Paediatric Chronic Otitis Research Articles

Balancing Benefits and Risks: Short-term Ventilation Tubes in Pediatric Chronic Otitis Media with Effusion

Balancing Benefits and Risks: Short-term Ventilation Tubes in Pediatric Chronic Otitis Media with Effusion

LONG-TERM functional results and effectiveness of tympanostomy tubes in pediatric chronic otitis media with effusion

• Tympanostomy tube placement in chronic otitis media with effusion is found to be functionally efficient in the long term. • Functional efficacy was also supported by tympanometry . • Timing of audiometric evaluation throughout the long term (9–22 months) does not affect the audiometric outcomes. • Our findings may be used to develop an algorithm or guideline for the timing of follow up after tympanostomy tube placement.

Is there fungal infestation in paediatric chronic otitis media – Mucosal disease?

ObjectivesTo determine the prevalence of fungal infestation in paediatric chronic otitis media (COM)-mucosal disease and to study the various factors that might influence the said infestation. MethodsA cross-sectional study was done on the cited subject in a sample size of 66 paediatric patients [Age group: 1–18 years] suffering from active COM-mucosal disease. In all we had 75 ears from which swab samples were taken as some patients had bilateral disease. Clinical record was documented in each case. Three sample swabs were analysed for aerobic, anaerobic and fungal infection respectively from the discharging ear. Fungal infection was diagnosed by culture. The data was tabulated and statistically analysed for any correlation of fungal infestation with age, sex, background, duration of COM, previous antibiotic/steroid usage and intractable otorrhoea. ResultsWe recorded a prevalence of 32% for fungal colonization of COM-mucosal disease in paediatric population i.e., 24 out of 75 ears. There was no association observed between fungal infestation and specific paediatric age group, sex, background or duration of the disease. However, a distinct statistical correlation was present between fungal infestation and previous antibiotic/steroid usage and intractable otorrhoea. ConclusionFindings of this study lead us to conclude that all cases of paediatric COM-mucosal disease should be analysed for fungal colonization, especially those with intractable otorrhoea and there should be judicious use of antibiotics and steroid ear drops in COM-mucosal disease.

Myringoplasty for pediatric chronic otitis media: An uncritical closure of a natural middle ear drainage?

BackgroundPerforming tympanoplasty for tympanic perforations in children and adolescents is often considered to be less successful than in adults. ObjectivesThe aim of our study was to evaluate the surgical outcome of tympanoplasty type I in patients under 15 years of age with chronic otitis media and to identify potential factors that influence the success rate. Materials und methodsThe present study was based on a retrospective analysis of the medical records of all patients under the age of 15 who were treated for chronic otitis media by means of type I tympanoplasty between 2005 and 2020. The minimum follow-up period was 6 months. The data were analyzed with regard to epidemiological parameters, tube-related pathologies in the contralateral ear, the local condition and the extent of the eardrum perforation as well as the extent of the surgical intervention (tympanoplasty type I with or without adenotomy). Results83 cases were included in our study. The mean age at the time of the surgery was 8.9 years. The mean follow-up time was 46 months (6–182 months). The anatomical closure rate was 88.0%. Children with “dry” tympanic perforations tended to perform better (p = 0.052). The average improvement in the air bone gap was 2.0 dB. ConclusionDetailed preoperative counseling about the advantages and disadvantages as well as the expected success rate of an early myringoplasty in this age group is just as important as an individualized approach for a high level of patient satisfaction.

Factors associated with the development of paediatric chronic otitis media by age nine: a prospective longitudinal cohort study of 6560 children.

This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine. This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group. Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated. The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.

Paediatric Type I Cartilage Tympanoplasty with or without Concomitant Adeno-tonsillectomy – An Institutional Experience

Introduction 
 In the management of COM in paediatric age group, eradication of the septic foci in the tonsil and the adenoids while addressing the dysfunction of Eustachian tube play a key role This study aims to assess the success rate of type I tympanoplasty with cartilage graft in mucosal type of chronic otits media in paediatric age group and finally, whether concomitant adeno-tonsillectomy plays any role in outcome of surgery or curing the disease process. 
 Materials and Methods 
 A prospective clinical study was done over a period of one and half years amongst 59 patients, aged between 5 and 12 years, presenting with chronic otitis media with dry central perforation of ear-drum and pure conductive hearing loss. Patients were divided into two groups. Group 1 (n1= 22) underwent type I cartilage tympanoplasty with adenoidectomy/ tonsillectomy/ both in the same sitting and Group 2 (n2= 37) underwent type I cartilage tympanoplasty without any adeno-tonsillectomy. 
 Results Graft uptake was 86.4% in Group 1 at 6 months post-operative follow up while that in Group 2 was found to be 86.5%. The mean hearing gain in two groups were found to be 15.91±6.54 dB and 17.02±8.96 dB respectively. No significant difference was found between graft uptakes and hearing gains in two groups at the end of the study. 
 Conclusion 
 Type I cartilage shield tympanoplasty, may be considered as an effective management strategy of paediatric chronic otitis media, mucosal disease. Type I tympanoplasty with concomitant adeno-tosillectomy did not prove to be better than type I tympanoplasty alone in terms of anatomic closure of tympanic perforation and hearing gain.

Mean Platelet Volume as a Potential Predictor of Cholesteatoma in Children

Cholesteatoma is a chronic inflammatory clinical disorder, and it may cause hearing loss and various complications due to its destructive nature. Mean platelet volume (MPV) is a prothrombotic and proinflammatory marker. The aim of this study is to investigate predictive values of MPV, neutrophil-to-lymphocyte ratio, erythrocyte distribution width, and platelet lymphocyte ratio in cholesteatomatous or noncholesteatomatous pediatric chronic otitis media. In this study, the authors retrospectively analyzed 24 patients with cholesteatomatous chronic otitis media, 9 patients with noncholesteatomatous chronic otitis media, and 36 age- and sex-matched healthy controls. Cholesteatomatous and noncholesteatomatous chronic otitis media groups were compared with each other, and with controls for WBC, MPV, erythrocyte distribution width, neutrophil-to-lymphocyte ratio, and platelet lymphocyte ratio. Mean platelet volume was significantly lower in patients with cholesteatoma (8.17 ± 1.22 fL) compared with the control group (10.42 ± 0.87 fL) (P <0.001). Region of conversion curve analysis showed that the cutoff level of 9.5 fL for MPV was an independent predictor for cholesteatoma with a high sensitivity (86%) and specificity (84%). Cholesteatomatous and noncholesteatomous chronic otitis media patients were similar for other parameters studied. Mean platelet volume may be used as a fast-to-obtain, reliable, and inexpensive marker with a high predictive level to indicate cholesteatoma in children.

Clinical Significance of Sensorineural Hearing Loss in Pediatric Chronic Otitis Media

Clinical Significance of Sensorineural Hearing Loss in Pediatric Chronic Otitis Media

Surgical success of boomerang-shaped chondroperichondrial graft in pediatric chronic otitis media cases

ObjectivesTo reveal the success of boomerang-shaped chondroperichondrial graft (BSCPG) in pediatric chronic otitis media cases. MethodsA total of 43 pediatric patients (age 7–16 years) who had undergone type 1 tympanoplasty with the diagnosis of chronic otitis media between March 2010 and March 2013 were included in this retrospective study. The main outcome measures were the graft success rate and level of hearing improvement. ResultsGraft intake success rate was 90.7%. Mean preoperative and postoperative air-bone gap values were 20.51±4.34dB SPL and 9.32±5.64dB SPL, respectively (p<0.001). Mean preoperative and postoperative pure tone average values were 28.6±3.52 and 12.24±5.22 respectively (p<0.001). Air-bone gap was improved to ≤10dB in 38 (88.37%) patients during the postoperative period. ConclusionsBoomerang-shaped chondroperichondrial grafting technique seems to be a successful alternative in the management of pediatric chronic otitis media cases. It has relatively higher grade graft success rate.

Risk factors for sensorineural hearing loss in pediatric chronic otitis media

ObjectivesTo assess the clinical significance of sensorineural hearing loss (SNHL) in a group of pediatric patients suffering from unilateral chronic otitis media (COM) with or without cholesteatoma, using the contralateral healthy ear as a control, and to define risk factors for the development of SNHL in such patients. MethodsThe subjects of this retrospective study were 124 pediatric patients with unilateral COM admitted for surgery. Mean age at surgery was 13.3±3.2 years (range, 7–18) and mean duration of the disease was 88.4±45.0 months (range, 6–192 months). The preoperative pure-tone average value (PTA) for bone conduction (BC) was calculated in each ear (BC-PTA) as the average of BC thresholds at 500, 1000, 2000, and 4000Hz. Potential risk factors for SNHL that we evaluated were demographics, duration of disease, presence of cholesteatoma, and previous otologic history. ResultsMean BC-PTA values in the diseased ears prior to surgery differed significantly from those in the healthy ears (12.74±8.75dB and 9.36±6.33dB, respectively; P<0.01). The degree of SNHL in the diseased ear at 2000Hz was found to be significantly correlated with the presence of cholesteatoma and with age above 10 years. ConclusionsOne of the complications of COM, with or without cholesteatoma, in addition to the conductive hearing loss, is the development of clinically significant SNHL. It is therefore imperative to actively treat pediatric patients diagnosed with COM, with the aim of preventing the possible development of SNHL.

Source of bacterial RNA in chronic otitis media with effusion.

The purpose of this study was to investigate whether the bacterial RNA detected by polymerase chain reaction (PCR) and reverse transcription (RT)-PCR methods in middle ear effusion (MEE) for pediatric chronic otitis media with effusion (OME) originated from live bacteria. Degradation of RNA was observed by spectroscopic analysis; we also investigated the effect of MEE on the digestive activity of RNase. The optical density of RNA solution was stable within 3 h. MEE could not degrade the RNA, while RNase could rapidly digest the RNA. MEE significantly inhibited the digestive activity of RNase, and the inhibitory effect was correlated with MEE concentration. The bacterial DNA and RNA detected by PCR and RT-PCR methods may not originate from live bacteria, but might instead originate from residues from previous bacterial infection(s). Chronic OME is not an infection of live bacteria, and therefore, antibiotics should be used with caution for clinical treatment of pediatric chronic OME.

Tympanoplasty, with or without mastoidectomy, is highly effective for treatment of chronic otitis media in children

Conclusion. The overall success rate of tympanoplasty, with or without mastoidectomy, in the treatment of chronic pediatric otitis media, was high and did not depend on patient age, the status of the contralateral ear, the inclusion or absence of surgical mastoidectomy, or the method of mastoidectomy (when this procedure was employed). Tympanoplasty may be expected to improve hearing in cases of chronic otitis media accompanied by perforation, but not in cases of cholesteatoma. Objectives. This study analyzed the clinical features of pediatric patents with chronic otitis media undergoing tympanoplasty, with or without mastoidectomy. Follow-up data were examined to determine the effectiveness of these procedures on the course of the patients' conditions. Subjects and methods. We retrospectively reviewed the medical records of 111 children (a total of 119 ears were treated from this group) aged 15 years or less, who underwent surgical treatment for pediatric chronic otitis media. The subjects were composed of children suffering from chronic otitis media with perforation (COMP) (63 ears), and patients presenting chronic otitis media with cholesteatoma (COMC) (56 ears). The mean follow-up period was 40 months. Preoperative and postoperative (at the final follow-up) audiometry and otologic examinations were performed. Data from postoperative otologic examinations and audiometric measurements were accompanied by examination of both the operative ear and the contralateral ear. Surgical success was defined as the presence of an intact tympanic membrane without perforation, retraction, or evidence of recurring cholesteatoma. Results. The mean ages at the time of operation were 11.1±3.3 years for COMP patients and 9.7±3.0 years for COMC subjects. Surgical treatments for pediatric COMP and COMC patients included tympanoplasty only in 45 ears (38% of ears treated) and tympanoplasty with mastoidectomy in 74 ears (62%). Most of patients with COMC received tympanoplasty with mastoidectomy. No patient with COMP underwent canal wall-down mastoidectomy. Mean pre-operative air-bone gaps (ABGs) and post-operative ABGs were compared. Significant improvement in ABG was evident in the COMP group, but not in the COMC group. Surgical success rates at follow-up after 6 months and 12 months were 97% and 95%, respectively, in the COMP group. In the COMC patients, surgical success rates at follow-up after 6 months and 12 months were 98% and 93%. There were no significant relationships between surgical success rate and patient age, the status of the contralateral ear, or the extent of surgery.

Expression of matrix metalloproteinase-9 and -2 in pediatric chronic otitis media with effusion

To evaluate the role of MMP-9 and MMP-2 in pediatric patients with middle ear effusion (MEE) and determine the pathogenesis of otitis media with effusion (OME) and allergy. The MEE samples were collected from 25 patients with allergy and 20 patients without allergy as a control. The levels of MMP-9 and MMP-2 were measured using a commercially available enzyme-linked immunosorbent assay (ELISA). The activity of MMP-9 and MMP-2 were measured by gelatin-zymography. The Mann-Whitney U-test was used for comparisons between the allergy positive and control groups. The level of MMP-9 was significantly elevated in MEE from the allergy positive group compared to controls. The amount of MMP-9 activity significantly increased in the allergy positive group compared to controls. MMP-9 and MMP-2 are mediators of inflammation in the OME; in addition, MMP-9 may play a significant role in the pathophysiology of OME with allergy.