Middle Ear Disease In Children Research Articles

Rising Resonance Frequency Is the Sole Sign of Early Middle Ear Disease in Children With Adenoid Hypertrophy.

The present study seeks to estimate the potential of multifrequency tympanometry in the diagnosis of primal otologic disorder in children with adenoid hypertrophy (AH). Prospective observational study. Tertiary pediatric institution. One hundred thirty-one children presenting consecutively at the otolaryngology clinic were divided on the basis of AH into 98 patients and 33 controls. Middle ear status was assessed using pneumatic otoscopy, standard, and wide band tympanometry. Tympanogram type/intratympanic pressure, and resonance frequency (RF) were correlated with each other as well as with a set of clinical parameters. Receiver operating characteristic analysis was employed to reveal the diagnostic value of RF. Mean RF declined in chronic otitis media with effusion by 43.25% (p < 0.001). In our entire cohort, children with AH under the age of 7 years presented with a relative risk = 2.43 of producing "B" tympanogram (p = 0.016) than their older peers. In patients' ears with normal, type "A," tympanogram, RF was the sole tympanometric marker of AH, being elevated by 28.26% in mean value (p = 0.010). On receiver operating characteristic analysis of RF's discriminating capability, the area under the curve was equal to 0.647 (p = 0.010). The optimal cut-off value of RF was set at 899 Hz. AH may induce middle ear stiffening, as RF's increase indicates. Wide band tympanometry output could be a warning sign of ongoing compliance reduction to the sound transmission apparatus, at a time point when physical examination and 226 Hz tympanometry are still unremarkable.

Subannular Tubes in Children With Cleft Palate.

To investigate subannular tube (SAT) placement as an alternative treatment of chronic middle ear disease in children with cleft palate. Retrospective cohort study. All children with cleft palate with intractable otitis media with effusion and/or with tympanic membrane retraction, operated for insertion of 1 or more sets of transtympanic tubes followed by SAT in a tertiary center. Audiological outcomes, average duration of tubes, and postoperative complications were analyzed. This study included 21 children with cleft palate, aged 3 to 14 years. A total of 38 ears was evaluated. The median time of follow-up was 42 months. During follow-up, 69.2% of the patients had no complications. Observed complications were otorrhea (13.5%) and tube obstruction (7.7%). In 7.9% of the cases, otitis media with effusion relapsed after tube extrusion. By the end of the study, 76.3% of the tubes remained in situ and 68.4% of the tympanic membranes had the SAT in place and had no significant alterations. The mean duration of SATs was 16 months, which was significantly superior to transtympanic tube duration. A significant sustained improvement in the hearing of children with SATs was observed. Subannular tube insertion results in hearing improvement to normal range and tympanic retraction pockets reversion in children with cleft palate with persistent otitis media with effusion and tympanic retraction/atelectasis. This surgery appears to be safe and provides long-term efficient middle ear aeration. Strict postoperative follow-up is crucial for the success of the treatment.

Precision Motion Control using Nonlinear Contact Force Model in a Surgical Device.

Otitis media with effusion (OME) is a common middle ear disease in children. The Ventilation Tube Applicator is an ear surgical device to treat OME by inserting a grommet into tympanic membrane (TM). This grommet insertion process requires very delicate control to minimise trauma to the TM and to ensure that the grommet is successfully inserted. This paper introduces a precision motion controller using Hunt-Crossley contact force model to provide a good prediction of the force on the TM during the insertion process. This predicted force was used to reject the disturbance in the motion control scheme and resulted in tremendous improvement in precision and accuracy. The maximum absolute tracking error of the motion controller was reduced by up to 29%, and the root mean square error was reduced by up to 43%. This novel use of a nonlinear contact force model has been proven to work well and can be considered for other robotic surgeries that involves contact and requires placement accuracy.

Pure tone hearing profiles in children with otitis media with effusion

Introduction: Otitis media with effusion (OME) is a common middle ear disease in children. The associated conductive hearing loss is a major concern for hearing health professionals. The aim of the present study was to describe the configuration of pure tone audiograms of children with OME and to design a statistical stratification algorithm to facilitate hearing loss profiling in children with OME.Methods: School age children with OME were recruited. Bone and air conduction thresholds were obtained using standard procedures. Hierarchical cluster analysis was employed to determine audiometric profile groups. The Mandarin Hearing in Noise Test was used to measure sentence perception in children for cluster analysis validity assessment.Results: Ninety-seven children (164 ears) aged between 72 months and 153 months were examined. Air conduction thresholds averaged for 500 Hz, 1000 Hz and 2000 Hz were in the range of 8.3–53.3 dB HL with a mean of 26.8 dB HL. Bone conduction thresholds were found to be influenced by middle ear pathology with a maximal elevation at 2000 Hz of 25 dB HL. Four audiometric profiles were identified. Cluster 1 contained 54 ears (32.9%) with normal or near normal hearing, Clusters 2 contained 37 ears (22.6%) with mild hearing loss, Cluster 3 included 48 ears (29.3%) and Cluster 4 included 25 ears (15.2%) with moderate hearing loss. Stability and validity of the four-cluster profiling procedure was examined and established with satisfactory results.Conclusions: OME in children is associated with pure tone hearing thresholds ranging from normal to moderate hearing loss. The hierarchical clustering algorithm proved useful as a novel means of profiling hearing loss in children with OME and may assist in identifying affected children at greater risk of auditory disadvantage.Implications for rehabilitationA hierarchical cluster analysis method can be used to determine audiometric profiles in children with OME.This algorithm assists to identify children at greater risk of auditory disadvantage.Cluster groups with more elevated pure tone thresholds may be targeted for priority in clinical surveillance and medical/surgical intervention.

Mucolytics in the treatment of acute and chronic diseases of the nose and paranasal sinuses and nonpurulent middle ear disease in children

By results of the studies performed by the World Health Organization recurrent respiratory infection (RRI) children experience more than 6 episodes of SARS per year. In the Russian Federation every 4th-5th child can be included in this group, which represents more than 60% of all diseases of childhood [1]. The most common pathologies in these children are acute respiratory viral infection followed by the addition of infectious and endocrine diseases. It must be remembered that recurrent respiratory infection children are characterized by a high incidence not only in the autumn-winter period but throughout the year, a prolonged duration of the inflammatory process, a tendency to recurrence or transition to a chronic form, resulting in special interest of practitioners to the treatment of such children and the disease prevention.

Parental Smoking and the Risk of Middle ear Disease in Children: A Systematic Review and Meta-Analysis

Parental Smoking and the Risk of Middle ear Disease in Children: A Systematic Review and Meta-Analysis

Parental Smoking and the Risk of Middle Ear Disease in Children

A systematic review and meta-analysis of studies of the association between secondhand tobacco smoke (SHTS) and middle ear disease (MED) in children. MEDLINE, EMBASE, and CAB abstracts (through December 2010) and reference lists. Sixty-one epidemiological studies of children assessing the effect of SHTS on outcomes of MED. Articles were reviewed, and the data were extracted and synthesized by 2 researchers. MAIN OUTCOME EXPOSURES: Children's SHTS exposure. Middle ear disease in children. Living with a smoker was associated with an increased risk of MED in children by an odds ratio (OR) of 1.62 (95% CI, 1.33-1.97) for maternal postnatal smoking and by 1.37 (95% CI, 1.25-1.50) for any household member smoking. Prenatal maternal smoking (OR, 1.11; 95% CI, 0.93-1.31) and paternal smoking (OR, 1.24; 95% CI, 0.98-1.57) were associated with a nonsignificant increase in the risk of MED. The strongest effect was on the risk of surgery for MED, where maternal postnatal smoking increased the risk by an OR of 1.86 (95% CI, 1.31-2.63) and paternal smoking by 1.83 (95% CI, 1.61-2.07). Exposure to SHTS, particularly to smoking by the mother, significantly increases the risk of MED in childhood; this risk is particularly strong for MED requiring surgery. We have shown that per year 130 200 of child MED episodes in the United Kingdom and 292 950 of child frequent ear infections in the United States are directly attributable to SHTS exposure in the home.

Rates of Ear Disease in Children Visiting a Mobile Community Ear Clinic in New Zealand—Two-Year Study of Over 2,000 Children

Abstract Aims: To describe rates of middle ear disease in children attending a nurse-led mobile community ear clinic over a 2-year period in Wellington, New Zealand. Methods: Analysis of records of ear examination carried out over a 2-year period to identify rates of middle ear disease in children aged 0 to 18 years. All data were collected at the time of consultation. Otitis media with effusion (OME) being a common middle ear disease in children was investigated in more detail. Results: 2,273 children were seen in the ear clinic between July 2004 and June 2006. Nearly one in three children (28%) was diagnosed as having OME at their first ear clinic visit. Males of Pacific Island ethnicity, aged between 0 to 4 years had the highest rates (48.3%) of OME. Conclusions: Chronic middle ear disease continues to be a significant problem for children in New Zealand, particularly in the Hutt Valley (Wellington) region. This study showed that the childhood rate of ear disease continues to be unacceptably high. Chro...

Comparison between myringotomy and tympanostomy tubes in combination with adenoidectomy in 3–7-year-old children with otitis media with effusion

The specific aim of this study was to compare, by means of a randomized clinical trial, the efficacy between the two surgical combinations – adenoidectomy with myringotomy and tympanostomy (A + T) and adenoidectomy with myringotomy (A + M) – in reducing middle ear disease in children with otitis media with effusion (OME). Seventy-eight 3–7-year-old patients (156 ears) with a history of bilateral middle ear effusion for at least 3 months were randomly assigned to either A + T or A + M. Hearing threshold levels, recurrence rate of the effusion and episodes of acute otitis media (AOM) and otorrhea were evaluated for a follow-up period of 1 year. Audiometry testing showed that there was no statistically significant difference in the hearing loss levels of both groups during the whole follow-up period. Free of AOM episodes were 72% of the patients in the A + T group and 75% of those in the A + M group. None of the patients with A + M had episodes with otorrhea which contrasted with the 40% occurrence rate in the A + T group. During the follow-up period we documented a 10% recurrence rate of OME in the A + T group and 14% recurrence rate in the A + M group. Overall our data suggests that the insertion of tympanostomy tubes in association with adenoidectomy provides no additional benefit to adenoidectomy in association with myringotomy alone in terms of hearing loss or AOM episode occurrences in patients with bilateral otitis media with effusion. Furthermore no relationship was found between the choice of operative intervention and the recurrence rate of OME despite the slightly greater relative risk in the A + M group.

Middle ear disease in children with cleft palate: Protocols for management

There is wide international variation in the protocols used for middle ear disease management in cleft palate patients. Ventilation tube (grommet) insertion may occur routinely at the time of palatoplasty or selectively on a separate occasion if symptomatic middle ear disease develops. The audiological and otologic outcomes of cleft palate patients were studied in a single institution over a timeframe in which both protocols were utilised. This was a retrospective study of 234 cleft palate patients who underwent palatoplasty from 1990 to 2005 at Middlemore Hospital, Auckland, New Zealand. Data on hearing loss, middle ear disease, and tympanic membrane abnormalities was collected from clinical notes. Audiological data was obtained from pure tone audiogram reports. Forty-five patients had routine grommets inserted concurrent with palatoplasty and 189 patients were managed conservatively with selective grommet insertion if indicated. Grommets were subsequently required in 79 (41.8%) of these 189 patients. There was no difference in the incidence of persistent conductive hearing loss, but recurrent middle ear disease, tympanic membrane abnormalities, and the total number of grommet insertions were significantly higher in the routine grommet group. Poorer outcomes were noted in patients who had undergone a greater number of grommet insertions. No significant deterioration in audiological outcomes and better otologic outcomes were found in cleft palate patients undergoing selective grommet insertion compared to routine grommet insertion. It is recommended that ventilation tube placement occur in patients selected on the basis of symptomatic infection or significant hearing loss.

Does Helicobacter pylori colonize the nasopharynx of children and contribute to their middle ear disease?

Objective. There is growing interest in studying the presence of HP in the upper aerodigestive tract. It was shown in several pilot studies that it colonizes the area, while other authors found no evidence of its presence there and a third group of authors believed that it had only a transient presence there. In this study we investigated a possible role for HP in middle ear disease in children. Material and methods. Consecutive patients undergoing myringotomy and adenoidectomy for chronic otitis media with effusion or recurrent otitis media were enrolled. Middle ear fluids were cultured on three types of agar plate (Brucella + laked horse blood; Brucella + sheep blood; and chocolate). A double polymerase chain reaction (PCR) was run to detect urease-C and adhesion subunit genes. Rapid urease enzyme testing and PCR were used on the adenoid specimens. Parents were interviewed regarding symptoms suggestive of gastroesophageal reflux in their children. Results. Eighteen patients were enrolled in the study (mean age 4.4 years; age range 3–8 years) with an equal gender distribution. All 28 middle ear fluid cultures were negative in all 3 media. Twenty-one of the 28 samples contained DNA, yet PCR revealed that none of them belonged to HP. Ten of the 13 adenoid specimens obtained were positive on rapid urease testing, but none on PCR. Seven of the 18 patients had at least 1 symptom suggestive of gastroesophageal reflux during the 6 months preceding the study but this did not have an impact on any of the results. Conclusion. There was no evidence from this study that Helicobacter pylori (HP) colonizes the nasopharynx of children with middle ear disease, whether dyspeptic or not. There is also no apparent role for this bacterium in middle ear pathology.

Middle ear disease in children with congenital velopharyngeal insufficiency.

To examine the incidence and natural history of middle ear disease in children with congenital velopharyngeal insufficiency (VPI) without cleft palate. Children with congenital VPI attending the combined cleft clinic at a tertiary cleft center. The diagnosis of congenital VPI in all cases was confirmed be the observation of hypernasality, nasal air escape, or both by a speech and language therapist and the demonstration of incompetence of the velopharyngeal sphincter by means of nasoendoscopy or videofluoroscopy. Children with overt cleft palate or postsurgical VPI were excluded. The children's medical records were reviewed, and a questionnaire regarding history of ear problems was sent to all parents. Children were divided into those with Pruzansky type I VPI (showing bifid uvula, midline diastasis of soft palate, or submucous cleft of the hard palate) and Pruzansky type II VPI (no visible stigmata). Incidence of reported ear problems, ear infections, hearing loss, and surgical intervention for middle ear disease in the whole group and in each of the subgroups. Seventy-one parents returned completed questionnaires. The overall incidence of middle ear disease was 63%, with 28% reported to have below-normal hearing. There was no significant difference between children with Pruzansky types I and II VPI with respect to incidence of otopathology or hearing loss. Irrespective of the presence of any visible palatal abnormalities, children with congenital VPI showed a substantial incidence of otopathology and should thus be closely monitored.

Incidence and outcome of middle ear disease in cleft lip and/or cleft palate

Objective: Otitis media with effusion is known to be very common among children with cleft palate, however, less is known regarding the natural history and outcome in this group. The purpose of the present study was to examine the incidence, natural history, treatment, and outcome of middle ear disease in children with clefts. Methods: A questionnaire was sent to the parents of all children registered on the cleft lip and palate database at our institution. The medical records of all respondents were also reviewed. Statistical analysis of the results was performed using Fisher's exact test in contingency tables and binary logistic regression analyses, where appropriate. Results: 397 fully completed questionnaires were returned. Ear disease was much more common in children with cleft palate, or cleft lip and palate, than in children with cleft lip. Among children with cleft palate, ear problems (infections and/or hearing loss) were most prevalent in the 4–6-year-old age group. However, ear problems persisted at a substantial level for many years after this; only after the age of 12 years did problems appear to settle. The incidence of below normal current hearing and of surgery for chronic otitis media was significantly related to history of ear infections ( P=0.000 and 0.000, respectively), and to increased number of ventilation tube insertions ( P=0.000 and 0.000, respectively). Conclusions: Middle ear disease is common in children with cleft palate, and, unlike the case for children without clefts, has a prolonged recovery, and a substantial incidence of late sequelae. The higher incidence of below normal hearing and surgery for chronic otitis media in children undergoing a greater number of ventilation tube insertions, although most likely reflecting an increased underlying severity of otitis media in these children, also underlines the lack of long-term benefits of ventilation tubes in this group.

The inclusion of partially reported studies in a Bayesian meta-analysis

Suppose we wish to carry out a meta-analysis of a collection of case-control studies each of which investigates the association between a given potential risk factor and the development of a particular disease. We describe a Bayesian formulation of the meta-analysis problem for which standard random effects meta-analysis provides an approximate solution. One of the problems with standard methods of meta-analysis is that they require detailed results of analysis for each individual study which is to be included. This requirement leads to the exclusion from the meta-analysis of some studies (particularly negative studies). It will be shown how studies, whose results are only partially reported, may be accommodated in the Bayesian framework. As an example, we consider a collection of case-control studies pertaining to the association between parental smoking and middle-ear disease in children. The results of a Bayesian meta-analysis of all available studies are compared with those of a similar analysis based only on fully reported studies. The effect of including the partially reported studies is to lower the estimate of the pooled log odds ratio and to reduce the length of the corresponding 95% high probability interval. The first effect occurs because most of the partially reported studies report no association between parental smoking and middle-ear disease and the second due to the increase in information achieved by the inclusion of a larger number of studies.

Auditory Learning as a Cause and Treatment of Central Dysfunction

Conductive hearing loss produced by middle ear disease (MED) is very prevalent in the first 5 years of childhood. Both MED in children and prolonged ear plugging in animals lead to a binaural hearing impairment that persists beyond the duration of the peripheral impairment. However, after cessation of the MED, or removal of the ear plug, binaural hearing gradually improves. We suggest here that this improvement is a passive form of auditory learning. We also show that active auditory learning, through repetition of discrimination tasks, can accelerate performance increments, both after hearing loss and in unimpaired individuals. A more detailed understanding of auditory learning holds out the prospect of improving rehabilitation strategies for the language- and hearing-impaired.

A new pathogenesis of mesotympanic (congenital) cholesteatoma.

To introduce a new, acquired pathogenetic theory of mesotympanic cholesteatoma behind an intact eardrum in children and to present some doubts on congenital pathogenesis. Literature review. The incidence and origination of mesotympanic cholesteatoma in children were thoroughly analyzed in the world literature and correlated to the histopathological studies on human middle ear epithelia and to epidemiological studies on secretory otitis, tubal occlusion, and acute suppurative otitis media. The new, acquired theory is based on the fact that that the place of origin of the anterosuperior mesotympanic cholesteatoma is the area of the malleus handle and malleus neck, and of the posterosuperior cholesteatoma, the long process of the incus. During the common pathological conditions there is a great risk of retractions and adhesions of the eardrum to these ossicles. After subsequent loosening of the retracted eardrum some cells of the keratinized squamous epithelium may be left behind and become included into the tympanic cavity, eventually causing an inclusion cholesteatoma. Four basic mechanisms of inclusions are proposed and the presence of great dynamics in middle ear disease in children, with high incidence of tubal dysfunction, retractions, secretory otitis, and acute suppurative otitis, is documented, making the acquired pathogenesis probable. The place of origin does not fit with the congenital pathogenesis of epithelial formation localized on the lateral wall of the eustachian tube close to the annulus. The origination around the malleus and incus fits better with the proposed acquired pathogenesis. There are no definitive proofs for the acquired pathogenesis of the mesotympanic cholesteatoma, nor is there experimental research to prove or disprove it. Mesotympanic cholesteatoma, congenital cholesteatoma, acquired pathogenesis of mesotympanic cholesteatoma, cholesteatoma in children, cholesteatoma behind intact eardrum.

Review : Parental Smoking and Middle Ear Disease in Children: A Review of the Evidence

This report presents a detailed review of the available epidemiological evidence concerning the prevalence of middle ear infections in children in relation to their expo sure to smoking by their parents or other household members and is based on English-language papers cov ering the period 1979-1998. Fifty-eight studies are in cluded in the review, with the most widely used index of exposure being parental smoking. Smoking by all house hold members, by either parent separately and by the mother during pregnancy were also considered in some of the studies. Only 3 studies attempted to quantify expo sure objectively, using measurements of cotinine and nicotine in hair, saliva and pericardial fluid. Tables listing unadjusted and adjusted relative risk estimates were constructed for both postnatal exposure to tobacco smoke and for maternal smoking during pregnancy. The results for postnatal exposure were separated into five disease categories. The overall data suggested some association of postnatal exposure to tobacco smoke with three categories; recurrent otitis media, otitis media with effusion and unspecified middle ear disease, with risk tending to increase with increasing exposure, but no association with acute otitis media or with persistent oti tis media with effusion. However, reported associations were generally quite weak, with relative risks typically below 1.5. Problems in interpreting the data arise from the difficulty of distinguishing possible effects of envi ronmental tobacco smoke and of maternal smoking dur ing pregnancy (for which the data also suggest an asso ciation), the possibility that the underlying cause of mid dle ear disease is in fact an infection, and from the var ious possibilities of bias inherent in epidemiological studies of a weak association, particularly due to inade quate control of confounding. Though it is prudent for parents not to expose their children to high doses of environmental tobacco smoke for long periods, the over all epidemiological evidence does not convincingly dem onstrate that exposure to environmental tobacco smoke increases the incidence of middle ear diseases in chil dren.

Passive Smoking Causes Middle Ear Disease in Children.

An estimated 38 to 60 percent of children breathe environmental tobacco smoke (ETS) at home. Although ETS has been named as a cause of middle ear

Health effects of passive smoking. 4. Parental smoking, middle ear disease and adenotonsillectomy in children.

BACKGROUND: A systematic quantitative review was conducted of evidence relating parental smoking to acute otitis media, recurrent otitis media, middle ear effusion, and adenoidectomy and/or tonsillectomy. METHODS: Forty five relevant...

Defining resistance: Breakpoints and beyond implications for pediatric respiratory infection

The emergence of isolates of Streptococcus pneumoniae with reduced susceptibility to penicillins, cephalosporins, trimethoprim-sulfamethoxazole, and macrolide antibiotics requires a re-evaluation of strategies for the treatment of community-acquired respiratory disease. One response has been the consideration of withholding initial antimicrobial therapy for children with acute otitis media (AOM). Review of clinical studies supports a reduction in suppurative complications, and a more rapid resolution of signs and symptoms as well as the course of middle ear disease in children treated with antimicrobial agents. Breakpoints established by the NCCLS for in vitro susceptibility reporting may not reflect clinical efficacy at all sites of disease. Clinical studies of AOM due to penicillin-resistant S. pneumoniae report success with both cefuroxime and amoxicillin-clavulanic acid, however, microbiologic studies suggest an increase in persistent infection in children with disease due to isolates with reduced susceptibility. Successful therapy for AOM due to highly resistant isolates (MIC ⩾2.0 μg/ml for penicillin) has been reported with clindamycin, ceftriaxone, and high-dose amoxicillin. The current risk of AOM due to a resistant S. pneumoniae remains low in most U.S. communities. Amoxicillin remains appropriate for most children, however, ongoing surveillance for resistance and close monitoring of response to therapy is necessary.