Otitis Media In Adults Research Articles

Labyrinthitis and sensorineural hearing loss—an unusual complication of acute otitis media in adult

Auditory neuropathy (AN) is a specific hearing disorder with abnormal auditory neural responses in the presence of normal cochlear function. Affection of vestibular portion of cochleo-vestibular (VIII) nerve was only reported in few studies.To evaluate the cochleo-vestibular function in these patients and to detect any relationship between both cochlear and vestibular functions.The study was conducted on forty (AN) patients. All subjects were submitted to: full audiological test battery; history taking, clinical otological examination, basic audiological evaluation, Auditory Brainstem Response (ABR), Transient Evoked Otoacoustic Emissions (TEOAEs) and threshold equalizing test (TEN). Vestibular test battery; (vestibular evoked myogenic potential (VEMP) and VNG test battery).Audiological test battery confirmed the audiological criteria for auditory neuropathy reported in the literature. Results of this work showed that, there was preservation of TEOAE in all patients. Also, there was an increase in amplitude of CM in AN. Moreover, all AN patients showed presence of dead regions that started first in low frequencies and with increase number of dead regions the mid and high frequencies also affected. In addition to that the vestibular function tests showed that VEMP was preserved bilaterally in 15 patients, unilateral in 10 patients and absent in 15 patients. On the other side, VNG showed normal central vestibular system with unilateral weakness in 10 ears only.Patients with auditory neuropathy could also have vestibular neuropathy. Vestibular neuropathy could be classified into three groups: superior vestibular neuropathy, inferior vestibular neuropathy and superior/inferior vestibular neuropathy.

Factors affecting the results of nonsurgical treatment of secretory otitis media in adults

Objective: There is only limited knowledge of the factors influencing the results of nonsurgical treatment of secretory otitis media (SOM) in adults. The present study was carried out to determine the effect of the middle ear (ME) inflation and to clear up the factors affecting the results of conservative treatment of SOM. Methods: A total of 198 adult patients were randomized to either a group receiving treatment with ME inflation for 10 days or to a group receiving ME inflation and antibiotics (oral Amoxicillin 500 mg 3/day) for 10 days or to a control group. A wide variety of anamnestic and clinical pre-treatment variables were assessed by administered questionnaires. Pneumo-otoscopy, tympanometry and pure-tone audiometry were performed before the treatment and at the 3–5th, 10th±2 and 60th±5 day of the study. For the prognostic factors, univariate analyses were first performed to determine the significant predictors, which were afterwards entered into a stepwise logistic regression model. Results: The effectiveness of treatment was 50.6% in Group A and 58.7% in Group B (control group—11%, P<0.001). The results of treatment were stable and were found unchanged 6 weeks after the treatment. The most important prognostic criteria were defined by analyzing the dynamics of tympanometry (OR, 2.17) and audiometry (OR, 10.27) during conservative treatment. The results of the treatment were related to the mastoid pneumatization, the pathology of paranasal sinuses, the previous history of SOM, the age, and the pre-treatment otoscopic data. Conclusions: The results suggest, that daily ME inflation can be effective treatment for adults patients with SOM having regard to the factors significant for the prognosis of treatment.

Suppurative meningitis due to acute otitis media in adults: report of two cases

Suppurative meningitis due to acute otitis media in adults: report of two cases

Arapid effect of kampou therapy for acute secretory otitis media in adults

Arapid effect of kampou therapy for acute secretory otitis media in adults

Acute otitis media in adults associated with bone conduction threshold shift

Acute otitis media in adults associated with bone conduction threshold shift

Early-response cytokine expression in adult middle ear effusions

Various cytokines are presently known to be associated with the regulation of inflammatory responses. In pediatric otitis media, cytokines that correlate with various degrees of inflammation are present in middle ear effusions as inflammatory mediators. The present study was undertaken to examine the potential role of the early-response cytokines, interleukin-1β and tumor necrosis factor-α, in adult otitis media. Fifty-nine adults with otitis media underwent tympanocentesis, and the effusion specimens were analyzed for the presence of both cytokines by enzyme-linked immunosorbent assay methods. Eighty-eight percent of the effusions were serous in nature. Sixty-seven percent of the patients had a known history of head and neck malignancy and radiation to the temporal bone. Twelve percent of the effusions were positive for interleukin-1β expression, compared with 85% of effusions in children with otitis media. Eight percent of the effusions contained tumor necrosis factor-α, compared with 85% of those collected in pediatric otitis media. All of the specimens that contained tumor necrosis factor-α also contained interleukin-1β. In the present study, there was no correlation with head and neck malignancy/radiation or the clinical degree of inflammation with the presence of either cytokine. We conclude that adult otitis media is associated with lower expression of an acute inflammatory response, as judged by the levels of interleukin-1β and tumor necrosis factor-α in the effusions. Additionally, adult otitis probably represents a less severe and more chronic inflammatory state in comparison with pediatric otitis media. Further analysis of inflammatory mediators in adult otitis media is necessary to evaluate the contribution of cytokines in relation to various etiologic factors. (Otolaryngol Head Neck Surg 1998;119:342-5.)

Disability and benefit from tonsillectomy in adults

In many areas of the United Kingdom, tonsillectomy in adults is as common as in children. However, little is known about the immediate postoperative disability and the longer term benefits from surgery in this group. The object of this study was to assess these factors in adults undergoing tonsillectomy for recurrent sore throats. One hundred and ten adults who had undergone tonsillectomy as an inpatient at least 6 months previously were sent a questionnaire. Sixty-seven (61%) responded. Seventy per cent were women and the median age was 25 years (range 14–48). The median time ill was 5.5 days (range 0–28). It took 7 days (range 0–56) to return to normal activities. Those who were employed returned to work after 15 days (range 0–63). Benefit from tonsillectomy was assessed by the Glasgow Health Benefit Inventory, a questionnaire designed to assess benefit from health care interventions. Adult tonsillectomy patients reported a mean benefit of 29 ( SD 22). This compares with a parent report of benefit in children undergoing tonsillectomy of 43 ( SD 7), surgery to improve hearing in adults of 17 ( SD 5) and surgery for active chronic otitis media in adults of 8 ( SD 5). On average, adult tonsillectomy is thus a highly beneficial operation but the range of benefit is large. Data is now available for preoperative advice as to the speed of postoperative recovery.

Multicenter study of the efficacy and safety of oral ciprofloxacin in the treatment of chronic suppurative otitis media in adults

Chronic suppurative otitis media is a common and potentially dangerous clinical condition that is difficult to treat because the most common infecting organisms are often resistant to many antibiotics. Recently, fluoroquinolones such as ciprofloxacin have provided a new therapeutic possibility, offering a wide range of antibacterial activity and proven concentration in the middle ear. Therefore in the current study, we assessed the efficacy and safety of oral ciprofloxacin (500 mg twice daily for 10 days) in the treatment of suppurative chronic otitis media in adults. One hundred sixty-four patients were enrolled during a 3-month period by 49 ear, nose, and throat physicians in general practice. The mean duration of symptoms was 158 months, with the acute exacerbation lasting 72.5 days. Staphylococcus aureus, Pseudomonas aeruginosa, and Proteus mirabilis were most commonly isolated. At the end of treatment, the otorrhea had disappeared in 104 of the 155 (67.1%) evaluated patients. The bacteriologic eradication rate was 64.5%. After 4 weeks of follow-up care, 93.2% of patients had no recurrence of infection. In 4 patients, treatment was discontinued prematurely after an adverse event. We conclude that ciprofloxacin is an effective and well-tolerated general practice treatment for suppurative chronic otitis media in adults. (Otolaryngol Head Neck Surg 1997;117:83-90.)

Secretory otitis media in adults: II. The role of mastoid pneumatization as a prognostic factor.

The sequelae of secretory otitis media (SOM) were monitored in 72 adult patients with SOM who were followed up for an average of 33 months. It was found that SOM became chronic and retraction of the tympanic membrane appeared as a function of the pneumatization of the mastoid. Ears with poor pneumatization (less than 6 cm2) developed chronic SOM in 52.2% of cases, as compared with 20% in cases with well-pneumatized ears (6 cm2 and above). Atelectasis developed in 37.3% of poorly pneumatized ears, and in only 5.7% of well-pneumatized ears. These sequelae may therefore be linked pathogenetically to the extent of pneumatization, as both the SOM and the sequelae appeared many years after formation and maturation of the pneumatic system. This study supports other studies that view the mastoid pneumatic system as an organ, as a middle ear pressure buffer. Well-pneumatized ears rarely develop a negative pressure and are seldom associated with chronic sequelae. Ears with poorly pneumatized mastoids lack the physiological function of such a pressure buffer. Ears with a tendency to develop a negative gas balance, whether as a result of deficient ventilation or excessive diffusion, will therefore develop a negative pressure more readily when their pneumatic system is underdeveloped, and consequently will be more prone to develop chronic sequelae.

Secretory Otitis Media in Adults: I. The Role of Mastoid Pneumatization as a Risk Factor

We analyzed clinically 102 ears with secretory otitis media (SOM) belonging to 72 adult patients who during their adult life had not suffered previously from ear disease. As in children, most of the cases (63%) could be traced directly to an upper respiratory tract infection. The most striking finding was the preponderance of poorly pneumatized mastoids-which were measured planimetrically-among our SOM cohort. This was found in adult SOM ears compared to contralateral healthy ears (4.59 versus 7.88 cm2), as well as when all 102 SOM ears were compared with values of the normal population (5.41 versus 12.9 cm2). This study showed that poorly pneumatized mastoids are a significant risk factor as far as adult SOM is concerned.

Micropathologic changes of pars tensa in children with otitis media with effusion.

Clinical studies have supported a relationship between otitis media with effusion in children and chronic otitis media in adults. Although clinical studies are numerous, relatively little is known about the histopathologic changes of the tympanic membrane in otitis media with effusion. Tympanic membranes were taken from the intermediate zone of the anteroinferior quadrant of the tympanic membrane during surgery for placement of tympanostomy tubes in 30 children (age range, 4 to 10 years) who did not show any improvement after 3 months of conservative treatment for otitis media with effusion. Control specimens were taken from normal temporal bones at autopsy. All specimens were observed with light and electron microscopy. Histologic degeneration of the tympanic membrane of patients with otitis media with effusion occurred most often in the lamina propria and the submucosal layer. There was an increase in the thickness of the tympanic membrane as a result of edema and fibrosis of the submucosal layer. A decrease in the thickness of the outer and inner fibrous layers occurred in the lamina propria. The histopathologic changes observed in the lamina propria may result in a change in the elastic properties of the tympanic membrane.

Otitis Media in Adults–Reply–I

Otitis Media in Adults–Reply–I

Seropositivity, adenoid hypertrophy, and secretory otitis media in adults--a recognized clinical entity.

Otolaryngologic manifestations of AIDS have been described in the past. In this study, I had examined 14 adults with nasal obstruction and mouth breathing. Nine patients also reported deafness--unilateral in three of them and bilateral in six. All of them revealed a mass in the nasopharynx, either on the posterior rhinoscopy or the x-ray neck-lateral view. To exclude nasopharyngeal malignancy, all of the patients underwent examination of the nasopharynx while under general anaesthesia and biopsy. The histopathologic diagnosis in every patient was nonspecific, reactive lymphoid hyperplasia, which has been described in the background of HIV infections. Four were already confirmed HIV-positive and 10 were found positive on the HIV antibody test. A strong association was established between seropositivity, adenoid hypertrophy, and secretory otitis media in adults.

Purulent Otitis Media in Adults

While the bacterial origin of otitis media has been studied extensively in children, there are few data regarding adults with this disease. We undertook this study to identify the incidence, prevalence, and bacteriologic origin of purulent otitis media in adults. This was accomplished through a review of the English-language literature on adult otitis media and a retrospective review of adult patients with this disease who were hospitalized at our institution. Results of literature review indicate that Streptococcus pneumoniae and Haemophilus influenzae are the most common causes of otitis media in ambulatory adults, but this illness is uncommon, with an incidence of only 0.25%. Hospitalized patients in whom this diagnosis was established suffered a variety of serious suppurative complications such as mastoiditis, meningitis, or brain abscess. Otalgia and fever were the most common symptoms noted in this patient population. Further studies of adult otitis media need to be performed to determine bacteriologic, symptomatic, and high-risk patient groups.

Bacteriology of acute otitis media in adults: Celin SE, Bluestone CD, Stephenson J, et al JAMA 266:2249–2252 Oct 23/30, 1991

Bacteriology of acute otitis media in adults: Celin SE, Bluestone CD, Stephenson J, et al JAMA 266:2249–2252 Oct 23/30, 1991

Bacteriology of Acute Otitis Media in Adults

--The objective of this study was to determine the bacteriology of acute otitis media in adults. Although this has frequently been studied in children, no data have recently been reported from adults in the United States. Additionally, information on the prevalence of Haemophilus influenzae as a causative organism in acute otitis media in adults has not been available. --Middle-ear aspirates for cultures were obtained by myringotomy from adults meeting entry criteria. --Emergency department, Eye and Ear Hospital of Pittsburgh, Pa. --Thirty-four patients (volunteer sample) met the eligibility requirements. Exclusion criteria included history of chronic otitis media, recent antibiotic therapy, immunosuppressive illnesses, or prior otologic surgery. --Ten days of oral cefuroxime axetil (250 mg) was prescribed. --Patients were followed closely for at least 6 weeks. Aerobic and anaerobic cultures were incubated and evaluated per the scheduled protocol. --Haemophilus influenzae and Streptococcus pneumoniae were grown on culture of specimens from nine and seven patients (26% and 21%), respectively. Twenty-two percent (2/9) of the H influenzae isolates and the single isolate of Moraxella catarrhalis produced beta-lactamase (9% overall). --The present results suggest that, as in children, amoxicillin would be an appropriate first-line agent for empiric therapy of acute otitis media in adults. Antimicrobials inactive against H influenzae (eg, penicillin V, cephalexin, erythromycin, or tetracyclines) are not appropriate for initial therapy. Antimicrobials with efficacy against organisms producing beta-lactamase, such as cefuroxime axetil, which was used to treat the study patients, do not appear to be required for routine initial therapy in adults. However, they would be appropriate when an organism producing beta-lactamase is isolated from the middle ear or when a patient fails to improve rapidly on amoxicillin therapy.

Bacteriology of acute otitis media in adults

Bacteriology of acute otitis media in adults

OTITIS MEDIA IN ADULTS.

The choice of antibiotics for otitis media in adults has been complicated by uncertainty over the prevalence of Haemophilus influenzae. To evaluate the current bacteriologic status of this illness, researchers cultured middle-ear aspirates of 34 patients aged …

Sultamicillin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use.

Sultamicillin is the tosylate salt of the double ester of sulbactam plus ampicillin. Sulbactam is a semisynthetic beta-lactamase inhibitor which, in combination with ampicillin, extends the antibacterial activity of the latter to include some beta-lactamase-producing strains of bacteria that would otherwise be resistant. The combination of sulbactam plus ampicillin for parenteral use has previously been shown to be clinically and bacteriologically effective in a variety of infections. The chemical linkage of sulbactam and ampicillin has now produced an orally effective compound, sultamicillin, with antibacterial activity and clinical efficacy which are similar to those of the parenteral formulation. Sultamicillin has been shown to be clinically effective in non-comparative trials in patients with infections of the respiratory tract, ears, nose and throat, urinary tract, skin and soft tissues, as well as in obstetric and gynaecological infections, and in the treatment of gonorrhoea. In a small number of controlled trials, sultamicillin has shown comparable clinical efficacy to phenoxymethyl penicillin (penicillin V) and to amoxycillin (alone and in combination with clavulanic acid) in the treatment of paediatric streptococcal pharyngitis and acute otitis media, respectively; to cefaclor in the treatment of acute otitis media in adults; and to bacampicillin, cloxacillin and flucloxacillin plus ampicillin in skin and soft tissue infections in adults, children and adult diabetic patients, respectively. Sultamicillin was superior in efficacy to bacampicillin in the treatment of chronic respiratory infections, to cefaclor in the treatment of acute otitis media in adults, and to cefadroxil in the treatment of patients with complicated urinary tract infections. However, in single-dose treatment of uncomplicated gonorrhoea, sultamicillin (1500mg plus probenecid 1g) was inferior to a 2g intramuscular dose of spectinomycin. While in several studies the incidence of diarrhoea associated with sultamicillin was greater than that with comparative antibacterials, sultamicillin-associated diarrhoea was generally mild and transitory, although occasionally severe enough to necessitate discontinuation of treatment. Further studies in larger groups of patients are needed to clarify the therapeutic efficacy and safety of sultamicillin in comparison with other antibacterial regimens, and to determine the optimum single dosage for the treatment of gonorrhoea. Nonetheless, sultamicillin appears to provide a similar pharmacodynamic and pharmacokinetic profile to that of parenteral sulbactam plus ampicillin and, as such, will extend the therapeutic efficacy of ampicillin, with the further advantage of allowing treatment of patients with an oral formulation, thus avoiding the potentially adverse clinical and financial effects of prolonged parenteral therapy.

Localized middle ear effusions: three unusual acute cases in adults.

Three cases of acute, non-suppurative otitis media in adults are described. They are unusual in that the effusion was confined to the upper middle ear, whilst the lower middle ear was aerated. The aetiology of such localized effusions, is probably related to the anatomy of the middle ear compartments, the mucosal folds forming them and the apertures allowing communication between them. The compartments are relatively constant and are a result of the embryological development of the middle ear. The localization of these effusions, demonstrates the segmental anatomy of the middle ear.