Outcome Of Otitis Media Research Articles

Advance in the pathogenesis of otitis media with effusion induced by platelet-activating factor.

A non-suppurative inflammatory disease of the middle ear with middle ear effusion and conductive hearing loss is called otitis media with effusion. Poor eustachian tube function, immunological factors, viral factors, and other factors are primarily involved in its pathophysiology, which has not yet been completely understood. Several researcher scholars have recently studied platelet-activating factor and they found that platelet-activating factor is closely associated to the occurrence, development, and outcome of otitis media with effusion. Platelet-activating factor is a significant element contributing to the extension of otitis media with effusion. In order to give a reference for further investigation into the mechanism and clinical management of this illness, the research status of platelet-activating factor and otitis media with effusion during the past two decades is reviewed in this study, along with the mechanisms of otitis media with effusion leading to otitis media with effusion.

The effects of treating GERD on the outcomes of otitis media with effusion: A systematic review and meta-analysis

ObjectiveGastroesophageal reflux disease (GERD) may cause otitis media with effusion (OME). However, whether treating GERD can benefit patients with OME has not been well studied. MethodsWe systematically searched PubMed, Embase, Cochrane Library, and Wanfang databases. The search period was from the establishment of the databases until December 31, 2022. Clinical studies related to GERD treatment on the outcomes of OME were included. Two reviewers independently conducted literature screening and data extraction according to the inclusion and exclusion criteria. To evaluate the quality of the included studies, we used the NOS assessment tool and the RevMan 5.4. Subgroup analysis was conducted to reduce the risk of heterogeneity, and Egger and Begg funnel plots were used to evaluate publication bias. Meta-analysis was performed using Stata14.0 and Review Manager 5.4 software. ResultsFinally, 21,744 patients from 16 studies were included. The results showed that the rate of GERD in OME patients was 0.56 (95 % confidence interval (CI): 0.33, 0.79), while it was 0.04 (95 % CI: 0.03, 0.05) in the adult GERD population. The combined risk ratio (RR) of OME in patients with versus without GERD was 1.58 (95 % CI: 1.35, 1.85; p < 0.01). The efficacy rate of GERD treatment in OME patients was 0.59 (95 % CI: 0.44, 0.74), especially for those with chronic OME (0.64, 95 % CI: 0.36, 0.92). Compared to the control group, treatment with GERD improved the symptoms and efficacy of OME (OR = 1.65; 95 % CI: 0.95, 2.85; p > 0.05). The hearing loss cure rate was 0.70 (95 % CI: 0.57, 0.82). ConclusionGERD has been suggested to be a high-risk factor for OME. Treatment of GERD can improve the symptoms of OME. However, further studies are required to verify these findings.

Comparison of two disease\u2011specific instruments assessing health-related quality of life in patients with chronic otitis media

PurposeEvaluating the current health state in chronic otitis media (COM), audiologic results are complemented by subjective outcomes, such as health-related quality of life (HRQoL). Two disease-specific instruments assessing HRQoL in COM in German-speaking patients exist, i.e., the chronic otitis media outcome test (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). Since the psychometric properties of these questionnaires in a concurrent application are unknown, the aim of this study was to compare the COMOT-15 and the ZCMEI-21.MethodsHRQoL was assessed in adult COM patients using the COMOT-15 and the ZCMEI-21. Psychometric properties were determined, including response distribution, concurrent validity, internal consistency, correlation to hearing and gender differences.ResultsIn 173 patients (mean age 51.5 years), both questionnaires showed normally distributed scores without strong floor and ceiling effects. The total scores and subscores of both questionnaires exhibited satisfactory internal consistency (Cronbach’s α 0.7–0.9) with the exception of the COMOT-15 hearing subscore (α = 0.94) and the ZCMEI-21 medical resource subscore (α = 0.66). Fair correlations between the air conduction pure-tone average and the total scores were found (COMOT-15: r = 0.36, p < 0.0001; ZCMEI-21: r = 0.34, p < 0.0001).ConclusionIn the first study comparing the COMOT-15 and the ZCMEI-21, both questionnaires exhibited satisfactory psychometric properties with several subtle differences. The COMOT-15 has a strong focus on hearing with a probably redundant content of the hearing subscore and may be suited for hearing-focused research questions. The ZCMEI-21 provides a comprehensive assessment of the COM symptom complex and may therefore also be used in research settings, where ear discharge, vertigo or pain should be covered.

Otitis media in children: Which phenotypes are most linked to allergy? A systematic review.

Allergic rhinitis is a common childhood disease responsible for a major impact on quality of life and healthcare resources. Many hypotheses have been proposed to explain the link between allergy and otitis media, although a definitive mechanism has not been identified yet. One of the major critical points is that authors failed in distinguishing among different phenotypes of middle ear inflammation. This review pointed out literature evidence from the laboratory and clinical experience linking allergy to different phenotypes of otitis media in children. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process. Our search yielded 3010 articles that were finally screened. This resulted in 20 manuscripts of which the full texts were included in a qualitative analysis. We paid particular attention in distinguishing among phenotypes of otitis media. Clinical evidence and analyses of biomarkers suggested that allergy may be linked to some phenotypes of otitis media and, in particular, to otitis media with effusion (OME) and acute re-exacerbations in children with middle ear effusion. It was not possible to perform the analysis for allergy and acute and chronic otitis media because of paucity and heterogeneity of data. Allergy should be considered in the diagnostic workup of children with OME as well as OME should be excluded in children with persistent moderate to severe AR. In these cases, clinicians should evaluate prompt and accurate treatment of allergy in improving outcomes, although futures studies are required to increase evidence supporting that anti-allergy treatment may be effective in the recovery and outcome of otitis media with effusion.

Impact of pediatric obesity on the prevalence and outcome of otitis media with effusion

IntroductionOtitis Media with Effusion (OME) is the most common cause of hearing impairment in the pediatric population. Pediatric obesity is another major health issue with numerous reported health consequences, however, published studies about its role in OME are limited. This study aims to investigate the impact of pediatric obesity on the prevalence and outcome of OME. MethodsA case-control study on 112 children aged 2-18 years who underwent ventilation tube insertion for the treatment of OME during 2015-2017 (cases) and 130 children with no history of OME matching for age and gender (control group). Each group was divided into four subgroups based on BMI by age and gender. The differences in the BMI between the cases and the control group were explored. The cases were further divided into obese and non-obese subgroups and were compared to determine the impact of obesity on the presentation and outcome of OME. ResultsMean±SD BMI is significantly higher in the cases compared to the control group (19.98±5.20 vs. 17.25±4.21) (P=0.032). Obesity is significantly more prevalent in patients with OME compared to the control group (25.0% vs. 19.2%) (P=0.021). Obese OME patients are more prone to develop recurrence compared to non-obese OME patients (OR 3.51, 95% CI1.12, 11.01). ConclusionPediatric obesity might be associated with the development of OME. Moreover, obese OME patients are more prone to develop recurrence compared to non-obese patients.

Clinical outcomes of otitis media with effusion following palatoplasty in patients with incomplete cleft palate

Background: Diagnosis and treatment strategies for CP with OME and the timing of ear tube insertion remain controversial.Objectives: To analyze the clinical outcomes of otitis media with effusion in children with incomplete cleft palate after palatoplasty prospectively.Methods: A total of 30 children (10 months–2 years old) with incomplete CP were enrolled in this study and received at least 6 months of follow-up evaluations after palatoplasty.Results: The overall improvement rate of OME was as high as 26% in this group. Average air conduction hearing threshold was significantly better than that before surgery in the 8 patients with improved OME (p < .05). Among the 8 children with improved OME, 7 (87.5%) were found to have middle ear effusion that improved within 6 months after CP repair. There was no significant difference in the improvement rate between the severe degree II group and the mild group.Conclusion: A 6-month follow-up period is recommended. The severity of incomplete CP is not fully related to the function of the eustachian tube.Significance: The overall improvement rate was as high as 26%, and effusion in the tympanic cavity subsided in 7 out of 8 cases within 6 months after the CP repair.

Antimicrobial susceptibility patterns of bacteria isolated from patients with ear discharge in Jimma Town, Southwest, Ethiopia

BackgroundOtitis media is among the leading causes of childhood illnesses although it can also affect the adults resulting in frequent physician visits, drug prescription and a key contributor to antibiotic resistance. The aim of this study was to determine the risk factors, bacterial profile, and the antimicrobial susceptibility pattern of the isolates from patients with discharging ears which clinically equates to draining otitis media in developing countries with limited medical resources such as otoscope.MethodsA prospective cross-sectional study was conducted on 173 patients with draining otitis media. The ear discharge specimens were collected and analyzed by standard microbial techniques. The antibiotic susceptibility profiles were determined for 19 different antibiotics by the standard disk diffusion method. Data was analyzed by SPSS version 22 and the P value of less than 0.05 was considered as statistically significant.ResultsAmong 173 otitis media patients participated in the study; majority, 102(63%) were pediatrics, out of which 72 (41.61%) were in the age group of less than 4 years. Ear infection was bilateral in 39 (22.54%) and chronic in 100 (57.8%) of the patients. Pathogens were isolated from 160 (92.5%) of the patients with a total of 179 isolates. The predominant isolate was Staphylococcus aureus (30.72%) followed by Proteus spp. (17.89%). The result of this study showed that adult age (p = 0.031), rural residence (p = 0.005), previous history of health care visit and treatment (p = 0.000), upper respiratory tract infection (p = 0.018) and presence of cigarette smoker in the house (p = 0.022) had statistically significant association with chronic otitis media. Most of the isolated bacteria showed high level of resistance to ampicillin/amoxicillin (88.3%), penicillin G (79.5%) followed by trimethoprim /sulfamethoxazole (73.8%). Conversely, the majority of bacterial isolates showed moderate susceptibility to ciprofloxacin (72.9%), gentamicin (70.4%), and amikacin (69.3%). Bacterial isolates identified in this study showed trend of multiple drug resistance, majority (67%) being resistant to three or more antimicrobials.ConclusionsMajority of the bacterial isolates were multidrug resistant, hence, efforts to isolate microorganisms and determine the susceptibility pattern should be strengthened to improve the treatment outcome of otitis media instead of the usual trend of empirical treatment.

Role of Grommets in Otitis Media with Effusion

The outcome of otitis media with effusion (OME) in children is generally good. 54 children with symptomatic otitis media with effusion not responding to medical treatment of four weeks were treated with grommet insertion at Jinnah Hospital. On one year follow-up no major complication was noted. However five patients required retympanostomy due to recurrence of disease. Procedure was accompanied by adenoidectomy in 15 patients and tonsillectomy in 8 patients. Adenotonsillectomy was decided on individual basis. The mean duration of stay for ventilation tubes was ???? and they extruded spontaneously in all except one patient, who required removal under general anesthesia. One patient had persistent residual perforation which was treated by cigarette paper method.

Treatment and Outcome of Otitis Media With Effusion in Cleft Palate Patients

Treatment and Outcome of Otitis Media With Effusion in Cleft Palate Patients

Treatment and Outcome of Otitis Media with Effusion in Cleft Palate Patients

Objectives: Otitis media with effusion (OME) is established to be universally present in children with cleft palate. It is found to be most prevalent during the age of 4 to 6 years. This problem may continue to recur in this group of patients, seeming to settle during adolescence. The aim of this retrospective study was to examine OME in cleft palate pediatric patients, with or without cleft lip, and determine the average number of ventilation tube insertions required for this group of patients from birth to 16 years of age. Methods: This retrospective study reviewed 258 pediatric patients who have undergone cleft palate repair and myringotomy with ventilation tube insertions in KKWCH during the period from 1990 to 2012. Information to be collated included: type of cleft, when repair of the cleft was performed, when ventilation tubes were inserted, and how many ventilation tube insertion procedures were performed. Results: The period of follow-up ranged from 2 to 13 years. The ratio of boys to girls was 1.3 to 1. It was found that a large percentage of patients between 2 years to 13 years of age had 3 or less sets of ventilation tube insertions. The youngest to have received tube insertion was 7 weeks old. The oldest was 14 years old. Conclusions: OME in cleft palate patients may be a recurrent problem. Knowing the likely progression of the disease is useful when counseling the parents involved.

A quantitative and qualitative assessment of verbal short-term memory and phonological processing in 8-year-olds with a history of repetitive otitis media

Language outcome in children experiencing fluctuant hearing loss due to otitis media (OME) remains highly equivocal. In the current study, we assessed performance on highly sensitive verbal short-term memory (STM), new word learning and phonological processing tasks in 8-year-old children who had suffered from recurrent OME before the age of 3. Relative to a control group with no history of OME, we observed strictly normal performance for different STM and new word learning tasks. Performance on these tasks was also normally influenced by phonotactic, lexical and semantic variables. However, at the level of phonological processing, a small but significant decrease of performance was found in a speeded nonword identification task and a rhyme judgment task. The results of this study suggest that outcome of OME is characterized by subtle impairments at the level of perceptual-phonological analysis, but there is no significant impact on verbal STM and new word learning abilities. Learning outcomes: As a result of this activity, the participant will be able to (1) explain the outcome of recurrent OME before age 3 on later language and verbal STM development, (2) be aware of the complex relationships that link language development and verbal STM, (3) explain how fluctuant hearing loss during infancy and early childhood could affect verbal STM development and learning capacity for new phonological information, (4) describe different verbal STM measures that distinguish retention capacities for phonological and lexico-semantic information, and (5) explain the influence of phonotactic frequency on nonword processing in language and verbal STM tasks.

Predicting the development and outcome of otitis media by tympanometry

Objective: Identification of children with high risk of development or prolongation of otitis media would be highly useful in clinical practice. In this study, tympanometry was assessed for its capability in predicting development and resolution of acute otitis media (AOM). Methods: Visits of 329 children followed in the Finnish Otitis Media Cohort Study from 2 to 24 months of age were evaluated for this report. Tympanometry was routinely performed on all children during their visits to a special study clinic. Adjacent consecutive visits were used for analysis of development and resolution of middle ear fluid (MEF) between the visits. Descriptive analysis utilized all data obtained during the longitudinal follow-up; confirmatory statistical analysis was performed on data of one randomly selected visit per subject to ensure independence of observations. Presence of MEF at the second visit was used as the outcome. Results: Negative tympanometric peak pressure (<−100 daPa) was found to predict the development of otitis media when observed during respiratory infection with no concomitant ear disease. Otitis media developed within 20 days to 40% of children with negative pressure compared with 20% of children without negative pressure. The observed association was confirmed statistically (odds ratio 4.8, 95% confidence interval 2.4–9.6). Poor outcome of AOM at the subsequent follow-up visit 3–5 weeks later was found in 9% of ears with negative pressure tympanogram compared with 24% with initial type B or normal pressure tympanogram during AOM. However, we could not confirm the finding in statistical analysis (odds ratio 0.6, 95% confidence interval 0.2–2.0). Conclusions: Profound negative tympanometric peak pressure is a significant marker of increased risk for development of otitis media. Children with negative pressure have to be thoroughly followed for subsequent progress of the respiratory disease and development of otitis media. For the prediction of resolution of AOM, the findings remained inconclusive.

Adult-onset otitis media with effusion: results following ventilation tube insertion.

The outcome of otitis media with effusion (OME) in children is generally good. However, it is less clear in adults. All adult patients who had a ventilation tube inserted for OME at the Ipswich Hospital between 1996 and 1997 were studied. Of 53 patients studied, 28 had had a previous history of ventilation tube insertion. Furthermore, at 15-27 months following ventilation tube insertion, the ventilation tube had already extruded in 31 patients and the OME had already recurred in 19 of these. Endoscopic examination revealed that many patients still had evidence of inflammation at the lateral nasal wall (26.4 per cent) and at the eustachian tube orifice (51 per cent). There is also a strong history of atopy in the studied group and the skin prick test was positive in 57 per cent of the patients. This study shows that many patients with adult-onset OME have underlying pathology that could lead to recurrence of OME following ventilation tube extrusion.

Management of otitis media and functional outcomes related to language, behavior, and attention: is it time to change our approach?

Outcomes research assesses the end results of health care from the perspective of those who receive the care, those who provide it, and those who pay for it. The article by Karin Minter and her colleagues1 at the Frank Porter Graham Child Development Center in Chapel Hill, North Carolina, provides important new information related to the functional outcomes of otitis media (OM) in early childhood. Their study documenting the relationship of otitis media with effusion (OME) and hearing loss with functional measures of attention and behavior obtained from parents, teachers, and clinicians appears in this issue of Pediatrics. 1 They conducted this prospective cohort study in 85 children whose middle ear and hearing status had been closely monitored from 6 months to 4 years of age. The diagnosis of OME was based on both pneumatic otoscopy and tympanometry. Audiologists who were unaware of the middle ear findings performed hearing assessments. The validated measures used to assess outcomes included the behavior rating scale of the Bayley Scales of Infant Development, the Parenting Stress Index, the Social Skills rating system, and the Conners' Teacher/Parent Rating Scale. Children's attention and behavior were assessed during infancy, preschool, and first grade. Mother's education, socioeconomic status, child gender, child care quality, and a measure of the home environment (home screening questionnaire) were included as covariates in all analyses. When these covariates were considered, there were no significant correlations between OME or hearing loss with any of the measures of attention and behavior at any age during the first 6 years of life. In a previous publication, the investigators failed to document an association between otitis or hearing loss and the acquisition of language skills in this population.2 The availability of this new data as well as the recent publication of several prospective cohort studies …

The role of respiratory viruses in otitis media

Evidence derived from numerous studies ranging from animal experiments to extensive clinical trials supports a crucial role for respiratory viruses in acute otitis media. Viral infection of the upper respiratory tract initiates the whole cascade of events that ultimately leads to development of acute otitis media, and viruses contribute to the pathogenesis of this disease by several mechanisms. Recent data indicate that at least some types of viruses actively invade the middle ear and may also interfere with the outcome of otitis media. The availability of effective vaccines against the principal viruses predisposing to acute otitis media could be expected to result in a substantial reduction in the incidence of this disease.

Epidemiology of Otitis Media and the Role of the General Practitioner in Management

Acute otitis media and otitis media with effusion are common diseases of children. Though related to each other, they are clinically separate entities. In order to assess the effectiveness of medical interventions it is important to know the epidemiology of the condition. This paper reviews the incidence, natural history and risk factors for otitis media. In most cases acute otitis media and otitis media with effusion are self-limiting disorders. Complications and an abnormal course are rare. There are, however, subgroups of otitis-prone children, identifiable on the basis of risk factors. These children need special attention from the general practitioner, for example a more frequent use of medical interventions and surveillance. It is important to realize that individual and family factors have more influence on the outcome of otitis media than do the various available medical interventions.

Course and outcome of otitis media in earlyinfancy: A prospective study

We determined the course of otitis media in a prospective, longitudinal study of infants who were enrolled at birth and followed to age 1 year. Bilateral chronic otitis media with effusion developed in eight of 24 (33%) with onset of otitis media before age 2 months, compared to two of 30 (7%) with later onset (P = 0.012). Infants with bilateral chronic otitis media with effusion could be identified early: eight of 15 (53%) infants with bilateral middle ear effusion at age 2 months subsequently had bilateral chronic otitis media with effusion, compared to two of 55 (4%) infants without bilateral effusions at age 2 months (P = 0.000007). The onset of otitis media was symptomatic in 29 of 54 (54%), and asymptomatic in 25 of 54 (46%). If regular well-child examinations with otoscopy had not been performed in asymptomatic infants, bilateral chronic otitis media with effusion would not have been detected in six of 10 infants. Infants with otitis media in early infancy may be asymptomatic and are at high risk for chronic otitis media with effusion.

Naldecon Claims Disputed

To the Editor.— In the October 1982 issue of Pediatrics is an advertisement by Bristol Laboratories concerning the use of Naldecon to improve the therapeutic outcome of otitis media with effusion. The advertisement states: "Naldecon improves therapeutic outcome in otitis media. A landmark study found that adjunctive administration of one antihistamine/decongestant liquid did more than relieve nasal symptoms. Naldecon actually improved the therapeutic outcome!" This statement appears to be in direct conflict with the study cited in the advertisement.1

Adenoidectomy in relation to otitis media.

Past studies of the efficacy of adenoidectomy in the management of children with otitis media have been inconclusive due to significant limitations in experimental design. At the Children's Hospital of Pittsburgh, the effect of adenoidectomy on the outcome of otitis media is currently being studied in a prospective manner. An attempt is being made to document and to control those factors cited as lacking in the previous studies. This report describes the techniques for assessment of nasal and Eustachian tube function and for the completeness of adenoidectomy.

Effects of x-ray on the tympanal mesenchyme cvcle. Experiments on the white rat.

The effects of ionizing radiation upon unresorbed embryonic mesenchyme in the middle ear have not been hitherto reported. In view of the use of x-ray as a treatment modality in certain pediatric otologic problems, such knowledge is desirable. The deleterious effect of mesenchyme upon the incidence and outcome of otitis media (including hearing) has been appreciated for some time. Wolff,¹Guggenheim,²and Wilson³have all emphasized the vicious cycle of cause and effect between persistent mesenchyme and otitis media and its sequelae. Their studies added a new chapter to the older interest in mesenchyme, dating from Wittmaack, which