treatment groups. Young-adult TS individuals frequently have structural ear pathology, and many suffer from hearing loss. This indicates that careful follow-up to detect ear and hearing problems is necessary, especially for those with a monosomy 45,X or isochromosome 46,X,i(Xq). Ox does not seem to have an effect on hearing.

Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study.

To study the effects of osteopathic manipulative treatment in routine pediatric care for children with recurrent acute otitis media. Pilot cohort study with 1-year posttreatment follow-up. At follow-up, subjects' parents or legal guardians and their referring and/or family physicians were contacted to determine recurrence of otitis media since intervention. A referred and volunteer sample of pediatric patients ranging in age from 7 months to 35 months with a history of recurrent otitis media (N=8). For 3 weeks, all subjects received weekly osteopathic structural examinations and osteopathic manipulative treatment. This intervention was performed concurrently with traditional medical management. Five (62.5%) subjects had no recurrence of symptoms. Of the three remaining subjects in this cohort, one had a bulging tympanic membrane, another had four episodes of otitis media, and the last underwent surgery after recurrence at 6 weeks posttreatment. Closer analysis of the posttreatment course of the last two subjects indicates that there may have been a clinically significant decrease in morbidity for a period of time after intervention. The present study indicates that osteopathic manipulative treatment may change the progression of recurrent otitis media, a finding that supports the need for additional research in this area.

Giant cell reparative granuloma of the pediatric cranium: case report and review of the literature

Giant cell reparative granulomas are rare bone tumors. Although benign, these tumors are locally destructive and can be highly vascular. They seldom occur in the cranial vault. We describe a multidisciplinary approach to a case of giant cell reparative granuloma of the cranium in a 3-year-old patient. A 3-year-old girl female referred to the pediatric neurosurgery department for evaluation of a retro-auricular mass. She had a history of recurrent otitis media with two subsequent courses of antibiotics without resolution. CT imaging revealed an expansive lesion located in the right mastoid region. Open surgical biopsy revealed a hemorrhagic tumor consistent with a giant cell reparative granuloma. Angiography identified a hypervascular tumor blush that was supplied by the occipital artery. Preoperative transcatheter embolization was performed followed by a multidisciplinary surgical resection and reconstruction. Blood loss was minimal, and the patient recovered well after surgery. Preoperative endovascular embolization and a multidisciplinary intraoperative approach with primary resection and cranial vault reconstruction is an effective approach to hypervascular giant cell reparative granulomas.