Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear's ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

Research the diagnosis of wide band acoustic absorbance in children otitis media with effusion / 安徽医科大学学报

Objective To research the diagnostic value of the wide band acoustic absorbance rate in children otitis media with effusion. Methods The wide band acoustic absorbance rate was tested in 114 children (a control group of 30 healthy children;50 patients shown middle ear effusion during tympanotomy;and 34 patients with chronic effusion shown no middle ear effusion during tympanotomy).The data of each group were analyzed, and the diagnostic value of wide band absorbance was analyzed with the receiver operating characteristic curve.Results The wide band acoustic absorbance rate of otitis media with effusion group was notably lower than that of non-effusion group and control group at the 0.5～4 kHz averaged absorbance (P＜0.05).After analyzing the receiver operating characteristic curve, it showed that the diagnosis value was highest in the range of 0.5～2 kHz (area under the curve0.984), followed by 1 kHz and 1.5 k Hz (area under the curve:0.973 and 0.967). Conclusion Compared with the conventional 226 Hz tympanometry, the wide band tympanometry is more accurate for the diagnosis of children otitis media with effusion.It can be used as a better method for the diagnosis of otitis media exudative lesions.

The Efficacy of Adjuvant Intratympanic Steroid Treatment for Otitis Media with Effusion in Children

Abstract Introduction Otitis media with effusion (OME) is a leading cause of hearing impairment in children. Therefore, early and proper management is essential. Objectives The objective of this research is to assess the efficacy of intratympanic (IT) steroids injection for management of otitis media with effusion (OME). Methods This study involved 42 children (84 ears) with bilateral OME. We used tympanometry to confirm the childreń s middle ear effusion and pure tone audiometry to determine hearing threshold. We performed myringotomy and inserted ventilation tubes (VTs) bilaterally, followed by a steroid injection of 0.4-0.6mLmethylprednisolone (40 mg/mL) into one randomly selected middle ear. This procedure was followed by once-weekly administration of steroids (0.5 mL methylprednisolone at a concentration of 40 mg/mL) into the middle ear for three consecutive weeks. Results We found recurrent OME after VT alone in nine (21.4%) ears; whereas, after VT combined with steroid administration, we found two (4.76%), with statistically significant difference. We noted tympanosclerosis postoperatively in six (12.9%) ears and in one of the injected ears (2.3%) (p = 0.0484). Otorrhea occurred in eight (19%) ears with VT alone and in three (7.1%) injected ears, with non-significant difference. The duration between VT insertion and its extrusion was 6.6 = 1.1months for ears with VT alone and 6.95 =1.12 months in injected ears (p = 0.1541 NS). Conclusion IT Steroids injection for treatment of OME is a safe and simple intervention with lower incidence of symptoms recurrence and postoperative complications. Thus, its use in management of OME is recommended.

A Contrastive Analysis on the Value of Tympanograms and of Temporal Bone CT Scans in Diagnosis of Secretory Otitis Media / 听力学及言语疾病杂志

Objective To investigate and contrastive analyse the respective value of tympanograms and high resolution CT scan of temporal bone in the diagnosis of secretory otitis media .Methods The clinical data of 150 hos-pitalized patients with secretory otitis media in Department of ENTHNS ,Tongji Hospital ,Wuhan from 2009 to 2012 were retrospectively analyzed .Based on the surgical finding of tympanic cavity fluid ,the diagnostic accordance rate of tympanograms and temporal bone CT for middle ear effusion were calculated respectively ,and their diagnos-tic value were evaluated .Results The diagnostic accordance rate of tympanogram B for the middle ear effusion in secretory otitis media was 94 .5% (138/146 ears) ,the rate of abnormal tympanograms was 91 .6% (206/225 ears) , while temporal bone CT with a rate of 99 .2% (117/118 ears) .The difference between the latter two data was statis-tically significant(P<0 .01) .Conclusion The temporal bone CT scan ,with a higher diagnostic value for middle ear effusion in secretory otitis media ,could be used as a supplement to the acoustic immittance measurement ,especially to non-B tympanograms for the diagnosis of secretory otitis midia .

Correlación microbiológica en cultivo de adenoides y glue en pacientes con OME / Microbiological correlation between adenoid and glue ear cultures in patients with OME

Introducción: La otitis media con efusión (OME) sigue siendo la patología otológica más prevalente en los preescolares de Chile; su etiología y factores predisponentes aún no están del todo claro; por ende su tratamiento es controversial. Objetivo: Demostrar una correlación microbiológica en cultivos de tejido adenoídeo y glue de ambos oídos en pacientes con OME. Material y método: Estudio prospectivo caso/control, donde se analizaron los cultivos bacterianos de tejido adenoideo y glue de ambos oídos en 40 pacientes con OME y cultivos bacterianos de tejido adenoídeo de 40 pacientes con hiperplasia adenoídea sin OME. Resultados: Casos: Cinco cultivos negativos de adenoides (12,5%), 28 positivos a comensales (70%) y 7 positivos a gérmenes no habituales (17,5%). El glue presentó cultivo negativo en 72,5% OD y 77,5% OI. Los cultivos de adenoides en los controles no difieren mayormente a los casos. Discusión: No se pudo establecer una correlación microbiológica entre glue y adenoides en pacientes con OME. Conclusiones: El número de cultivos de glue negativos se correlaciona con la literatura mundial. No existe un patrón que permita correlacionar los cultivos de adenoides de los casos con los cultivos de glue, ni con los cultivos de adenoides de los controles.

Introduction: Otitis Media with Effusion is still the most prevalent otological pathology in preschool children in Chile. Its etiology and predisposing factors are not entirely clear yet. Hence, its treatment is controversial. Aim: To demonstrate a microbiological correlation in adenoid tissue and glue ear cultures in both ears in patients with OME. Material and method: Prospective case control study, which analyzed bacterial adenoid tissue cultures and glue ear cultures in both ears in 40 patients with OME, and a second control group of bacterial cultures in 40 patients with adenoid hyperplasia without ear effusion. Results: Cases: Five negatives in adenoid cultures (12.5%), 28 positive to guest bacteria (70%) and 7 positive at unusual germs (17.5%). The glue ear presented negative culture at 72.5% in the right ear and 77.5% in the left ear. Adenoid control cultures did not differ with OME studied cases. Discussion: A microbiological glue ear and adenoid correlation could not be established. Conclusions: The number of negative glue ear cultures is similar to published literature. There is not a pattern which allows a positive correlation between adenoid cases cultures and glue ear cultures or with control adenoid cultures.

Factors Affecting the Extrusion Rate of Ventilation Tubes

OBJECTIVES: The objective of this study was to determine the various factors that affect the extrusion rate of ventilation tubes (VTs), including the nature of the middle ear effusion. METHODS: A retrospective chart review of 82 pediatric patients (177 ears) who received VT insertion surgery under general anesthesia was carried out to evaluate the relationship between various factors and the VT extrusion rate. The factors we analyzed included age, gender, the adenoid size, the amount and content of the middle ear effusion after myringotomy, bleeding events, associated adenoidectomy and the findings of the tympanic membrane status, the tympanometry and the audiometry of the air bone gap. RESULTS: The mean extrusion time was 254 days (range, 11 to 809 days). The patients with no history of previous VT insertion had a longer extrusion time (mean, 279 days) than did the patients who had undergone previous VT insertion (mean, 203 days). The patients with serous effusion had the shortest extrusion time (mean, 190 days) as compared to those patients with glue (273 days) and pus (295 days) effusions. Other factors had no statistical significant relationship with the extrusion time. CONCLUSION: The mean VT extrusion time was 254 days. The VT extrusion time was significantly related to the characteristics of the middle ear effusion and a history of previous VT insertion. Thus, the nature of middle ear effusion can provide a clinical clue to predict the VT extrusion time.

Expression of HSP70 and Its Relation with Other Cytokines in Human Middle Ear Effusion

OBJECTIVES: While other cytokines are known to be associated with otitis media with effusion (OME), the involvement of heat shock protein 70 (HSP70) in middle ear effusion (MEE) is unknown. This study was undertaken to investigate the possibility of there being a HSP70 expression in human MEE and to determine its potential role as a cytokine in OME. METHODS: The levels of HSP70, tumor necrosis factor-alpha and interleukin-1beta were measured by enzyme-linked immunosorbent assay in the effusion of different groups of OME patient following collection of the MEE using our new collection system. The clinical characteristics of the OME patients and the MEE status were analyzed. RESULTS: HSP70 was expressed in all the types of MEE. The mucous and seromucous effusions showed higher HSP70 levels than that of the serous effusion. The HSP70 level was correlated with the levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta in the effusions. The positive correlations between HSP70, TNF-alpha and IL-1beta were statistically significant (P<0.05). CONCLUSION: The highly elevated level of HSP70 in the seromucous and mucous effusions implicates this protein in the chronicity of OME.

L'otite seromuqueuse de l'enfant

L'OSM est la cause la plus frequente de surdite acquise de l'enfance. Environ 90des enfants presentent au moins un episode d'OSM avant l'age de 6 ans avec une frequence maximale a l'age de 2 ans. Le developpement de l'OSM peut etre explique par la defaillance d'autres barrieres protectrices (systeme mucociliaire; systeme immunitaire; trompe auditive) qui n'assurent plus de resistance aux bacteries. Le meilleur moyen diagnostic actuel de l'OSM est l'otoscopie pneumatique qui a une sensibilite de 94et une specificite de 80. La tympanometrie sert surtout a documenter l'OSM et a suivre l'evolution. Le traitement de l'OSM ne peut etre envisage que si un benefice persistant et cliniquement significatif est assure par rapport a l'evolution spontanee. Aucun traitement medical n'a fait la preuve de son efficacite. Le traitement deconges- tionnant nasal et les antihistaminiques n'ont montre aucune superiorite par rapport au placebo. Ailleurs; l'indication chirurgicale (ATT) depend de la perte auditive; des symptomes associes; des facteurs de risque au developpement; et de la prevision anticipee du temps de resolution de l'epanchement. Malgre son diagnostic relativement aise; la strategie therapeutique etant controversee. Le traitement n'est justifie que lorsque l'OSM est chronique. L'ATT demeure l'unique traitement efficace. La prevention des causes de l'inflammation est primordiale mais s'avere difficile. Nous nous proposons de resumer les avancees actuelles en epidemiologie; pathogenie; diagnostic et dans la prise en charge de l'OSM

A Case of Middle Ear Effusion due to Lipoma on the Eustachian Tube / 대한이비인후과학회지

Lipoma of the head and neck region rarely occurs, if any, on the posterior triangle of neck. We have experienced a lipoma on Eustachian tube, which caused recurrent middle ear effusion. A 42-year-old female patient was presented with right aural fullness and hearing disturbance. She had a history of several cases of right middle ear effusion in the past and insertions of ventilation tubes to relieve each of them. A yellowish round mass was found on the pharyngeal orifice of the right Eustachian tube by fiberoptic nasopharyngoscopy. It was removed via endoscopic endonasal approach and there is no evidence of recurrence along about 3 months after the surgery. This would be a good case for the importance of nasopharyngeal examination in patient with middle ear effusion.

Various Causes of Vertigo in Children with Normal Eardrum

BACKGROUND AND OBJECTIVES: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most popular diseases in childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and assist in making a differential diagnosis of vertigo. MATERIALS AND METHOD: The sixty eight children (less than 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 1995 and April 2003 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, audiograms, vestibular functions, and differential diagnosis. RESULTS: The most common causes for vertigo in children were benign paroxysmal vertigo of childhood (BPVC) in 21 (30.9%) and migraine in 20 (29.4%). Other less frequent causes included four cases of trauma, three cases of acute vestibular neuritis. two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, juvenile rheumatoid arthritis, leaving eleven cases (16.2%) as unclassified. Abnormal findings were noted in 14 (20.6%) in pure tone audiogram, 3 (4.4%) in positioning test, 11 (16.2%) in bithermal caloric test, and 47 (69.1%) in rotation chair test. CONCLUSIONS: The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by BPVC and migraine. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.

The Study of DNA in Middle Ear Effusions / 中国医师杂志

Objective To determine whether or not the bacterial DNA which was detected by PCR comes from viable bacteria.Methods Observe the effection of middle ear effusion(MEE) on DNA viscosity and enzymatic digestion of DNA.Results The middle ear effusion and DNA are stable and DNase 1 rapidly digests DNA,The effusion does not seem to degrade DNA.The middle ear effusion signifcantly inhibits DNase 1.Conclusions Middle ear effusion provides an inhibition of the enzymatic digestion of purified DNA.Thus any DNA found in effusion by PCR techniques could well be fossilized remains and chronic otitis media with effusion may not be the bacterial infection that recent studies have suggested.

Penetration of Cefprozil into Middle Ear Effusion in Pediatric Chronic Otitis Meida with Effusion / 대한이비인후과학회지

BACKGROUND: From a pharmacokinetic standpoint, middle ear effusion (MEE) acts as a sequestered compartment since diffusion of antibiotics from serum and to this compartment is limited. The effectiveness of an antibiotic to eradicate infection within an anatomic compartment is related to both its ability to penetrate and the susceptibility of the causative pathogen. OBJECTIVE: The goal of this study was to determine the steady state plasma and MEE concentrations of cefprozil in pediatric chronic otitis media with effusion (COME). MATERIALS AND METHODS: Twenty-five children with COME were enrolled, and MEE was collected using a ventilation tube insertion after 0.5, 2, 3, 5, and 6 hours of single oral administration of 15 mg Cefprozil/kg body weight. Blood samples were also collected as soon as the MEE was collected, and analyzed in order to measure the concentration of Cefprozil using the validated high performance liquid chromatography (HPLC) method. RESULTS: The mean concentrations of cefprozil in MEE ranged from 0.4 to 4.4 ug/ml. The penetration of cefprozil into the MEE was rapid and effectively. Cefprozil in the MEE was maintained at a greater level than MIC90 in Streptococcus pneumoniae for at least 6 hours after administration of 15mg/kg. CONCLUSION: Cefprozil penetrates well into MEE in patients with pediatric COME.

Effects of Laser Myringotomy on the Treatment of Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otitis media, with effusion has been known to require long term medical treatment. When medical treatment fails, myringotomy with or without ventilation tube insertion needs to be performed, but the duration of middle ear ventilation with myringotomy is very limited. The insertion of ventilation tubes may also cause some complications, and may require general anesthesia when performing at a young age. The purpose of this report is to see if myringotomy using CO laser can be used as an effective tool in the treatment of otitis media with effusion. MATERIALS AND METHODS: We retrospectively studied 66 ears of patients who went through myringotomy using CO laser between March, 1998 and May, 1999. We analyzed myringotomy size, patency time, recurrence and cost effectiveness. RESULTS: The average size of myringotorny was 2.1 mm in diameter. It remained patent for as long as 1.9 weeks in average. All myringotomy sites were healed without persistent perforations. Average recurrence rate and time were 27% and 3.2months, respectively. The medical treatment is expensive and needs more frequent follow-ups, but laser treatment is cheaper and requires less frequent follow-ups. CONCLUSIONS: CO laser myringotomy is a safe and cost effective procedure which can be done easily at the office in most of the cases.

The Effect of Middle Ear Effusion on Otoacoustic Emissions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The transmission properties of the middle ear directly influence otoacoustic emissions (OAEs) which are transmitted from the cochlea to the ear canal via middle ear. The purpose of this study is to evaluate the effects of middle ear effusion (MEE) on detectability of various OAEs and to assess the potential applicability of DPOAE measurements in monitoring the middle ear status. MATERIALS AND METHOD: Spontaneous otoacoustic emissions (SOAEs), transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) were recorded for 44 normal ears and 32 ears with MEE. DPOAEs were collected in two basic forms consisting of distortion product audiograms(DPgrams) and input-output (I-O) functions, elicited by two primary tones fl and f2 with varying geometric mean frequencies between 1-6 kHz. RESULTS: SOAEs were absent in 21 ears of 32 ears with MEE, TEOAEs were diminished in 28 ears with MEE, and DPgrams were eliminated in 17 ears with MEE. I-O function curves at 3 kHz and 4 kHz were significantly diminished by equal levels of fl and f2 primary tones of 45 & 55 dB SPL under the condition of MEE (p<0.05). CONCLUSION: The results suggest that MEE affects the detectability of various OAEs and that the DP I-O function curve measurement at 3 and 4 kHz may be valuable to monitor the middle ear status in pediatric patients.

Effect of IL-1beta on Hearing and Penetration through Round Window Membrane in Guinea Pig / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Interleukin (IL)-1beta has been detected in human middle ear effusion (MEE) and the MEEs of experimental otitis media. The object of this study was to investigate whether this cytokine 1) penetrates through the round window membrane (RWM) and 2) induces hearing loss. MATERIALS AND METHODS: Guinea pigs were randomly assigned as control and IL-1beta groups and each was subdivided into three different groups by applying 1 ng, 10 ng, 100 ng of IL-1beta on RWM. They underwent hearing test by auditory brainstem response (ABR) prior to experiments. In the ontrol group, 5nL of phosphate buffered saline (PBS) soaked in a small piece of gelfoam was applied on the RWM. In IL-1beta groups, three different concentrations of IL-1beta 1 ng, 10 ng, 100 ng soaked in a small piece of gelfoam were applied on the RWM. ABR measurements were performed at 3 and 6 hours after application of different concentrations of IL-1beta. At the end of 6 hours, cochleas were harvested and perilymphs were collected for assay of IL-1beta level by the ELISA method. RESULTS: At 6 hours after application, the control group animals did not show any significant hearing loss. The IL-1beta were undetectable in perilymph of control group. In IL-1beta group, IL-1beta was detected in perilymph in dose dependent increasing concentrations. There was a significant hearing loss in this IL-1beta group in dose dependent manner in 3 and 6 hours. The hearing loss in 100 ng was significant comparing to control group. CONCLUSION: The result of this study indicated that IL-1beta applied on RWM penetrate to the perilymph and caused hearing loss. The result of this study suggest that IL-1beta in MEE may cause sensorineural hearing loss in guinea pig.

Changes in External Ear Resonance after Ventilation Tube Insertion in Pediatric Patients with Middle Ear Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Middle ear effusion (MEE) is common in children, so the effects of the ventilation tube (VT) should be taken into account in prescribing hearing aids. With the ventilation tube, the external auditory canal communicates with the middle ear space, hence changing the impedance in the middle ear. This change, in turn, will have an effect on the external ear resonance (EER, real ear unaided response (REUR)). The aim of this study is to observe the effects of the tympanic membrane perforations caused by the ventilation tube on EER. MATERIAL AND METHODS:We selected 30 ears with MEE and measured EER before and after the ventilation tube insertion. We compared the EERs of the control group with the MEE group and two types of VT groups. RESULTS: In the subjects who had middle ear effusion, the average gain of the peak resonance was larger than that of the control group. After the VT insertion, the amplitude of the gain decreased to the level of control groups, although negative gain appeared in some cases characteristically around 1000 Hz. This negative gain was observed more frequently in the VT with larger diameter. CONCLUSION: The external ear resonance gain can be changed according to disease status or by VT insertion in patients with MEE. These changes should be considered especially in the low frequencies around 1000 Hz when prescribing the hearing aids for patients.

Infection of Respiratiory Viruses and Secretony Otitis Media / 听力学及言语疾病杂志

Objective To discuss the relationship between the infection of respiratory viruses and secretory otitis media(SOM). Methods The alkaline phosphatase anti-alkaline phosphatase(APAAP) bridged rapid diagnosis was used to detect the antigens of the common respiratory viruses in middle ear effusions(MEES). Results One or more kinds of antigens of respiratory viruses were detected in 73.9% MEES. Six kinds of antigens were detected in three patients' MEES at the same time. There were significant differences positive rates of the antigens of respiratory viruses in MEES with or without a cold history(P

Effects of Effusion on Transient Evoked Otoacoustic Emission in Pediatric Patients Having Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transient evoked otoacoustic emission (TEOAE) has an increasingly signficant role in pediatric otological practice such as screening hearing in newborn babies. To assess the potential applicability of the TEOAE measurements on the sequential monitoring of pediatric patients with middle ear effusion (MEE), we investigated the effects of MEE on the TEOAE responses. MATERIALS AND METHODS: TEOAE responses were recorded from 33 patients (56 ears) before and after ventilation tube insertion. RESULT: In the 37 cases with MEE, we found that the average band reproducibility below 2 kHz was recovered significantly after the tube placement, although the band reproducibility at 5 kHz was diminished. In the 19 cases without MEE, no significant changes in echo amplitude and band reproducibility were noted in the postoperative TEOAE measurements compared to the preoperative measurements. CONCLUSION: The results of this study suggest that an improvement in echo response and band reproducibility less than 2 kHz in serial TEOAE measurements may indicate the resolution of MEE in children with OME.

Relation Between Secretory Otitis Media and Chlamydia Pneumonia / 听力学及言语疾病杂志

Thirty-one patients with middle ear effusion were evaluated for the presence of chlamydia pneumonia by using polymerase chain reaction (PCR) assay. The presence of chlamydia neumonia was 19. 3% (6/31). The results indicated that PCR assay is a highly sensitive and specific for the detection of chlamydia pneumonia in the middle ear effusion and chlamydia pneumonia may be an aetiological agent of middle ear effusion.