Characteristics and clinical significance of wideband tympanometry of otitis media with effusion in young children / 中华耳鼻咽喉头颈外科杂志

Objective: To study the characteristics of wideband tympanometry(WBT) and its application value in the diagnosis of otitis media with effusion(OME) in young children. Methods: We compared wideband acoustic energy absorbance(EA) under peak pressure in young children with OME(190 ears) and healthy control subjects(121 ears) from Ninth People's Hospital of Shanghai Jiaotong University School of Medicine between January 2018 and June 2020. Both groups were divided into three groups, 1-6 months, 7-36 months and 37-72 months. SPSS 20.0 statistical software was used to analyze and compare the EA parameters between OME children of different months and the control group. Receiver operating characteristic (ROC)curve was used to analyze the diagnostic value of WBT in young children with OME. Results: There were significant differences in EA among three OME groups from 500 Hz to 2 000 Hz(P<0.05).Compared with the control groups, EA of 1-6 m OME group decreased significantly below 4 000 Hz(P<0.05), EA of 7-36 m OME group decreased significantly at 545-1 600 Hz(P<0.05), EA of 37-72 m OME group decreased significantly above 545 Hz(P<0.05).ROC curve indicated that EA at 1 000 Hz had the greatest diagnostic value (AUC was 0.890), followed by 1 500 Hz and the range of 500-2 000 Hz (AUC was 0.883 and 0.881, respectively).EA at 1 000 Hz with a cutoff value of 0.55 had the best diagnostic sensitivity of 90.8%, which was higher than conventional tympanometry (85.8%). The maximum AUC (0.932) could be obtained by combining EA, peak pressure and admittance amplitude of 226 Hz tympanometry as predictors. Conclusions: EA is significantly decreased in young children with OME. Compared with the conventional single frequency tympanometry, WBT is more accurate in the diagnosis of OME in young children, and the prediction accuracy would be better if combined with 226 Hz tympanometry.

Effect of autoflation on the prognosis of otitis media with effusion in children / 中华耳鼻咽喉头颈外科杂志

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.

Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria / Características audiológicas e otológicas de diabéticos tipo 2 em uma instituição de saúde terciária na Nigéria

ABSTRACT INTRODUCTION: This cross-sectional comparative study was carried out at the Diabetes outpatient clinic of LAUTECH Teaching Hospital (LTH) Ogbomoso, Nigeria. OBJECTIVE: This study assessed patterns of otologic diseases and auditory acuity among type 2 diabetics and determinants of these findings among diabetics. METHODS: Ninety-seven consenting patients with clinical diagnosis of diabetes mellitus (194 ears) were matched for age and sex with ninety non-diabetic patients (180 ears). These patients were screened using otoscopy and pure tone audiometry over a 6-month period. RESULTS: The study reported a crude prevalence rate of 21.6% hearing loss in T2DM patients. The most common type of otologic disease that showed significant association with T2DM patients was otitis media with effusion (p = 0.027). T2DM was significantly associated with abnormal audiometric findings (p = 0.022), particularly sensorineural hearing loss (p = 0.022), of the moderate grade (p = 0.057). There were no differences of the audilogical findings for any particular ear, and no differential affectation of frequency range was observed. Coexisting hypertension and poor glycaemic control were significantly associated with aggravation of the hearing of the T2DM patients (p < 0.001, and p = 0.009 respectively). CONCLUSION: T2DM had appreciable effects on hearing acuity. T2DM was significantly associated with the type and the degree of the hearing loss. The need for screening of hearing acuity of T2DM patients, in order to detect early changes, and promptly offer an adequate management and remedial measures was emphasized in this study.

Resumo Introdução: Este estudo de caso-controle foi realizado no Ambulatório de Diabetes do LAUTECH Teaching Hospital (LTH), em Ogbomoso, Nigéria. Objetivos: Este estudo avaliou os padrões de doenças otológicas e acuidade auditiva entre os diabéticos tipo 2 e os fatores determinantes desses achados entre os diabéticos. Método: Ao todo, 97 pacientes com diagnóstico clínico de diabetes melito (194 orelhas) deram seu consentimento e foram pareados por idade e sexo, com 90 pacientes não diabéticos (180 orelhas). Eles foram avaliados por otoscopia e audiometria tonal liminar por um períodode seis meses. Resultados: O estudo relatou uma taxa de prevalência bruta de 21,6% de perda auditiva em pacientes com DM2. O tipo mais comum de doença otológica, afetando significativamente pacientes com DM2, foi otite média com efusão (p = 0,027). A DM2 foi associada com achados audiométricos alterados (p = 0,022), principalmente perda auditiva neurossensorial (p = 0,012), de grau moderado (p = 0,057). Não houve predileção dos efeitos da DM2 para uma das orelhas em particular, e também não houve efeito diferencial da faixa de frequência. A coexistência de hipertensão e controle glicêmico inadequado associou-se significativamente à piora da audição dos pacientes com DM2 (p < 0,001 e p = 0,009, respectivamente). Conclusão: A DM2 mostrou apresentar efeitos significantes na acuidade auditiva afetando significativamente o tipo e o grau da disacusia. Este estudo mostrou a necessidade de avaliação da acuidade auditiva de pacientes com DM2, a fim de detectar as alterações iniciais, e poder rapidamente oferecer medidas corretivas adequadas.

Otitis media with effusion in children younger than 1 year / Otite média com efusão em crianças menores de um ano

Objective: To determine the prevalence of otitis media with effusion in children younger than 1 year and its association with the season of the year, artificial feeding, environmental and perinatal factors. Methods: Retrospective study of 184 randomly included medical records from a total of 982 healthy infants evaluated for hearing screening tests. Diagnosis of otitis media with effusion was based on otoscopy (amber-gold color, fluid level, handle of malleus position), type B tympanometric curves and absence of otoacoustic emissions. Incomplete medical records or those describing acute otitis media, upper respiratory tract infections on the assessment day or in the last 3 months, neuropathies and craniofacial anomalies were excluded. Data such as gestational age, birth weight, Apgar score, type of feeding and day care attendance were compared between children with and without otitis media with effusion through likelihood tests and multivariate analysis. Results: 25.3% of 184 infants had otitis media with bilateral effusion; 9.2% had unilateral. In infants with otitis media, the following were observed: chronological age of 9.6±1.7 months; gestational age >38 weeks in 43.4% and birth weight >2500g in 48.4%. Otitis media with effusion was associated with winter/fall, artificial feeding, Apgar score <7 and day care attendance. The multivariate analysis showed that artificial feeding is the factor most often associated to otitis media with effusion. Conclusions: Otitis media with effusion was found in about one third of children younger than 1 year and was mainly associated with artificial feeding.

Objetivo: Determinar prevalência de otite média com efusão em menores de um ano e sua associação com estação do ano, aleitamento artificial, fatores ambientais e perinatais. Métodos: Estudo retrospectivo com 184 prontuários incluídos de forma randomizada dentre 982 lactentes saudáveis avaliados para testes de triagem auditiva. Diagnóstico de otite média com efusão baseou-se em otoscopia (coloração âmbar-ouro, nível líquido, posição do cabo do martelo), curva timpanométrica tipo B e otoemissões acústicas ausentes. Excluíram-se prontuários incompletos ou que descreviam otite média aguda, infecções de vias aéreas superiores no dia da avaliação ou nos últimos três meses, neuropatias e anomalias craniofaciais. Dados como idade gestacional, peso ao nascimento, Apgar, tipo de aleitamento, frequência à creche foram comparados entre crianças com e sem otites com efusão por meio de testes de verossimilhança e análise multivariada. Resultados: 25,3% dos 184 lactentes apresentavam otite média com efusão bilateral; 9,2% unilateral. Nos lactentes com otite média, observou-se idade cronológica 9,6±1,7 meses; idade gestacional >38 semanas em 43,4% e peso ao nascer >2.500g em 48,4%. Otite média com efusão foi associada ao inverno/outono, aleitamento artificial, Índice de Apgar <7 e atendimento à creche. Já a análise multivariada demonstrou que o aleitamento artificial é o fator mais associado à otite média com efusão. Conclusões: A otite média com efusão foi encontrada em cerca de 1/3 dos menores de um ano e principalmente associada ao aleitamento artificial.

Síndrome de Gradenigo: una complicación poco frecuente de la otitis media aguda / Gradenigo syndrome: a rare complication of acute otitis media

El síndrome de Gradenigo consiste en una tríada clínica dada por otitis media aguda, parálisis unilateral del VI par craneano y dolor retroorbitario ipsilateral. Se atribuye a una petrositis apical aguda, complicación evolutiva de una infección del oído medio. La disponibilidad, el acceso y el uso adecuado de la terapia antibiótica han contribuido a una disminución de la frecuencia de estas complicaciones intratemporales o intracraneales de elevado riesgo de morbimortalidad. El tratamiento de la petrositis aguda ha evolucionado, desde la cirugía radical en la era preantibiótica, al tratamiento médico y cirugía menor combinados, en los últimos años. La oftalmoplejia externa plantea diagnósticos diferenciales con otras entidades clínicas: traumatismos, neoplasias, hipertensión endocraneana y procesos infecciosos intracraneales, como trombosis del seno venoso lateral, abscesos intracraneales epi y subdurales. En esta comunicación se jerarquiza el reconocimiento oportuno de las manifestaciones clínicas de esta complicación poco frecuente con el objetivo de sensibilizar a los profesionales para su abordaje diagnóstico y terapéutico oportuno y adecuado.

The Gradenigo syndrome consists in a clinical triad of acute otitis media, unilateral paralysis of the VI cranial nerve and ipsilateral retroorbital pain. It is attributed to an acute apical petrositis by evolutionary complication from an infection of the middle ear. The availability, the access and adequate use of antibiotic therapy have contributed to decrease the frequency of this intratemporal or intracranial complications with high risk of morbidity and mortality. The treatment of acute petrositis has evolved from radical surgery in the pre-antibiotic era, to medical treatment and minor surgery combined, in recent years. The external ophthalmoplegia raises differential diagnosis with other clinical entities: trauma, neoplasms, endocranial hypertension and intracranial infections like venus thrombosis of the lateral sinus, epi and subdural abscesses. In this communication we rank the early recognition of the clinical manifestations of this rare complication to sensitize the professionals for its diagnostic and therapeutic approach timely and adequate.

The historic data series on AIDS in the state of Ceará, Brazil / Série histórica da AIDS no Estado do Ceará, Brasil

This study describes the historic records on AIDS in the Brazilian state of Ceará, with analysis by gender, age group and race. It is a descriptive, retrospective, ecological study, analyzing 7,896 notifications of cases of AIDS, of people aged 13 and above, resident in the Ceará, over the period 2001 through 2011. Percentage occurrences and other data were calculated based on the variables gender, age group and race. Average and comparison tests were made, considering p < 0.05 and the trend line. There is a progressive increase in the number of cases. The majority of cases are in men. The ratio between the sexes falls from 2003 through 2007, but the number of women is still lower overall in the period. Higher rates of occurrence were found between the ages of 30 and 39, and of those with black-white mixed-race skin color (80%). Based on the variables studied in the series that was analyzed, the results indicate a need for differentiated strategies in prevention and control of the disease in the state.

Objetivou-se descrever a série histórica da AIDS, no Ceará, relacionada a sexo, faixa etária e raça. Estudo ecológico, descritivo e retrospectivo, analisou 7.896 notificações de casos de AIDS, de pessoas ≥ 13 anos, residentes no Ceará, entre 2001 e 2011. Calculou-se a incidência dos casos, das variáveis sexo, faixa etária e raça. Realizaram-se testes de médias e comparações, considerando p < 0,05 e a linha de tendência. A taxa de AIDS revela o aumento progressivo do número de casos. Os homens detêm a maioria dos casos. De 2003 a 2007, verificou-se queda na razão entre os sexos, porém o número de mulheres mantém-se inferior no período. Maiores incidências foram verificadas nas idades entre 30 e 39 anos, e entre os de cor parda (80%). Mediante as variáveis estudadas na série analisada, aponta-se a necessidade de estratégias diferenciadas em prevenção e controle da doença no Estado.

L'otite sereuse chez l'adulte : demarche diagnostique et therapeutique

L'otite seromuqueuse (OSM) de l'adulte est une situation regulierement rencontree en consultation ORL. Le but de notre travail est de dicter a travers notre serie et une revue de la litterature une demarche diagnostique et therapeutique en presence d'une otite seromuqueuse de l'adulte. Patients et Methodes : Nous avons mene une etude retrospective sur une periode de 10 ans allant de 2002 a 2011. Ont ete inclus les patients de plus de 18 ans chez qui a ete porte le diagnostic d'otite seromuqueuse avec un suivi minimum de un an. Resultats : Notre population etait constituee de 53 patients. 60 des patients avaient des antecedents de traitement par radiotherapie du massif facial. Vingt patients etaient suivis pour rhinite chronique. Tous les patients ont eu un examen ORL complet et un scanner des rocher dans tous les cas. 62 des patients ont eu un traitement medical. 92 de nos patients ont ete operes; 17 patients ont eu une regression complete et persistante dans le temps. Discussion : le diagnostique etiologique d'une otite seromuqueuse chronique de l'adulte passe par un examen ORL complet; suivi d'un scanner injecte des rocher. Le traitement n'est pas clairement codifie

Korean Clinical Practice Guidelines: Otitis Media in Children

Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media.

Alterações condutivas em neonatos que falharam na triagem auditiva neonatal / Conductive impairment in newborn who failed the newborn hearing screening

In newborn hearing screening little importance is attributed to changes in the middle ear. Children with secretory otitis in the neonatal period are at risk for developing otitis media in the first year of life. AIM: To determine if children who failed the hearing screening because of conductive hearing loss have more episodes of conductive hearing impairment during their first years of life. MATERIALS AND METHODS: The study group comprised 62 children who failed the screening for conductive impairment. The control was made up of 221 who passed. Both had audiologic and otolaryngological assistance and were compared regarding the occurrence of conductive disorder. Were used the Fisher's Exact test for statistical analysis and logistic regression models. The study was prospective and retrospective. RESULTS: Children who failed the screening by conductive disorder had more episodes of otitis media during the first year of life than those who did not fail, with statistically significant difference. CONCLUSION: Infants who failed the screening in the first month of life for conductive alteration are more likely to experience otitis in the first year of life. The high incidence of otitis indicates the need for joint action with otolaryngologist for diagnosis of such changes.

Na triagem auditiva neonatal pouca importância é atribuída às alterações de orelha média. As crianças que apresentam otites secretoras no período neonatal são de risco para desenvolver otite média no primeiro ano de vida. OBJETIVO: Verificar se as crianças que falharam na triagem auditiva por alteração condutiva têm mais episódios de comprometimento condutivo durante o primeiro ano de vida. MATERIAL E MÉTODO: O grupo estudo foi constituído por 62 crianças que falharam na triagem por comprometimento condutivo. O controle foi formado por 221 que passaram. Ambos tiveram acompanhamento audiológico e otorrinolaringológico e foram comparados quanto à ocorrência de comprometimento condutivo. Foram utilizados para análise estatística o teste Exato de Fisher e modelos de Regressão Logística. O estudo foi prospectivo e retrospectivo. RESULTADOS: As crianças que falharam na triagem por comprometimento condutivo tiveram mais episódios de otite média durante o primeiro ano de vida do que as que não falharam, com diferença significante. CONCLUSÃO: Os neonatos que falharam na triagem no primeiro mês de vida por alteração condutiva têm maior chance de apresentarem otite no primeiro ano de vida. A elevada ocorrência de otite indica a necessidade da atuação conjunta com otorrinolaringologista para o diagnóstico de tais alterações.

Aspectos diagnósticos da otite média com derrame na faixa etária pediátrica: [revisão] / Diagnostic aspects of otitis media with effusion in children: [review]

OBJETIVOS: apresentar e discutir aspectos diagnósticos da otite média com derrame (OMD) na prática clínica da atenção primária à saúde. MÉTODOS: foram pesquisadas as bases de dados Medline, Lilacs e SciELO (1994-2004). Identificados 523 artigos, dos quais 30 foram considerados para o presente trabalho. RESULTADOS: os estudos revelaram disparidade entre as definições, inconsistência no quadro clínico e falta de padronização dos critérios diagnósticos. Isto contribuiu para a inadequação diagnóstica da OMD. As evidências que levaram ao diagnóstico de efusão foram: a) pelo menos duas anormalidades do tímpano relacionadas à coloração, opacificação e mobilidade; e/ou b) membrana timpânica (MT) tipicamente retraída, côncava, e com alteração da coloração; e/ou c) mobilidade reduzida ou ausente na otoscopia pneumática (OP). A OP mostrou ser mais acurada que a otoscopia simples (OS), sendo considerada como método de escolha para o diagnóstico clínico da OMD. Quando houver dúvida na otoscopia pneumática, pode-se indicar a timpanometria, que aumenta a acurácia deste diagnóstico. CONCLUSÕES: na prática clínica, o diagnóstico da OMD deve ser realizado, primariamente pela otoscopia pneumática, em toda criança com suspeita de OMD. Em caso de dúvida deve-se indicar a timpanometria.

OBJECTIVES: to present and discuss diagnostic aspects of middle ear infection with effusion at a primary health care clinic. METHODS: research was carried out using the Medline, Lilacs and SciELO databases (1994-2004). Five hundred and twenty-three articles were found, of which 30 were considered for this review. RESULTS: the study revealed considerable disparity with regard to definitions, inconsistency in terms of clinical profile and a lack of standardization of diagnostic criteria. This has contributed to inadequate diagnosis of otitis media with effusion (OME). Evidence leading to a diagnosis of effusion were: a) at least two eardrum abnormalities relating to discoloration, darkening and mobility; and/or b) tympanic membrane (MT) typically retracted, concave, and with altered coloration; and/or c) reduced mobility or absence of mobility on pneumatic otoscopy (PO). The PO was shown to be more accurate than simple otoscopy (SO), which is considered the method of choice for diagnosis of OME. When the pneumatic otoscopy is inconclusive, tympanometry may recommended, as this increases the accuracy of the diagnosis. CONCLUSIONS: in clinical practice, diagnosis of OME should be carried out principally by way of pneumatic otoscopy, to which all children suspected of having OME should be submitted. Where there is doubt, tympanometry is recommended.

Otitis media con efusión / Otitis media with effusion

La Otitis Media con Efusión, (OME) es un proceso inflamatorio crónico del espacio del oído medio caracterizado por la acumulación de líquido seroso o mucoide, en ausencia de signos o síntomas de enfermedad aguda como fiebre o dolor. El objetivo del capítulo es presentar una revisión de la evidencia disponible relacionada con la epidemiología, etiología, diagnóstico clínico y tratamientos médicos y quirúrgicos para ayudar en la toma de decisiones frente al paciente.

The Otitis Media with Effusion, (OME) is a chronic inflammatory process of the space of the middle ear, characterized by the accumulation of serous liquid or mucoide secretion, in the absence of signs or symptoms of acute disease like fever or pain. The objective of the chapter is to present a revision of the evidence available related to epidemiology, aetiology, clinical diagnosis and medical and surgical treatments to help in the decision making in front of the patient.

Gradiente y ancho del timpanograma en niños de 4 a 6 años / Tympanogram gradient and width in Children 4 to 6 years-old

Background: Impedanciometry is a sensitive test that allows the diagnosis of intratimpanic efusion. Both tympanogram gradient (TG) and tympanogram width (TW) can be obtained from it. Usually, international reference values for these variables are used, but their distribution in chilean pediatric population remains uncertain. Objective: Establish normal values for these parameters in chilean children 4 to 6 years-old. Method: This study was performed at the Otorhinolaryngology Service of Hospital Militar in Santiago, contemplating all chilean army personnel children, both sexes, 4 to 6 years-old who assisted to the center between March and June 2003. 180 children were evaluated by anamnesis, otoscopy, audiometry and impedanciometry. Results: Normal values for TG were determined with a 95 percent confidence interval. These were 0,21 to 0,62 for girls and 0,22 to 0,57 for boys. Percentiles were determined for TW, where its normal value can be estimated in our population by means of its inverse, with significative correlation with TG. Conclusions: These normal values will improve impedanciometry accuracy in the diagnosis of intratimpanic effusion, at the moment based on timpanometric shape and compliance peak.

Introducción: La impedanciometría es un estudio sensible para la pesquisa precoz de efusión intratimpánica que permite obtener las variables gradiente (GT) y ancho del timpanograma (AT). Generalmente, se utilizan valores de referencia internacionales de dichas variables para este propósito, pues se desconoce su distribución en la población pediátrica chilena. Objetivo: Establecer valores de normalidad de estos parámetros en niños chilenos entre 4 y 6 años. Pacientes y Método: Este estudio se realizó en el Servicio de Otorrinolaringología del Hospital Militar de Santiago. Población: todos los niños y niñas entre 4 y 6 años, hijos del personal del Ejército de Chile, asistentes al hospital entre marzo y junio de 2003. Muestra: 180 niños, evaluados mediante anamnesis, otoscopia, audiometría e impedanciometría. Resultados: Valores normales de GT: 0,21 a 0,62 en niñas y 0,22 a 0,57 en niños. Ambos con un intervalo de confianza de 95 por ciento. Para AT se determinaron percentiles y su valor de normalidad se estima mediante la correlación inversa existente entre GT y AT, que es significativa. Conclusión: Estos valores de normalidad aumentarán la precisión impedanciométrica en el diagnóstico de efusión intratimpánica, que actualmente, en Chile, se basa en la forma timpanométrica y peak de complianza.

Brain abscess due to Scedosporium apiospermum in a non immunocompromised child.

Scedosporium apiospermum is a filamentous fungi that commonly causes cutaneous infection. In certain circumstances, S. apiospermum can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited and the prognosis is poor. Early identification and treatment can decrease the mortality rate. Here we present a case of brain abscess with chronic suppurative otitis media, caused by S. apiospermum. This is the first such case report from Nepal. We could identify the organism only post mortem. We could not save the patient, probably due to delay in diagnosis.

Reflectometría acústica: un método objetivo para el estudio de efusión en el oído medio / Acoustic reflectometry: an objective method for the study of middle ear effusion

La efusión el oído medio es una de las patologías más frecuentes en pediatría, y requiere para su diagnóstico la confirmación de líquido en el oído. La timpanometría es el método objetivo más usado para confirmar efusión en el oído medio cuando la otoscopía es dudosa o alterada. La reflectometría acústica es un nuevo método que ofrece las ventajas de ser portátil, indoloro y de fácil manejo. Se estudiaron 104 niños entre seis meses y 18 años, a los que se les realizó timpanometría y reflectometría acústica con un total de 204 oídos evaluados, considerando como riesgo de efusión en el oído medio valores de ángulo de gradiente espectral entre 0 y 64º. Al comparar la reflectometría con la timpanometría (prueba estándar) se observó una especificidad de 99 por ciento, una sensibilidad de 57 por ciento, un valor predictivo positivo de 97 por ciento y un valor predictivo negativo de 75 por ciento. Estos resultados nos permiten recomendar a la reflectometría acústica como método objetivo para descartar con alta seguridad la presencia de líquido en el oído medio. Por sus ventajas sugerimos su implementación y utilización masiva en la población pediátrica, lo que ayudaría a un manejo más expedito y adecuado de la otitis media secretora.

Actualización en el manejo médico de la otitis media con efusión y la otitis media aguda / Update on the medical management of the otitis media with effusion and the acute otitis media

La otitis media con efusión y la otitis media aguda son dos patologías frecuentes en la población pediátrica. Existen diversas medidas costo-fectivas para su manejo que permiten optimizar los resultados. Si bien muchas de estas conductas se practican diariamente, la evidencia en torno a ello es escasa y muchas veces débil. Nuevas áreas de investigación sugieren que el screening es una medida efectiva, permitiendo identificar a sujetos de mayor riesgo. El uso de nuevas vacunas no esta recomendado de manera rutinaria.

Secreção na orelha média em lactentes - ocorrência, recorrência e aspectos relacionados / Secretion of middle ear in infants - occurrence, recurrence and related factors

OBJETIVO: O presente estudo objetivou avaliar a ocorrência e recorrência de secreção na orelha média e os possíveis fatores associados, em 190 recém-nascidos e lactentes observados nos 2 primeiros anos de vida, participantes de um programa de prevenção, detecção e intervenção interdisciplinar desenvolvido na Clínica de Educação para Saúde da Universidade do Sagrado Coração. MÉTODOS: Os recém-nascidos e lactentes foram submetidos mensalmente a anamnese, otoscopia, avaliação audiológica comportamental por meio de instrumentos sonoros e tons puros (audiometria pediátrica) e timpanometria. RESULTADOS: Os resultados revelaram que 68,4 por cento dos lactentes apresentaram um ou mais episódios de secreção na orelha média nos 2 primeiros anos, com maior recorrência para o sexo masculino. A idade de maior ocorrência foi entre 4 e 12 meses. Quanto mais cedo ocorreu o primeiro episódio, maior foi a probabilidade de recorrência. Os meses do ano de maior incidência foram de maio a agosto. Das variáveis estudadas, constatou-se que o período de aleitamento materno exclusivo atuou como um fator protetor. Quanto aos fatores de risco, verificou-se que a presença tabagismo passivo, refluxo gastroesofágico, alergia respiratória esteve relacionada à recorrência de efusão. CONCLUSAO: Os achados revelaram a importância do acompanhamento auditivo periódico para lactentes nos 2 primeiros anos de vida, considerando ser o período crítico para o processo de maturação do sistema auditivo, no qual privações sensoriais auditivas podem ser responsáveis por seqüelas para o desenvolvimento de fala e linguagem.

[Role of multi-frequency tympanometry in diagnosis of chronic middle ear ventilation problems]

Standard tympanometry provides a valuable tool for evaluating middle ear abnormalities although it often fails to distinguish different pathologies that effect the ossicular chain. Multi-frequency tympanometry [MFT] has made it possible. The aim of the present study was to evaluate the role of MFT for distinguishing chronic middle ear pathologies. This cross-sectional study was conducted on 60 patients. One ear was selected from each patient [60 ears] and was classified into 4 groups according to the type of their middle ear pathology adhesive otitis media; middle ear effusion; atelectasis and retraction pocket. The following parameters were elicited from MFT: static admittance, resonant frequency, and phase angle. The clinical results were compared with the operative findings. There is significant difference between resonant frequency and phase angle of 4 groups. No statistical correlation exists between phase angle and resonant frequency. The operative results of MFT are correlated with the operative findings. The most significant parameter derived from MFT to distinguish between the 4 groups seems to be the resonant frequency