Recurrent Otitis Research Articles

Canine atopic dermatitis and recurrent otitis

The development of canine atopic dermatitis (CAD) and recurrent otitis are frequently interrelated conditions in dogs, representing a significant challenge in veterinary diagnosis and treatment. This case study details the experience of the dog crossbred (SRD), adopted with year of age, who suffers from CAD and frequent episodes of recurrent otitis caused by Malassezia sp. The objectives of this study were to investigate the relationship between CAD and recurrent otitis, as well as to develop an integrated approach for the effective management of these conditions. The dog underwent a comprehensive clinical evaluation, which included a detailed history, observation of symptoms, and allergy testing. Treatment consisted of the use of antihistamines, corticosteroids and immunosuppressants, in addition to the application of monoclonal antibodies every four weeks to control itching. Immunotherapy has been introduced to modulate the long-term immune response. Recurrent otitis was managed with regular cleaning and topical treatments with Chlorhexidine; miconazole and omega 3,6 and 9, applied three times a week, complemented by a restrictive diet to minimize food allergens. The results showed that the combination of these strategies provided significant relief from dog symptoms, improving their quality of life. The integrated approach, including environmental control, drug therapy and dietary management, proved effective in controlling CAD and recurrent otitis. This study highlights the importance of personalized and ongoing management, as well as suggesting the need for more research into new therapeutic approaches for these chronic conditions. It is concluded that coordination between veterinarians and owners is essential for the success of treatment and the well-being of affected dogs.

Otorhinolaryngological Problems in Mucopolysaccharidoses: A Review of Common Symptoms in a Rare Disease

Background: The mucopolysaccharidoses (MPSs) are very rare lysosomal diseases. MPSs belong to inherited diseases; however, newborns are usually asymptomatic. A deficiency of one of the enzymes, which is responsible for glycosaminoglycan (GAG) catabolism, results in the accumulation of this material. GAGs lead to progressive damage to tissues. More than 90% of patients with MPS suffer from otitis media with effusion or recurrent otitis media, craniofacial dysmorphia, obstructive sleep apnea, different types of hearing loss, and progressive upper and lower airway dysfunction. Patients visit otolaryngologists often before the diagnosis of MPS. Thus, the awareness of symptoms of MPS is crucial for otolaryngologists and pediatricians. The earlier the diagnosis is made, the more effective treatment is. Ineffective or delayed treatment leads to premature death. Two principal treatments for MPS are currently available: hematopoietic stem cell transplantation (HSCT) and enzyme replacement therapy (ERT). In recent years, there has been a growing interest in gene therapy as a potential treatment for patients with MPS. Mortality in patients with MPS typically occurs during childhood and early adolescence as a consequence of upper and lower respiratory diseases. Methods: This systematic review is based on papers available in the following scientific databases: MEDLINE (via PubMed), Web of Science, Scopus, and the Cochrane Library. Results: After screening, 72 articles met our inclusion criteria. Conclusions: It is of paramount importance that otolaryngologists are involved in this field. This narrative review examines and synthesizes the otolaryngologic issues encountered in patients with MPS.

Giftedness and allergy: A comparative study of the risk factors in gifted and typical children

Aim: To compare the various parameters associated with giftedness and allergy in gifted children within their group and with typical children of average intelligence. Methods: The case-control questionnaire study was conducted in Adıyaman, Türkiye, in April-May 2023. The study included 75 gifted and 190 typical children aged 6-14. The face-to-face survey consisted of 37 questions, 16 of which were added to the 21 questions of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3. Results: The prevalence of recurrent ear infections in gifted children (33.3%) was found to be significantly higher than in typical students (20.5%) (P= 0.028). The rate of asthma in gifted students with recurrent ear infections (40%) was found to be significantly higher than the rate in gifted students without recurrent ear infections (16%) (P=0.022). The rate of allergic rhinitis in gifted students with food allergies (38.5%) was found to be significantly higher than the rate of those without food allergies (11.3%) (P=0.029). The high food selectivity (21.3%) of gifted students was found to be significantly higher than that of typical students (8.4%) (P=0.002). Among the gifted students, 50% of those who were very selective about food had asthma (P=0.014), and 37.5% had allergic rhinitis (P=0.029). Conclusions: The study has shown the association between giftedness and various allergic conditions, suggesting that certain factors like recurrent otitis and food selectivity behavior may contribute to the higher prevalence of these conditions in gifted children.

A Systematic Review and Meta-Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children.

Acute otitis media (AOM) is a common childhood infection. Recurrent AOM affects a subset of children, resulting in an adverse impact on quality of life, socioeconomic disadvantage, and risk of long-term sequelae. Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance. A comprehensive literature search was undertaken using Medline (1946-October 2023) and Embase (1974-October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the I2 statistic. The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. assessment of antimicrobial agents and outcomes in children with risk factors. Assessment of qualitative data was performed on 20 studies (n = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta-analysis on nine pre-PCV studies (n = 1087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45-0.77). Families and clinicians must balance marginal short-medium term benefit (based on pre-PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.

Antimicrobial and antibiofilm effect of promethazine on bacterial isolates from canine otitis externa: an in vitro study

Otitis externa is an inflammatory disease of the external ear canal of complex and multifactorial etiology associated with recurrent bacterial infection. This study aimed to assess the antimicrobial and antibiofilm activity of promethazine against bacterial isolates from dogs with otitis externa, as well as the effect of this compound on the dynamics of biofilm formation over 120 h. Planktonic bacterial susceptibility to promethazine was evaluated to determine the minimum inhibitory concentrations (MIC). The minimum biofilm eradication concentration (MBEC) was also determined by broth microdilution. To evaluate the effect on biofilm growth, promethazine was tested at three concentrations MIC, MIC/2 and MIC/8, with daily readings at 48, 72, 96 and 120 h. The MICs of promethazine ranged from 48.83 to 781.25 μg mL−1. Promethazine significantly (P < 0.05) reduced mature biofilm biomass, with MBECs ranging from 48.8 to 6250 μg mL−1 and reduced (P < 0.01) biofilm formation for up to the 120-h, at concentrations corresponding to the MIC obtained against each isolate. Promethazine was effective against microorganisms associated with canine otitis externa. The data suggest that promethazine presents antimicrobial and antibiofilm activity and is a potential alternative to treat and prevent recurrent bacterial otitis in dogs. These results emphasize the importance of drug repurposing in veterinary otology as an alternative to reduce antimicrobial resistance.

Complex trauma sequelae: Mycobacterium goodii and Priestia endophytica Hardware infection in a patient with Ehlers-Danlos syndrome

A 26-year-old man with Ehlers-Danlos syndrome, recurrent otitis externa, and chronic otitis media sustained a left lower extremity amputation and open femur fracture with internal hardware fixation after a motor vehicle collision in Arizona. He presented to the emergency department at our institution with severe left leg pain and purulent discharge despite receiving two unidentified antibiotics upon discharge. Evaluations revealed an abscess and malunion of the femur. Initial cultures yielded scant Priestia endophytica, leading to daptomycin treatment. His condition worsened until Gram-positive bacilli identified as Mycobacterium goodii, a rare nosocomial mycobacterial species, were found. Significant improvement occurred with appropriate antibiotics. This case highlights the challenges in diagnosing and managing M. goodii infections in immunocompromised patients with orthopedic complications and notes P. endophytica as a previously unreported, possibly opportunistic human pathogen.

The overlapping of phenotypes in Wiedemann-Steiner, Kleefstra and Coffin-Siris syndromes: a study of eleven patients

BackgroundSome chromatinopathies may present with common clinical findings (intellectual disability, brain and limb malformation, facial dysmorphism). Furthermore, one of their cardinal shared features is growth dysregulation.We aimed to assess and deepen this resemblance in three specific conditions, namely Wiedemann-Steiner (WDSTS), Kleefstra (KLEFS1) and Coffin-Siris syndrome (CSS1), with a particular focus on possible metabolic roots.Methods Eleven patients were enrolled, three with WDSTS, five with KLEFS1 and three with CSS1, referring to Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy. We performed both a physical examination with detailed anthropometric measurements and an evaluation of the patients’ REE (rest energy expenditure) by indirect calorimetry, comparing the results with age- and sex-matched healthy controls.ResultsWe observed new clinical features and overlap between these conditions suggesting that different disturbances of epigenetic machinery genes can converge on a common effect, leading to overlapping clinical phenotypes. The REE was not distinguishable between the three conditions and healthy controls.ConclusionsEpigenetic machinery plays an essential role both in growth regulation and in neurodevelopment; we recommend evaluating skeletal [craniovertebral junction abnormalities (CVJ) polydactyly], otolaryngological [obstructive sleep apnea syndrome (OSAs), recurrent otitis media], dental [tooth agenesis, talon cusps], and central nervous system (CNS) [olfactory bulbs and cerebellum anomalies] features. These features could be included in monitoring guidelines. Further studies are needed to deepen the knowledge about energy metabolism.

MED13L-related disorder characterized by severe motor speech impairment.

MED13L-related disorder is associated with intellectual disability, motor delay, and speech deficits. Previous studies have focused on broad clinical descriptions of individuals, but limited information regarding specific speech diagnoses and results of direct testing has been published to date. We conducted deep phenotyping to characterize the speech, language, motor, cognitive, and adaptive phenotypes of individuals with MED13L-related disorder. In this cross-sectional study, we administered standardized articulation, language, motor, and cognitive testing to 17 children and adolescents (mean age 9y 9m; SD 4y 5m; range 4y 2m to 19y 7m). In-person testing was supplemented with broad developmental, medical, and behavioral information collected virtually from a cohort of 67 individuals. All individuals who completed in-person articulation testing met diagnostic criteria for speech apraxia, dysarthria, or both. Language impairment was present in all of the in-person cohort and almost all (97%) of the virtual cohort. Those who were able to complete motor testing demonstrated significant deficits in visual motor integration (mean 57.08, SD 9.26). Full scale IQs fell in the borderline to intellectual disability range, consistent with reported cognitive impairment in 97% of the virtual cohort. Notable medical features included hypotonia (83%), vision problems (72%), recurrent otitis media (58%), gastrointestinal problems (57%), and seizures (31%). MED13L-related disorder is characterized by a high rate of motor speech disorders that occur in the context of globally impaired motor, language, and cognitive skills. Children would benefit from intensive, individualized speech therapy and the early adoption of augmentative communication strategies.

Reduction of Antibiotic-Associated Conditions After Tympanostomy Tube Placement in Children.

Tympanostomy tube placement has been shown to decrease systemic antibiotics usage in patients with recurrent acute otitis media. Systemic antibiotics in children are associated with an increase in antibiotic-associated conditions (asthma, allergic rhinitis, food allergy, atopic dermatitis, celiac disease, overweight/obesity, attention-deficit hyperactivity disorder [ADHD], autism, learning disability, and Clostridium difficile colonization) later in life. The objective of this study is to estimate whether tympanostomy tube placement is associated with a reduction in antibiotic-associated conditions in children with recurrent acute otitis media (RAOM). A retrospective cohort review of electronic medical records from 1991 to 2011 at a large pediatric hospital system was performed identifying 27,584 patients under 18 years old with RAOM, defined by 3 or more episodes of AOM. Antibiotic-associated conditions were defined using ICD-9 and ICD-10 codes. The enrollment population was largely composed of White patients (28.9%), Black patients (30.1%), and Hispanic/Latino patients (16.4%). The number of systemic antibiotics prescribed per encounter was significantly lower in children who pursued tympanostomy tubes (0.14 antibiotics per encounter) versus those who did not (0.23 antibiotics per encounter) (p < 0.001). Patients with RAOM who received tympanostomy tubes were less likely to have diagnoses of overweight/obesity (OR. 0.62 [0.55, 0.68]; p < 0.001), asthma (OR 0.8 [0.74, 0.87]; p < 0.001), allergic rhinitis (OR 0.72 [0.65, 0.81]; p < 0.001), and atopic dermatitis (0.78 [0.71, 0.86]; p < 0.001). Tympanostomy tube placement is associated with less systemic antibiotic administration and a decreased incidence of overweight/obesity, asthma, allergic rhinitis, and atopic dermatitis in children diagnosed with RAOM. 4 Laryngoscope, 2024.

Children with previous COVID-19 infection are more likely to present with recurrent acute otitis media or tube otorrhea

ObjectiveSince December 2021, the number of children with COVID-19 infections has increased. Sequelae in children have not been well-described. Our goal was to determine if children with a history of COVID-19 infection (C19 group) were more likely to present with recurrent acute otitis media (rAOM) or post-ventilation tube otorrhea (VTO) than children who had no history of COVID-19 infection (NoC19 group). MethodsCharts of consecutive children presenting at a pediatric otolaryngology clinic from March–May 2022 were reviewed. Demographics, COVID-19 test history, comorbidities, ultimate diagnosis, physical exam findings, and management plan were included. No children had a known COVID-19 infection at the time of visit. Results524 children were included, 228 (43.5 %) girls and 296 (56.5 %) boys. Mean age was 5 years (95 % CI 4.6–5.4). 115 (21.9 %) had a history of COVID-19 infection.104 (19.8 %) had a diagnosis of rAOM or VTO, 26.1 % (30/115) children in C19 and 18.1 % (74/409) children in NoC19 (Fisher's Exact p = .04, OR = 1.6). For children without ventilation tubes in place, 23.5 % (27/115) in C19 had rAOM versus 15.2 % (62/409) in NoC19 (p = .03, OR = 1.7). 18.3 % (21/115) of the C19 group had nasal congestion compared to 6.6 % (27/409) of the NoC19 group (p < .001, OR = 3.2). There was no difference in incidence of otitis media with effusion, tonsil/adenoid hypertrophy, sleep-disordered breathing, or epistaxis between the groups. ConclusionInfection with COVID-19 may be associated with an increased risk of rAOM and VTO in children. This may affect healthcare utilization by increasing the need for pediatric and otolaryngologic care.

Study of Risk Factors in Children with Recurrent Acute Otitis Media

Study of Risk Factors in Children with Recurrent Acute Otitis Media

Advancements in Otorhinolaryngological Management of Mucopolysaccharidosis: A Comprehensive Review

Abstract Mucopolysaccharidosis (MPS) is a group of rare lysosomal storage disorders caused by a lack of specific lysosomal enzymes, resulting in the accumulation of glycosaminoglycans in various tissues and organs. Ear, nose, and throat disorders are frequently present as early and common symptoms in MPS patients, particularly in types I, II, and VI. These conditions include recurrent otitis media with effusion, hearing loss, chronic rhinosinusitis, nasal obstruction, adenotonsillar hypertrophy, and upper airway obstruction, which results in obstructive sleep apnea syndrome. Pediatric otolaryngologists are critical in enabling early diagnosis, initiating multidisciplinary treatment, and providing optimal perioperative care to MPS patients. This review examines the pediatric otolaryngologists’ involvement and role in managing MPS, respiratory complications that come with it, potential treatment options, such as novel surgical techniques and enzyme replacement therapy, and the significance of hearing impairment as a critical diagnostic indicator for MPS. Furthermore, it emphasizes the importance of a smooth transition from pediatric to adult care for MPS patients.

Risk of otitis media in offspring following maternal prenatal stress exposure

ObjectivesThere is limited but consistent evidence that suggests prenatal factors, including maternal stress, may contribute to susceptibility for otitis media. We aimed to determine the effect of multiple life stress events during pregnancy on risk of acute and recurrent otitis media in offspring at three and five years of age. MethodsExposure data on stressful life events were collected from pregnant women in a longitudinal prospective pregnancy cohort study, at 18 and 34 weeks’ gestation. We used longitudinal regression models stratified by offspring sex to examine associations between the number, type and timing of maternal prenatal stress events and the likelihood of any OM in addition to recurrent OM infection at age three and five years, adjusting for pre-specified prenatal sociodemographic and environmental confounders. ResultsEach additional stressful life event in pregnancy was associated with increased risk of any OM at both ages (3 years: OR = 1.07, 95%CI = 1.02, 1.12; 5 years: OR = 1.07, 95%CI = 1.02, 1.12), with larger effect sizes for recurrent otitis media (3 years: OR = 1.11, 95%CI = 1.05, 1.17; 5 years: OR = 1.09, 95%CI = 1.04, 1.14). Risk of offspring otitis media did not differ with timing of stress nor by offspring sex. Specific types of stress (pregnancy and relationship problems, issues with other children) were each associated with increased risk of recurrent OM at age three and five years. ConclusionsWe observed a dose-response relationship between maternal stressful life events in pregnancy and the risk for offspring otitis media in the preschool years, most marked for recurrent otitis media.

Gut microbiota composition in recurrent acute otitis media: a cross-sectional observational study.

Recurrent acute otitis media (rAOM) poses a significant challenge in children aged 1 to 6 years, characterized by frequent and treatment-resistant ear infections. While existing studies predominantly focus on alterations in the nasopharyngeal microbiome associated with rAOM, our research explores the understudied association with the gut microbiome.In this cross-sectional observational prospective study, we enrolled 35 children aged 1 to 6 years during the 2021/2022 cold season. The test group comprised children with rAOM (n = 16), and the control group consisted of generally healthy children (n = 19). Samples (stool and nasopharyngeal swabs) were collected in late spring to ensure an antibiotic-free period. Detailed metadata was gathered through a questionnaire examining factors potentially influencing microbiota. Microbiota composition was assessed through amplicon sequencing of the V3-V4 region of the 16S rRNA gene. Our findings revealed limited alterations in gut microbiota composition among children with rAOM compared to healthy controls. Six bacterial taxa (Veillonella, Lachnospiraceae, Ruminococcaceae, Lachnospiraceae, Bacteroides and Blautia) were differentially represented with weak statistical significance. However, several bacterial taxa displayed correlations with multiple consecutive infections, with Turicibacter showing the most significant association. Additionally, day care centre attendance emerged as a potent gut microbiota modifier, independent of rAOM. Although our study identified limited differences in gut microbiota composition between children with rAOM and healthy controls, the observed correlations between the number of infections and specific bacterial taxa suggest a potential link between rAOM and the gut microbiota, warranting further investigation.

Otitis externa in dogs (prevalence, etiology, clinical course, and treatment regimens)

Otitis externa is a reasonably common problem in dogs. The most difficult is the treatment of recurrent chronic otitis media. After all, otitis externa in dogs is a polyetiological disease; therefore, to prescribe effective treatment, the doctor needs to identify the primary cause and take it under control, as well as identify and eliminate secondary infections and develop a prevention plan following predisposing factors. That is why a detailed analysis of the scientific literature on the distribution, etiology, clinical course, and scheme of treatment of dogs with the development of otitis externa was made. To ensure the accuracy and speed of diagnosis of otitis externa, it is promising to develop a diagnostic algorithm that will help the general practitioner clearly understand the etiological factors and eliminate them or take them under control. Many researchers have confirmed that otitis is characterized by seasonality (18.6 % occurs in summer, 30.2 % in autumn, 15.6 % in winter, and 35.6 % in spring). Depending on otitis's etiology in small domestic animals, microorganisms, fungi, and mites are decisive. According to the reports of some authors, otitis externa can be secondary; that is, the etiology of such pathology is already an infection (Staphylococcus and Pseudomonas bacteria, Malassezia yeast). Clinically, otitis externa in dogs, as a rule, is manifested by characteristic symptoms, while the existing peculiarities of the course are, in most cases, determined by etiological factors. In most cases, otitis externa is treated locally with drugs applied directly to the ear. Most of these products contain different ingredients that are active against bacteria, yeast, and inflammation at the same time. There are several remedies for the treatment of otitis externa at the veterinarian's choice, which require different treatment regimens. Recently, the practice of veterinary medicine has increasingly included complex drugs that, on the one hand, are effective in the treatment of otitis and, on the other hand, are safe for the animal body. Such drugs, as a rule, should show, at the same time, anti-inflammatory, anti-parasitic, anti-allergic, analgesic, immunomodulating, and other types of action. Because of this, the search and development of new drugs in the system of comprehensive measures for the prevention and treatment of inflammation of the external ear is relevant and promising.

Exploring predisposing factors of hearing loss in prematurely born children: A nationwide case-control study

BackgroundWe conducted a nationwide population-based case-control study to analyse potential predisposing factors for hearing loss (HL) that present during the fetal, perinatal, and postnatal periods in prematurely born children. DesignThis study enrolled 21,576 children born at < 37 weeks of gestation; 3,596 with HL and 17,980 with normal hearing born between 2002 and 2015, matched for sex, age at diagnosis, and enrollment time. Data were abstracted from the concatenation of three nationwide databases for overall risk factors till the diagnosis of HL. ResultsMaternal HL, maternal diabetes, particularly type 1 diabetes mellitus, and at or before 32 weeks of gestation were the major obstetric risk factors for HL. Prematurely born children who were born via cesarean section and received a combination of antenatal steroids and magnesium sulfate exhibited a significantly reduced risk of developing HL. Ear malformation was a critical predictor for HL. The major postnatal risk factors included seizure and ototoxic drugs use. Premature infants diagnosed with more than 1 diagnosis of bronchopulmonary dysplasia, necrotizing enterocolitis, and intracerebral hemorrhage were at an increased risk of developing HL. Congenital CMV infection and recurrent acute otitis were also independent postnatal factors for HL in prematurely born children. ConclusionsTo reduce the incidence of childhood HL in prematurely born children, aggressive management of premature birth-related consequences and treatable causes and longitudinal audiological follow-up with early detection and adequate intervention are crucial.

Second opinions: Do otolaryngologist demographics matter?

ObjectivePediatric patients and their caregivers may receive information from their primary care physician (PCP) that does not match current American Academy of Otolaryngology (AAO) guidelines. The purpose of this study is to evaluate the frequency of parents deciding to seek a second opinion based on the demographics of pediatric otolaryngologists who deliver guideline supported advice, contrary to advice from their child's PCP. MethodsA survey was distributed to parents in a pediatric otolaryngology clinic between June 2021 and July 2023. Demographics included parent age category, gender, race, and age of youngest child. The survey included a scenario depicting recurrent otitis media with clear ears and a suggestion to defer tympanostomy tube insertion per AAO guidelines after their child's PCP recommended tubes. Thirteen variations of otolaryngologist photos were used in the case, including a control case with no picture. ResultsOf the 658 participants, 460 (69.9 %) were female. 551 (83.7 %) were aged 30–49 years, 70 (10.7 %) were younger, and 37 (5.6 %) were older. 545 (82.8 %) were White, 30 (4.6 %) were Black, 20 (3.0 %) were Asian, and 31 (4.7 %) were Hispanic. 39.9 % of parents would seek a second opinion if an otolaryngologist recommended watchful waiting following evaluation of their child's otitis media. Participants given the control case were 2.23 times more likely to listen to the otolaryngologist's advice (p = .025). If a picture was provided, respondents were more likely to follow advice given if the pictured otolaryngologist was female (p = .025, OR = 1.47) or Asian (p = .042, OR = 1.53). ConclusionIn this group, there is evidence that physician race and gender may influence decision making when considering action versus monitoring in the context of recurrent otitis media.

Dual novel variants in CD40 leading to hyper IgM syndrome: a case report of a school-aged female with new-onset recurrent pneumonia

Introduction: Hyper IgM (HIGM) syndrome is an inborn error of immunity (IEI) that occurs due to defects in immunoglobulin class switch recombination (Ig-CSR). HIGM syndrome typically presents with recurrent infections in early childhood, and is often characterized on investigation with decreased IgG, IgA, and IgE titres, alongside normal or elevated IgM. A common cause of HIGM syndrome is a disruption to the CD40-CD40 ligand (CD40L) interaction that triggers Ig-CSR, of which variants in CD40 are much rarer than those in CD40L. We present a case of an 11-year-old female with HIGM syndrome caused by two novel variants of in the CD40 gene. Aim: To describe a case report of an eleven-year-old female with HIGM syndrome presenting with recurrent pneumonia. Methods: Data was collected retrospectively from the patient’s medical records. Laboratory investigations included quantitative immunoglobulins, quantitative B and T cell subsets, genetic testing using a primary immunodeficiency panel, and a functional assay for CD40 expression. Results: The proband is an 11-year-old female, who presented with recurrent pneumonia, otitis, and septic arthritis. Investigations revealed neutropenia, low IgA, elevated IgM and normal IgG, along with absent vaccine responses. She was identified to harbour two novel variants in CD40: an intronic variant c.52-13A&gt;G p.(?) and a missense variant c.466T&gt;C p.(Ser156Pro). Functional assay indicated low expression of CD40 compared to healthy control, confirming the diagnosis of CD40 deficiency. Conclusion: Class switch defects, such as CD40 deficiency, are rare but significant diagnoses within the spectrum of IEI. This case demonstrates that despite the absence of some clinical red flags for immunodeficiency in infancy, IEIs remain an important consideration in pediatric patients regardless of age. Increasing clinical awareness of IEI will lead to earlier diagnoses, initiation of appropriate treatment, and prevention of potential complications. Statement of novelty: We describe a patient with a late presentation of hyper IgM syndrome due to two novel variants in the CD40 gene, thus expanding the spectrum of CD40 gene variants.

Risk Factors for Otitis Media with Effusion in Preschool and School Children in Calabar Municipality.

Predisposing factors for otitis media with effusion are multifactorial, ranging from genetic and anatomical abnormalities to environmental factors and inflammation of the nose and adjacent structures. The study determined the risk factors for otitis media with effusion (OME) among children in Calabar Municipality. This was a descriptive, cross-sectional, community-based study including children aged 1-10 years randomly selected from government and privately owned daycares, nurseries (preschool), and primary schools. The risk factors assessed included upper respiratory tract infection, allergic rhinitis, adenoid enlargement, acute otitis media, recurrent acute otitis media parental educational level, overcrowding (four children sleeping in a room), duration of breastfeeding, cleft palate, and Down's syndrome. Allergic rhinitis was diagnosed when a child had at least two of the rhinological symptoms: nasal congestion, running nose, sneezing, itching of the eye or nose, and at least one of the following: history of allergy, family history of allergy, and positive history of asthma. The questionnaire was the research instrument used to assess the risk factors for OME. OME diagnosis was made with otoscopy and tympanometry. Data were collected and analyzed with IBM SPSS version 25, and a P value <0.05 was considered statistically significant. A total of 24 daycare pupils, 141 nursery pupils, and 155 primary pupils were recruited into the study. The prevalence of otitis media with effusion was more in younger children than in older children and the relationship was statistically significant (P < 0.001). Female children were more statistically affected than male children (P = 0.007). Children with allergic rhinitis accounted for a higher proportion of those with OME than those without allergic rhinitis (26.7% vs. 11.6%), and the difference was statistically significant (P = 0.007). The association between OME and upper respiratory tract infection, acute otitis media, and recurrent acute otitis media was not statistically significant (P > 0.05). Multivariate binary logistic regression was used to identify predictors for the otitis media with effusion. There are many endogenous and exogenous risk factors for OME, but notable risk factors in our study were age 1-2 years, female sex, and allergic rhinitis.

Clinical analysis of ear symptoms of 40 patients with ANCA-associated vasculitis

Objective:To analyze the clinical feature, diagnosis and treatment of Anca-associated vasculitis with ear symptoms. Methods:In this retrospective study, we summarized the clinical and laboratory examination, pure tone audiometry, aural immittance measurement, CT scan of temporal bone and treatment of 40 patients in the First Medical Center of the PLA General Hospital. Results:A total of 11 cases（27.5%） had the initial symptom in the ear. The most common symptoms were hearing loss, and the other symptoms included a sense of ear fullness, otorrhea and tinnitus. There were 35 cases with hearing loss: 19 cases with conductive hearing loss（47.5%）, 9 cases with sensorineural hearing loss（22.5%）, and 7 cases with mixed hearing loss（17.5%）. 5 cases had a sense of ear fullness or tinnitus, and the results of the hearing test were normal（12.5%）. All of the 40 patients had multi-system involvement, and respiratory system accounted for the most. All patients had a positive result of Anti-neutrophil cytoplasmic antibody（ANCA）. Treatment included systemic hormonal, immunosuppressive, or biologic therapy. There were 3 cases recovered（7.5%）, 22 cases with alleviated ear symptoms（55.0%）, 6 cases with recurrent hearing loss（15%） and 9 cases had no significant improvement（22.5%）. Conclusion:Conductive deafness（secretory otitis media） can be the first manifestation in the early stage of otitis media with AAV（OMAAV）, later it may turn to binaural mixed deafness. Otolaryngologists need to consider OMAAV diagnosis when diagnosing and treating patients with recurrent secretory otitis media. Multi-system symptom consultation and ANCA examination can help identify. Early systemic medication and the application of immunosuppressants or biological agents can help relieve the ear symptoms.