Treatment Of OME Research Articles

INFLATE: a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children

BackgroundOtitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children.Methods/designThis multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3–16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken.DiscussionINFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies.Trial registrationAustralia New Zealand Clinical Trials Registry ACTRN12617001652369. Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration.

Automatic detection of eardrum otoendoscopic images in patients with otitis media using hybrid‐based deep models

AbstractOtitis media with effusion (OME) is fluid accumulation in the middle ear without signs of systemic infection. OME can cause hearing loss, ear fullness, speech retardation, and a decrease in social relations and school success. In the treatment of OME, methods such as medical treatment and placing a tympanostomy tube in the eardrum are used. Correct evaluation of the eardrum is necessary to diagnose OME and follow‐up properly in the following period. In this study, we aimed to evaluate the otoendoscopic images of the eardrum in patients with otitis media with effusion using deep models. In the proposed model, Efficientnetb0, Darknet53, and Densenet201 architectures are used as the base. The feature maps obtained using these architectures are combined. In this way, different features of the otoendoscopic images of the eardrum in the data set were extracted and combined using different architectures. neighborhood component analysis optimization technique is used to select important features from the combined feature maps. By using this optimization method, the size of feature maps is reduced. In this way, the model is trained faster, and the testing process is carried out in a shorter time. When these features are classified in different classifiers, the model we propose has the most successful average accuracy value of 94.27% in the SVM classifier.

Role of intratympanic steroid injection in treatment of otitis media with effusion: A systematic review/ Meta -Analysis

Abstract Background Otitis media with effusion (OME) is a worldwide major health problem for both children and adult, who have a history of chronic eustachian tube dysfunction. Aim of the Work to review the effect of intratympanic injection of steroids in treatment of chronic otitis media with effusion (persistent more than 3 months after failure to medical treatment [e.g. local & systemic steroids or decongestants] or surgical ventilation tubes). Material and Methods This systematic review was done as a collective analysis of 5 retrospective and prospective cohort studies done on patients with OME. Studies on Patients who were diagnosed with chronic otitis media with effusion not responding to conventional methods of treatment. Results The data analysed and results showed an improvement of 41.2% of the cases treated with intratympanic injection of steroids compared to 11% improvement in cases treated by conventional medical methods with a relative improvement around 6.4 folds to intratympanic injection of steroids over medical treatment. All of these studies have shown that there are more advantages of directed ototopical steroid therapy over systemic therapy. Topical medications often have limited systemic effects due to their limited systemic uptake. It may be less expensive as compared to systemic medications. Conclusion Intratympanic injection of long acting steroids has good effect in management of OME resistant to medical and surgical treatment and has superior effect and high rate of recovery on local nasal steroid spray. In children combination of ventilation tubes and intratymapnic injection of steroids is the best known modality of treatment. Further studies are needed to evaluate the best medical treatment of chronic OME.

Improving The Treatment Of Paradontic Diseases With The Help Of Immunomodulating And Probiotic Drugs

Parodontitis is one of the most common types of dental pathology. Many factors play a role in the emergence and development of this disease. Despite certain achievements in the study of the etiological and pathogenetic ome and in the development of parodontitis diagnostics and methods of treatment of Ome, its emergence and development have not yet been determined to the end. The emergence and passage of parodontitis is accompanied by significant changes in the content of humoral factors in the oral fluid: IgA, which plays a leading role in the defense of the mucous membrane of the oral cavity, immunoglobulins of IgG classes and secretory immunoglobulins - slgA; albumin, whose concentration in the oral fluid increases as a result of increasing the permeability of the walls

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

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

Impact of pediatric obesity on the prevalence and outcome of otitis media with effusion

IntroductionOtitis Media with Effusion (OME) is the most common cause of hearing impairment in the pediatric population. Pediatric obesity is another major health issue with numerous reported health consequences, however, published studies about its role in OME are limited. This study aims to investigate the impact of pediatric obesity on the prevalence and outcome of OME. MethodsA case-control study on 112 children aged 2-18 years who underwent ventilation tube insertion for the treatment of OME during 2015-2017 (cases) and 130 children with no history of OME matching for age and gender (control group). Each group was divided into four subgroups based on BMI by age and gender. The differences in the BMI between the cases and the control group were explored. The cases were further divided into obese and non-obese subgroups and were compared to determine the impact of obesity on the presentation and outcome of OME. ResultsMean±SD BMI is significantly higher in the cases compared to the control group (19.98±5.20 vs. 17.25±4.21) (P=0.032). Obesity is significantly more prevalent in patients with OME compared to the control group (25.0% vs. 19.2%) (P=0.021). Obese OME patients are more prone to develop recurrence compared to non-obese OME patients (OR 3.51, 95% CI1.12, 11.01). ConclusionPediatric obesity might be associated with the development of OME. Moreover, obese OME patients are more prone to develop recurrence compared to non-obese patients.

Intranasal versus systemic corticosteroids in treatment of otitis media with effusion in the presence or absence of adenoid hypertrophy in children

BackgroundOtitis media with effusion (OME) is defined as the presence of fluid in the middle ear without signs or symptoms of acute infection. The condition is common and affects ~90% of children before school age, who develop an average of four episodes of OME per year, most often between the ages of 6 months and 4 years.AimThe aim of this study was to investigate the role of systemic versus local corticosteroids in treatment of OME in the presence or the absence adenoid hypertrophy in children.Patients and methodsIn our study, 60 children who fulfilled the inclusion criteria were divided into two equal groups: group A included children with OME with adenoidal hypertrophy and group B included children with OME without adenoidal hypertrophy. Then, each group was subdivided into two groups, where one received topical intranasal steroids (A1 and B1), and the other one received oral steroids (A2 and B2). Tympanograms were done for all patients every 2 weeks.ResultsThe final result is that both topical intranasal and systemic steroids are effective in the treatment of OME in children, without significant difference between the two methods, so oral steroid complications could be avoided by using local steroid spray, and the effectiveness of steroids (oral or topical) in treatment of OME is better in absence of adenoidal hypertrophy than in the presence of adenoidal hypertrophy.ConclusionBoth topical intranasal and oral steroids are effective adjunctive treatment for OME in children in the short term.

Orostachys japonicus A. Berger (Crassulaceae) Exerts Antidiabetic Activity by Improving Glucose and Lipid Levels in Type 2 Diabetic Mice.

Orostachys japonicus A. Berger and Momordica charantia Linn have been widely used as an alternative medicine. Recently, patients with type 2 diabetes (T2D) have paid increasing attention to medical nutrition therapy due to its safety and cost-effectiveness. Therefore, we have developed a new health functional food that consists of a mixed extract of O. japonicus and M. charantia. The aim of this study is designed to assess the antidiabetic efficacy of O. japonicus and M. charantia extracts (OME, in an 8:2 ratio), especially focusing on the effects of O. japonicus via in vivo and in vitro experiments. Seven-week-old C57BL/Ksj-db/db (db/db; a genetic animal model of T2D) mice were used for inducing diabetes. Mice were administered with various concentrations of OME (OME 0, 100, 200, or 400 mg/kg/day) for 6 weeks. Metabolic parameters, fasting blood glucose and glycosylated hemoglobin levels were measured. Histopathologic analysis and the levels of serum or hepatic biochemicals were assessed to evaluate diabetic liver injury and steatosis. The expression levels of lipogenic and gluconeogenic genes were determined by quantitative real-time polymerase chain reaction. Activation of Akt was assessed by western blot analysis. Administration of OME significantly improved metabolic parameters in db/db mice, and also reduced diabetic liver injury and steatosis were observed by OME administration in db/db mice as confirmed by histopathologic and serum or hepatic biochemical analysis. Consistently, treatment of OME significantly increased Akt activation resulting in decreased expression levels of lipid-accumulation or gluconeogenesis-related genes. Similar results were observed in in vitro experiments using single extract of O. japonicus and using OME. OME has antidiabetic effects with increased insulin sensitivity, and may be a safe alternative therapy for the management of T2D.

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.

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.

Plain Language Summary: Otitis Media with Effusion.

This plain language summary serves as an overview in explaining otitis media with effusion (pronounced Oh-TIE-tis ME-dee-uh with Ef-YOO-zhun), abbreviated "OME" and often called "ear fluid." The summary applies to children aged 2 months through 12 years with OME and is based on the 2015 "Clinical Practice Guideline: Otitis Media with Effusion (Update)." The evidence-based guideline includes research to support more effective diagnosis and treatment of OME in children. The guideline was developed as a quality improvement opportunity for managing OME by creating clear recommendations to use in medical practice.

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care.

Otitis media with effusion (OME) is a very common problem in primary care, but one that lacks an evidence-based non-surgical treatment. To determine the clinical effectiveness of nasal balloon autoinflation for the treatment of OME in children. A pragmatic, two-arm, open randomised controlled trial. Forty-three general practices from 17 UK primary care trusts recruited between January 2012 and February 2013. School children aged 4-11 years with a history of OME symptoms or related concerns in the previous 3 months, and a type B tympanogram, diagnostic of a middle ear effusion, in one or both ears. Three hundred and twenty children were randomised, 160 to each group, using independent web-based computer-generated randomisation (with minimisation based on age, sex and baseline severity of OME) to either nasal balloon autoinflation performed three times per day for 1-3 months plus usual care, or usual care alone. The proportion of children demonstrating clearance of middle ear fluid in at least one ear (with normal tympanograms) at 1 and 3 months, assessed blind to treatment. An ear-related measure of quality of life (QoL) [a 14-point questionnaire on the impact of OME (OMQ-14)], weekly diary recorded symptoms, compliance and adverse events were all secondary outcomes. At 1 month, the proportion of children with normal tympanograms was 47.3% (62/131) in those allocated to autoinflation and 35.6% (47/132) in those receiving usual care [adjusted relative risk (RR) 1.36, 95% confidence interval (CI) 0.99 to 1.88]. At 3 months, the proportions were 49.6% (62/125) and 38.3% (46/120), respectively (adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). The change in OMQ-14 also favoured the intervention arm (adjusted global score difference -0.42; p = 0.001). Reported compliance was good: 89% in the first month and 80% in months 2 and 3. Adverse events included otalgia in 4% of treated children compared with 1% in the control group. Minor nosebleeds (14% vs. 15%) and respiratory tract infections (18% vs. 13%) were noted. We found the use of autoinflation in young children with OME to be feasible in primary care and effective in both clearing effusions and improving child and parent ear-related QoL and symptoms. This method has scope to be used more widely. Further research is needed for very young children, and to inform prudent use in different health settings.

Hearing 25 years after surgical treatment of otitis media with effusion in early childhood

ObjectiveTo determine the long-term hearing following surgical treatment of chronic OME in early childhood (myringotomy or ventilation tube) and to determine the impact of the occurrence and the extension of specific eardrum pathology on the hearing level. Patients and methodsIn 1977–1978, 224 consecutive children (91 girls and 133 boys) with chronic bilateral OME were enrolled and treated by adenoidectomy, bilateral myringotomy and insertion of a ventilation tube on the right side only.In 2002, a follow-up examination included otomicroscopy and audiometry. Hearing thresholds were compared to an age- and gender-matched normative data set. For the determination of the impact of specific eardrum pathology on the hearing, multiple linear regression modelling was used in adjustment for age and concomitant eardrum pathologies. ResultsLong-term hearing after chronic OME and associated treatment is not different from age and gender-matched normal hearing. Treatment modality (myringotomy or ventilation tube) has no impact on the long-term hearing level.The regression analyses showed that the presence of myringosclerosis is associated with an overall hearing loss in myringotomised ears (4–5dB), but not in tubed ears, for which only high frequencies were affected. Conversely, tensa atrophy is associated with an overall hearing loss in tubed ears (3–4dB), but not in myringotomised ears, for which only high frequencies were affected. ConclusionsHearing 25 years after surgical treatment of chronic OME is not different from age and gender matched normal hearing. In addition, treatment modality (myringotomy or ventilation tube) has no impact on the long-term hearing level. However, atrophy is associated with a hearing loss in tubed ears, whereas myringosclerosis is associated with a hearing loss in myringotomised ears. The hearing loss associated with pathology is of limited magnitude (up to about 5dB PTA). Even though pathology does occur more frequently and more extensively in tubed ears, the effect on the hearing at the group level is too small to have an impact. It is important to note, that this may be due to a type 2-error (number of patients too small to show an effect).

Antihistamine effects on experimental middle ear inflammatory model

Allergy is thought to be one of the etiologic factors in otitis media. The purpose of this study was to determine the histopathologic effects of H1 histamine receptor antagonists in an experimental histamine-induced middle ear inflammation model. In group A (20 rabbits), histamine challenge followed a 3-day intramuscular pretreatment with a single dose of 0.1 ml hydroxyzine hydrochloride (50 mg/ml) per day. In group B (20 rabbits), histamine challenge followed a 3-day pretreatment with a single dose 1.2 mg desloratadine per day orally. In group C (20 rabbits), histamine challenge followed a 3-day pretreatment with a single dose 1.2 mg levocetirizine per day orally. On the fourth day after baseline otomicroscopy 0.5 ml histamine 20 mg/ml was injected transtympanically on the right. Middle ear mucosa was removed and the following parameters were assessed: edema, vascular dilatation and congestion, inflammation, acute inflammatory component, presence of eosinophils, activity of the inflammation and fibrosis. A semi-quantitative grading system of 0-3 was used for grading of all parameters and statistical analysis performed by using the Mann-Whitney non-parametric test. Group A mucosae showed lower grades of all the parameters evaluated compared with those of group B. Histopathology of the mucosae of group C showed lower grade of inflammation compared with group B with significant statistical difference for the seven parameters tested. Our data validate the use of antihistamines in the treatment of refractory OME of allergic origin. Oldest H1 antagonists can be replaced by the newest agents who counteract successfully histamine effects, without any interactions or adverse effects from central nervous system.

Skuteczność tympanopunkcji w leczeniu dzieci chorych na wysiękowe zapalenie ucha środkowego

Otitis media with effusion is the most frequent cause of conductive hearing impairement (HL) at pediatric age. This entity can be asymptomatic for an important period of time (silent OME). There is a surgical and a nonsurgical approach for OME. In case of failure of conservative treatment of OME the ventilation tube insertion (VT) with adenoidectomy alone or combined with tonsillectomy should be choosed. If the hearing loss is less than 20 dB children are candidates for conservative treatment and myringotomy. From 1999 to 2003, 50 children with bilateral and 9 with unilateral OME underwent the surgical treatment in our ENT Department. Mean age of patient population was 6,8 years. Clinical evaluation of the OME treatment outcome was done in 2004. Surgical procedure involved myringotomy, aspiration of the middle ear effusion, middle ear irrigation with soline solution 0.9 % Sodium Chloride (NaCl) followed by suction of diluted glue. Depo-Medrol (methylprednisolone acetate) was administrated into the middle ear. Our procedure included the management of the upper airways obstruction. Good long-term outcomes after surgical treatment of OME were obtained in 30 patients (79%). In this group of children the upper airways management included adenoidectomy and partial tonsillectomy. 8 children presented poor response to the treatment. In this group the surgical procedure consisted of adenoidectomy and inferior turbinate reduction. Two children presented acute otitis media and improved after conservative treatment. Other children with poor outcome were: a boy who underwent multiple surgical procedures due to laryngotracheal stenosis, a girl who suffered from chondrodysplasia. Remaining two patients presented few months ago aggravation of conductive hearing loss. According to positive familial history they underwent allergical examinations. One boy was planned for readenoidectomy and laser myringotomy, a girl already operated at the age of tree years, was planned for ventilation tubes insertion and readenoidectomy in another ENT Department.

P102: Treatment of Recurrent OME in Irradiated NPC Patients

P102: Treatment of Recurrent OME in Irradiated NPC Patients

Prospective study of tympanic membrane retraction, hearing loss, and multifrequency tympanometry

Tympanic membrane retraction is a significant sequela of OME and has been linked clinically to atelectasis, ossicular erosion, and cholesteatoma. We investigated important factors for prediction of tympanic membrane retraction in a prospective study of 112 children. After 4 to 6 years of follow-up, 12% of ears had pars tensa retraction without atrophy, and 28% had various degrees of retraction with atrophy. Mild pars flaccida retraction was present in 23%, and severe pars flaccida retraction was present in 12%. Retraction severity was related to hearing level and multifrequency tympanometry. Three factors were significantly related to retraction severity: type of tube, male sex, and percent of visits in the second year with abnormal tympanograms. This study shows that type of tube was the most important factor in long-term outcome after tympanostomy tube treatment of OME. (Otolaryngol Head Neck Surg 1999;121:514-22.)

Chronic otitis media with effusion.

Chronic OME, which arises from a complex series of inflammatory events in the middle ear, affects approximately 5% to 30% of children. The mean duration of MEE is 16 to 20 weeks during the first 2 years of life. This condition is diagnosed best with pneumatic otoscopy and tympanometry. The risk of chronic OME is increased by environmental factors and characteristics of the child, including disease history. Approximately 70% of MEE are culture-positive, with approximately 50% of these yielding S pneumoniae, H influenzae, or M catarrhalis. However, antibiotic treatment of acute otitis media and OME has only a minimal effect on the long-term resolution of MEE. Research has shown that 70% of children who have chronic OME suffer mild-to-moderate hearing loss, so a child who has bilateral MEE for 3 months should undergo hearing evaluation. If the child has hearing impairment, referral to an otolaryngologist for myringotomy and tympanostomy tube insertion is a treatment option that the AHCPR recommends after 4 months of effusion with hearing loss. Sequelae of chronic OME include deficient expressive language and poorer attention skills due to the temporary hearing loss associated with OME, high-frequency sensorineural hearing loss, tympanic membrane atrophy, perforation, retraction, atelectasis, and cholesteatoma.

The role of inflammatory mediators and anti-inflammatory drugs in otitis media.

Despite multiple studies, the role of anti-inflammatory drugs in the treatment of AOM and OME is unclear. Although the AHCPR was against the use of steroids in OME, other studies suggest a possible role with potential cost savings and a decrease in the need for surgery in some patients. But the risk-benefit ratio of steroid treatment is unclear. There is some evidence that NSAIDs may decrease otalgia associated with AOM, but no proof that NSAIDs reduce or prevent inflammatory changes in the middle ear associated with AOM and OME.

難治性浸出性中耳炎とＣＡＭ少量長期投与

The Clinical efficacy of low dose clarithromycin (CAM) was evaluated in refractory OME patients (aged 10 to 20 years) with chronic nasal sinusitis and no sign of organic disorder of the eustachian tube.Twenty seven patients (35 ears) were divided into two groups. Group 1 (15 ears) received CAM in a dose of 200 mg/day for 3 months and group 2 patients (20 ears) were treated by ventilation tube insertion for more than 3 months.Within the 3-month follow-up period after CAM treatment, 11 of the 15 ears (73%) showed satisfactory healing with type A or C 1 tympanograms. On the other hand, only 35% of the OME ears treated with ventilation tubes showed improvement of the tympanogram after extrusion of the tubes.These results indicate that low dose CAM may be useful in the treatment of refractory OME with accompanying chronic nasal sinusitis.