Mucoid Effusions Research Articles

Cell division cycle 42 positively correlates with T helper 2 cytokine, effusion viscosity, and hearing loss degree in otitis media with effusion patients.

Cell division cycle 42 (CDC42) participates in the pathogenesis of some T-cell-mediated inflammatory diseases via regulating CD4+ T-cell differentiation and inflammation response. This study aimed to evaluate the correlation of CDC42 and T helper (Th)1/Th2 cytokines with disease risk, effusion viscosity, and hearing loss degree of otitis media with effusion (OME). CDC42, interleukin (IL)-4, and interferon-gamma (IFN-γ) in effusion and serum of 78 OME patients were determined by enzyme-linked immunosorbent assay. Besides, the effusion (irrigating fluid) and serum samples of 30 controls (adenoid hypertrophy patients without OME) were also obtained for CDC42, IL-4, and IFN-γ determination. Effusion CDC42 and IL-4 were elevated in OME patients compared with controls (both p < 0.001). Effusion CDC42 was positively correlated with effusion IL-4 in OME patients (p=0.004) and controls (p=0.012) but was not related to effusion IFN-γ (both p > 0.050). Additionally, effusion CDC42 (p=0.025) and IL-4 (p=0.023) were increased in OME patients with mucoid effusion compared to patients with serous effusion, while effusion IFN-γ was of no difference between those patients (p=0.215). Meanwhile, elevated effusion CDC42 (p=0.012) and IL-4 (p=0.033) were linked with increased hearing loss degrees, whereas effusion IFN-γ was not related to hearing loss degrees (p=0.057). Moreover, the findings of serum CDC42, IL-4, and IFN-γ showed similar trends as effusion ones; nonetheless, their correlation with disease features was generally weaker. OME patients present with elevated CDC42 and IL-4 levels; the latter factors are intercorrelated and positively associate with effusion viscosity and hearing loss degree.

Reconstruction of the Obliterated Eustachian Tube: A Pilot Case Series.

To investigate the safety and early efficacy of a procedure for reconstruction of the obliterated Eustachian tube (ET). Retrospective case series. Patients with total obliteration of the cartilaginous ET, with intractable mucoid effusion causing repeated occlusion of tympanostomy tubes were included. Patients underwent endoscopic transnasal/transoral reconstruction of the obliterated ET using transtympanic illuminated guidewire guidance. A temporary stent (angiocatheter filled with bonewax) was placed to maintain patency while healing. In four cases an additional steroid-eluting propel stent was placed in the ET orifice. Main outcome measures were otomicroscopy results, absence of middle ear effusion, and nasopharyngoscopy showing patency of the ET orifice. Nine ETs (seven patients), ages 17-68 years (mean 37.9) underwent ET reconstruction. Follow-up ranged from 4 to 56 months (mean 30.9 months). 89% of operated ears had no effusion at last follow-up. Two patients (three Eustachian tubes) underwent successful reoperation. There were no complications directly related to the procedure. Etiologies of obliteration included scarring after sinus surgery, obstruction after maxillo-mandibular advancement surgery (two patients), bullous pemphigus, gunshot trauma, and previous patulous obliteration (two patients). Complete occlusion of the cartilaginous ET can be associated with intractable mucoid effusion; endoscopic examination should be considered in such cases. In this pilot study, ET reconstruction was found to be a safe and possibly effective procedure in patients with total obliteration of the ET from various etiologies. Larger studies with long term follow up are indicated. 4 Laryngoscope, 133:1970-1975, 2023.

Factors Affecting the Extrusion Rate and Complications After Ventilation Tube Insertion: A Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion-Part II.

The impacts of ventilation tube (VT) type and effusion composition on the VT extrusion rate and complications in children with otitis media remain unclear. This part II study evaluated the factors affecting the extrusion rate, recurrence rate, and complications of VT insertion. A prospective study was conducted between June 2014 and December 2016 (the EVENT study [analysis of the effectiveness of ventilation tube insertion in pediatric patients with chronic otitis media]), with follow-up data collected until the end of 2017. Patients aged <15 years diagnosed with otitis media with effusion who received VT insertion were recruited at 15 tertiary hospitals. The primary outcomes were time to extrusion of VT, time to effusion recurrence, and complications. Data from 401 patients were analyzed. After excluding the. of long-lasting tubes (Paparella type II and T-tubes), silicone tubes (Paparella type I) exhibited a significantly longer extended time to extrusion (mean, 400 days) than titanium tubes (collar-button-type 1.0 mm: mean, 312 days; P<0.001). VT material (hazard ratio [HR], 2.117, 95% confidence interval [CI], 1.254-3.572; P=0.005), age (HR, 3.949; 95% CI, 1.239-12.590; P=0.02), and effusion composition (P=0.005) were significantly associated with the time to recurrence of middle ear effusion. Ears with purulent (mean, 567 days) and glue-like (mean, 588 days) effusions exhibited a shorter time to recurrence than ears with serous (mean, 846 days) or mucoid (mean, 925 days) effusions. The revision VT rates during follow-up were 3.5%, 15.5%, 10.4%, and 38.9% in ears with serous, mucoid, glue-like, and purulent effusions, respectively (P<0.001). The revision surgery rates were higher among patients aged <7 years than among those aged ≥7 years. Silicone tubes (Paparella type I) were less prone to early extrusion than titanium 1.0 mm tubes. VT type, patient age, and effusion composition affected the time to recurrence of effusion.

Assessment of Pediatric Middle Ear Effusions With Wideband Tympanometry.

To determine if wideband tympanometry (WBT) can differentiate types of middle ear effusion (MEE): serous, mucoid, and purulent. Prospective cohort study. Tertiary care children's hospital. Children who met American Academy of Otolaryngology-Head and Neck Surgery's guidelines for ventilation tube insertion had WBT after anesthesia induction but before tympanotomy. MEE was categorized into 1 of 4 comparison groups: serous effusion, mucoid effusion, purulent effusion, or no effusion. WBT measurements were averaged to 16 one-third octave frequency bands, and comparison of the absorbance patterns for each MEE type was performed through a linear mixed effects model. A total of 118 children (211 ears) were included: 47 females (39.8%) and 71 males (60.2%). The mean age was 2.73 years (95% CI, 2.25-3.22); mean weight, 14.35 kg (95% CI, 12.85-15.85); and mean Z score, 1.13 (95% CI, -0.64 to 2.33). Effusions included 61 mucoid (28.9%), 30 purulent (14.2%), and 14 serous (6.6%), with 106 (50.2%) having no effusion. No significant differences were found for sex, race, age, weight, or Z score among the 4 types of effusion (P < .05). WBT showed a significant difference in median absorption among the effusion groups (P < .001), with a medium effect size of 0.35. WBT has potential use to differentiate types of MEE and should be studied further as a tool for investigating how the natural history and management of serous and mucoid effusions may differ.

Transcript Analysis Reveals a Hypoxic Inflammatory Environment in Human Chronic Otitis Media With Effusion.

Chronic otitis media with effusion (COME) is the most common cause of childhood hearing loss in the developed world. Underlying pathophysiology is not well understood, and in particular the factors that lead to the transition from acute to chronic inflammation. Here we present the first genome-wide transcript analysis of white blood cells in the effusion of children with COME. Analysis of microarray data for enriched pathways reveals upregulation of hypoxia pathways, which is confirmed using real-time PCR and determining VEGF protein titres. Other pathways upregulated in both mucoid and serous effusions include Toll-like receptor signaling, complement, and RANK-RANKL. Cytology reveals neutrophils and macrophages predominated in both serous and mucoid effusions, however, serous samples had higher lymphocyte and eosinophil differential counts, while mucoid samples had higher neutrophil differential counts. Transcript analysis indicates serous fluids have CD4+ and CD8+ T-lymphocyte, and NK cell signatures. Overall, our findings suggest that inflammation and hypoxia pathways are important in the pathology of COME, and targets for potential therapeutic intervention, and that mucoid and serous COME may represent different immunological responses.

Effect of vascular endothelial growth factor and its receptors in adult otitis media with effusion.

Some studies have demonstrated that vascular endothelial growth factor (VEGF) plays a critical role in the pathogenesis of otitis media with effusion (OME) in animal models. However, the levels of VEGF and its receptors in adult OME have not been clarified. Our study was designed to detect the levels of VEGF and its receptors in adult OME and explore their relationship with effusion types, duration and prognosis of OME. 61 patients with secretory otitis media were enrolled including 21 males and 40 females, with an average age of 54.7 ± 17.5years. The middle-ear effusions were collected by tympanocentesis or myringotomy. The protein concentrations were determined by enzyme-linked immunosorbent assay and messenger RNA by real-time quantitative PCR. VEGF level was higher in AOME group, but not correlated with the recurrence of OME. VEGFR1 and VEGFR2 levels were lower in recurrent group compared with non-recurrent group. VEGFR2 level was higher in serous effusions than mucoid effusions. VEGF messenger RNA was positively correlated both with HIF-1α and MUC5B. VEGF and its receptors function to induce the production of middle-ear effusions (MEEs) at acute stage of OME rather than chronic or recurrent stage, which is mainly mediated by HIF-1α pathway. The formation of mucoid effusions is associated with MUC5B and VEGFR2, but not with duration and recurrence of OME.

Younger patients with COME are more likely to have mucoid middle ear fluid containing mucin MUC5B

BackgroundChronic otitis media (COM) is one of the most common childhood diseases. Its pathophysiology is complex and multifactorial. The role of specific mucin glycoprotein subtypes in OM is only recently being elucidated. ObjectiveTo determine the relationship between middle ear fluid mucins and clinical variables of patients needing tympanostomy tubes (TT). MethodsMiddle ear effusions (MEE) from children receiving TT were collected over a 2-year period. Western blot characterization of mucins MUC5B and MUC5AC along with chart review of age, gender, effusion viscosity, hearing loss >30 dB, history of allergies, and/or respiratory disease were performed. ResultsMEE samples from 58 patients were available for analysis. Overall, MUC5B was significantly more often detected in middle ear fluid relative to MUC5AC (90% vs. 51%, p = 0.005). MUC5B presence was statistically associated with mucoid effusions relative to serous effusions (100% vs. 57%, p = 0.0064), MUC5AC presence was not significantly different in mucoid and serous fluid (55.1% vs. 37.5%, p = 0.447). Patients younger than 48 months were more likely to present with mucoid effusion, compared to those older than 48 months of age (p = 0.038). Finally, patients with effusions positive for MUC5B were younger than those with effusions negative for MUC5B (35.1 vs. 76 months, p = 0.045). No other variables correlated to either effusion viscosity or specific mucin content. ConclusionPatients younger in age needing TT placement are more likely to present with mucoid effusions, predominantly containing MUC5B mucin. As such, we postulate a distinct pathophysiology for mucoid and serous effusions across ages in children with COM.

A novel predictive marker for the viscosity of otitis media with effusion

ObjectivesTo evaluate the significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the prediction of the viscosity of otitis media with effusion. MethodsThis retrospective study was performed on 81 patients who were admitted to the otolaryngology clinic.The patients were divided into two groups according to their effusion type, as serous or mucoid, which was defined intraoperatively after myringotomy. The NLR and PLR were calculated as a simple ratio between the absolute neutrophil/platelet and absolute lymphocyte counts.Tympanostomy tube insertion was performed for all cases.Under direct visualization, the effusion was aspirated and classified as serous or mucous. ResultsWe postulated that an NLR value of less than 1.38 may show mucoid effusion and if the PLR value is less than 97.96, the effusion is mucoid. ConclusionsWe speculate that a useful predictor of viscosity for a middle ear effusion could prevent unnecessary surgeries and additional costs in the treatment of EMO. Additional studies are needed to confirm our results.

Pediatric cartilage tympanoplasty with primary intubation.

The purpose of this study was to analyze the anatomical and audiologic results in pediatric Type I cartilage tympanoplasties with primary intubation. Our hypothesis was that the outcome of patients with tubes placed would be similar to those without tubes, even though the ears that received tubes were in worse condition. Retrospective chart review of patients undergoing cartilage tympanoplasty with intubation between 2007 and 2012. All surgeries were performed or supervised by the senior author as the surgeon, using a modification of the perichondrium/cartilage island flap. All patients had a tube placed through the cartilage to allow for middle ear aeration. Hearing results were reported using a four-frequency (500, 1,000, 2,000, 3,000 Hz) pure-tone average and a pure-tone average air-bone gap (PTA-ABG). Postoperative complications were recorded. During the study period, cartilage with intubation was used for tympanic membrane reconstruction in 20 patients. Of these, 10 (50.0%) had craniofacial abnormalities, and the remainder had documented Eustachian tube dysfunction with mucoid effusion present at the time of surgery. The average patient age was 8 years, and the average follow-up was 39 months. The average pre- and postoperative PTA-ABGs were 25.1 ± 11.2 dB (standard deviation, SD) and 15.1 ± 10.2 dB (p < 0.05), respectively, and the average pre- and postoperative PTAs were 36.6 ± 12.4 and 24.9 ± 12.0 dB (p < 0.05), respectively. Only one case had to undergo revision, which was a result of a cholesteatoma. Of the 20 patients, 15 still had patent tubes at last follow-up, three had their tubes removed, and two had tube extrusion. Cartilage tympanoplasty with intubation achieves good anatomical and audiologic results when Eustachian tube dysfunction or craniofacial abnormalities are present. Significant hearing improvement was realized in a patient population that is characteristically more prone to problems.

Measurement of the sound intensity during suction of middle-ear fluid following myringotomy.

To determine noise intensity during middle-ear aspiration in order to evaluate whether levels can be potentially harmful. In this prospective, observational study, middle-ear effusion was aspirated following myringotomy using a suction instrument with a probe tube microphone. Sound pressure levels and duration were measured, and frequency domain analysis was performed. Forty-four ears were analysed, consisting of 20 with mucoid effusion, 11 with serous effusion and 13 with no effusion. Maximum peak sound intensity ranged from 84 to 157dB. Half of the ears (50 per cent) were exposed to greater than 140dB; of these, 82 per cent were exposed for longer than 0.2ms (range, 0.05-14ms). There was no significant difference in sound pressure level between ears with mucoid and serous effusion; however, ears with mucoid effusion required longer suction times (p<0.0030). In addition, peak intensity was greater for ears with mucoid effusion versus those with serous or no effusion (p<0.0001). Middle-ear aspiration during myringotomy caused noise levels within a potentially harmful range.

Atrial Natriuretic Peptides in Patients with OME: Serous Otitis Media and Mucoid Otitis Media

Objectives: Atrial natriuretic peptides (ANPs) are located within extracardiac tissues known to play an important role in the maintenance of fluid/electrolyte homeostasis. It is not known whether ANPs are expressed in middle ear effusions (MEEs) and whether ANP is correlated in development of serous or mucoid effusion (OME). In order to determine whether secretion of ANP is affected in chronic disease condition, we compared the ANP concentration in the mucoid effusions with that in the serous effusions. Methods: MEE concentrations of ANP were measured in 21 patients (12 mucoid, 9 serous) with OME. The patients underwent myringotomy and/or insertion of a ventilation tube for treatment of OME and collected MEEs. The samples were divided into serous or mucoid types based on observation by the naked eye. ANP immunoreactive cells and ANP levels were measured in the tissues and effusions of the patients with OME, using IHC and radioimmunoassay. Results: In human MEE samples, ANP levels showed a significant increase with the mucoid effusions when compared with the serous effusions and control plasma. ANP concentration was increased in mucoid effusion but was decreased in patients with serous effusion and in control plasma. ANP-immunoreactive (ANP-IR) cells are showed in the tall columnar cells of the middle ear mucosa. Conclusions: Our results suggest that a high concentration of ANP in mucoid secretions promotes chronicity of mucoid otitis media and hypothesize that ANP may also play a role in the pathogenesis of OME through changes in the transport of water and ions across the middle ear epithelium.

호산구성 중이염을 동반한 알레르기성 진균성 부비동염 1예

Eosinophilic otitis media (EOM) is a middle ear disease with extremely viscous mucoid effusion containing numerous eosinophils associated with allergic rhinitis and bronchial asthma. EOM is extremely unresponsive to conventional treatment for the common type of otitis media. EOM patients have the deterioration of the bone conduction hearing level, due to the inflammatory mediators released from inflammatory cells could enter the inner ear. One of the most effective treatments for esoinophilic inflammation is the administration of a steroid. Although EOM is commonly associated with nasal polyps, their relation to allergic fungal sinusitis is not reported. Hence we report a case of EOM proceeded with allergic fungal sinusitis with a review of literature. (J Clinical Otolaryngol 2012;23:279–282)

Ultrasound characterization of middle ear effusion

PurposeTo further enhance and assess the ability to characterize middle ear effusion (MEE) using non-invasive ultrasound technology. Materials and MethodsThis is a prospective unblinded comparison study. Fifty-six children between the ages of 6months and 17years scheduled to undergo bilateral myringotomy with pressure equalization tube placement were enrolled. With the child anesthetized, the probe was placed into the external ear canal after sterile water was inserted. Ultrasound recordings of middle ear contents were analyzed by computer algorithm. Middle ear fluid was collected during myringotomy and analyzed for bacterial culture and viscosity. ResultsUltrasound waveforms yielded a computer algorithm interpretation of middle ear contents in 66% of ears tested. When a result was obtained, the sensitivity and specificity for successfully characterizing middle ear fluid content as either void of fluid, thick fluid (mucoid), or thin fluid (serous or purulent) were at least 94%. Mucoid effusions had higher measured viscosity values (P=.002). Viscosity measures were compared to culture result, and those with low viscosity (thin consistency) had a higher likelihood of having a positive culture (P=.048). ConclusionThe device sensitivity and specificity for fluid detection were 94% or greater among interpretable waveforms (66% of those tested). Although this technology provides important information of the middle ear effusion presence and characteristic, further technological improvements are needed.

Mucin Production and Mucous Cell Metaplasia in Otitis Media

Otitis media (OM) with mucoid effusion, characterized by mucous cell metaplasia/hyperplasia in the middle ear cleft and thick fluid accumulation in the middle ear cavity, is a subtype of OM which frequently leads to chronic OM in young children. Multiple factors are involved in the developmental process of OM with mucoid effusion, especially disorders of mucin production resulting from middle ear bacterial infection and Eustachian tube dysfunction. In this review, we will focus on several aspects of this disorder by analyzing the cellular and molecular events such as mucin production and mucous cell differentiation in the middle ear mucosa with OM. In addition, infectious agents, mucin production triggers, and relevant signaling pathways will be discussed.

Otitis Media and Relevant Clinical Issues

Otitis Media (OM), an infection in the space behind the ear drum, is one of the most common childhood infectious diseases worldwide. More than 70% of all children have at least one middle ear infection by the age of six years. Among them, approximately 5–10% of patients turn to chronic OM which eventually causes hearing loss and sequelae. The pathogenesis of chronic and/or recurrent OM are multifactorial, including genetic predisposition, dysfunction of the Eustachian tube, impairment of the mucociliary system, hyperproduction of mucins, metaplasia/hyperplasia of mucous cells, and active secretion of ions and water. No matter what contributes to the development of the disease, mucin production and mucous cell metaplasia/hyperplasia are always problems in this disease. Mucous cell metaplasia/hyperplasia occur in the middle ear mucosa and tend to drive OM into a chronic status, leading to abundant production and accumulation of mucus in the middle ear cavity. Under the circumstances, this leads to the development of an OM entity, that is, OM with mucoid effusion. Mucous cell metaplasia/hyperplasia is frequently associated with chronic purulent otorrhea when the tympanic membrane is performed, making OM irreversible and intractable. However, it is unclear how this event initiates at an acute setting of OM and deteriorates in the chronic stage of OM. In this particular issue, there are seven papers in total, covering the clinical areas and basic sciences relevant to OM. In the clinical areas, there are five papers, dealing with application of auditory brainstem response in the operating room, measuring thickness of middle ear mucosa with MRI and CT, hearing loss in cleft palate patients, otoacoustic emissions in children with OM with effusion, and appraisal of pneumococcal vaccine trials. In the basic sciences, there are two review articles, focusing on the role of Atoh1 in mucous cell metaplasia and mucin production and mucous cell metaplasia/hyperplasia, respectively. In these two review articles, what has been discussed includes the cellular events through which mucous cells are induced from general epithelial stem cells; bacterial metabolites/inflammatory cytokines that modulate the development of mucous cells in the middle ear, transcription factors and other molecules that are responsible for differentiation of mucous cells in the middle ear, possible factors that increase the risks for mucous cell metaplasia/hyperplasia, and signal pathways that are involved in the mucin disorders and mucous cell metaplasia/hyperplasia. Jizhen Lin Joseph E. Kerschner Per Caye-Thomasen Tetsuya Tono Quan-An Zhang

Eosinophilic Otitis Media: CT and MRI Findings and Literature Review

Eosinophilic otitis media (EOM) is a relatively rare, intractable, middle ear disease with extremely viscous mucoid effusion containing eosinophils. EOM is associated with adult bronchial asthma and nasal allergies. Conventional treatments for otitis media with effusion (OME) or for chronic otitis media (COM), like tympanoplasty or mastoidectomy, when performed for the treatment of EOM, can induce severe complications such as deafness. Therefore, it should be differentiated from the usual type of OME or COM. To our knowledge, the clinical and imaging findings of EOM of temporal bone are not well-known to radiologists. We report here the CT and MRI findings of two EOM cases and review the clinical and histopathologic findings of this recently described disease entity.

Differences between children and adults with otitis media with effusion treated with CO 2 laser myringotomy

Background The safety and advantages of CO 2 laser myringotomy for otitis media with effusion (OME) are well described. The goal of such treatment is to avoid unnecessary ventilation tube insertion. Comparisons between different age groups treated with this modality are lacking, and prognostic factors for treatment outcomes are not available. Methods We conducted a retrospective cohort study that included 130 children (160 ears) and 96 adults (108 ears) with OME persisting after conservative antibiotic treatment. In eligible patients, we performed laser myringotomy in the affected ear. Follow-up was scheduled every week for 1 month and then every month for 6 months. Results for 233 ears were available for analysis; 24 ears were excluded (19 due to cancer, four due to a cleft palate, and one due to Down syndrome) and 10 patients (11 ears) were lost during follow-up. A logistic regression model was used for analysis, with success of therapy as the binary outcome. Results Adult patients had more unilateral lesions ( p < 0.001) and serous fluid effusions ( p < 0.001) than did the pediatric patients. However, there was no significant difference in the cure rate (children: 58.1%; adults: 64.7%) and positive culture rate (children: 15.1%; adults: 14.3%) between patient groups. Three factors were found to be associated with a poor prognosis: multiple occurrences in children ( p < 0.001), mucoid effusion ( p = 0.04), and a history of ventilation tube use in adults ( p < 0.001). No other variables predicted treatment outcome. Conclusion Our findings suggest that CO 2 laser myringotomy is a useful treatment modality for OME in children and adults, except for children with multiple occurrences and in adults with mucoid effusions and a history of ventilation tube use.

Pediatric hearing assessment by auditory brainstem response in the operating room

Objectives To investigate the factors contributing to the discrepancies between auditory brainstem response (ABR) thresholds obtained in the operating room (OR) and hearing outcomes obtained in the follow-up period and to explore the benefits and limitations of performing ABR in the OR. Methods A retrospective review study was conducted in a pediatric tertiary care facility. A total of 116 patients were identified with complete records, including OR-ABR results, medical examination and surgical procedure notes, and follow-up medical/audiological evaluation. Patients were divided into three groups: (1) 58 patients with middle ear effusion underwent myringotomy and tube placement, (2) 12 patients underwent myringotomy without tube placement, (3) 46 patients underwent ear examination only without effusion found. OR-ABR results were compared to audiological follow-up evaluations and analyzed for each group. Results In patients with middle ear effusion and tube placement, the average threshold difference between OR-ABR and follow-up audiological evaluation was 9.7 dB (±12.7), with highest discrepancy of 45 dB. On the other hand, in patients with dry ears and/or no tube placement, the average threshold difference was only 3.8 dB (±8.6). Moreover, the discrepancy was more prominent in patients with mucoid effusion and larger at lower frequency, i.e., 1000 Hz. Conclusions The hearing thresholds estimated by ABR testing in the OR can be elevated and follow-up hearing evaluation after tube placement is needed. While ABR testing is valuable in the assessment of pediatric patients, especially for children who are difficult-to-test or have complicated medical conditions, caution should be taken when interpreting OR-ABR results.

MUC5ACExpression in Human Middle Ear Epithelium of Patients With Otitis Media

To compare levels of middle ear (ME) MUC5AC expression in patients with otitis media (OM) with patients without OM. Mucin gene 5AC has been identified as a major secretory mucin in the ME and is fundamentally important in the development of ME mucoid effusions, hearing loss and also provides ME mucosal protection and bacterial clearance. Case control. Tertiary, academic, pediatric otolaryngology practice. Patients 9 months to 7 years old undergoing routine tympanostomy tube (TT) insertion for recurrent otitis media (RecOM) or chronic otitis media with effusion (COME) were compared with control patients without a history of OM undergoing cochlear implantation. During routine TT placement or cochlear implantation, a 1-mm biopsy sample of the ME epithelium was obtained. RNA was extracted, and real-time reverse transcriptase-polymerase chain reaction was used to quantify levels of MUC5AC expression. Twenty-three patients with OM (12 with RecOM and with 11 COME) were evaluated using 5 controls. Mean age was not different between groups. In the RecOM group, mean expression of MUC5AC was 25.92 times greater than in controls. In the COME group, the mean expression was 155.40 times greater than in controls. Levels of MUC5AC expression in the human ME are significantly increased in patients with RecOM and COME compared with controls. This study demonstrates MUC5AC gene changes in patients with OM and highlights the need for greater understanding of the molecular responses in OM; particularly that of mucin. A thorough exploration of these factors will provide opportunities to develop novel interventions for the extremely common problem of OM.

Experimental evidence suggestive of early intervention in mucoid otitis media

Conclusions. Mucoid effusion can undergo a process of organization related to the inflammatory process and hypoventilation; organized effusion in the presence of epithelial breaks is a potential source for formation of granulation tissue and cholesterol granuloma within 3 months of evolution. Objectives. The aim of this study was to investigate the evolution of mucoid otitis media and its relationship with the organized effusion within a time-span of 3 months. Materials and methods. Two groups of animals were selected. In group I, 15 chinchillas had a chemically modified bovine collagen type 2 gelatin membrane placed through a mechanically induced tympanic membrane perforation, bridging the external auditory canal and the promontory. In group II, 75 cats underwent eustachian tube obstruction with soft grade silastic sponges. Experimental phases and animal sacrifices were performed under general anesthesia. After sacrifice, temporal bones were prepared, stained with hematoxylin and eosin and evaluated under light microscopy. Results. The experimental ears in both groups were observed to undergo gradual pathological changes with increasing survival times. The acute inflammatory phase turned into chronic irreversible changes, which correlated directly with the initial amount of effusion and the areas of epithelial breaks, granulation tissue, cholesterol granuloma, and epithelial migration.