Otitis Media Group Research Articles

Quantitative bacterial culture from adenoid lymphatic tissue with special reference to Haemophilus [corrected

Homogenized adenoid tissue from 55 children (28-153 months) undergoing adenoidectomy because of nasopharyngeal obstruction was investigated by means of quantitative aerobic bacterial culture. The children were divided into two groups, the hypertrophy alone group--AH (n = 29)--and the hypertrophy with longstanding secretory otitis media group--SOM (n = 26). A nasopharyngeal culture was obtained preoperatively from 38 of the cases. Non-typeable H. influenzae (NTHI) was found in twice as many cases in the AH group as in the SOM group, 21/29 (72%) compared to 11/26 (42%) (p < 0.05) and in a significantly higher mean concentrations, 5.7 x 10(5) CFU/g compared to 1.9 x 10(5) CFU/g (p = 0.02). For the other aerobic potentially pathogenic bacteria no such difference was found. The bulk of the NTHI-positive cases and the cases with the highest concentrations were found in the children below the age of 6 years. In the nasopharyngeal cultures NTHI alone or together with S. pneumoniae and/or B. catarrhalis was found in 29% of the cases in both the AH group and SOM group. NTHI was found in only 50% of the nasopharyngeal cultures corresponding to a positive quantitative culture (10/20). These findings suggest that NTHI is harboured within the adenoid and could thereby chronically stimulate the local immune defense. However, the present study indicates that there is no aerobic bacterial overload in the adenoid tissue in children with SOM compared to children without middle-ear disease.

Chronic otitis media: a new extra-articular manifestation in ankylosing spondylitis?

Following a study reporting a fourfold increase in the occurrence of chronic otitis media in patients with ankylosing spondylitis, this prospective study examines this association with respect to severity, duration of disease, and acute phase in ankylosing spondylitis. Forty two consecutive patients with classical ankylosing spondylitis seen at the rheumatology clinic of a teaching hospital where the features of ankylosing spondylitis were recorded had an otological examination by an otolaryngologist. The occurrence of chronic otitis media (all categories) was 12/42 (29%). The acute phase serum markers (C reactive protein and IgG) were increased in patients with active or inactive chronic otitis media. Extra-articular manifestations were significantly more common in the chronic otitis media group than in those with no history of chronic otitis media. The results of this study suggest that chronic otitis media may be another extra-articular manifestation of ankylosing spondylitis. Alternative explanations, however, include similar aetiological factors for the two conditions or a previously unrecognised increased occurrence of HLA-B27 in patients with chronic otitis media.

Binaural Masking Level Differences in Children with a History of Otitis Media

The binaural hearing of children with and without a history of otitis media (OM) was assessed by determining their binaural masking level differences (BMLDs). The test was also administered to a group of adults. BMLDs for the non-OM children were not significantly different from those of adults. However the mean BMLD of the OM children was significantly lower than that of non-OM children. Some children in the OM group had small (15-25 dB HL) sensitivity deficits in one or both ears. However, no correlation was found between BMLD and hearing level in cases of either symmetric or asymmetric loss. Exclusion of OM children with residual middle ear abnormalities did not abolish the significant difference between the OM and non-OM groups. We suggest that the small BMLDs in the OM group may be associated with these children having difficulties detecting and attending to signals in noisy environments.

Histopathology of the tensor tympani muscle in otitis media

Involvement of the tensor tympani muscle (TTM) and tendon in otitis media have been suggested both clinically and experimentally. Extensive postmortem histopathological studies of the human TTM in cases with known otitis media have not been done. One-hundred-five human temporal bones with and without otitis media were evaluated using light microscopy to determine the pathological changes of the TTM and tendon. Fatty cell infiltration and degenerative changes of the muscle fibers were observed in non-otitis and otitis media groups, but were greater in those cases with otitis media. Inflammatory cell infiltration and fibroblastic reactions occurred more often in chronic and purulent otitis media, and hypercontracted fibers were more frequent in serous and chronic otitis media. This study indicates that the human TTM and tendon are pathologically involved in the inflammatory process of otitis media.

上気道感染症と肺炎球菌血清型分布

Sixty strains of S. pneumoniae isolated from the patients with upper respiratory tract infections were immunologically classified by use of Danish type/group specific antisera. The percentages of S. pneumoniae serologically defined were 23.3% for Group 23, 20.0% for Group 19, 13.3% for Group 6, 10.0% for Type 3, 3.3% for Type 4, 3.3% each for Type 9 and 18, and 1.6% for Type 14. It was confirmed that in case of acute otitis media Group 19 and Type 3 were characteristic showing 30.0% and 13.4%, while rhinosinusitis were highly related to Group 23 of S. pneumoniae. An additional analyses revealed that Type 3 of S. pneumoniae were mostly found in the patients over 50 years old, though the patients under 5 years old were related to Group 19.

Evaluation of temporal bone pneumatization on high resolution CT (HRCT) measurements of the temporal bone in normal and otitis media group and their correlation to measurements of internal auditory meatus, vestibular or cochlear aqueduct

Evaluation of temporal bone pneumatization on high resolution CT (HRCT) measurements of the temporal bone in normal and otitis media group and their correlation to measurements of internal auditory meatus, vestibular or cochlear aqueduct

Vestibular Dysfunction in Preschool Children with a History of Otitis Media

A study was conducted to investigate vestibular dysfunction in normal preschool children with and without a history of otitis media. Thirty-five preschoolers (age range 4 years, 2 months, to 5 years, 8 months) were assigned to an otitis media (OM) group (children with a history of 6 or more episodes of otitis media) or a no otitis media (NOM) group (children with no known episodes of otitis media), based on information obtained from a parent questionnaire. The Southern California Postrotary Nystagmus Test (SCPNT) and five tests from the Miller Assessment for Preschoolers (MAP) (Stepping, Vertical Writing, Romberg, Walks Line, and Hand-Nose tests) were administered. Results showed that children with a history of otitis media had significantly decreased percentile rank scores on Stepping (deviation) ( p &lt; .001) and Vertical Writing ( p &lt; .01), which measure vestibulospinal function. No significant difference was found for duration of nystagmus as measured by the SCPNT ( p &lt; .93). Clinical implications and suggestions for further research are discussed.

Studies on middle ear effusions.

AbstractThe analyses of middle ear effusion (MEE) in otitis media may prove important information for better understanding of etiology, evaluation of inflammatory stages of the middle ear cavity, and evaluation of the efficacy of the treatment. Biochemical composition of serous and mucoid effusion has been characterized in terms of enzymes (lactate dehydrogenase, (LDH), lysozyme, alkaline and acid phosphates), and hexosamine content of MEE. In addition to immunoglobulin (IgA, G, and M) content, several new immunochemical parameters (immune complexes, complements, secretory IgA) and histamines have been determined in various types of MEE. Bacteriological findings of MEE, age of patients, viscosity of MEE, and clinical course (fresh or recurrent) have been correlated with the results of biochemical and immunochemical analyses of MEE. Parallel studies of animal models (serous otitis media by eustachian tube obstruction, purulent otitis media by direct innoculation of pneumococcus) showed sequential changes of mucoperiosteum and alteration of enzyme levels (LDH, lysozyme) at various times after the induction of experimental otitis media. It was found that LDH and lysozyme levels were higher in the purulent otitis media group than in the serous otitis media group and that enzyme levels decreased with clearing of the bacteria along with the resorption of inflammatory changes evidenced by histology. Human MEE studies showed that lysozyme levels were higher in the culture positive group than in the negative group, substantiating the animal findings.Strong indications have been shown that biochemical and immunochemical characteristics of MEE can reflect the degree of inflammatory changes in the middle ear cavity. Thus, baseline information necessary to specify the factors responsible for chronicity or the tendency of recurrence of otitis media has been established. Further longitudinal studies are necessary to evaluate the efficacy of presently available treatment on the management of the disease process in otitis media.

Silent otitis media.

There is a traditional view that chronic otitis media and chronic mastoiditis must exist in the presence of a tympanic membrane perforation. Based on a human histopathological study of 123 temporal bones with chronic otitis media out of 333 temporal bones with all forms of otitis media pathology, only 24 patients (36 ears) had symptoms of otological disease recorded on their charts and only 19.5% of these had an associated tympanic membrane perforation. Unsuspected findings of chronic otitis media (active or inactive) are occasionally confirmed at exploratory tympanotomy. Such quiet chronic pathological findings in the middle ear have occurred in association with endolymphatic hydrops and cochlear end organ lesions suggesting the possibility that silent chronic otitis media may help explain sensorineural hearing loss, vertigo, and tinnitus for certain patients. We put forth the hypothesis that clinically undetectable silent otitis media in neonates and infants might help explain why certain children are otitis media prone. Our otopathology laboratory includes 111 ears harvested from neonates and infants (average age 8 months). Histological analysis revealed normal findings in some, whereas significant numbers of others show all forms of otitis media, including purulent otitis media, chronic otitis media, serous otitis media, and mucoid otitis media, with occasional overlap of types. Clinical implications will be discussed with emphasis on silent otitis media and its relationship to the pathogenesis of otitis media and silent chronic otitis media and its possible role in causing insidious labyrinthine changes. A significant outcome of this study was the marked degree of unresolved mesenchyme in the clinically manifest otitis media group or silent otitis media group as compared to a control group. This association and role of mesenchyme is discussed relative to the pathogenesis of infantile otitis media.

Attachment of Streptococcus Pneumoniae to Human Pharyngeal Epithelial Cells in Vitro

The aim of this study has been to develop a test system for attachment of pneumococci to pharyngeal cells. Cells scraped from a healthy person were washed and quantitated, bacteria added and after incubation the suspension was washed and the number of adhering bacteria counted. Among strains from different infectious foci the highest number of strains with adhesive capacity was found in the otitis media group. Capacity to attach to the pharyngeal mucosa might be a virulence factor of pneumococci causing otitis media. There was a lack of distinct relation between capsular serotype and adhesive capacity indicating that the polysaccharide is not primarily responsible for the binding to epithelial cells. If attachment to the pharyngeal mucosa is a first step necessary for colonization and subsequent invasion of the tissues, then antibiotics in the secretions preventing such colonization might be of protective value in otitis-prone children.