Secretory Otitis Research Articles

Effect of vascular endothelial growth factor and its receptors in adult otitis media with effusion.

Some studies have demonstrated that vascular endothelial growth factor (VEGF) plays a critical role in the pathogenesis of otitis media with effusion (OME) in animal models. However, the levels of VEGF and its receptors in adult OME have not been clarified. Our study was designed to detect the levels of VEGF and its receptors in adult OME and explore their relationship with effusion types, duration and prognosis of OME. 61 patients with secretory otitis media were enrolled including 21 males and 40 females, with an average age of 54.7 ± 17.5years. The middle-ear effusions were collected by tympanocentesis or myringotomy. The protein concentrations were determined by enzyme-linked immunosorbent assay and messenger RNA by real-time quantitative PCR. VEGF level was higher in AOME group, but not correlated with the recurrence of OME. VEGFR1 and VEGFR2 levels were lower in recurrent group compared with non-recurrent group. VEGFR2 level was higher in serous effusions than mucoid effusions. VEGF messenger RNA was positively correlated both with HIF-1α and MUC5B. VEGF and its receptors function to induce the production of middle-ear effusions (MEEs) at acute stage of OME rather than chronic or recurrent stage, which is mainly mediated by HIF-1α pathway. The formation of mucoid effusions is associated with MUC5B and VEGFR2, but not with duration and recurrence of OME.

The Adenoids but Not the Palatine Tonsils Serve as a Reservoir for Bacteria Associated with Secretory Otitis Media in Small Children.

Acute otitis media (AOM), secretory otitis media (SOM), and acute pharyngotonsillitis are the most frequent reasons for visits to general practitioners, pediatricians, and otolaryngologists. Microbial colonization of the epithelial lining of Waldeyer's lymphatic tissues, consisting of the palatine tonsils, lingual tonsils, adenoids, and Eustachian tube tonsil, is a well-known clinical challenge during infancy due to frequent episodes of upper respiratory tract infections. However, no previous studies have investigated the combined role of the palatine tonsils and the adenoids as a reservoir for pathogens associated with SOM in small children. We analyzed the combined crypt microbiome of the palatine tonsils and adenoids from 14 small children with hyperplasia of the tonsils or adenoids and 14 small children with SOM using 16S rRNA gene pyrosequencing. Our study demonstrated a significant difference between the microbiome of the adenoids and that of the palatine tonsils in the two groups but not between the two anatomical locations within the two groups. In particular, the potential pathogens Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were almost exclusively found in the adenoids of both patient groups, indicating that the adenoids and not the palatine tonsils are the main reservoir for potential pathogens leading to AOM and SOM. IMPORTANCE Our findings that the microbiome differs between crypts of the adenoids and crypts of the palatine tonsils, including the relative abundances of potential pathogens such as Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis, may be the stepping stone for further investigation of individual microbiomes in a longitudinal design that includes recording of the fluctuating health status of the child. Such studies may have the potential to lead to new preventive measurements such as implantation of protective nonpathogens at the nasopharynx as an alternative to adenoidectomy.

Bacteriology and cytology of otic exudates in 41 cavalier King Charles spaniels with primary secretory otitis media.

Primary secretory otitis media (PSOM) in the cavalier King Charles spaniel (CKCS) is similar to otitis media with effusion (OME) in humans. A proposed aetiology of OME is inflammation of the middle ear mucosa, usually due to bacterial infection, leading to auditory tube dysfunction. Our objective was to characterize the microbiological and cytological findings of otic exudates from the external ear canal (EEC) (n = 68) and middle ear (ME) (n = 69) from 41 CKCSs with PSOM. Swab samples from the EEC and mucus aspirated from the ME after performing a myringotomy were obtained for bacterial culture and cytological analysis. Fifty-five of 68 (81%) EEC and 46 of 69 (67%) ME yielded no bacterial growth. Thirty-eight of the 68 (56%) ears had no microbial growth from neither the EEC nor ME; seven (10%) had bacteria isolated from the EEC only; 17 (25%) had bacteria isolated from the ME only, and six (8%) had bacteria isolated from both EEC and ME. Thirty-four total bacterial isolates were cultured from ME. The most common bacterial species isolated were coagulase-negative staphylococci, followed by Staphylococcus pseudintermedius. Otic cytology identified coccoid organisms in only three of 68 EEC and four of 69 ME. The role of bacteria in the pathogenesis of PSOM in CKCS is unclear. The majority of the EEC and ME of the CKCS with PSOM were negative by conventional bacterial culture and the cytological presence of bacteria was not correlated with culture positives. The potential role of noncultivable microbiota in PSOM requires exploration using molecular methods.

Evaluating short and long term outcomes following pediatric Myringoplasty with Gelfoam graft for tympanic membrane perforation following ventilation tube insertion

BackgroundMyringotomy with ventilation tube (VT) insertion to treat recurrent acute otitis media and chronic secretory otitis media has become one of the most common surgical procedures performed in children. Although contemporary literature has detailed the various patient and perioperative factors that affect successful pediatric myringoplasty, there is still limited evidence surrounding the increasing number of graft material options. In particular, gelfoam patching has arisen as a simple and efficient modality for perforation closure, but has a paucity of evidence particularly in pediatric cohorts. Our study aims to evaluate the clinical and audiometric outcomes following gelfoam myringoplasty for TMP following prolonged VT insertion in an urban pediatric population.MethodsA retrospective review of pediatric patients who underwent myringoplasty between 2013 and 2018 following ventilation tube insertion. Patient demographics, comorbidities, and graft material were correlated with audiometric and clinical outcomes on follow up examination.ResultsOne hundred twenty patients underwent myringoplasty, with 61 (50.8%) males with a mean age of 8.9 years old. 101 (84.2%) of patients eventually underwent successful tympanic membrane (TM) closure, with 93 (77.5%) demonstrating closure at initial follow up. In the gelfoam cohort, 77 (90.6%) of patients demonstrated successful TM closure at initial follow up. Overall mean time to closure was 5.6 (standard error (SE) 0.9) months. A multivariate Cox proportional hazards model demonstrated none of the covariates including graft material significantly affected TM closure. Mean change in air conduction threshold were comparable between graft materials.ConclusionsPediatric myringoplasty with gelfoam graft material is a safe and viable alternative with favorable short and long term clinical and audiometric outcomes.

Comparative Study between Adenoidectomy with Myringotomy and Adenoidectomy with Ventilation Tube Insertion in Management of Secretory Otitis Media

Background:Otitis media with effusion is one of the most common chronic otological conditions and the most common cause of conductive hearing loss in the pediatric population. Ventilation tubes insertion with or without adenoidectomy is considered as a standard surgical procedure. Objective:this study aimed to compare the efficacy and the complications of adenoidectomy with myringotomy in comparison with adenoidectomy and ventilation tube insertion in management of otitis media with effusion. Patients and Methods: this was a prospective study carried out between October 2017 to October 2018 (One year). The study included 60 cases diagnosed with persistent otitis media with effusion due to adenoid enlargement and they were categorized randomly into two groups (30 cases per each). Group I underwent myringotomy alone with adenoidectomy and group II underwent myringotomy with ventilation tube insertion with adenoidectomy. All patients were subjected to full ENT examination, tympanometry and hearing evaluation. Patients were followed up (After myringotomy healing, at one month and 3 months after healing) for 3 months after tube extrusion or myringotomy closure. Postoperative evaluation was done for all patients and complications were assessed. Results: the mean healing time was significantly longer in children who underwent adenoidectomy with ventilation tube (Group II) compared to patients of group I, (p<0.001) (28.5 vs. 2.2 weeks). The number of cases with OME recurrence after 3 months of healed myringotomy were significantly higher in group I (18 ears, 30.0%) compared to group II (6 ears, 10.0%), (p<0.006). Postoperative tympanogram was improved in both groups but, it was significantly improved in the group who underwent adenoidectomy with ventilation tube (Group II) compared to the group who underwent adenoidectomy with myringotomy only at all follow up intervals (p=0.015, 0.002, 0.022), respectively. The incidence of some postoperative complications such as otorrhea and tympanic sclerosis was significantly higher in group II (p=0.024 for otorrhea and p<0.001 for tympanic sclerosis). Conclusion: both used procedures were effective in the treatment of OME in children, but adenoidectomy with ventilation tube insertion was significantly better in improving tympanogram and reducing OME recurrence, while, it may increase the incidence of some complications. Further studies are warranted with larger number of cases and longer follow-up period to confirm these results.

Наш способ микроэндоскопического исследования слуховой трубы

help of fine optical systems. The authors suggested various techniques of micro-endoscopic examination of the auditory tube (Chays A., Magnan J.; Kimura et al.; Edelstein et al.; Klug C. et al.; Christopher J. Linstrom, etc.) However, it should be noted that all the previously presented techniques had a number of technical drawbacks, such as: low resolution of optical instruments; imperfection of the method of optical fibers feed the into the auditory tube; contamination of the distal endoscope part with mucous discharge; the absence of easy but reliable methods of controlling the optical fiber position in the middle ear. The article presents our method of micro-endoscopic examination of the auditory tube. Working at this task, we used a flexible unguided micro-endoscope Omex, model OME 400. The device has the following specifications: diameter: 0.78 mm, minimal bending radius: 25 mm, resolution: 15,000 pixels. The insertion of the instrument into the auditory tube was performed by means of a special device for examination and management of the auditory tube diseases and a special elastic catheter. The article provides various options of the auditory tube examination both from the pharyngeal orifice and from the tympanic orifice side during tympanoplasty. The group of authors conducted endoscopic examination of the auditory tube in 90 children aged 3 to 12 years during cold-plasma adenotomy and shunting of the tympanic cavities under general anesthesia. Besides, the examination of the auditory tube in adult patients during tympanoplasty was performed. The total number of examinations was 20 people, males and females, aged 29-61 years. We revealed a number of pathomorphological changes of the auditory tube mucous membrane in chronic secretory otitis media, chronic purulent otitis media. We observed edema, folding of the mucous membrane of the auditory tube in the membranous cartilaginous part; polypus-changed mucous membrane in the area of the auditory tube tympanic orifice; fibrin strands in the area of auditory ossicles and the absence of changes in the auditory tube in the middle ear pathology.

Отражение современных концепций патогенеза экссудативного среднего отита у детей в клинической практике

The scientific work presents the data of observation of 52 patients with combined lymphoepithelial pharyngeal ring pathology and exudative otitis media (EOM), admitted for routine surgical treatment. The study results indicate, that the pathology of the lymphoepithelial pharyngeal ring was accompanied by a significant Eustachian tube dysfunction with the development of catarrhal and serous stages of secretory otitis media in 90.38% (47 patients) and mucoid stage (the «glue ear») in 9.62% (5 children) who needed tympanostomy tube. The authors have considered the key problems of etiopathogenesis of suppurative otitis media in children based on the analysis of their own clinical experience and the present-day clinical experimental works, reputable monographs. According to some authors, some cases of tympanic cavity exudate are supposedly the result of incomplete resolution of previous acute purulent inflammation. It is indirectly indicated by the data of inoculation of material for detection of bacterial flora and identification of cellular composition (the signs of infectious etiology). The results prove, that the viral and bacterial infections play an important role in the pathogenesis of EOM. The use of antibacterial therapy in some cases will probably result in a sluggish inflammatory process and the preservation of exudation in the tympanic cavity. However, in 46.2% cases, the patients diagnosed with the exudative otitis media had no acute otitis media in anamnesis. The aseptic nature of ear secret was revealed by bacteriological method in 88.5% cases, but the data of cytological analysis in 57.7% cases indirectly indicate the previous inflammation of infectious etiology. The allergic anamnesis in 73% (38 people), in particular, allergic rhinitis in 36.5% (19 people), could also accelerate and/or trigger the development of EOM.

Persistant dysfunction of the eustachian tube: solving the problem

Each person experienced an unpleasant sensation of congestion of the ear during a flight or in rhinorrhea, which is caused by dysfunction of the Eustachian tube (ET). People with persistent ET dysfunction live with this sensation for months and years. Persistent ET dysfunction in children reaches 40%, in adults it is up to 5%. Most of the pathological conditions of the middle ear, leading to socially significant hearing loss, and the main reasons for failures in hearing-improving operations are associated with persistent ET dysfunction. The effectiveness of various methods of treating this pathology, despite their large quantity, still remains doubtful due to the lack of clear criteria and golden standard for diagnosis, indications for specific methods and long-term results of treatment. According to the aim of the study a diagnostic and treatment algorithm was developed for persistent ET dysfunction in adults and children. We researched this problem for more than 10 years, and the effectiveness of the proposed diagnostic and therapeutic measures has been statistically proven, both by a large sample of patients and by a long period of observation. Researchers of L. I. Sverzhevsky Research Institute of Otorhinolaryngology have developed a diagnostic algorithm for persistent ET dysfunction, optimized the treatment of persistent dysfunction and recurrent concomitant secretory otitis media, and also determined the indications and methods for conducting ET balloon dilatation in adults and children with persistent ET dysfunction. We improved the functionality results of hearing-improving operations (tympanoplasty) in patients with persistent ET dysfunction. All of the above allowed us to reduce the treatment time for this group of patients by up to 50%, to achieve high clinical efficacy in up to 100%, and to obtain a lasting functionality in hearing-improving operations in 93% of cases.

Comparative Study between Adenoidectomy with Myringotomy and Adenoidectomy with Ventilation Tube Insertion in Management of Secretory Otitis Media

Background:Otitis media with effusion is one of the most common chronic otological conditions and the most common cause of conductive hearing loss in the pediatric population. Ventilation tubes insertion with or without adenoidectomy is considered as a standard surgical procedure. Objective:this study aimed to compare the efficacy and the complications of adenoidectomy with myringotomy in comparison with adenoidectomy and ventilation tube insertion in management of otitis media with effusion. Patients and Methods: this was a prospective study carried out between October 2017 to October 2018 (One year). The study included 60 cases diagnosed with persistent otitis media with effusion due to adenoid enlargement and they were categorized randomly into two groups (30 cases per each). Group I underwent myringotomy alone with adenoidectomy and group II underwent myringotomy with ventilation tube insertion with adenoidectomy. All patients were subjected to full ENT examination, tympanometry and hearing evaluation. Patients were followed up (After myringotomy healing, at one month and 3 months after healing) for 3 months after tube extrusion or myringotomy closure. Postoperative evaluation was done for all patients and complications were assessed. Results: the mean healing time was significantly longer in children who underwent adenoidectomy with ventilation tube (Group II) compared to patients of group I, (p<0.001) (28.5 vs. 2.2 weeks). The number of cases with OME recurrence after 3 months of healed myringotomy were significantly higher in group I (18 ears, 30.0%) compared to group II (6 ears, 10.0%), (p<0.006). Postoperative tympanogram was improved in both groups but, it was significantly improved in the group who underwent adenoidectomy with ventilation tube (Group II) compared to the group who underwent adenoidectomy with myringotomy only at all follow up intervals (p=0.015, 0.002, 0.022), respectively. The incidence of some postoperative complications such as otorrhea and tympanic sclerosis was significantly higher in group II (p=0.024 for otorrhea and p<0.001 for tympanic sclerosis). Conclusion: both used procedures were effective in the treatment of OME in children, but adenoidectomy with ventilation tube insertion was significantly better in improving tympanogram and reducing OME recurrence, while, it may increase the incidence of some complications. Further studies are warranted with larger number of cases and longer follow-up period to confirm these results.

A case report of papilloma of the eustachian tube with secretory otitis media

A case report of papilloma of the eustachian tube with secretory otitis media

Comparison of tympanocentesis, CO₂ laser tympanostomy and grommet insertion in the treatment for secretory otitis media in children

Objective:To compare adenoidectomy combined tympanocentesis, CO₂ laser tympanostomy and grommet insertion in the treatment for secretory otitis media (SOM) in children, and to provide basis for selection of surgical treatments. Method: Four hundred and twenty-six ears in 244 children with adenoid hypertrophy and SOM were divided into 3 groups which were: group A, 80 cases (142 ears) were treated with adenoidectomy combined with tympanocentesis; group B, 86 cases (145 ears) were treated with adenoidectomy combined with CO₂ laser tympanostomy; group C, 78 cases (139 ears) were treated with adenoidectomy combined with grommet insertion. Endotoscopy, tympanometry and PTA (or ABR) were conducted. Based on the characters of the middle ear effusion in operation, each ear were divided into two groups: Serous group and Mucus group. All patients conducted PTA (or ABR) 6 months after surgery and they were followed up until 1 year after surgery. The efficacy and postoperative complications and recurrence rate were compared among 3 groups, the prognosis of both serous group and mucus group were analyzed. Result:The effective rate of 3 groups at 6 months postoperative were 89.44%, 90.34% and 96.40% respectively, which showed no statistical difference among 3 groups and statistical difference between group C and group A, B was found. No statistical difference was found among 3 groups in serous group. The effective rate of group C was higher than that of group A and group B, with statistical difference. The rate of postoperative complications (permanent tympanic membrane perforation, middle ear infection postoperative, tympanic tube blockage or detachment, etc.) during 1 year postoperative in 3 groups were: 16.20%, 13.10%, 33.81%, respectively. The recurrence rates were: 11.02%, 12.98%, 3.73%, respectively, and the reoperation rate in all 3 groups were 0. Conclusion:In the treatment for SOM in children with adenoid hypertrophy, adenoidectomy combined with tympanocentesis or combined with CO₂ laser tympanostomy showed a similar effects, which was slightly lower than adenoidectomy combined with gromment insertion. Considering the complications postoperative and recurrence rates of different operations, tympanocentesis or CO₂ laser tympanostomy is recommended to be conducted as routine, and grommet insertion is recommended to be conducted when mucus-like middle ear effusion is found during surgery.

A clinical study to determine the effects of adenoidectomy in cases of secretory otitis media in school going children

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Secretory otitis media (SOM) is common otological symptom in children. If left untreated it leads to hearing and speech impairment. Surgical management is effective in serious cases. The present study was done with the objective&lt;strong&gt; &lt;/strong&gt;to assess the effect of adenoidectomy by pure tone and impedance audiometry in cases of SOM with hypertrophied adenoids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study comprised 50 cases, who were aged 5-12 years and diagnosed as SOM with adenoid hypertrophy. It was carried out for a period one and half years from December 2015 to July 2017 at Mamata Medical College and Research Hospital, Khammam, Telangana. After detailed history and clinical examination, investigations such as pure tone audiogram, impedance audiometry, X-ray nasopharynx and diagnostic nasal endoscopy were carried out to confirm the diagnosis. All patients were posted for adenoidectomy and when indication was present tonsillectomy was also done. They were followed up at 1st, 3rd and 6th month for pure tone audiometry and impedance was done at 6th month of surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study, maximum number (60%) of cases belonged to 5-7 years age group, with slight male preponderance (56%). On pure tone audiometry 68% had 16-25 dB and 32% had 26-40 dB hearing loss and average being 24.95 dB. On impedance only 14% had peak preoperatively. Postoperatively, no peak/peak conversion was seen in 33% of cases and mean A-B gap improvement at 1st, 3rd and 6th month was 13 dB, 13.2 dB and 12.7 dB respectively (p value is 0.0001,&amp;lt;5%) when compared to preoperative findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Adenoidectomy is effective in the management of middle ear infection in children having hypertrophied adenoids.&lt;/p&gt;

Analysis of clinical status of contralateral ear in cases of unilateral squamosal chronic otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Squamosal COM is a condition caused by various etiological factors which are likely to affect the other side too. If diagnosed and intervened in time, the progression of the disease from simple negative middle ear pressure to cholesteatoma formation can be prevented and ear can be protected from hearing loss. Therefore it is important to assess and evaluate the contralateral ear appropriately.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study included patients above six years of age suffering from unilateral squamosal chronic otitis media. Their contralateral ears were examined and assessed for any ear disease. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We found various conditions in contralateral ears ranging from normal tympanic membrane to various types and grades of retractions of pars tensa as well as pars flaccida and some infectious conditions too. The commonest finding was secretory otitis media (23%) and the least common was otomycosis (3%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most common status in contralateral ear was found to be secretory otitis media in adult and paediatric age groups (23%). In our study, 84% of the patients showed pathology in the contralateral ear and 16% were normal, so the study proves that in patients with unilateral squamosal otitis media, with no complaints or previous history of discharge in contralateral ear shows pathology to quite a good extent¸ so the contralateral ear should always be evaluated comprehensively to efficiently diagnose any alterations and provide timely therapeutic intervention to prevent further progression of the disease and hearing loss.&lt;/p&gt;

Clinical comparative study of different kind of hormone delivery regimen in the treatment of patients with chronic secretory otitis media

Objective To investigate the clinical effects and safety differences of endoscopic hormone injection by tympanic membrane puncture and eustachian tube in the treatment of patients with chronic secretory otitis media. Methods From January 2015 to September 2016, 90 patients with chronic secretory otitis media in Zhoushan Hospital were chosen.They were randomly divided into two groups according to the digital table.The tympanic membrane puncture group (65 patients) was treated with hormone injection by tympanic membrane puncture and the eustachian tube group(65 patients) was treated with endoscopic hormone injection by eustachian tubeThe total clinical effective rate, the bone conduction threshold value in 1kHz, 2kHz, 4kHz and 8kHz, the ETDQ-7 score and the levels of laboratory index before and after treatment, the secondary tympanic effusion rate and the recurrence rate with follow-up of both groups were compared. Results The total clinical effective rate of the tympanic membrane puncture group and eustachian tube group were 77.78% and 93.33%, respectively.The total clinical effective rate of the eustachian tube group were significant higher than that of the tympanic membrane puncture group(χ2=9.84, P<0.05). The bone conduction threshold value in 1kHz, 2kHz, 4kHz and 8kHz of the tympanic membrane puncture group after treatment were (10.42±1.60)kHz, (12.86±2.50)kHz, (16.09±2.81)kHz, (15.26±2.68)kHz, respectively.The bone conduction threshold value in 1kHz, 2kHz, 4kHz and 8kHz of the eustachian tube group after treatment were (9.75±1.36)kHz, (11.13±2.02)kHz, (14.82±2.44)kHz, (13.78±2.11)kHz, respectively.The bone conduction threshold value in 1kHz, 2kHz, 4kHz and 8kHz of the eustachian tube group after treatment were significant lower than those of the tympanic membrane puncture group and those before treatment(t=3.10, 3.56, 3.29, 3.96, 2.87, 3.15, 2.91, 3.28, 2.67, 2.81, 2.78, 2.50, all P<0.05). The ETDQ-7 scores of the eustachian tube group after treatment were significant lower than those of the tympanic membrane puncture group and those before treatment(t=3.31, 3.87, 2.89, all P<0.05). The levels of laboratory index of the eustachian tube group after treatment were significant higher than those of the tympanic membrane puncture group and those before treatment(t=3.36, 3.77, 3.71, 4.02, 2.83, 3.06, all P<0.05). The secondary tympanic effusion rate and the recurrence rate with follow-up of the eustachian tube group were significant lower than those of the tympanic membrane puncture group(χ2=9.87, 12.33, 10.67, all P<0.05). Conclusion Compared with endoscopic hormone injection by tympanic membrane puncture, endoscopic hormone injection by eustachian tube in the treatment of patients with chronic secretory otitis media possess the advantages including relieve the clinical symptoms, improve the bone conduction threshold and eustachian tube function, regulate the laboratory indexes and reduce the risk of recurrence and effusion. Key words: Otitis media with effusion; Tympanic membrane; Punctures; Eustachian tube; Dexamethasone

Analysis of vertigo after tympanic puncture in patients with secretory otitis media

Analysis of vertigo after tympanic puncture in patients with secretory otitis media

Bacteriology of Otitis Media with Effusion in Children and Their Sensitivity to Antibiotics in Erbil City

Background and objectives: Otitis media with effusion is considered one of the major causes of hearing loss in children. The pathogenesis remains unclear, an interaction between bacterial infection, Eustachian tube dysfunction, aller- gy and immunologic factors is proposed. Newer theories suggest a bacterial induced inflammatory reaction is the main aetiology. The aim is to analyse the bacterial involvement in otitis media with effusion and to determine the bacterial susceptibility to antimicrobial agents used in Erbil. Methods:Middle ear effusion fluid was collected from 40 children aged 2-12 years with secretory otitis media and scheduled to undergo tympanostomy tube placement. The samples were inoculated into culture media and stained by a gram stain. The bacterial susceptibility to (amoxicillin clavulanic acid, cefixime, and azithromycin) was tested. Results: Bacterial culture was positive in 24 out of 72 ears (33.3%). The most frequent isolated bacteria were Haemophilus influenzae (62.5%), while Streptococcus pneumonia and Staphy- lococcus aureus constituted (25%) and (12.5%) respectively. Sensitivity to amoxicillin clavulanic acid was 93.3% for influenzae, 83.3% for S. pneumoniae, and none for S. aureus, While 66.7% of S. aureus, 16.7% of S. pneumoniae, and none of the H. influenza were sensitive to azithromycin. Most of the cultured bacteria were resistant to cefixime. Conclusions: The prevalence of bacteria in otitis media with effusion in our study is comparable to what is reported in the literature, with Haemophilus. influenzae being the most frequent microorganism cultured. The finding of the high percentage of bacterial resistance to Cefixime and azithromycin suggests that the injudicious overuse of antibiotic is leading to the increase in bacterial resistance to antibiotics.

Preliminary exploration for recurrent secretory otitis media treatment by balloon dilation Eustachian tuboplasty combined with tympanotomy tube insertion

Preliminary exploration for recurrent secretory otitis media treatment by balloon dilation Eustachian tuboplasty combined with tympanotomy tube insertion

Ефективність застосування топічного кортикостероїдного препарату «Флікс» при лікуванні секреторного середнього отиту у дітей

Ефективність застосування топічного кортикостероїдного препарату «Флікс» при лікуванні секреторного середнього отиту у дітей

Effect of intratympanic injection of triamcinolone acetonid on IL-4 and IFN-γ in patients with secretory otitis media

Objective To study the effect of intratympanic injection of triamcinolone acetonid on interleukin-4(IL-4) and interferon-gamma (IFN-γ) in patients with secretory otitis media. Methods 110 patients with secretory otitis media were selected, and they were randomly divided into the observation group and control group according to digital table, 55 cases in each group.All patients were treated with puncture in the tympanic cavity.The control group was injected with dexamethasone, while the observation group was injected with triamcinolone acetonid.Two groups were treated for 2 times/week, continuous treatment for 1 month.Fasting blood samples were collected before and after treatment to determine serum IL-4 and IFN-γ levels. Results The total effective rate of the control group was 58.2%, which was significantly lower than 70.9% of the observation group (χ2=4.68, P<0.05). After treatment, the serum levels of IL-4 and IL-4/IFN-γ in the two groups were significantly decreased (t=4.698, 10.262, 3.924, 4.264, all P<0.01). After treatment, the serum IFN-γ levels were significantly higher in the two groups(t=3.016, 5.116, all P<0.05). Compared with the control group after treatment, the serum IL-4, IL-4/IFN-γ in the observation group decreased more significantly (t=3.082, 2.971, all P<0.01). The serum IFN-γ level increased significantly (t=2.142, P<0.05). Conclusion Triamcinolone acetonid intratympanic injection can significantly improve the efficacy in patients with secretory otitis media, and improve the balance of Th1/Th2. Key words: Otitis media with effusion; Triamcinolone acetonid; Interleukin-4; Interferon-gamma

The efficacy comparation of adenoidectomy with acupuncture and tympanonstomy in children secretory otitis media

Objective:This study aims to the comparative study of AT+A (adenoidectomy with acupuncture) and AT+T (adenoidectomy with tympanonstomy tube) to monitor and compare the therapeutic effect and prognosis of secretory otitis media in children. The study make a summary and give the clinical suggestions as well.Method:We collected and analyzed 280 outpatients of children secretory otitis media from March 2015 to March 2016.Among them,172 cases took the adenoidectomy with acupuncture and 108 cases took the adenoidectomy with tympanonstomy tube. This research used the therapeutic effect indicators,middle ear effusion time and one year follow-up to evaluate the pros and cons of two surgery methods in different areas.Result:The patients of both groups had relatively good therapeutic effect which promoted with time. There were no significant difference between AT+A and AT+T in tympanic membrane. While AT+T group acted better than AT+A group in pure tone average and tympanum figure. The middle ear effusion time of AT+T group was significantly shorter than AT+A group. In one year follow-up, there were no difference in hearing loss between two groups.But AT+T group performed better in recurrence rate, infection rate and total rate.Conclusion:Since the adenoidectomy with tympanonstomy tube method has a lot of advantages over adenoidectomy with acupuncture,it's better to use AT+T in severechildren secretory otitis media when situation is available.