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Abstract Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001). Conclusions The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of
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OBJECTIVE To assess changes in the demographic characteristics of patients with otitis media with effusion during the COVID-19 epidemic.METHODS This retrospective study analyzed cases of otitis media with effusion in the Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital.The cases were divided into two groups:a pre-Covid-19 group(from December 1,2018,to January 31,2019),and a Covid-19 group(from December 1,2022,to January 31,2023).Patient demographics including age,sex,ear side and audiology results were collected.Additionally,age composition ratio,sex composition ratio,disease-side ratio,and audiological results were analyzed.RESULTS A total of 1 872 patients were included in the pre-COVID group,with an average age of(30.45±23.17)years(949 males and 923 females).Among them,910 were children and 962 were adults.The Covid-19 group included 1 194 patients,with an average age of(48.31±18.92)years(623 males and 571 females).Among them,95 were children and 1 099 were adults.Statistical analysis of the data revealed that the overall age distribution of the disease was different between the two groups(Z=-20.820,P<0.001).There was a significant difference in the composition ratio of children to adults(χ2=546.838,P<0.001),with a significant decrease and increase in the prevalence rate of otitis media with effusion in children and adults,respectively,in the COVID-19 group.Compared to the pre-COVID-19 group,the proportion of cases in the age group of 7-18 years was significantly reduced in the children's group(Z=-5.641,P<0.001),and the proportion of prevalence increased significantly in the adult group aged 46-75 years(Z=-3.134,P=0.002).Additionally,there was a significant increase in the number of male patients in the Covid-19 group(χ2=5.15,P=0.023)when compared to the pre-COVID-19 group.CONCLUSION Compared to the pre-Covid-19 period,a significant change in the age distribution of otitis media with effusion was observed during the COVID-19 epidemic,with a significant decrease in the proportion of children and a signification increase in the proportion of adults.
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La otitis media con efusión (OME) se define como la presencia de líquido en la cavidad del oído medio, sin signos ni síntomas de infección. Es una patología frecuente en niños, alcanzando una prevalencia del 14,8% en población de 4 a 16 años y su patogenia en este grupo se encuentra ampliamente estudiada. Sin embargo, en adultos su prevalencia es baja y, consecuentemente, su patogenia y mecanismos están menos dilucidados. El objetivo de esta revisión es describir la fisiopatología de la OME en adultos, describir sus etiologías y proponer un algoritmo de estudio diagnóstico adecuado.
Otitis media with effusion (OME), is defined as the presence of fluid in the middle ear, with no signs of acute infection. It is a frequent pathology in children, with a prevalence of 14.8% in the population between 4-16 years old, and its pathology has been widely studied in this group. However, its prevalence in adults is low; therefore, the pathology and mechanisms are less elucidated. The aim of this review is to describe the physio-pathology of the OME in adults, its etiology, and propose an algorithm for the proper diagnosis of this disease.
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Humanos , Masculino , Femenino , Adulto , Otitis Media con Derrame/etiología , Otitis Media con Derrame/fisiopatologíaRESUMEN
Abstract Objectives To review the evidence pertaining to the association between cow's milk protein allergy and recurrent acute otitis media and otitis media with effusion. Methods The CENTRAL, Web of Science, EMBASE, MEDLINE, LILACS databases, and gray literature were searched. Results Four studies were included, identifying the prevalence rates: 0.2% of delayed speech due to chronic otitis media with effusion in 382 children with cow's milk protein allergy, 10.7% of cow's milk protein allergy in 242 children who underwent ENT procedures, 40% of cow's milk protein allergy in 25 children with recurrent otitis media with effusion and higher tendency to otitis media in children with cow's milk protein allergy of 186 children (1.5 + 0.6 vs. 0.4 + 0.1; p< 0.1). Conclusion Considering the characteristics and methodological variations of the identified studies, it is not possible to state that there is reliable evidence of an association between cow's milk protein allergy and otitis media.
Resumo Objetivo Revisar as evidências sobre a correlação entre alergia à proteína do leite de vaca e otite média aguda recorrente e otite média com efusão. Métodos As buscas foram feitas nas bases de dados Central, Web of Science, Embase, Medline, Lilacs e na literatura cinzenta. Resultados Quatro estudos foram incluídos, identificaram‐se as prevalências: 0,2% de fala atrasada devido a otite média com efusão crônica entre 382 crianças com alergia à proteína do leite de vaca, 10,7% de alergia à proteína do leite de vaca entre 242 crianças submetidas a procedimentos otorrinolaringológicos, 40% de alergia à proteína do leite de vaca entre 25 crianças com otite média com efusão recorrente e maior tendência à otite média em alérgicos à proteína do leite de vaca entre 186 crianças (1,5 + 0,6vs.0,4 + 0,1; p < 0,1). Conclusão Se considerarmos as características e variações metodológicas dos estudos identificados, não é possível afirmar a existência de evidência confiável sobre a correlação entre alergia à proteína do leite de vaca e otite média.
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Background: OME usually present because of the associated hearing impairment, defective speech and sometimes with a preceding history of fever and otalgia consequent on an episode of acute otitis media. Objective: The aim of the study was to evaluate adenotonsillectomy operation in children is effective to improve otitis media with effusion.Material & Methods:This was a clinical study done in the otolaryngology department of medical college for women and hospital, Uttara, Dhaka from January 2003 to December 2005 for three years. Children with 4 to 15 years of age admitted with chronic tonsillitis and enlarged adenoid having otitis media with effusion were included in the study. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22).Results:All of these patients underwent adenotonsillectomy operation and were followed up for up to six months. The overall success rate of resolution of middle ear effusion was 81% at six months post operatively.Conclusions:Our findings demonstrated that adenotonsillectomy operation is effective for the treatment of persistent otitis media with effusion due to chronic tonsillitis with enlarged adenoid.
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Abstract Introduction Otitis media with effusion (OME) is considered one of the most common disorders that affect children during the first years of life. There are many risk factors of persistent middle ear effusion; one of these risk factors is gastroesophageal reflux. Association between persistent OME and gastroesophageal reflux diseases (GERDs) could be explained by respiratory tract infections, insufficient ciliary clearance, and poor drainage of the Eustachian tube. Objective To investigate whether the control of gastroesophageal reflux plays a role in the management of persistent OME and decreases tympanostomy tube insertion Method A cross-sectional study was conducted on 50 children complaining of persistent OME. Their ages ranged between 5 and 12 years old. All children were subjected to full history taking, audiological assessment and 24-hour esophageal pH monitoring. The study group was divided according to pH results into two groups: GERD positives and GERD negatives. Result The prevalence of GERD in persistent OME was 58%. There were statistically significant differences in the hearing levels and middle ear condition before and after the treatment (p < 0.05). The percentage of improvement of children complaining of persistent OME after antireflux treatment was 52%. Conclusion Gastroesophageal reflux disease should be considered in patients with persistent OME. The administration of proton pump inhibitor (PPI) can set aside superfluous surgical treatment (such as tympanostomy).
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RESUMEN Introducción y objetivos : Determinar si el tipo de fisura labio palatina está asociada a mayor riesgo de alteración de la trompa de Eustaquio. Materiales y métodos : Se realizó un estudio descriptivo serie de casos con análisis inferencial de niños operados de fisura labiopalatina en el Hospital San Bartolomé durante el 2018 y 2019. Resultados : Se evaluó a un total de 48 pacientes a quienes se les realizó timpanometría, encontrándose 62,5 % varones (n=30) y 37,5 % mujeres (n=18) y la media de edad fue de 1,3 años, para determinar el tipo de fisura labiopalatina se usó la clasificación de Veau, el tipo más frecuente hallado fue Veau tipo III, con 62,5 % (n=30), siendo la menos frecuente Veau tipo I con 4,2 % (n=2). La evaluación de la función de la trompa de Eustaquio se realizó mediante timpanometría definiéndose como patológica la curva tipo B, en el grupo de estudio se encontró una prevalencia global de curvas tipo B de 66,7 % (n= 32), mientras que las curvas A y C, tuvieron 33,3 % (n=16). La probabilidad que el diagnóstico Veau IV tenga curvas tipo B de forma más frecuentes que los otros tipos, mediante la prueba Binomial fue significativo. (p=0,000038<0,05). Conclusiones : El tipo de fisura palatina mayormente asociado con alteración de la función del oído medio, expresado mediante curvas de timpanometría tipo B, es la fisura tipo IV según clasificación de Veau, esta relación es estadísticamente significativa.
ABSTRACT Introduction and objectives : The objective of this study is to determine if the type of cleft lip and palate is associated with a higher risk of alteration of the Eustachian tube. Materials and methods : A descriptive case series study was carried out with an inferential analysis of children operated on for cleft lip and palate at the San Bartolomé hospital during the years 2018 and 2019. Results : 48 patients with tympanometry were evaluated, 62.5% male (n = 30) and 37.5% female (n = 18), the mean age was 1.3 years. The type of cleft lip and palate was determined using the Veau classification, the most frequent type found was Veau type III: 62.5% (n = 30), the least frequent type was Veau I with 4.2% (n = 2). The evaluation of the function of the Eustachian tube was performed with tympanometry, defining the type B curve as pathological. In the study group, there was an overall prevalence of type B curves of 66.7% (n = 32), while type A and C curves were 33.3% (n = 16). The probability that the Veau IV crack type has an association with type B curves more frequently than the other types, using the Binomial test, was significant. (p = 0.000038 <0.05). Conclusions : The type of cleft palate that is most associated with impaired middle ear function, expressed by type B tympanometry curves, is type IV cleft according to Veau's classification, this relationship is statistically significant.
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Objective:To study the mechanism of Tongqi Powder in the treatment of Otitis Media with Effusion based on network pharmacology.Methods:TCMSP platform was used to screen out the effective components and targeted proteins of Tongqi Powder, and UniProt database was used to map the targeted genes of it. The related targets of Otitis Media with Effusion were obtained based on OMIM, DisGeNET, GeneCards and other databases, finding that the common target of Tongqi Powder and Otitis Media with Effusion was the predicted target, Then, a medicine- component-target-disease network was obtained by using Cytoscape software. Repeated targets were imported into the STRING platform to construct a PPI network of protein interactions. Go enrichment analysis and KEGG pathway enrichment analysis were performed on the target of Tongqi Powder by Metascape platform.Results:There were 37 effective components and 211 targets of Tongqi Powder, and the key active components included quercetin, kaempferol, luteolin, β-sitosterol, etc. There were 1 431 disease targets, 76 co-acting targets of Tongqi Powder and Otitis Media with Effusion, and the key targets included TNF, JUN, AKT1, etc. A total of 273 signal pathways were obtained by enrichment analysis.Conclusion:Tongqi Powder could suppress the development of Otitis Media with Effusion through AGE-RAGE, fluid shear stress, atherosclerosis, cancer pathway, IL-17, tumor necrosis factor and other signaling pathways.
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La otitis media crónica es una inflamación crónica del mucoendostio del oído medio y anexos, con o sin perforación de la membrana del tímpano, con o sin exudado. Según los datos obtenidos por la Organización Mundial de la Salud posterior al análisis de trabajos de investigación publicados, la prevalencia para Sudamérica y América Central se encuentra alrededor del 1,5%. El Paraguay no cuenta con un estudio similar al presente que haya sido publicado. Por tal motivo nos propusimos a determinar la carga de la enfermedad y las características sociodemográficas y clínicas de los pacientes con otitis media crónica operados en el Hospital de Clínicas en el período 2015-2019. Se realizó un estudio observacional, descriptivo de corte transverso, retrospectivo. De 41885 pacientes operados (9,42%) fueron pacientes de la Cátedra y Servicio de Otorrinolaringología y de estos, 274 tenían otitis media crónica, lo que representa el 6,94% del total de pacientes operados por la Cátedra y Servicio de Otorrinolaringología y el 0,65% del total de pacientes operados en el Hospital en el mencionado periodo de tiempo. Pudimos concluir que la otitis media crónica es una patología de alta prevalencia para el servicio de otorrinolaringología del Hospital de Clínicas, no obstante, representa una baja carga para la administración hospitalaria total.
Chronic otitis media is a chronic inflammation of the mucoendostium of the middle ear and annexes, with or without perforation of the eardrum, with or without exudate. According to data obtained by the World Health Organization after the analysis of published research papers, the prevalence for South America and Central America is around 1.5%. Paraguay does not have a study similar to this one that has been published. For this reason, we set out to determine the burden of the disease and the sociodemographic and clinical characteristics of patients with chronic otitis media operated at the Hospital of Clinics in the period 2015-2019. An observational, descriptive, cross-sectional, retrospective study was conducted. Of 41885 patients operated 9.42% were patients of the Chair and Department of Otolaryngology and of these, 274 had chronic otitis media, which represents 6.94% of the total of patients operated by the Chair and Department of Otolaryngology and 0,65% of the total of patients operated in the Hospital in the mentioned period of time. We could conclude that chronic otitis media is a pathology of high prevalence for the otolaryngology service of the Hospital of Clinics, however, it represents a low burden for total hospital administration.
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Otitis Media/epidemiología , PrevalenciaRESUMEN
Abstract Introduction: It is proposed that Helicobacter pylori can be responsible for the development of otitis media with effusion. Objective: The aim of this study is to investigate the prevalence of H. pylori in the adenoid tissue and fluid of the middle ear in patients who suffer from adenoid hyperplasia and otitis media with effusion in comparison with those who suffer from adenoid hyperplasia without otitis media with effusion. Methods: This is a case-control study that was carried out in 50 children of age 2-7 years old who were admitted with adenoid hyperplasia. Patients were divided into case and control groups. The study group included 25 patients with adenoid hyperplasia and otitis media with effusion and the control group included 25 patients with adenoid hyperplasia without otitis media with effusion. The patients in both groups underwent surgical adenoidectomy. For the case group we carried out myringotomy and placement of tympanostomy tube, and fluid samples were collected under sterile conditions. The samples were sent to the laboratory for polymerase chain reactions. Results: In the case group H. pylori was found to be positive in 18 samples of the middle ear fluid (70%) and in 1 polymerase chain reaction adenoid tissue sample (4%). In the control group H. pylori was positive in 3 samples of adenoid tissues (12%). There was no gender difference. Conclusion: H. pylori is one of the important bacteria that plays a role in the pathogenesis of otitis media with effusion. Whether adenoid tissue may be a reservoir for H. Pylori is unclear.
Resumo Introdução: Propõe-se que o Helicobacter pylori possa ser responsável pelo desenvolvimento de otite média com efusão. Objetivo: Investigar a prevalência de H. pylori no tecido adenoideano e no fluido da orelha média em pacientes com hiperplasia de adenoide e otite média com efusão em comparação àqueles com hiperplasia de adenoide sem otite média com efusão. Método: Este é um estudo de caso-controle feito em 50 crianças de 2 a 7 anos, com sinais e sintomas de hiperplasia de adenoide. Os pacientes foram divididos em grupo de estudo e grupo controle. O grupo de estudo incluiu 25 pacientes com hiperplasia de adenoide e otite média com efusão e o grupo controle incluiu 25 pacientes com hiperplasia de adenoide sem otite média com efusão. Os pacientes dos dois grupos foram submetidos a adenoidectomia e, no grupo de estudo, realizou-se também miringotomia com colocação de tubo de ventilação e amostras de fluidos foram coletadas sob condições estéreis. As amostras foram enviadas para o laboratório, para investigação por reação de polimerase em cadeia. Resultados: No grupo de estudo, houve positividade para H. pylori em 18 amostras do fluido de orelha média (70%) e uma amostra de tecido adenoideano foi positiva na reação de polimerase em cadeia (4%). No grupo controle, houve positividade para H. pylori em 3 amostras de tecido adenoideano (12%). Não houve diferença entre os gêneros. Conclusão: H. pylori é uma das bactérias importantes que desempenham um papel na patogênese da otite médica com efusão. Se o tecido adenoideano pode ou não representar um reservatório para H. pylori ainda necessita ser esclarecido.
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Humanos , Masculino , Femenino , Preescolar , Niño , Otitis Media con Derrame/microbiología , ADN Bacteriano/genética , Helicobacter pylori/genética , Infecciones por Helicobacter/diagnóstico , Estudios de Casos y Controles , Reacción en Cadena de la Polimerasa , Helicobacter pylori/aislamiento & purificaciónRESUMEN
Otitis media with effusion is a salient disease and its clinical symptoms are not so obvious to be noticed by parents or even doctors. Therefore early diagnosis and treatment are important as hearing deprivation in children can have effect on linguistic development of child. Methods: This retrospective study was conducted on children with hearing loss aged between 3-15 years presenting to ENT OPD of SMGS Hospital, for a period of 1 year from. Total of 100 children were included. Detailed history aand complete ENT examination was done. PTA and Impendance Audiometry was done. Results: The mean age was 7 years with male: female ratio of 1.8: 1. Hearing loss which was the chief complaint. Other complaints were aural fullness (38%) followed by otalgia (29%), poor attention (17%) and poor acaedemic performance(16%).Higher prevalence in males(59%) of OME as compared to females. About 30% patients showed congested drum suggestive of acute suppurative otitis media. Other findings noted were dull drum (20%), air bubbles (6%) and air fluid level (8%) all were suggestive of otitis media with effusion.. Pure tone audiometry revealed moderate hearing loss in 59% patients of otitis media with effusion whereas it was mild in 14 patients.Impedance audiometry revealed B type graph in 85% patients. Conclusion: To prevent delayed diagnosis which leads to development of this disease, parents must be informed about the preventable risk factors and symptoms of otitis media with effusion.
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Primary Ciliary Diskinesia (PCD) is a heterogeneous, rare genetic disease that can be present in up to 5% of the patients with recurrent respiratory infections. The underlying pathogenesis is disrupted ciliary function which results in delayed mucus transportation leading to chronic inflammation in the upper and lower respiratory tract. Almost all PCD patients have otolaryngologic manifestations, characterized by recurrent ear and sinus infections, chronic inflammation at this level, sensorioneural and conductive hearing loss, and sleep-disordered breathing. This article reviews the diagnostic and therapeutic aspects of these manifestations.
La Disquinesia Ciliar Primaria (DCP) es una enfermedad genética heterogénea rara que puede estar presente en hasta un 5% de los pacientes que presentan infecciones respiratorias a repetición. La patogenia es secundaria a una alteración de la función ciliar que a su vez provoca una alteración del transporte de moco, resultando en una condición inflamatoria crónica en la vía aérea superior e inferior. Las manifestaciones clínicas de la esfera otorrinolaringológica en los pacientes portadores de DCP están presentes prácticamente en la totalidad de los mismos, y se caracterizan por infecciones recidivantes de oídos y cavidades perinasales, inflamación crónica a este nivel, hipoacusia neurosensorial y conductiva, y alteraciones respiratorias durante el sueño. En este artículo se revisarán los aspectos diagnósticos y terapéuticos de dicho compromiso.
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Humanos , Niño , Adulto , Otitis Media/epidemiología , Sinusitis/epidemiología , Rinitis/epidemiología , Síndrome de Kartagener/epidemiología , Otitis Media/terapia , Rinitis/terapia , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/fisiopatologíaRESUMEN
SUMMARY OBJECTIVE To investigate the relations of T lymphocytes, cytokines, immunoglobulin E, and nitric oxide with otitis media with effusion (OME) in children and their clinical significances. METHODS Fifty children with OME treated in our hospital were enrolled in the study (observation group). Fifty healthy children were selected as control. The percentages of CD4+ and CD8+ T lymphocyte and CD4+/CD8+ ratio in peripheral blood, and the levels of cytokine (IL)-2, IL-4, IL-6, immunoglobulin E (IgE) and nitric oxide (NO) in peripheral blood and middle ear effusion (MEE) in both groups were detected. The correlations of these indexes with OME were analyzed. RESULTS The percentage of peripheral blood CD4+ and CD8+ levels, CD4+/CD8 ratio, IgE, and NO levels in the observation group were significantly higher than those in the control group (P < 0.01). In the observation group, the IL-2 and IL-6 levels, and IgE and NO levels in the MEE were significantly higher than those in peripheral blood (P < 0.01). In addition, in the observation group, the MEE IL-2 and IL-6 levels were positively correlated with peripheral blood CD4+/CD8+ ratio, respectively r = 0.366, P = 0.009; r = 0.334, P = 0.018. CONCLUSIONS The levels of peripheral blood CD4+ and CD8+ lymphocytes and MEE IL-2, IL-6, IgE, and NO levels are increased in children with OME. These indexes have provided significant clues for the diagnosis of OME in children.
RESUMO OBJETIVO Investigar as relações entre linfócitos T, citocinas, imunoglobulina E e óxido nítrico e a otite média com efusão (OME) em crianças e sua significância clínica. MÉTODOS Cinquenta crianças com OME tratadas em nosso hospital foram incluídas no estudo (grupo de observação). Selecionamos também 50 crianças saudáveis como controle. As porcentagens de linfócitos T CD4 + e CD8 + e a razão CD4+/CD8+ no sangue periférico, além dos níveis das citocinas IL-2, IL-4, IL-6, imunoglobulina E (IgE) e óxido nítrico (NO) no sangue periférico e de efusão no ouvido médio (MEE) de ambos os grupos foram medidos. A correlação desses índices com a OME foi analisada. RESULTADOS A porcentagem dos níveis de CD4+ e CD8 +, da razão CD4+/CD8+, de IgE e NO no sangue periférico do grupo de observação foram significativamente maiores do que no grupo controle (P < 0,01). No grupo de observação, os níveis de IL-2 e IL-6, IgE e NO em MEE foram significativamente maiores do que no sangue periférico (P < 0,01). Além disso, no grupo de observação, foi encontrada uma correlação positiva entre os níveis de IL-2 e IL-6 em MEE e a razão de CD4+/CD8+no sangue periférico, respectivamente, r = 0,366, P = 0,009; r = 0,334, P = 0,018. CONCLUSÃO Os níveis de linfócitos CD4 + e CD8 + no sangue periférico e IL-2, IL-6, IgE e NO em MEE são mais altos em crianças com OME. Esses índices forneceram evidências valiosas para o diagnóstico de OME em crianças.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Otitis Media con Derrame/sangre , Inmunoglobulina E/sangre , Linfocitos T CD4-Positivos , Citocinas/sangre , Linfocitos T CD8-positivos , Óxido Nítrico/sangre , Valores de Referencia , Membrana Timpánica/metabolismo , Estudios de Casos y Controles , Recuento de Linfocitos , Citometría de FlujoRESUMEN
Background: Adenoid hypertrophy (AH) is a common cause of upper airway obstruction in paediatric patients and can have a significant influence on the health of the child. Children who have hypertrophic adenoids often exhibit nasal obstruction, snoring, sleep apnea, otitis media with effusion and craniofacial abnormalities. The main objective of this study was to know the association between size of adenoids and occurrence of otitis media with effusion (OME) and to correlate the grades of AH by lateral nasopharyngeal radiograph and nasal endoscope.Methods: This was an observational cross-sectional study of 100 children who were diagnosed as chronic adenoiditis were studied clinically with relevant investigations. The digital X-ray nasopharynx lateral view and nasal endoscopic results of all the patients were analyzed and graded.Results: Mean Adenoidal-nasopharyngeal ratio for which OME was present was 0.72 which corresponds to X-ray grade 2. It was also found that 80.6% of X-ray grade 3 adenoids had OME and 100% of cases of endoscopic grade 4 adenoids had OME in either or both ears. 36 cases with grade 3 X-rays, 69% were in endoscopic grade 3 and 19.4% cases were shown to have complete choanal obstruction (grade 4).Conclusions: There is significant association between the size of adenoids and OME. The X-ray nasopharynx provides a more convenient method and nasal endoscopy is the gold standard method for determining whether the AH is clinically significant or not.
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Objective To observe the characteristics of secretory otitis media after radiotherapy for nasopha-ryngeal carcinoma(NPC) and analyze its related factors.Methods From January 2015 to January 2017,one hundred and eighty-four NPC patients with secretory otitis media after radiotherapy in the Fifth People's Hospital of Datong were selected as observation group,and 56 NPC patients without secretory otitis media were selected as control group.The time and location of secretory otitis media after radiotherapy for NPC patients were observed and recorded.The clinical data of the two groups were compared,and the related factors were analyzed.Results Of the 184 patients,67.4% patients were unilateral and 32.6% patients were double ears.Twelve months after radiotherapy,the highest incidence rate was 44.6% (82/184).Compared with the control group,the radiotherapy time of the observation group[(13.6 ± 4.8)months] was longer,the radiation dose[(72.7 ± 26.8) Gy] was greater,the proportion of the eustachian tube involvement(65.2% ),the T3-T4 phase of the tumor stage(55.4% ) and the atrophy of the palatine tensor muscle of the palatine velum more than or equal to 30% (63.0% ) were higher,and the differences were statistically significant (t=6.231,5.683,χ2 =8.944,5.527,7.198,all P<0.05).Logistic multivariate analysis showed that the radiation dose of more than 70Gy, palatine tensor muscle atrophy more than 30% , tumor T3 - T4 staging, eustachian tube involvement and radiotherapy time were the risk factors of secretory otitis media in NPC patients after radiotherapy. Conclusion The postoperative radiotherapy of NPC with secretory otitis media is often in one side.The risk factors are the time of radiotherapy,the dose of radiotherapy,the tumor stage,the involvement of the eustachian tube and the atrophy of the palatine tensor muscle.
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ABSTRACT Objective To analyze the incidence of otorrhea in the postoperative period of patients submitted to tympanotomy to place ventilation tube, and who did not protect the ear when exposed to water. Methods Open, randomized-controlled trial. Eighty patients submitted to unilateral or bilateral ear grommet tympanostomy were included and divided into two groups: Auricular Protection and Non-Protection to water during bathing and activities in water. Results In the first postoperative month, the Non-Protection Group presented a significant increase in the number of patients with otorrhea and in the incidence. Four patients of the Protection Group (11%) presented at least one episode of otorrhea in this period, representing an incidence of 0.11 (standard deviation ±0.32) episode/month, whereas in the Non-Protection Group there were 12 episodes (33%; p=0.045) and incidence of 0.33 (±0.48; p=0.02). Between the 2nd and the 13th postoperative months, there was no difference between groups. Seven patients in the Protection Group (20%) had at least one episode of otorrhea, representing an incidence of 0.04 (±0.09) episodes/month, while in the Non-Protection Group there were seven episodes (22%; p=0.8) and incidence of 0.05 (±0.1; p=0.8). Conclusion Patients who underwent ear protection when exposed to water had a lower incidence of otorrhea in the first postoperative month than those who did not undergo protection. From the second month, there was no difference between groups.
RESUMO Objetivo Avaliar a incidência de otorreia no período pós-operatório em pacientes submetidos à timpanotomia para colocação de tubo de ventilação e que não realizaram proteção auricular quando expostos à água. Métodos Ensaio clínico controlado, aberto e randomizado. Foram incluídos 80 pacientes submetidos à timpanotomia para colocação de tubo de ventilação unilateral ou bilateral, divididos em dois grupos: Grupo Proteção e Grupo Não Proteção auricular da água durante o banho e as atividades aquáticas. Resultados No primeiro mês pós-operatório, o Grupo Não Proteção apresentou aumento significativo tanto no número de pacientes com otorreia quanto na incidência. Quatro pacientes do Grupo Proteção (11%) apresentaram ao menos um episódio de otorreia neste período, representando incidência de 0,11 (desvio padrão ±0,32) episódio/mês, enquanto no Grupo Não Proteção ocorreram 12 episódios (33%; p=0,045) e incidência de 0,33 (±0,48; p=0,02). Entre o 2º e o 13º meses pós-operatórios, não houve diferença entre os grupos. Sete pacientes do Grupo Proteção (20%) apresentaram ao menos um episódio de otorreia, representando incidência de 0,04 (±0,09) episódios/mês, enquanto no Grupo Não Proteção foram registrados sete episódios (22%; p=0,8) e incidência de 0,05 (±0,1; p=0,8). Conclusão Pacientes que realizaram a proteção auricular quando expostos à água apresentaram menor incidência de otorreia no primeiro mês pós-operatório do que aqueles que não a realizaram. A partir do segundo mês, não houve diferença entre os grupos.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Adulto Joven , Otitis Media Supurativa/etiología , Otitis Media Supurativa/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Agua/efectos adversos , Ventilación del Oído Medio/efectos adversos , Otitis Media Supurativa/epidemiología , Complicaciones Posoperatorias/epidemiología , Natación , Factores de Tiempo , Baños/efectos adversos , Brasil/epidemiología , Modelos Logísticos , Incidencia , Factores de Riesgo , Resultado del Tratamiento , Estadísticas no Paramétricas , Dispositivos de Protección de los OídosRESUMEN
Abstract Introduction Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life. Objective To understand the benefit of this recommendation. Methods Observational study - retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression. Results We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51-2.85, p = 0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p = 0.5). Conclusion We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group.
Resumo Introdução A miringotomia para inserção de tubo de ventilação é a cirurgia otológica mais comum. Otorreia é uma complicação frequente deste procedimento e, para evita-la, a maioria dos cirurgiões recomenda evitar o contato com a água, pois acredita-se que isso possa afetar negativamente a qualidade de vida pós-operatória. Objetivo Verificar o benefício dessa recomendação. Método Estudo observacional - estudo de coorte retrospectivo, comparando a incidência de otorreia pós-operatória e seu impacto na qualidade de vida dos pacientes, em dois grupos de pacientes com crianças menores de 10 anos submetidas à miringotomia bilateral e colocação de tubo de ventilação para o tratamento de otite média crônica com efusão, entre maio de 2011 e maio de 2012. Um grupo recebeu cuidados de proteção contra a água após a cirurgia, o outro não. Os dados foram coletados através de entrevista telefônica, após um ano de seguimento (um ano após o procedimento). A exposição à água sem proteção foi considerada o evento de exposição. A incidência de otorreia e o impacto percebido na qualidade de vida foram as medidas de resultado. Os resultados foram comparados após a regressão logística. Resultados Incluímos 143 crianças: 116 não foram expostas à água sem proteção e 27 foram expostas. No grupo não exposto, 36,2% apresentaram pelo menos um episódio de otorreia, em comparação com 40,0% do grupo exposto. A razão de chances (odds ratio) para otorreia no grupo exposto foi de 1,21 (IC 95%: 0,51-2,85, p = 0,6). O impacto negativo na qualidade de vida foi relatado pelos pais de 48,2% nas crianças não expostas, em comparação com 40,7% no grupo exposto. Essa diferença não foi significante (p = 0,5). Conclusão Não verificamos um efeito benéfico sobre a incidência de otorreia ao recomendar a proteção contra a água após colocação de tubos de ventilação para otite média com efusão. Entretanto, tais medidas não parecem ter tido um impacto negativo na qualidade de vida.
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Humanos , Masculino , Femenino , Preescolar , Niño , Otitis Media Supurativa/etiología , Otitis Media Supurativa/prevención & control , Complicaciones Posoperatorias/prevención & control , Otitis Media con Derrame/cirugía , Agua , Ventilación del Oído Medio/efectos adversos , Otitis Media Supurativa/epidemiología , Portugal/epidemiología , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Modelos Logísticos , Incidencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Oído Medio/metabolismo , Prevención SecundariaRESUMEN
BACKGROUND: Otitis media with effusion (OME) is defined as middle ear effusion without acute signs of infection. OME usually resolves spontaneously; however, persistent OME may require the insertion of a ventilation tube. This study investigated risk factors for persistent OME in children who undergo ventilation tube insertion.METHODS: Children who were admitted to undergo ventilation tube insertion at Jeju National University Hospital between August 2015 and July 2016 were enrolled as the case group. Healthy children without persistent OME from August 2016 to July 2017 were enrolled as the control group. Baseline characteristics and predisposing factor data were collected using an interview questionnaire. Middle ear fluids were collected from the case group.RESULTS: A total of 31 patients underwent ventilation tube insertion. The mean age of the case group was 4.53 years, with a male-to-female ratio of 21:10. Twenty-nine (93.5%) children attended a daycare center, and 21 (67.7%) had experience with bottle feeding. Fifteen (48.4%) children in the case group and 3 (9.7%) in the control group first attended a daycare center at < 1 year of age (odds ratio=9.96; 95% confidence interval=2.44–39.70; p=0.001). No bacteria were found in middle ear fluid collected from the 31 operated children. Nasopharyngeal bacterial colonization was found in 13 (41.9%) and 17 (54.8%) children in the case and control groups, respectively.CONCLUSION: Earlier attendance at a daycare center was the only predisposing factor for ventilation tube insertion in our study. The aseptic nature of middle ear fluids found in children with OME highlights the efficacy of antimicrobial use.
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Niño , Humanos , Bacterias , Alimentación con Biberón , Estudios de Casos y Controles , Causalidad , Colon , Oído Medio , Ventilación del Oído Medio , Otitis Media con Derrame , Otitis Media , Otitis , Factores de Riesgo , VentilaciónRESUMEN
Objective To investigate the hearing outcome efficiency of tympanostomy tubes and when combined with adenoidectomy for otitis media with effusion treatment. Methods A systematic literature review of tympanostomy tubes and tympanostomy tubes combined with adenoidectomy were performed using PubMed, EMBASE,the Cochrane Library,MEDLINE,all of the included studies were randomized controlled trial. The quality of included studies was evaluated according to the Risk of Bias Table of the Cochrane Handbook. Data were analyzed with Review Manager 5.02 software. Heterogeneity was examined,and forest plot was drawn. Results All of the included 4 studies were randomized controlled trials. At 6 month follow-up patients,the tym-panostomy tubes and tympanostomy tubes combined with adenoidectomy had no difference in hearing improvement (WMD = 1.06,95%CI-0.18 ~ 2.29,P = 0.09). At 12 month follow-up patients,the tympanostomy tubes com-bined with adenoidectomy were better than tympanostomy tubes alone(WMD = 3.03,95%CI 0.91 ~ 5.14,P =0.005). Conclusions The meta analysis result reveals that tympanostomy tubes combined with adenoidectomy have an advantage in long term follow up time for hearing improvement in children's otitis media with effusion treatment.
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Objective To study the effect of intratympanic injection of triamcinolone acetonid on interleukin -4(IL-4) and interferon-gamma (IFN -γ) in patients with secretory otitis media.Methods 110 patients with secretory otitis media were selected , and they were randomly divided into the observation group and control group according to digital table ,55 cases in each group .All patients were treated with puncture in the tympanic cavity .The control group was injected with dexamethasone ,while the observation group was injected with triamcinolone acetonid . Two groups were treated for 2 times/week,continuous treatment for 1 month.Fasting blood samples were collected before and after treatment to determine serum IL -4 and IFN -γlevels.Results The total effective rate of the control group was 58.2%,which was significantly lower than 70.9% of the observation group (χ2 =4.68,P <0.05).After treatment,the serum levels of IL-4 and IL-4/IFN-γin the two groups were significantly decreased (t=4.698,10.262,3.924,4.264,all P<0.01).After treatment,the serum IFN-γlevels were significantly higher in the two groups(t=3.016,5.116,all P<0.05).Compared with the control group after treatment ,the serum IL-4, IL-4/IFN-γin the observation group decreased more significantly (t=3.082,2.971,all P<0.01).The serum IFN-γlevel increased significantly (t =2.142,P <0.05).Conclusion Triamcinolone acetonid intratympanic injection can significantly improve the efficacy in patients with secretory otitis media , and improve the balance of Th1/Th2.