Prognosis Of Otitis Media Research Articles

Prognosis of otitis media with effusion in pediatric patients with cleft palate during language-acquisition period treated by simultaneous tympanostomy tube placement with palatoplasty

ObjectiveCleft palate (CP) in children is frequently complicated by otitis media with effusion (OME) due to Eustachian tube dysfunction. Although tympanostomy tube (TT) placement can be beneficial in the treatment of OME to prevent short-term hearing loss, there is no consensus regarding the indications for and timing of TT insertion. The present study was performed to define the safety and effectiveness of simultaneous TT placement with palatoplasty during the language-acquisition period. MethodsWe retrospectively reviewed the medical charts of pediatric patients who underwent palatoplasty for CP in a tertiary medical center, Kyoto University Hospital, from June 2010 to October 2018. The TT retention time was estimated using the Kaplan-Meier method. The incidence of OME recurrence was compared among four Veau classification groups based on the patients' sex, type of CP, median TT retention time, and type of fluid. ResultsSeventy-six subjects (150 ears) were enrolled in the study. The median follow-up duration was 48.7 months (range, 18.2–108.0 months) after the first TT placement. A first TT retention time of <20.1 months was a significant risk factor for OME recurrence. Subjects with maxillofacial anomaly complex and subjects with cleft lip and palate and an alveolar cleft showed a significantly higher OME recurrence rate than subjects with clefts only in the hard and/or soft palate. There was no significant difference in the occurrence of sequelae between subjects with only a single TT placement and subjects with more than one TT placement. ConclusionsBased on the findings of the present study, it is reasonable to perform TT insertion at the same time as palatoplasty on patients who meet the indications. This technique may reduce the number of times the patient requires general anesthesia and maintain good middle ear condition during the period of language acquisition between 1 and 3 years of age.

Effect of autoflation on the prognosis of otitis media with effusion in children

Objective: To investigate the effect of autoinflation on the prognosis of OME in children. Methods: Total of 325 pediatric patients, age ranged from 3 to 8 years, with OME(486 ears)diagnosed in our department from January 2019 to January 2020 were collected. Among them, 177 were males, 148 were females. Disease course ranged from 25 to 86 days. According to watchful waiting and autoinflation application during follow-up, these children were divided into two groups including 183 cases(271 ears) and 142 cases(215 ears), respectively. The average auditory threshold and tympanogram curve type in two groups were analyzed in the period of 3 months follow-up, and the recovery of OME was evaluated. Results: At the end of 1- and 2- month follow-up, the auditory threshold of patients in autoinflation group was significantly lower than that in watchful waiting group (t=2.139 5 and 2.680 6, P<0.05). However, at the end of 3- month follow-up, there was no significant difference between two groups (t=1.158 5, P>0.05). At the end of 1-, 2- and 3- month follow-up, 89 (33%, 89/271), 200 (74%, 200/271), 220 (81%, 220/271) and 176 (82%, 176/215), 178 (83%, 178/215), 183 (85%, 183/215) ears in watchful waiting group and autoinflation group had a hearing threshold <20 dB HL, respectively, in which ears with auditory threshold<20 dB HL in watchful waiting group were significantly less than those in autoinflation group at the end of 1 and 2 month follow-up (P<0.05), However, ears with auditory threshold<20 dB HL in watchful waiting group were not significantly different from that in the autoflation group at the end of 3- month follow-up (P>0.05). The proportion of ears with type A tympanogram curve was 74%(159/215), 79%(170/215), and 85%(183/215) at the end of 1-, 2- and 3- month follow-up in autoinflation group and 36%(98/271), 71%(192/271) and 76%(206/271) in watchful waiting group, respectively. Proportion of ears with type A tympanogram curve in autoflation group was significantly higher than that in watchful waiting group (P<0.05). Conclusion: Autoinflation can improve the hearing of children with OME in early stage, restore normal middle ear pressure, increase recovery rate, and reduce the choice of surgical treatment of OME.

Role of the Tympanometric Gradient and Acoustic Reflex on Prognosis of Otitis Media With Effusion

Role of the Tympanometric Gradient and Acoustic Reflex on Prognosis of Otitis Media With Effusion

Clinical role of vitamin D in prognosis of otitis media with effusion

ObjectiveTo investigate the clinical role of Vitamin D in prognosis of Otitis media with effusion. MethodsThis prospective-controlled study was conducted at otolaryngology department in Duzce University, Turkey. The study group comprised children who were diagnosed with Otitis media with effusion between September 2016 and February 2017. Control group was conducted with children underwent circumcision or inguinal hernia repair operations that confirmed with ENT examination they do not have any sign of otitis media. After 3 months of follow-up without any treatment, unresolved cases who were accepted as chronic otitis media with effusion were operated under general anesthesia for ventilation tube application. Study and control groups were assessed depending on the serum 25(OH)Vitamin D levels at the end of 3 months; < 15 ng/mL was accepted as vitamin D deficiency. The results were compared with the control group in terms of vitamin D levels. Also, subgroup analysis was performed addressing to the complete recovery otitis media with effusion and chronic otitis media with effusion. ResultsOne-hundred-seventy-four children with otitis media with effusion and 80 control patients were included to the study. One-hundred-eight (62%) out of 174 patients with otitis media with effusion was completely recovered after a 3-months follow up. Of those 66 out of 174 children, they had persistent diseases, underwent ventilation tube insertion after a 3-months follow-up. The mean 25(OH)Vitamin D level was 18.98 ± 10.60 in otitis media with effusion group and 28.07 ± 14.10 in control group and the difference was statistically significant between the study and control group (p < 0.001). Vitamin D deficiency was observed in 33 out of 66 patients (50.0%) in chronic otitis media with effusion group whilst 35 out of 108 patients (32.4%) in complete recovery otitis media with effusion group (p = 0.021). The rate of 25(OH)Vitamin D deficiency was 25% in control group which was statistically different from chronic otitis media with effusion and recovery chronic otitis media with effusion groups (p = 0.006). ConclusionsThis study not only shows the relationship between Vitamin D and otitis media with effusion development, but also demonstrates the effects of Vitamin D on otitis media with effusion prognosis. There is a significant association between 25(OH)Vitamin D deficiency and follow-up outcomes of otitis media with effusion.

The prognosis of otitis media with effusion in children

The prognosis of otitis media with effusion in children

Effect of 23 valent pneumococcal polysaccharide and Haemophilus influenza conjugated vaccines on the clinical course of otitis media with effusion.

To determine if there is any clinical effect of 23-valent pneumococcal and type B conjugate vaccine on prognosis of otitis media with effusion. All children who have middle ear effusion despite long-standing antibiotherapy with a beta lactamase stable agent were offered for tympanostomy tube insertion between February 1999 and December 2001. Patients who accepted the surgical intervention were operated under general anesthesia and a Shepard grommet-type tympanostomy tube was inserted. Those who refused the surgical intervention were vaccinated with 23-valent pneumococcal and type B conjugate vaccine. State of the middle ear effusion was evaluated at the end of the 12th month in the vaccine group and 1 month after the myringotomy site was healed in the tympanostomy tube insertion group. Twenty-six children in the vaccine group and 37 children in the tympanostomy tube insertion group proved the inclusion criteria at the end of study. Complete or partial resolution of middle ear effusion was observed in 73.1% of 26 children in the vaccine group and 59.5% of children in the tympanostomy tube insertion group. There was no significant difference between the two groups. Vaccination against and type b seems to aid resolution of middle ear effusion in children with otitis media with effusion.

小児浸出性中耳炎の予後と乳突蜂巣発育度

We examined 858 ears of children aged 3 to 15 years to determine whether or not the prognosis of otitis media with effusion could be predicted from the degree of pneumatization. The area of the cellulae was determined by the square area technique, from X-ray films taken according to the method of Schüller. Four areas were considered: below 6cm2, 6-10cm2, 10-15cm2 and over 15cm2.When the area was over 15cm2, the disease was healed in nearly all ears, and rapid healing (within one year) was observed in 55%. When the area was 10-15cm2, the rate of healing was over 90%. When the area was 6-10cm2, the incidence of complication by secondary disease was 7%, and the percentage of ears requiring treatment for 5 years or longer was 8%, although the final rate of healing was close to 90%. But the area was 6-10cm2 at ages over 10 years, the incidence of secondary disease was 28%. When the area was below 6cm2, healing took even longer, and the incidence of secondary disease rose sharply to 26%, although the final rate of healing was 60%. But the area was below 6cm2 at ages over 10 years, the incidence of secondary disease was as high as 64%.These results suggest that patients with a cellula area below 10cm2 require careful treatment, and that those whose cellulae increase during the follow-up period tend to have a better prognosis.

Current Concepts of Mucociliary Dysfunction in Otitis Media with Effusion

From a survey of the literature on mucociliary function in the tubotympanum, it is clear that mucociliary activity and ciliary activity are deeply involved in the pathogenesis, pathology, and prognosis of otitis media with effusion. Ciliary function in the middle ear, especially in the tympanic orifice and the Eustachian tube, has an important role in the mucociliary clearance of surplus secretion to the pharynx. Our review demonstrates that ciliary activity in the tubotympanum is sensitive to a variety of pathological agents including bacteria, bacterial endotoxin, irritant gases, and irradiation, resulting in mucociliary dysfunction of the tubotympanum.

Prognosis of Otitis Media with Effusion in Children, and Size of the Mastoid Air Cell System

We studied 334 ears in 176 patients who were chosen from children diagnosed as having otitis media with effusion (OME) at our clinic. These 176 patients were re-examined about 5 years and 10 months after the first visit and categorized into three groups according to otological findings at the time of review: group A (normal), group B (sequelae), group C (OME). For this study, 168 ears of 86 persons were examined by roentgenography both at the time of the first visit and at review, and the size of mastoid pneumatization and differences in size between the three groups were compared. The results of the investigation can be summarized as follows. The size of mastoid pneumatization in group A was large at the time of the first visit and the increase in size was also greater than in the other two groups. These results led us to conclude that the degree of mastoid pneumatization is an important prognostic sign of the clinical course of OME and provides important information about treatment.