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.

The Efficacy of Nasal Steroids in Treatment of Otitis Media with Effusion: A Comparative Study

Introduction Otitis media with effusion (OME) continues to be an important pediatric clinical problem, and more studies are needed to decide the proper treatment for it. Objective To assess the efficacy of nasal steroids in the management of OME by comparing its results with that of oral steroid and that of nasal saline spray as placebo. Methods This study was carried on 60 patients with OME who were divided into three groups: in group 1, 20 patients received mometasone furoate spray, one puff in each nostril daily, for 3 months; in group 2, 20 patients received oral prednisolone, 5 mg three times per day for the first 3 weeks; in group 3, 20 patients received nasal saline spray, one puff in each nostril daily for 3 months. Results A highly significant difference between systemic or topical (nasal spray) steroid therapy and saline nasal spray was detected (p < 0.001), and the difference between systemic and topical steroid was nonsignificant (p > 0.05). Conclusion Nasal steroid spray can be used as an effective treatment for OME, giving a significant result similar to systemic steroid. Further studies are needed to investigate its use for longer duration and in recurrent cases.(AU)

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.

Otitis media con efusión en pacientes con fisura palatina: comparación de estrategias terapéuticas / Otitis media with effusion in patients with cleft palate: comparison of treatment strategies

Introducción: La otitis media con efusión presenta una alta prevalencia en pacientes con fisura palatina, debido a una obstrucción funcional de la tuba auditiva. Dada su asociación con hipoacusia y una baja tendencia de resolución espontánea, existe controversia sobre la necesidad de instalar tubos de ventilación en estos pacientes. Objetivo: Comparar resultados anatómicos y audiológicos de dos estrategias de tratamiento. Material y método: Estudio de cohorte histórica en niños de 8 a 11 años con fisura velopalatina operada. La otitis con efusión de un grupo se trató con tubos de ventilación, mientras otro grupo tuvo un manejo conservador. La presencia de alteraciones timpánicas e hipoacusia se compararon entre ambos grupos mediante Xi cuadrado y test de Fischer. Resultados: Cincuenta y seis pacientes fueron reclutados, 24 en estrategia quirúrgica y 32 en conservadora. Todos los pacientes presentan una evaluación fonoaudiológica normal. Existe mayor frecuencia de retracción timpánica, perforación timpánica e hipoacusia de conducción en aquellos niños sometidos a una estrategia agresiva de tratamiento. Discusión: Existen mayores alteraciones timpánicas e hipoacusia en los pacientes sometidos a una estrategia de tratamiento quirúrgica, por lo que parece prudente realizar una evaluación individual y determinar la necesidad de cirugía de acuerdo a cada paciente.

Introduction: Otitis media with effusion (OME) is a frequent finding in patients with cleft palate due to a functional obstruction of the Eustachian tube. Because of its association with hearing loss and low rate of spontaneous resolution the use of ventilation tubes as treatment appears as beneficial The clinical and audiological consequences of this conduct areinot well established. Aim: To compare anatómical and audiologics results with two strategies of treatment. Material ana method: Historical cohort study of children from 8 to 10 years, with cleft palate, surgically corrected, and with OME. One group was treated with ventilation tubes, and an expectant management was carried out with the other group. The following parameters were compared by Xi-square test and Fischer: tympanic membrane state, presence of compiications and hearing level. Results: Fifty six patients were admitted, 24 in surgical management and 32 in conservative. Every child had a cleft palate corrected without velopharyngeal insufficiency It was found a higher frequency of tympanic membrane retraction, tympanic membrane perforation and hearing loss in the case groups were found. Discusion: We found a greater presence of tympanic alterations and hearing disorders in patients subjected to ventilation tubes as treatment of OME. It seems prudent to evalúate the surgical alternative individually according to each patient characteristic.

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.

Outcome of myringotomy with ventilation tube for otitis media with effusion in Thai children: Ramathibodi experiences.

OBJECTIVE: Study the otologic and audiologic outcome when using a ventilation tube (VT) for the treatment of otitis media with effusion (OME) in Thai children. MATERIAL AND METHOD: The medical records of twenty-three pediatric patients, 17 male and 6 female, aged 4 to 11 (mean age of 6.8 years), with the diagnosis of OME who attended the Department of Otolaryngology, Faculty of Medicine Ramathibodi Hospital, between January 2001 and December 2006 were reviewed. Seventeen (73.9%) patients had associated diseases, 26% with allergic rhinitis (AR), 21.7% with obstructive sleep apnea from chronic hypertrophic tonsillitis and adenoid hypertrophy (OSA), and 26% with cleft palate (CP). The audiometric with tympanometric assessment were done pre- and post-operative with mean of 47.3 and 294.2 days respectively. All children were treated with myringotomy and insertion of VT. Oto-microscopic examinations for tympanic membrane pathologic abnormalities were confirmed Post operative otorrhea cases were identified. The extrusion rates of VT were also recorded after the insertion. RESULTS: Twenty-three patients were enrolled in the present study. Mean air-bone gap was 18.24 (SD = 13.04) and 10.83 (SD = 8.26) before and after the operation respectively, and the difference was statistically significant (p = 0.0013). This could be interpreted that myringotomy with insertion VT could improve hearing by decreasing the air-bone gap dB. Having assessed the effect of associated diseases (i.e., AR, OSA, and CP) on differences of air-bone gap between before and after operation, the authors found that having AR, OSA, and CP did not statistically affect the results of the operation. However the mean differences of air-bone gap between before and after operation were quite different for AR versus non-AR (-11.58 vs. -5.78), and OSA versus the non-OSA group (-12.10 vs. -5.95). This might have the effects of the two factors but with this small sample size and thus low power could not detect the effect. Tympanometric pattern was mainly type B in the pre-operative (79.3%) and post operative (62.5%) period after tympanic membrane closure in both ears. Mucoid fluid in the middle ear cavity of both ears was detected during the operation in all patients. Post operative otorrhoea occurred in 16.7%. The mean of extrusion rate of VT was 307.2 +/- 204.7 days with maximum of 760 days. The mean duration of OME before surgery was 384.1 days. CONCLUSION: The effects of conventional VT in Thai children with OME could improve statistical significant hearing by decreasing the air-bone gap. The associated diseases (i.e., AR, OSA, and CP) did not statistically affect the results of the operation.

Comparison of adenoidectomy and myringotomy with and without tube placement in the short term hearing status of children with otitis media with effusion: a preliminary report

Otitis media with effusion [OME] is the most frequent indication for surgery in children. Some surgeons prefer to use adenoidectomy and myringotomy with tympanostomy tubes insertion to prevent the sequelae of the disease and also more improvement of hearing. The aim of this study is to compare adenoidectomy-myringotomy with adenoidectomy-myringotomy plus tympanostomy tube in the management of OME. Thirty children with OME [age range 4-8 year] were randomly assigned to receive adenoidectomy with myringotomy in one ear or adenoidectomy, myringotomy plus tympanostomy tube insertion in the other. The patients were subjected to auditory examinations 1 and 6 months post operation to evaluate hearing levels. The results showed no significant difference in hearing level improvement between these two methods of surgery. It is concluded that adenoidectomy with myringotomy is sufficient for management of otitis media with effusion in children in short term

Volume equivalente: um estudo em indivíduos com otite média crônica / Equivalent volume: study in subjects with chronic otitis media

O Volume Equivalente do Meato Acústico Externo está na faixa de 0,3ml a 1,0ml em crianças e 0,65ml a 1,75ml em adultos. Em indivíduos com Otite Média Crônica estes valores podem sofrer alterações, de acordo com as condições da doença. OBJETIVO: Estudar o volume equivalente de 52 orelhas de pacientes com Otite Média Crônica com e sem infecção ativa. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. MATERIAL E MÉTODO: O volume equivalente da orelha foi obtido em 52 orelhas com Otite Média Crônica, com e sem infecção ativa, e num grupo controle de mesma idade e sexo do grupo estudo. O grupo estudo com infecção foi avaliado antes e após tratamento clínico. RESULTADOS: A média do volume equivalente para os grupos estudos sem e com infecção e para o grupo controle foi, respectivamente, 2,86ml; 1,42ml e 0,80ml. A média do volume equivalente para o grupo estudo com infecção antes e após tratamento clínico foi, respectivamente, 1,42ml e 1,82ml. CONCLUSÕES: 1. O Volume Equivalente médio da Orelha é maior em pacientes com Otite Média Crônica. 2. Não foi observada variação no Volume Equivalente antes e após o tratamento clínico.

Timpanometria em pacientes com otite média secretora submetidos a tratamento com corticosteróide e manobras de insuflação / Tympanometric in patients with otitis media secretory subjected to corticosteroids treatment and autoinflation maneuver

O presente estudo tem por objetivo observar as variações timpanométricas ocorridas em pacientes com OMS submetidos a tratamento com corticosteróide por via spray nasal e manobras de insuflação. Foram estudados 33 pacientes com OMS. Todos foram avaliados através de imitanciometria na semana do diagnóstico e após tratamento, aos 15 e 30 dias da primeira avaliação. Das 66 orelhas avaliadas na primeira semana do diagnóstico, 42 (63,630) apresentavam curva B, 22 (33,33) apresentavam curva C e 2 orelhas (3,03) tinham curva A. Na última avaliação, apenas 17 orelhas (25,76) permaneciam com curva B, 26 (39,39) apresentavam curva C e 23 (34,85) tinham curva A. O tratamento com corticosteróides por via spray nasal combinado com manobras de insuflação pode ser boa opção terapêutica para o tratamento de OMS.

Adult-onset otitis media with effusion

This study was conducted to analyze the data concerning adult-onset otitis media with effusion [OME] in order to configure its clinical profile, etiology, diagnostic approaches, and therapeutic management. Design: A retrospective study. Materials and Sevety seven consecutive cases [105 ears] of OME were seen.All the patients were older than 16 years. Initial symptoms, physical examination, operative findings, underlying diseases, and therapy were analyzed. Hearing impairment [94.8.3%] was the most prevalent initial symptom, followed by ear stuffiness [54.5%]. The condition was bilateral in 39 patients [50.6%] and unilateral in 28 patients [49.4%]. Both mucoid and serous effusion occurred with predominance of the former. The most common two associated etiological conditions were sinusitis [22.2%] and nasopharyngeal malignancy [11.1%]. Other factors included adenoid, allergy, and nasopharyngitis. No etiological factor was detected in 10 patients [13%]. Sinusitis and nasopharyngeal carcinoma were the main associated etiologic factors OME in adults. In addition to treatment of sinusitis, nasopharyngeal check-up is mandatory in the management of adults with OME

Otitis media (secretora) con derrame y alergia. Estudio prospectivo en pediatría / Allergy and secretory otitis media: Prospective study in children

Antecedentes: los mecanismos y la respuesta alérgica en el oído medio y trompa de Eustaquio en niños son motivo de controversia. Estudios clínicos previos y nuevas evidencias de investigación en inmunología parecen orientar a que, efectivamente, la mucosa de estos órganos reacciona como otras áreas similares en la enfermedad atópica. Material y método: este estudio prospectivo en 80 niños se ectuó para demostrar que la evolución fue estadísticamente significativa en cuanto a la mejoría en niños que además del tratamiento quirúrgico específico para la otitis media con derrame, también completaron un periodo con inmunoterapia

Etiología de la otitis media supurativa en el Hospital Materno Infantil del Este "Dr. Joel Valencia Parpacen" / Etiology of the supurative otitis media at the Hospital Materno Infant of the east \"Dr. Joel Valencia Parpacen\"

Con la finalidad de conocer los agentes etiológicos bacterianos más frecuentes de la Otitis Media Aguda (OMA) en el Hospital "Dr. Joel Valencia Parpacen", de Petare, Edo. Miranda, se escogieron 26 pacientes, 84,61 por ciento varones y 15,39 por ciento niñas, distribuídos etariamente como 80,77 lactantes, 11,54 por ciento preescolares y 7,69 por ciento escolares. Por medio del cultivo de la secreción del oído medio de los pacientes se encontró que tanto el H. influenzae (16,,,32 por ciento) y el staf aureus (16,32 por ciento) compartieron el primer lugar, seguidos por el Stp pneumoniac (9,30 por ciento) y el Staf epidermides (9,30 por ciento).

Role of aspiration of middle ear effusions prior to ventilation tube insertion

The aim of this study was to assess the role of middle ear aspiration for clearance of middle ear prior to ventilation tube insertion. This work was done on 36 children aged from 4 to 13 years with bilateral middle ear effusion. They were assessed before surgery by clinical examination, pure tone audiometry and impedance audiometry. Each child underwent bilateral myringotomy with aspiration of the right ear only and bilateral insertion of ventilation tubes. Postoperative follow up of the children 24 hours, one week and 3 months by clinical examination, audiometry and tympanometry showed no significant difference between the ears [the aspirated and non-aspirated] as regard hearing improvement, presence and patency of tubes. So, routine aspiration of middle ear prior to ventilation tube insertion is not necessary to avoid hazards of aspiration

Diclofenaco potásico en el tratamiento de la otitis media aguda / Diclofenac potassium in the treatment of the acute otitis media

Se estudiaron 41 pacientes con diagnóstico de otitis media aguda (OMA) para evaluar la eficacia y tolerabilidad del diclofenaco potásico. Se distribuyeron aleatoriamente en dos grupos tratados con amoxicilina 50 mg/Kg durante 10 días, más diclofenaco potásico en un grupo y placebo en otro. Se evaluó la fiebre, otalgia y timpanograma antes de iniciar el tratamiento, al tercer y al sexto día. Se encontró una mayor remisión de la otalgia en el grupo de diclofenaco. No hubo ninguna diferencia en la reabsorción del líquido del oido medio entre los dos grupos. En ningún caso se presentaron efectos indeseables.