Recurrent Otitis Media Research Articles

Turbinate hypertrophy in children with allergic rhinitis: clinical relevance.

Allergic rhinitis (AR) is the most common immune-mediated disorder in childhood as it may affect up to 40% of children. Turbinate hypertrophy (TH) is an important sign as reliably predicts AR both in children and adults. Consistently, nasal obstruction is a very common symptom in AR patients and is closely linked with turbinate hypertrophy. This study investigated 544 (304 males) children with AR to define factors associated with TH. TH was diagnosed in 438 (80.81%) AR children. The multivariate analysis demonstrated a significant association between age, male gender, and recurrent acute otitis media (RAOM), and TH (p-values: 0.0219, <0.0001, and 0.0003, respectively; OR 0.87, 3.97, and 0.22 respectively). In conclusion, this real-life study showed that TH was very frequent in children with AR and age, male gender, and RAOM were significantly associated with TH. (www.actabiomedica.it)

A case of recurrent cholesteatoma otitis media accompanied by intraoperative cerebrospinal fluid leakage and postoperative bacterial meningitis

A case of recurrent cholesteatoma otitis media accompanied by intraoperative cerebrospinal fluid leakage and postoperative bacterial meningitis

Family studies of warts, hypogammaglobulinemia, immunodeficiency, myelokathexis syndrome.

WHIM syndrome (warts, hypogammaglobulinemia, immunodeficiency, myelokathexis, or WHIMs) is a very rare autosomal dominant immunodeficiency disorder attributable to mutations in CXCR4. We reviewed clinical manifestations in 24 patients in 9 families to expand understanding of this syndrome. Warts, cellulitis and respiratory infections are common in patients with WHIMs. Less commonly these patients have congenital heart disease, human papilloma virus-associated malignancies (cervical and vulvular) and lymphomas. Hearing loss because of recurrent otitis media is another important complication. Treatment with granulocyte colony-stimulating factor is controversial; this review indicates that it is effective to prevent and treat infections based upon long-term observations of patients enrolled in the Severe Chronic Neutropenia International Registry. Understanding the natural history and diversity of this syndrome are important for ongoing clinical trials of novel agents to treat WHIMs. WHIM syndrome has diverse manifestations; some features occur consistently in almost all patients, for example, neutropenia, lymphocytopenia and mild hypogammaglobulinemia. However, the clinical consequences are quite variable across patient cohorts and within families. Each complication is important as a cause for morbidity and a source for patient and family concerns.

High concentrations of middle ear antimicrobial peptides and proteins and proinflammatory cytokines are associated with detection of middle ear pathogens in children with recurrent acute otitis media.

Recurrent and chronic otitis media (OM) are often refractory to antibiotics due to bacterial persistence in biofilm within the middle ear. In vitro and in vivo studies have demonstrated that antimicrobial proteins and peptides (AMPs) are bactericidal against otopathogens, indicating potential therapeutic value for recalcitrant OM. We measured concentrations of 6 AMPs and 14 cytokines in middle ear effusion (MEE) from 67 children undergoing ventilation tube insertion for recurrent acute OM. Sixty one percent of children had bacterial otopathogens detected in their MEE, 39% by PCR and 22% by PCR and culture. Groups were defined as: PCR-negative/culture-negative (absence of bacterial otopathogen), n = 26; PCR-positive/culture-negative (presence of nonculturable bacterial otopathogen), n = 26; PCR-positive/culture-positive (presence of culturable bacterial otopathogen), n = 15. Age, antibiotic usage, day-care attendance, presence of respiratory viruses in MEE and number of AOM episodes were similar between groups. AMP and cytokine concentrations were higher in children with bacterial otopathogens in their MEE compared to those with no bacterial otopathogens. Median concentrations of AMPs (except HBD2) were 3 to 56-fold higher in MEE from children with bacterial otopathogens detected in their MEE (P ≤ 0.01). Similarly, median cytokine concentrations (except TGFβ) were >16-fold higher in MEE with bacterial otopathogens detected (P ≤ 0.001). This is the first study to measure AMPs in MEE and together with the cytokine data, results suggest that elevated AMPs and cytokines in MEE are a marker of inflammation and bacterial persistence. AMPs may play an important role in OM pathogenesis.

Impact of cortical mastoidectomy on tympanoplasty for recurrent suppurative otitis media: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media condition is characterized by an ear discharge and a perforation in the tympanic membrane. Tympanoplasty and tympanoplasty with mastoidectomy are the two common surgeries performed to manage this condition.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 50 patients were divided into two groups of 25 each. On Group I, tympanoplasty alone was done and on Group II tympanoplasty along with mastoidectomy was performed and outcome was noted. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The most common age group to be affected was 21-30 years. Discharge of 1-3 years was observed in 32% in Group I and 36% in Group II. 84% in Group I and 72% in Group II had mild hearing loss, and in both the groups, moderate perforations were more common. 84% of the patients in Group I and 88% in group II showed acceptance to the surgeries and the hearing gain in both the groups was around 10.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study shows that tympanoplasty with mastoidectomy has no added advantage over tympanoplasty alone in the patients with chronic suppurative otitis media.&lt;/p&gt;

Our experience of a paediatrician-led clinic for the medical management of children with obstructive sleep-disordered breathing.

Obstructive sleep-disordered breathing (OSDB) is very common in children. Adenotonsillectomy is usually curative, but there is emerging evidence that topical nasal steroids can also be effective for some children and may avoid the need for surgery. The number of children referred for assessment of OSDB is increasing and in some departments, waiting times are long. We established a paediatrician-led clinic for assessment and initial medical management of OSDB and in this study we report the proportion of children who avoided the need for surgery. Referral letters to the otolaryngology department were screened and those with suspected OSDB and no significant co-morbidities were diverted to the paediatrician-led clinic. We recorded data for a consecutive series of children seen in this clinic with suspected OSDB over a 3-month period. Parents completed a 5-item subset of questions from the OSA-11 questionnaire before and after treatment with 6weeks of topical nasal steroids. In the 3-month study period, 103 children were seen, with a mean age of 6 (range 1-16). Six (5.8%) had improved spontaneously before clinic attendance. Of the 97 children who were still symptomatic, 17 (17.5%) were referred directly for surgery on the basis of the severity of their symptoms, or because of other coexisting conditions that required surgical treatment (such as recurrent tonsillitis or otitis media). Three declined intranasal steroids. Seventy-seven had a trial of intranasal steroids, of whom 34 (35%) reported enough improvement to avoid surgery, and 29 (28%) failed to improve and were referred for surgery. Fourteen (14%) failed to attend after the trial of steroids: of these, 5 (5%) were contactable by phone and confirmed improvement after topical steroids. OSA-5 scores were significantly improved following intranasal steroids. A paediatrician-led clinic can be an effective way to ease the workload of an over-stretched otolaryngology service, and judicious use of topical nasal steroids can help around 40% of children with OSDB avoid surgery.

Early-life programming of pain sensation? Spinal pain in pre-adolescents with pain experience in early life.

Neurobiological mechanisms can be involved in early programming of pain sensitization. We aimed to investigate the association between early-life pain experience and pre-adolescence spinal pain. We conducted a study of 29,861 pre-adolescents (age 11-14) from the Danish National Birth Cohort. As indicators of early-life pain, we used infantile colic and recurrent otitis media, reported by mothers when their children were 6 and 18 months. Self-reported spinal pain (neck, middle back, and/or low back pain) was obtained in the 11-year follow-up, classified according to severity. Associations between early-life pain and spinal pain in pre-adolescents were estimated using multinomial logistic regression models. To account for sample selection, inverse probability weighting was applied. Children experiencing pain in early life were more likely to report severe spinal pain in pre-adolescence. The association appeared stronger with exposure to two pain exposures (relative risk ratio, 1.31; 95% CI, 1.02-1.68) rather than one (relative risk ratio, 1.14; 95% CI, 1.05-1.24). We observed similar results when using headache and abdominal pain as outcome measures, underpinning a potential neurobiological or psychosocial link in programming of pain sensitization.Conclusion: Experience of early-life pain is seemingly associated with spinal pain in pre-adolescence. The study highlights that early-life painful experiences can influence programming of future pain responses.What is Known:• Spinal pain in pre-adolescents is common, causes marked discomfort and impairment in everyday life, and may be an important predictor of spinal pain later in life.• Neurobiological mechanisms have been suggested as involved in early programming of pain sensitization.What is New:• Pain exposure in early postnatal life in terms of infantile colic and recurrent otitis media is associated with spinal pain in pre-adolescence; thus, experience of such painful conditions in the early postnatal period may seemingly influence programming of future pain sensation.

The importance of video otoscopy in the diagnosis and treatment of chronic otitis in dogs

Summary Chronic otitis is one of the most common reasons why dogs are presented to veterinary facilities in Lebanon. The chronicity of this disease is due to the failure to diagnose correctly the primary cause and the incapacity to treat it effectively. The objective of this study is to show the importance of the video otoscopy in the diagnosis and treatment of recurrent otitis externa and/or otitis media. A total of twenty cases (twelve dogs) with chronic otitis externa and/or media were used for this study. Video otoscopy was performed in all 20 cases where it was used for diagnosis in 13/20 cases and treatment in 17/20. Thirteen (65%) of the cases showed a change in the diagnosis after undergoing video otoscopy. Seventeen (85%) of the cases showed an improvement after using the video otoscopy for ear flushing and lavage, in conjunction with home therapy, for treatment purposes. Improvements were judged subjectively seven, fourteen, and twenty-one days after the otoscopic lavage took place. Three (15%) of the cases underwent a surgery due to the presence of polyps that were not removable with the video otoscope.

Impact of the 13-valent pneumococcal conjugate vaccine on the incidences of acute otitis media, recurrent otitis media and tympanostomy tube insertion in children after its implementation into the national immunization program in Turkey

ABSTRACTThe aim of this study was to investigate changes in the incidences of acute otitis media (AOM), recurrent AOM (rAOM) and tympanostomy tube (TT) insertion in children following the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the national immunization program (NIP) of Turkey in April 2011. National coverage for the PCV7 was 97% in 2009, 93% in 2010, 96% in 2011 and for the PVC13 was 97% in 2012, 97% in 2013, 96% in 2014, 97% in 2015, 98% in 2016, and 96% in 2017 for Turkish children younger than 12 months of age. A total of 499932 pediatric visits were recorded, and AOM was diagnosed in 23005 (4.6%) children. The incidence of AOM in children ≤5 years of age decreased from 10700/100000 (2011) to 4712/100000 (2017), with a significant decreasing trend (p < .001, r = −0.965). When the mean annual incidences of AOM between the transition period of PCV13 (years 2011/2012) were compared with those of a post-PCV13 period (years 2016/2017) for children ≤5 years of age, the incidence of AOM was found to be decreased by 54% (p = 0.013). The mean incidence of TT insertion was found to be decreased by 65% (p = 0.003) between the transition period of PCV13 and a post-PCV13 period for children ≤5 years of age. On the other hand, rAOM incidence was found to be increased in whole pediatric age groups. Our study showed a significant decrease in the incidences of AOM and TT insertion in children ≤5 years old after implementation of PCV13 in the NIP in Turkey.

Sociodemographic, Socioeconomic and Clinical Risk Factors for Chronic Otitis Media in Childreen

Aim:The aim of present study is to identify COM-related clinic, sociodemographic and socioeconomic risk factors.Method: 103 children diagnosed for COM and treated in Department of Otorhinolaryngology, Faculty of Medicine, Gaziantep University during 2005-2015 and 116 healthy children were included in this study. The questionnaire about risk factors of COM were filled by interviewing verbatim with mothers and/or fathers of all children. Result: Patient and control groups were composed of 53 boys (51.5%) and 50 girls (48.5%), and 48 boys (41.4%) and 68 girls (58.6%), respectively. The mean age of patients was 13.1 years (range, 2-16), and the mean age of the control group was 12.05 years (range, 6-16). Multiple logistic regression models and univariate analysis were used to determine association between risk factors and COM. Maternal smoking during pregnancy (p=0.014), otitis media history in the first year of life (p=0.001), recurrent otitis media history (p=0.001), upper respiratory tract infection history in the first year of life (p=0.001), ventilation tube insertion history (p=0.001), tonsillectomy and/or adenoidectomy history (p=0.001), otitis media history in family members (p=0.008) and lack of health insurance (p=0.001) were found to be significantly associated with COM. In multivariate analysis, otitis media history in the first year of life (OR=8,00, %95 CI= [3,34-19,17], p=0.001), father’s otitis media history (OR=8.43, %95 CI= [1,47-48,42], p=0.017) and lack of health insurance (OR=3,09 %95 CI=[1,35-7,11], p=0.008) were significantly associated with COM. Conclusion: Chronic otitis media (COM) is a long-term inflammation of middle ear that leads to irreversible changes in eardrum. COM is a common disease in children, and if not treated, it may cause severe complications and sequelae. Thus, if risk factors causing COM are elucidated, the potential complications might be prevented and prophylactic strategies can be developed. This study indicated that history of otitis media in the first year of life, having a father with history of otitis media and lack of health insurance are risk factors for COM.

Effect of balloon dilation eustachian tuboplasty combined with tympanic tube insertion in the treatment of chronic recurrent secretory otitis media.

To investigate the long-term clinical effect of balloon dilation eustachian tuboplasty (BET) combined with tympanic tube insertion (TTI) in the treatment of chronic recurrent secretory otitis media (CRSOM). A retrospective study of 30 cases of CRSOM treated with BET combined with TTI under general anesthesia between August 2014 and September 2016. Thirty cases of CRSOM treated with TTI in the same period were taken as the control group. All cases were followed over 24months. The scores of eustachian tube (ET) function preoperation, 1month, 6months, 12months, and 24months postoperation were collected and analyzed, respectively. A satisfaction questionnaire was used to evaluate the therapy at 24-months postoperation. The symptoms were significantly improved and the ET score was obviously increased postsurgery in most cases treated with BET plus TTI compared with those treated with TTI alone. The highest ET score was obtained at 6months post BET. Five (14%) cases (6 ears) of CRSOM recurred. The 24-month postoperation follow-up questionnaire showed that 84.6% of the patients were satisfied with the treatment, while ten cases (25%) in the TTI group recurred. BET combined with TTI surgery is an effective therapy for patients with CRSOM.

Clinical and immunological features in a cohort of patients with partial DiGeorge syndrome followed at a single center

AbstractDiGeorge syndrome (DGS) is a primary immunodeficiency characterized by various degrees of T-cell deficiency. In partial DGS (pDGS), other risk factors could predispose to recurrent infections, autoimmunity, and allergy. The aim of this study was to assess the effect of different factors in the development of infections, autoimmunity, and/or allergy in patients with pDGS. We studied 467 pDGS patients in follow-up at Great Ormond Street Hospital. Using a multivariate approach, we observed that palatal anomalies represent a risk factor for the development of recurrent otitis media with effusion. Gastroesophageal reflux/dysphagia and asthma/rhinitis represent a risk factor for the development of recurrent upper respiratory tract infections. Allergy and autoimmunity were associated with persistently low immunoglobulin M levels and lymphopenia, respectively. Patients with autoimmunity showed lower levels of CD3+, CD3+CD4+, and naïve CD4+CD45RA+CD27+ T lymphocytes compared with pDGS patients without autoimmunity. We also observed that the physiological age-related decline of the T-cell number was slower in pDGS patients compared with age-matched controls. The age-related recovery of the T-cell number depended on a homeostatic peripheral proliferation of T cells, as suggested by an accelerated decline of the naïve T lymphocytes in pDGS as well as a more skewed T-cell repertoire in older pDGS patients. These evidences suggest that premature CD4+ T-cell aging and lymphopenia induced spontaneous peripheral T-cell proliferation might contribute to the pathogenesis of autoimmunity in patients with pDGS. Infections in these patients represent, in most of the cases, a complication of anatomical or gastroenterological anomalies rather than a feature of the underlying immunodeficiency.

Indications for tympanostomy tube insertion in children

Introduction. Tympanostomy tube insertion is one of the basic paediatric otolaryngological procedures. Otitis media with effusion (OME) is the primary indication for elective qualification for this procedure. Currently, there are no recommendations suggesting pharmacotherapy for effusion. In cases of recurrent otitis media or acute complications of otitis media, tube insertion is a method of choice to support systemic antibiotic therapy. Aim. The main aim of this study was to evaluate indications for tympanostomy tube insertion. Secondary aims included characteristics of the study population and an intraoperative assessment of the tympanic membrane. Material and methods. We conducted a retrospective analysis of ear tube placement procedures performed in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw between January 1, 2018 and December 31, 2018. Results. A total of 213 children (aged between 2 months and 18 years) underwent tympanostomy tube insertion and a total of 368 tubes were placed due to otitis media with effusion in 2018 in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw. Elective tube insertion accounted for 69.48% of procedures. Recurrent otitis media (22.07%), complications of acute otitis media and, most of all, acute mastoiditis (23.33% of urgent procedures) came second. In a large majority of cases, Mikolow tympanostomy tubes were placed; in isolated cases, long-term tympanostomy tubes were used (14 T-tubes, 7 Paparella tubes). Mucous effusion dominated (62.44%). Ear tube placement alone was performed in more than half of cases (62.44%), while in 1/3 of patients the procedure was combined with adenoidectomy. Microscopically confirmed tympanic lesions indicative of advanced inflammation were found in 28 patients (13.14%). Conclusions. Although commonly accepted, tympanostomy tube insertion is not devoid of negative consequences. Possible complications include persistent tympanic perforation, tympanosclerosis, premature extrusion of an ear tube, ear discharge, tube obstruction and, in some cases, the need for surgical tube removal. Therefore, the procedure requires permanent and systematic otolaryngological care.

Successful hematopoietic stem cell transplantation in a patient with a novel mutation in coronin 1A

Introduction: Coronin 1A is part of a family of highly conserved actin regulatory proteins with key roles in T cell homeostasis and T cell receptor signaling. Null mutations in coronin 1A result in severe combined immunodeficiency, whereas hypomorphic mutations have been associated with a somewhat milder immunological phenotype. Nevertheless, all patients described so far have markedly reduced naïve peripheral T cells, impaired T cell responses to mitogens, and limited T cell receptor diversity. Interestingly, despite poor thymic output, thymus architecture appears normal. To date, only 2 cases of hematopoietic stem cell transplantation (HSCT) have been reported in coronin 1A deficiency. Aim: To describe the identification, transplantation course, and long term outcome of a Canadian Inuit patient diagnosed with coronin 1A deficiency. Methods: Patient chart review was performed in accordance with institutional research ethics approval. A combination of immunological investigations and molecular genetic analyses were utilized to identify a novel mutation in the tryptophan-aspartate repeat region of coronin 1A. Based on the patient’s profound T cell dysfunction, the decision was made to proceed with HSCT. Results: The patient presented with a history of recurrent urinary tract infections, otitis media, and developmental delay involving poor axial and peripheral muscle tone. Axillary lymphadenopathy was noted and subsequent thymus biopsy revealed aberrant CD7+ T cell deficiency. Lymphocyte responses to mitogens and T cell receptor excision circle levels were markedly reduced, consistent with the diagnosis of severe combined immunodeficiency. Whole exome sequencing and Sanger confirmation revealed a novel mutation in coronin 1A. HSCT using a HLA-matched unrelated donor resulted in long term engraftment and solid immune reconstitution. Conclusion: Very few patients with coronin 1A deficiency have been described to date, making it difficult to evaluate its natural history and management. Here, we describe the presentation, identification, transplantation, and outcome in our patient. Statement of novelty: We describe the successful hematopoietic stem cell transplantation course and outcome in a patient with a novel mutation in coronin 1A.

Balloon dilation of Eustachian tube combined with tympanostomy tube insertion and middle ear pressure equalization therapy for recurrent secretory otitis media

ObjectiveTo report outcomes of balloon dilation Eustachian tuboplasty combined with tympanostomy tube insertion and middle ear pressure equalization therapy in treatment of recurrent secretory otitis media. MethodsFifty one patients with recurrent secretory otitis media (62 ears) underwent balloon dilation of Eustachian tube and tympanic tube insertion under general anesthesia, followed by long term middle ear pressure equalization therapies. The Eustachian tube score (ETS) and Eustachian tube function questionnaire (ETDQ-7) were used for pre- and postoperative (up to 12 months) evaluation of Eustachian tube functions. ResultsThe mean ETS score was 2.34 ± 0.97 preoperatively, and 6.17 ± 1.54, 7.23 ± 1.62, 8.24 ± 1.97, and 7.63 ± 1.86 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). The ETDQ-7 score was 4.82 ± 1.07 preoperatively, and 2.20 ± 0.54, 2.32 ± 0.68, 2.53 ± 0.79, and 2.67 ± 0.76 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). ConclusionBalloon dilation of Eustachian tube combined with tympanostomy and catheterization resulted in significant improvement of subjective symptoms and objective evaluation of Eustachian tube functions in most patients with recurrent secretory otitis media, as indicated by the ETS and ETDQ-7 scores, demonstrating high levels of efficacy and patient satisfaction.

Hurler\u2013Scheie syndrome in Niger: a case series

BackgroundHurler–Scheie syndrome is an intermediate form of mucopolysaccharidosis type I which is a rare lysosomal storage disorder caused by the deficiency or complete absence of enzyme alpha-L-iduronidase activity. We report the first documented cases of Hurler–Scheie syndrome observed in Niger in a Touareg family.Case presentationWe studied the case of two 12-year-old twin Touareg boys and their 10-year-old Touareg sister whose parents are first-degree cousins, and there was no history of similar cases in their previous generations. The diagnosis of Hurler–Scheie syndrome was considered in these patients on the basis of clinical and radiological arguments, with the highlighting of a deficiency of enzyme alpha-L-iduronidase in serum and leukocytes. The twins had presented the first symptoms at the age of 24 months and the diagnosis of Hurler–Scheie syndrome was made at the age of 12 years. In their younger sister, the first symptoms were observed at the age of 3 years and the diagnosis was made at the age of 10 years. The three probands were born after a normal full-term pregnancy and a spontaneous vaginal delivery according to their parents. Their birth weight, height, and head circumference were within normal limits according to their parents. The three probands were brought in for consultation for stunted growth, joint stiffness with gait disorders, deformities of the thoracolumbar spine, recurrent otitis media, decreased hearing, increased abdominal volume, snoring during sleep, and facial dysmorphism.ConclusionsEven in countries with limited access to diagnostic means, a good knowledge of the clinical manifestations of the disease can help to guide the diagnosis of mucopolysaccharidosis type I.

The Association Between ENT Diseases and Obesity in Pediatric Population: A Systemic Review of Current Knowledge.

Obesity in pediatric population is an important global problem. The prevalence of obesity in children is dramatically rising. According to World Health Organization, about 41 million children under the age of 5 years are obese or overweight worldwide. Overweight and obesity are well-known risk factors for a number of health disorders. Diseases commonly observed in this group of patients are metabolic disorders, type 2 diabetes mellitus, cardiovascular diseases, fatty liver disease, musculoskeletal problems, and many others. The main aim of this study was to present the current knowledge of the association between childhood obesity and common otorhinolaryngological disorders. It is suggested that obese children are more prone to suffer from otorhinolaryngological illnesses than the lean ones. Obesity may predispose to otorhinolaryngological diseases in various ways. It strongly interferes with the immune system (increases serum levels of interleukin 6, tumor necrosis factor, C-reactive protein, and leptin and reduces adiponectin concentration) affecting organs of the upper respiratory tract. Additionally, obesity induces mechanical disorders in the upper airways. According to our review, obesity predisposes to otitis media with effusion, acute otitis media, recurrent otitis media, obstructive sleep apnea, sensorineural hearing loss, adenotonsillar hypertrophy, and post-/perioperative complications after adenotonsillectomy. Obesity in children significantly correlates with both obstructive sleep apnea (OSA) and asthma and constitutes a significant component of "OSA, obesity, asthma" triad.

Impact of mastoidectomy on tympanoplasty for recurrent suppurative otitis media

BackgroundThere are still many questions about the pathogenesis of chronic suppurative otitis media (CSOM) and consequently about the optimal management medical or surgical interventions. Many otolaryngologists continue to routinely perform mastoidectomy with tympanoplasty, arguing that surgical aeration of the mastoid will improve outcomes by providing a reservoir of air that can buffer pressure changes in the middle ear according to Boyle’s law.Patients and methodsDuring the period from December 2013 to October 2017, the mean age was ranging from 20 to 50 years; 25 (62.5%) patients were females, whereas 15 (37.5%) patients were male who were attending the Otorhinolaryngology Department, Al Zahraa University Hospital, with recurrent suppurative otitis media refractory to medical treatment. The 20 patients selected for this study were randomly assigned to undergo tympanoplasty with cortical mastoidectomy (n=20) and tympanoplasty alone (n=20).ResultsThe factors that may influence surgery success rates are age, perforation location and size, Eustachian tube conditions, status of the middle-ear mucosa, the type of graft used, and surgeon experience. The primary argument in favor of mastoidectomy has been an improvement in the middle ear and mastoid environment through clearance of the diseased mucosa and through the ventilatory mechanisms of an open mastoid system, as a buffer to the changes in pressure within the middle ear.ConclusionThere was no additional benefit to performing mastoidectomy with tympanoplasty for uncomplicated perforations. Mastoidectomies were generally performed with a worst disease, as suggested by the presence of extensive inflammation, or a sclerotic middle ear or mastoid.

A case of de novo 18p deletion syndrome with panhypopituitarism.

Deletion on the short arm of chromosome 18 is a rare disorder characterized by intellectual disability, growth retardation, and craniofacial malformations (such as prominent ears, microcephaly, ptosis, and a round face). The phenotypic spectrum is wide, encompassing a range of abnormalities from minor congenital malformations to holoprosencephaly. We present a case of a 2-year-old girl with ptosis, a round face, broad neck with low posterior hairline, short stature, and panhypopituitarism. She underwent ventilation tube insertion for recurrent otitis media with effusion. Brain magnetic resonance imaging showed an ectopic posterior pituitary gland and a shallow, small sella turcica with poor visualization of the pituitary stalk. Cytogenetic and chromosomal microarray analysis revealed a de novo deletion on the short arm of chromosome 18 (arr 18p11.32p11.21[136,227–15,099,116]x1). She has been treated with recombinant human growth hormone (GH) therapy since the age of 6 months after diagnosis of GH deficiency. Her growth rate has improved without any side effects from the GH treatment. This case expands the phenotypic spectrum of 18p deletion syndrome and emphasizes the positive impact of GH therapy on linear growth in this syndrome characterized by growth deficiency. Further studies are required to define the genotype-phenotype correlation according to size and loci of the deletion in 18p deletion syndrome and to predict prognosis.

Human adenovirus replication and persistence in hypertrophic adenoids and palatine tonsils in children.

The role of human adenovirus (HAdV) infection in different acute diseases, such as febrile exudative tonsillitis, conjunctivitis, and pharyngoconjunctival fever is well established. However, the relationships, if any, of HAdV persistence and reactivation in the development of the chronic adenotonsillar disease is not fully understood. The present paper reports a 3‐year cross‐sectional hospital‐based study aimed at detecting and quantifying HAdV DNA and mRNA of the HAdV hexon gene in adenoid and palatine tonsil tissues and nasopharyngeal secretions (NPS) from patients with adenotonsillar hypertrophy or recurrent adenotonsillitis. HAdV C, B, and E were detectable in nearly 50% of the patients, with no association with the severity of airway obstruction, nor with the presence of recurrent tonsillitis, sleep apnea or otitis media with effusion (OME). Despite the higher rates of respiratory viral coinfections in patients with HAdV, the presence of other viruses, including DNA and RNA viruses, had no association with HAdV replication or shedding in secretions. Higher HAdV loads in adenoids showed a significant positive correlation with the presence of sleep apnea and the absence of OME. Although this study indicates that a significant proportion (~85%) of individuals with chronic adenotonsillar diseases have persistent nonproductive HAdV infection, including those by HAdV C, B, and E, epithelial and subepithelial cells in tonsils seem to be critical for HAdV C production and shedding in NPS in some patients, since viral antigen was detected in these regions by immunohistochemistry in four patients, all of which were also positive for HAdV mRNA detection.