Middle Ear Fluid Research Articles

Otorrhea bacterial profile, epidemiology before widespread use of the third-generation pneumococcal conjugate vaccine in French children, a prospective study from 2015 to 2023

ObjectivesThe aim of this study was to describe the bacterial profile of middle ear fluid from spontaneous perforation of the tympanic membrane (SPTM) prior to widespread utilization of third- generation pneumococcal conjugate vaccines (PCVs). Patients and methodsFrom October 2015 to January 2023, children with SPTM were prospectively enrolled by pediatricians. ResultsAmong the 852 children with SPTM, 73.2% were less than 3 years old; more frequently than older children, they were and suffering from complex acute otitis media (AOM) (27.9%) and conjunctivitis (13.1%). In children under 3 years of age, NT Haemophilus influenzae (49.7%) was the main otopathogen isolated, particularly in those with complex AOM (57.1%). In children over 3 years of age, Group A Streptococcus accounted for 57%. In pneumococcal cases (25.1%), serotype 3 was the main serotype isolated (16.2%), followed by 23B (15.2%). ConclusionOur data from 2015 to 2023 represent a robust baseline preceding the widespread utilization of next-generation PCVs.

Prevalence and risk factors of otitis media with effusion in children with obstructive sleep apnea.

The aim of this study was to investigate the correlation between obstructive sleep apnea (OSA) and otitis media with effusion (OME) in Chinese children and identify risk factors for OME to support the development of standardized diagnostic and treatment methods. Clinical data of 1,021 children with OSA admitted to our hospital between January 2019 and December 2020 were collected. The prevalence of OME was assessed based on age groups and different grades of adenoid hypertrophy (AH). Multivariate logistic regression was performed to determine risk factors for OME in this population. Among the patients, only 73 (6.15%) reported hearing loss as the main complaint, while 178 (17.43%) were diagnosed with OME after the examination. Acoustic immittance showed higher detection rates for OME compared to those of otoscopy and pure tone audiometry. In addition, the incidence of OME did not increase with AH grade but was higher in children with OSA with AH grade IV. Multivariate regression analysis showed that the younger age group (2-5 years), AH grade IV, nasal inflammatory disease, and passive smoking were significant risk factors for OSA and OME. However, sex, age of 6-12 years, and presence of chronic tonsillitis/tonsillar hypertrophy had no significant impact on the prevalence of OME. OME is highly prevalent in children with OSA. Clinicians should be vigilant in diagnosing OME, should conduct routine audiological examinations, and actively screen for middle ear fluid in all children with OSA, especially in younger children (2-5 years) with nasal mucosa inflammation and a history of passive smoking. This will help improve the detection rate of OME, as early intervention is paramount for preventing complications.

The effect of pneumococcal conjugated vaccines on occurrence of recurrent acute otitis media among infants diagnosed with acute otitis media at an age younger than 2months.

To examine the impact of pneumococcal conjugate vaccines (PCV) on the occurrence of recurrent acute otitis media (rAOM) among infants diagnosed with an early acute otitis media (AOM) episode. Retrospective cohort study of pediatric patients with a first episode of AOM at an age < 2months. Data included clinical, demographic, and microbiological findings at the first AOM episode. In addition, a 5-year follow-up after the patient's first episode was completed from the medical records. This information included documentation of rAOM episodes and complications of AOM (hearing loss, speech disturbance, mastoiditis, and tympanic membrane perforation) and of ear-related surgical procedures (ventilation tube placement, adenoidectomies, and mastoid surgery). Two groups were studied: patients diagnosed between 2005 and 2009 (representing the unvaccinated group, group 1) and those diagnosed in 2010-2014 (the vaccinated group, group 2). A total of 170 infants were diagnosed with a first AOM episode at an age < 2months; 81 of them belonged to group 1 and 89 to group 2. Streptococcus pneumoniae was isolated in the middle-ear fluid in the first AOM episode in 48.1% of the patients in group 1 and in 30.3% in group 2 (P = 0.0316). 49/81 (60.5%) infants in group 1 were diagnosed with rAOM versus 39/80 (43.8%) in group 2 (P = 0.0298). No statistical differences were found between the groups with respect to long-term complications or need for surgery later in life. Conclusion: Our study showed a significant decrease in the occurrence of rAOM in infants diagnosed with AOM during the first 2months of life and timely immunized with PCVs following this initial AOM episode. What is Known: • 30% of children experience recurrent AOM (rAOM) at the first year of life. The earlier the age of the first AOM, the greater the risk for future complications. • After the introduction of PCVs, the overall pneumococcal AOM incidence declined. We investigated the future effect of PCVs on rAOM occurrence, when administered after the first AOM episode. What is New: • A retrospective cohort of 170 infants with a first AOM episode at an age <2 months and followed for 5 years, showed a significant decrease (28.0%) of rAOM in immunized infants following the initial AOM episode. • Our findings supplement previous data suggesting that the widespread PCVs use prevents rAOM by preventing early AOM and emphasize the importance of timely administration of the PCVs.

Wideband Tympanometry and Absorbance for Diagnosing Middle Ear Fluids in Otitis Media with Effusion.

Surgical tympanostomy tube insertion is a standard procedure in Otitis media with effusion after proper follow-up. During the surgery, the presence of serous or mucoid fluids, atelectatic tympanic membrane, or empty ear may be observed, despite all patients having the same diagnosis. A better method based on a non-invasive approach can help avoid unnecessary surgery. This study aimed to compare surgically confirmed otitis media with effusion with wideband tympanometry and absorbance tests. A total of 122 children diagnosed with otitis media with effusion were included. Eighty healthy children were included as controls. Ears were divided into 4 groups: serous, mucoid, atelectasis, and empty. Resonance frequency, 226 Hz and 1000 Hz compliance, wideband peak pressure, and absorbance data were used for comparison. The most practical tests were the average of 500, 1000, and 2000 Hz absorbance according to positive likelihood ratio (4.8) and model 2 according to negative likelihood ratio (0.11). It was better than the standard 226 Hz and 1000 Hz compliance tests. Although some statistically significant parameters were observed between serous fluid and empty ear, they were not sufficiently impactful for a differential diagnosis. No parameter could help us differentiate between serous and mucous fluids. According to negative likelihood ratio (0.11), a person with normal middle ear is 9 times more likely to have negative test with the use of resonance frequency, wideband tympanometry, and average absorbance together. To differentiate serous fluid from the empty ear, using only 226 Hz or 1000 Hz compliance for surgical indication can potentially cause wrong decisions according to negative likelihood ratios.

The effects of the COVID-19 pandemic on pediatric patients with otitis media with effusion

Otitis media with effusion (OME) is a frequently self-limiting middle ear fluid accumulation. During the COVID-19 pandemic, there was a decrease in patient referrals to pediatric Otorhinolaryngology (pENT) outpatient clinics. The aim of this study was to compare the patients who presented at our pENT outpatient clinic with OME during the pandemic with patients who presented during the equivalent period before the pandemic, and to investigate the effects of pandemic measures on OME. The study included patients aged 1-15 years who presented at the pENT Outpatient Clinic due to OME. Four groups were created based on the date of March 2020, when the first COVID-19 case was recorded in Turkey. The groups were formed as one for each year from March 2018 to March 2022. The total number of patients admitted to the pENT outpatient clinic was recorded. Group 1 (March 2018-March 2019) included 1338 patients diagnosed with OME, which constituted 12% of the total number of patients. Group 2 (March 2019- March 2020) included 1238 patients, Group 3 (March 2020-March 2021) 241 (8%), and Group 4 (March 2021-March 2022) 432 (9.4%). From this study, it was observed that the greater attention paid to the mask, social distance and hygiene rules during the COVID-19 pandemic, and the implementation of distance education decreased the frequency of upper respiratory tract infections, and had a positive effect on the number of OME cases.

Evaluation of Temporal Bone Infections - Comparing Sensitivity of Multiplex Assay to Standard Bacterial Culture

Background: The multiplex assay is a nucleus acid/base assay that can detect a wide array of distinct nucleic acid sequences from different pathogens. This study hopes to show the necessity and utility of this technology in detecting pathogens that cause middle ear infections. Methods: This observational study was conducted from May 2021-July 2022 to assess the sensitivity of a multiplex assay in a microfluidics pouch in the detection of bacterial and viral pathogens in middle ear fluids. Standard bacterial culture was used as a control. Middle ear fluid was obtained from 98 pediatric patients undergoing tympanostomy to treat otitis media. The BioFire PNA panel was used, which detects bacterial, viral, drug resistance, and atypical bacterial nucleic acid targets. Patient demographics, past medical history, and otitis media risk factors were also recorded.&#x0D; Results: A total of 107 ear samples were assessed from 98 patients. The average age of study subjects was 3.53 ± 2.99 years. The population of this study was 61.22% male, 75.51% Caucasian, 22.44% African American, and 2.04% Other, 88.78% Non-Hispanic, 10.2% Hispanic, and 1.02% Unknown. We found that Haemophilus influenzae was she most common pathogen detected (multiplex; culture) - (34.58%; 14.02%), followed by Moraxella catarrhalis (10.28%; 4.67%), Streptococcus pneumoniae (6.54%; 2.80%), Staphylococcus aureus (1.5%; 5.61%), and Proteus spp. (.94%; 0%). All bacteria, except Staphylococcus aureus were identified in more ear specimens by multiplex testing than bacterial culture.&#x0D; Conclusion: Our study demonstrates that multiplex testing is more sensitive than culture in identification of pathogens in middle ear fluid from patients undergoing tympanostomy for treatment of otitis media. The increased sensitivity for bacterial identification and simultaneous detection of viral targets in a very limited patient specimen make the multiplex assay a novel diagnostic tool which may be useful in the management of patients with otitis media in the future.

Clinical Decision Making for Intraoperative Auditory Brainstem Response Testing in Children following Tympanostomy Tube Placement.

Intraoperative auditory brainstem response (ioABR) testing following tympanostomy tube (TT) placement may be biased due to temporary threshold shifts (TTS). The purpose of the study was to assess the evidence for TTS in children who have undergone ioABR using prolonged latencies of wave I (males > 1.95 ms, females > 1.88 ms) as a marker of a persisting air-bone gap. Eighty-three children underwent ioABR following surgical procedures at University Hospital Bonn, Germany. The primary outcome measure was the latency of wave I at 80-dB SPL. The total sample consisted of 66 males (79.5%) and 17 females (20.5%) with a mean (SD) age of 46.4 (26.6) months. Of 163 operated ears (83 children), 72 (44.2%) had no middle ear fluid, 19 (11.6%) serous fluid, and 72 (44.2%) mucoid fluid. The risk of having a prolonged latency of wave I at 80-dB SPL was OR 4.61 (95% CI 2.01-10.59; p < 0.001) in those with mucoid fluid as compared to those without mucoid fluid. Intraoperative ABR results should account for sex differences and be interpreted with caution and be verified. Ultimately, parents should be engaged in a preoperative discussion to decide if an ioABR should be postponed if mucoid fluid was found.

Biofilms and intracellular infection in otitis media

Otitis media (OM), middle ear infection, represents a significant burden on children, their families, and the healthcare system. OM is the major cause of hearing loss in children and if left untreated in children who suffer chronic and recurrent forms of OM, this disease can have serious life-long sequelae. Chronic and recurrent OM are recalcitrant to current therapies due to the formation of biofilms and intracellular biofilm pods by otopathogens on the middle ear mucosa and within the middle ear fluid. These pathogens actively hijack the children’s own immune response and persist in the neutrophil extracellular trap-derived DNA in the middle ear. Children who suffer from chronic and recurrent forms of OM have also been shown to have reduced antibody levels to important anti-biofilm protein antigens. These both represent potential targets for treatment or prevention and are under investigation.

Nasopharyngeal rapid diagnostic testing to reduce unnecessary antibiotic use and individualize management of acute otitis media.

Acute otitis media (AOM) is the most common indication for antibiotics in children. The associated organism can influence the likelihood of antibiotic benefit and optimal treatment. Nasopharyngeal polymerase chain reaction can effectively exclude the presence of organisms in middle-ear fluid. We explored the potential cost-effectiveness and reduction in antibiotics with nasopharyngeal rapid diagnostic testing (RDT) to direct AOM management. We developed 2 algorithms for AOM management based on nasopharyngeal bacterial otopathogens. The algorithms provide recommendations on prescribing strategy (ie, immediate, delayed, or observation) and antimicrobial agent. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life day (QALD) gained. We used a decision-analytic model to evaluate the cost-effectiveness of the RDT algorithms compared to usual care from a societal perspective and the potential reduction in annual antibiotics used. An RDT algorithm that used immediate prescribing, delayed prescribing, and observation based on pathogen (RDT-DP) had an ICER of $1,336.15 per QALD compared with usual care. At an RDT cost of $278.56, the ICER for RDT-DP exceeded the willingness to pay threshold; however, if the RDT cost was <$212.10, the ICER was below the threshold. The use of RDT was estimated to reduced annual antibiotic use, including broad-spectrum antimicrobial use, by 55.7% ($4.7 million for RDT vs $10.5 million for usual care). The use of a nasopharyngeal RDT for AOM could be cost-effective and substantially reduce unnecessary antibiotic use. These iterative algorithms could be modified to guide management of AOM as pathogen epidemiology and resistance evolve.

Clinical decision making in paediatric otitis media: A pilot quality improvement study.

This study aimed to improve local management of paediatric otitis media using the 2022 American-Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) Clinical Practice Guideline for Tympanostomy Tubes in Children. A SQUIRE 2.0 compliant quality improvement study was carried out within the outpatient department of our otolaryngology tertiary referral centre. Local outpatient management of paediatric otitis media was compared to the AAO-HNS guidelines, specifically focussing on the decision to offer tympanostomy tubes. Following initial audit of practice, an educational session was performed within the otolaryngology department and local practice was subsequently re-evaluated. Overall, 88 children were included (46 pre-intervention and 42 post-intervention) with a mean age of 7.6 years (range 1-12 years). Sixty-four (72.7%) children presented with suspected otitis media with effusion. The remainder presented with recurrent or persistent acute otitis media (24/88, 27.3%). Twenty-six children were offered tympanostomy tubes (29.5%). Initial evaluation of practice identified that the decision to offer tympanostomy tubes was guideline appropriate in 76.1% of children (35/46). This significantly improved following an educational session (40/42, 95.2%, p=0.02). The reasons for non-guideline compliance included: otitis media with effusion <3 months, no evidence of middle ear fluid and patients meeting criteria for tympanostomy tube insertion not being offered. A focussed educational intervention may improve local adherence to guidelines in the management of paediatric otitis media. Continued re-evaluation of local practice is essential in order to ensure children are managed in accordance with the guidelines.

Symptoms: Purple Ear Drum and Hearing Loss

Symptoms: Purple Ear Drum and Hearing Loss

187. Nasopharyngeal Testing to Individualize Management of Acute Otitis Media

Abstract Background There are &amp;gt; 10 million antibiotics prescribed yearly for acute otitis media (AOM). The associated organism can influence the likelihood of antibiotic benefit and optimal treatment. A rapid diagnostic test (RDT) for AOM could prevent unnecessary antibiotic use, while assuring those likely to benefit from antibiotics receive the appropriate agent. Nasopharyngeal (NP) polymerase chain reaction can effectively exclude the presence of organisms in middle ear fluid and may be useful to individualize care. Objective: To explore the potential cost-effectiveness and reduction in antibiotics with NP RDTs to direct AOM management. Methods We developed two algorithms for AOM management based on NP bacterial otopathogens (Figure1). The algorithms provide recommendations on prescribing strategy (immediate, delayed, or observation) and antimicrobial agent. We utilized a tiering system based on expected pathogen-associated severity and resistance. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality adjusted life day gained (QALD). We used a decision-analytic model to evaluate the cost-effectiveness of the RDT algorithms compared to usual care from a societal perspective over a 30-day time horizon. Secondary outcomes included the (1) cost at which a RDT would be cost-effective and (2) potential reduction in annual antibiotics used. Flow diagram Figure 1:Flow diagram for management of AOM including RDT-DP and RDT-OBS algorithms Results An RDT algorithm that used immediate, delayed prescribing, and observation based on pathogen (RDT-DP) had an ICER of $1336.15/QALD compared with usual care and strongly dominated the RDT that used only immediate prescribing and observation (RDT-OBS). At an RDT cost of $278.56, the ICER for RDT-DP exceeded the willingness to pay threshold ($274 per QALD gained); however, if the cost of the RDT was &amp;lt; $212.10, the ICER was below the threshold. Both algorithms reduced annual antibiotic use, including broad-spectrum use, compared to usual care (RDT-DP 4.7 million (56% reduction), RDT-OBS 5.4 million (49% reduction), usual care 10.5 million). Conclusion The use of a NP RDT for AOM is likely to be cost-effective and substantially reduce unnecessary antibiotic use. These iterative algorithms could be modified to guide AOM management as scientific knowledge evolves. Disclosures All Authors: No reported disclosures.

Symptoms Underestimate the Presence of Obstructive Sleep Apnea in Patients with Spontaneous Cerebrospinal Fluid Leaks of the Temporal Bone.

To determine the severity of symptoms and degree of obstructive sleep apnea (OSA) in patients with spontaneous cerebrospinal fluid (sCSF) leaks of the temporal bone given the known association between sCSF leaks and OSA. Retrospective case review. Ambulatory clinics in tertiary referral centers. Polysomnogram testing in 34 consecutive patients who had been diagnosed with sCSF leaks of the temporal bone was examined. Diagnosis of sCSF leak was defined as biochemically confirmed CSF from middle ear fluid with no other obvious source. Diagnostic. Patient characteristics (age, sex, body mass index, Epworth Sleepiness Scale score, presence of hypoxia, overnight change in blood pressure, and apnea hypopnea index [AHI]) were recorded. Diagnosis of OSA was defined as mild when AHI ≥5 and <15/h, moderate when AHI ≥15 and <30/h, and severe when AHI ≥30/h. Of the 34 patients, 28 (82%) had a confirmed diagnosis of OSA. There was a male predisposition in those with OSA, and 17 of 28 (61%) were male. A majority were overweight, and the mean body mass index was 30.1 (SD, 4.8; range, 23.2-40) kg/m2. The mean severity of OSA was moderate, and the mean AHI was 28.7 (SD, 21.9; range, 5.4-92.8). Of the 28 patients, 13 with OSA (46%) had Epworth Sleepiness Scale scores higher than 8, suggesting that many were asymptomatic for excessive daytime sleepiness at the time of presentation. OSA is highly prevalent among patients with sCSF leaks of the temporal bone. Patients with sCSF leaks irrespective of symptoms of OSA should undergo formal polysomnogram testing.

Use of optical coherence tomography otoscopy to overcome cerumen and other view obstructions during ear examination and assessment

AbstractChildhood ear infections are highly prevalent and diagnosed with the otoscope, a simple tool that illuminates and magnifies the eardrum to subjectively assess color, translucency and presence of any middle ear fluid. Frequently, however, this view is obstructed by cerumen, complicating clinician assessment and appropriate and effective management. An optical coherence tomography (OCT)‐otoscope capable of capturing both depth‐resolved OCT images and digital color surface images was used to compare OCT against otoscopy for imageability and readability despite cerumen obstruction. Image data were collected from 26 human subjects and read by 12 blinded clinicians and 5 blinded OCT experts. An average of 64.6% of otoscopy views were obstructed. For cases with &gt;75% otoscopy view obstruction, OCT imageability was 84.6%, while otoscopy imageability was 37.5%, excluding complete obstruction cases. OCT‐otoscopy is a promising technology to improve practical middle ear assessment despite the presence of obstructions that frequently render current diagnostic assessments ineffective.

Temporal Bone Skull Base Defects-The Value and Importance of Early Based Detection to Prevent Late Costly Morbidity and Mortality.

Objective: The purpose of this value-based retrospective study was to compare 20 patients with acute bacterial otogenic meningitis to patients with spontaneous cerebrospinal fluid leaks (sCSF) from idiopathic intracranial hypertension (IIHT), assessing demographics including age, sex, body mass index (BMI) and radiographic features. Materials and Method: This study is a retrospective chart and radiographic review, with focus on value-based care, of 20 patients with acute bacterial otogenic meningitis over five years from January 2014 to January 2019, at tertiary hospitals Perth, Western Australia, compared to recently published cohort of 90 patients with sCSF (49). Mann-Whitney U Test was used to compare the differences between the two groups, an alpha value of 0.05 was considered statistically significant. Patients were compared with respect to age, sex, body mass index, clinical exam and radiological investigations. Results: Patients with otogenic meningitis had similar characteristics to sCSF and IIHT, characterised by middle to older age and elevated BMI and non-traumatic skull base temporal bone defects. At risk patients may require ENT assessment and dedicated skull base and temporal bone imaging to exclude skull base or tegmen defects. Conclusions: Retrospective review of 20 acute bacterial meningitic patients, revealed demographics similar to sCSF, including elevated BMI and mid to slightly older age. Value- based care in patients with fluid in middle ear and mastoid is enhanced by ENT evaluation and dedicated skull base and temporal bone imaging to evaluate for bony dehiscence that may necessitate treatment to prevent otogenic meningitis with associated morbidity and mortality.

Middle Ear Condition at the Time of Pediatric Myringotomy Tube Placement: Pain Associations Following Intraoperative Fentanyl/Ketorolac and Seasonal Variation.

Ketorolac-refractory pain behavior following bilateral myringotomy and pressure equalization tube placement (BMT) is associated with the absence of middle ear fluid. Intraoperative fentanyl/ketorolac affords more reliable pain control than ketorolac alone. We hypothesized that middle ear condition would correlate with postoperative pain despite such combination therapy. We further sought to demonstrate seasonal variation in ear condition and its influence on pain. We conducted a single-institution retrospective cohort study of healthy children (9 months-7 years), who underwent BMT by a single surgeon from 2015 to 2020. Anesthetic care included sevoflurane/nitrous oxide/oxygen/air by mask and intramuscular fentanyl/ketorolac. Left/right middle ear fluid status was recorded at the time of BMT, and ear condition (primary exposure) was dichotomized as bilateral infected (mucoid or purulent) or normal/unilateral infected. The primary outcome was maximum postanesthesia care unit Face, Legs, Activity, Cry, and Consolability (FLACC) score: 4-10 (moderate-to-severe pain) versus 0-3 (no-to-low pain). Rescue oxycodone, acetaminophen administration, and emergence agitation were secondary outcomes. Statistical analysis incorporated generalized linear mixed-effect models (GLMMs) with random intercepts to account for clustering by anesthesia provider. A year-over-year monthly time-series analysis was conducted using an autoregressive integrated moving average (ARIMA) regression model. Excluding recurrent cases, 1149 unique evaluable subjects remained. Bilateral infection prevalence was 39.8% (457/1149; 95% confidence interval [CI], 37.0-42.6). Probability of moderate-to-severe pain behavior was 23.5% (270/1149; 95% CI, 21.1-26.0) overall. Compared to patients with bilateral infected middle ears, those with normal/unilateral infected ears were more likely to have a FLACC score ≥4 (26.7% [185/692] versus 18.6% [85/457]; odds ratio [95% CI], 1.7 [1.2-2.3]; P = .002). Variability in pain outcome explained by the multivariable GLMM was 4.7%. Fentanyl dose response was evidenced by oxycodone administration differences ( P ≤ 0.002). Moderate-to-severe pain and emergence agitation were more likely with reduced fentanyl dosing. Bilateral infection prevalence exhibited seasonality, peaking in March and nadiring in July. However, pain outcomes did not vary by season. Normal/unilateral infected ears at time of pediatric BMT are associated with higher incidence of moderate-to-severe postoperative pain following intraoperative fentanyl/ketorolac administration, but the predictive value of ear condition on pain is limited. Infections were less common in the summer.

Pathogenesis of Streptococcus pneumoniae serotype 3 during natural colonization and infections among children and its IgG correlate of protection in a mouse model

Current licensed pneumococcal conjugate vaccines (PCVs) are effective against pneumococcal diseases caused by the serotypes contained in the PCvs However; several studies evaluating pneumococcal colonization and acute otitis-media (AOM) prevention in young children vaccinated with PCV13, observed less effectiveness against serotype-3. One possible reason for less effectiveness may be release of the capsular polysaccharide (CPS) of serotype-3 (CPS-3) as an immune evasion mechanism. Here we evaluated free CPS-3 levels released from 6 clinical isolates from young children compared to WU2 strain and to serotype-19A CPS (CPS-19A) released in vitro when interacting with nasopharyngeal, middle-ear and lung cell-lines. Clinical serotype-3 strains showed greater release of CPS than WU2 with the interaction to 2 cell-lines and all 6 clinical serotype-19A strains. We next evaluated CPS-3 vs CPS-19A levels in middle-ear fluid (MEF) and the nasopharynx (NP) of young children and found higher levels of CPS-3 compared to CPS-19A in MEF during AOM but not in NP secretions during colonization. With anti-CPS-3 IgG in MEF and NP secretions at time of health and onset of AOM, a significant negative correlation (r = -0.75, p < 0.05) between unbound anti-CPS-3 IgG levels and free- anti-CPS-3 in MEF were found, and a significant lower detection of unbound anti-CPS-3 IgG in NP at the time of health with serotype-3 SPN (p < 0.05) compared to irrelevant SPN serotypes were found. In a mouse model of AOM and pneumonia, we sought a correlate of protection against serotype-3 infection using human serum-derived anti-CPS-3 IgG. We conclude that serotype-3 clinical isolates from children release more capsule than WU2 strains or 19A strains during in vitro testing; release more capsule in the MEF of children during AOM than serotype 19A; unbound anti-CPS-3 IgG levels negatively correlate with free-anti-CPS-3; and a level of 2.8 µg/ml anti-CPS-3 antibody protects mice from AOM and pneumonia but not colonization.

The association between Helicobacter pylori and chronic otitis media with effusion.

Chronic otitis media with effusion (COME) is a common condition in children and a leading cause for hearing loss and ventilation tubes (VT) insertion. Among other risk factors, it is suggested that Helicobacter pylori (H. pylori) infection may have a role in the pathogenesis of COME. Previous studies have reached different results, and therefore, there is a need for further data on the relationship between H. pylori infection and COME development in children. Our objective is to investigate the presence of H. pylori in the middle-ear fluid (MEF) from children with COME. A Comparative cross-sectional study. Children ≤ 18years were included. The study group included children diagnosed with COME and required VT insertion. The control group included children with acute otitis media (AOM) who required myringotomy in the emergency room. Middle-ear fluid samples were sent for both culture and bacterial identification using polymerase chain reaction (PCR) testing. A total of 43 children were included. Eighteen with COME (median age 4years, IQR 3-6), and 25 with AOM (median age 1year, IQR 1-2). All samples were cultured for H. pylori. Twenty-two samples underwent H. pylori PCR testing of them, 12 samples from children with COME, and 10 from children with AOM. All cultures and PCR tests results were negative for H. pylori. Our results suggest that H. pylori does not have a role in the pathogenesis of COME. Future larger studies are needed to investigate whether H. pylori has a role in the pathogenesis of COME.

Increase in Haemophilus influenzae Detection in 13-Valent Pneumococcal Conjugate Vaccine Immunized Children With Acute Otitis Media.

NTHi was the predominant pathogen in ear cultures from severe acute otitis media (AOM) episodes in PCV-13 vaccinated children, more commonly in girls. NTHi-AOM episodes were associated with more myringotomies due to a higher treatment failure incidence. The low rate of β-lactamase NTHi isolates in middle ear fluid cultures from PCV-13 vaccinated children presenting with AOM strengthens to still use amoxicillin as the first-line antibiotics.

Multimodal Handheld Probe for Characterizing Otitis Media - Integrating Raman Spectroscopy and Optical Coherence Tomography.

Otitis media (OM) is a common disease of the middle ear, affecting 80% of children before the age of three. The otoscope, a simple illuminated magnifier, is the standard clinical diagnostic tool to observe the middle ear. However, it has limited contrast to detect signs of infection, such as clearly identifying and characterizing middle ear fluid or biofilms that accumulate within the middle ear. Likewise, invasive sampling of every subject is not clinically indicated nor practical. Thus, collecting accurate noninvasive diagnostic factors is vital for clinicians to deliver a precise diagnosis and effective treatment regimen. To address this need, a combined benchtop Raman spectroscopy (RS) and optical coherence tomography (OCT) system was developed. Together, RS-OCT can non-invasively interrogate the structural and biochemical signatures of the middle ear under normal and infected conditions.In this paper, in vivo RS scans from pediatric clinical human subjects presenting with OM were evaluated in parallel with RS-OCT data of physiologically relevant in vitro ear models. Component-level characterization of a healthy tympanic membrane and malleus bone, as well as OM-related middle ear fluid, identified the optimal position within the ear for RS-OCT data collection. To address the design challenges in developing a system specific to clinical use, a prototype non-contact multimodal handheld probe was built and successfully tested in vitro. Design criteria have been developed to successfully address imaging constraints imposed by physiological characteristics of the ear and optical safety limits. Here, we present the pathway for translation of RS-OCT for non-invasive detection of OM.