Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial / Proteção auricular da água em pacientes com tubo de ventilação em membrana timpânica: ensaio clínico randomizado

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.

Water protection after tympanostomy (Shepard) tubes does not decrease otorrhea incidence - retrospective cohort study / Proteção contra a água após colocação de tubos de ventilação (Shepard) não diminui a incidência de otorreia - estudo retrospectivo de coorte

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.

Otorrea en lactantes y niños. Estudio descriptivo de 72 casos / Otorrhea in infants and children. A descriptive study of 72 cases

Las enfermedades del oído medio representan la causa más frecuente de otorrea en la infancia. En nuestro medio, la persistencia de la misma determina la consulta especializada al otorrinolaringólogo. Objetivo: Determinar las características clínicas y las causas de otorrea en la infancia en nuestro medio. Pacientes y métodos: Estudio prospectivo, longitudinal y descriptivo durante 5 meses en un servicio de ORL de un hospital pediátrico durante los meses de septiembre 2015 a Febrero 2016. Se evaluaron 74 niños derivados por primera vez al otorrinolaringólogo por presentar otorrea. Se realizó otoaspiración, otomicroscopía y demás prácticas diagnósticas y terapéuticas. Resultados: Se incluyeron 72 niños en el estudio. El 41.7% niñas y el 58,3% varones. La edad media fue 36 meses (rango 3-179 meses). El motivo de consulta predominante fue la otorrea purulenta. El tiempo medio de otorrea fue 13 días (rango 1-180 días). El 61,1% de los pacientes estaba recibiendo tratamiento antimicrobiano empírico. El 78% de los casos presentaron catarro de vías aéreas superiores (CVAS) previo al episodio de otorrea. Se diagnosticó otitis media crónica simple (OMCS) en el 48,6%, otitis media aguda supurada (OMAS) en el 33,3%, otitis externa (OE) en el 9,7%; otitis media crónica colesteatomatosa (OMCC) en el 2,8%; miringitis bullosa (MB) en 2.8% y, en 2 casos (2,8%), histiocitosis de células de Langerhans. Conclusiones: La otomicroscopía y la otoaspiración son elementos fundamentales para el diagnóstico causal de la otorrea en la infancia. Considerar la edad mediana, los signos y síntomas asociados es importante para el diagnóstico presuntivo diferencial. La otitis media aguda supurada y la otitis media crónica simple reagudizada son las causas más comunes de otorrea en la infancia (AU)

Diseases of the middle ear are the most frequent cause of otorrhea in children. In our setting, persistent otorrhea requires consultation with the otolaryngologist. Objective: To determine the clinical features and causes of otorrhea in childhood in our setting. Patients and methods: A 5-month prospective, longitudinal, descriptive study was conducted at the Department of ENT of a pediatric hospital between September 2015 and February 2016. Seventy-four children were evaluated for the first time by an otolaryngologist because of otorrhea. Aspiration, otomicroscopy, and other diagnostic and therapeutic procedures were performed.Results: 72 children were included in the study; 41.7% were girls and 58.3% boys. Mean age was 36 months (range, 3-179 months). The main reason for consultation was purulent otorrhea. Mean duration of otorrhea was 13 days (range, 1-180 days). Of all patients, 61.1% was receiving empiric antimicrobial treatment. Overall, 78% of the cases had had an upper resprtaory tract infection (URTI) prior to the episode of otorrhea. Simple chronic otitis media (SCOM) was diagnosed in 48.6%, acute otitis media (AMO) in 33.3%, external otitis (EO) in 9.7%, chronic cholesteatomatous otitis media (CCOM) in 2.8%, myringitis bullosa (MB) in 2.8%, and Langerhans cell histiocytosis in 2 cases (2.8%). Conclusions: Otomicroscopy and aspiration are fundamental tools in the diagnosis of otorrhea in children. Median age and the associated signs and symptoms are important in the differential diagnosis. Acute suppurative otitis media and acute episodes of simple chronic otitis media are the most common causes of otorrhea in childhood (AU)

Procesamiento bacteriológico y micológico de muestras de infecciones de vías respiratorias superiores: otitis media (OMA) y sinusitis / Processing specimens of upper respiratory tract infections for bacteria and fungi: otitis media and sinusitis

Las infecciones del tracto respiratorio superior son la causa infecciosa más frecuente de consulta al médico. En el caso de la otitis media y sinusitis aguda, los agentes etiológicos más frecuentes son S. pneumoniae, H. influenzae no "b" y M. catarrhalis; en tanto que en las formas crónicas aumenta la incidencia de anaerobios, bacilos gram negativos y S. aureus. La punción de oído medio y de senos paranasales se recomienda para casos puntuales como inmunocomprometidos, fracaso terapéutico, complicaciones supurativas, neonatos con otitis media, pacientes intubados con sinusitis y tal vez pacientes provenientes de áreas con alto porcentaje de cepas resistentes

Bacteriology of chronic suppurative otitis media and antibiotic sensitivity pattern of the bacteria isolated

Between November 1993 and March 1996, 185 ear swabs from patients with chronic suppurative otitis media were cultured. Bacteria could be isolated from 156 samples. Pseudomonas aeruginosa was the most common pathogen [54.5%] followed by Staphylococcus aureus [20.5%], Proteus sp [12.8%], Escherichia coli [10.9%] and Klebsiella sp [1.3%]. Quinolones and aminoglycosides were found to be the most effective antimicrobials in vitro, while amoxycillin, doxycycline and trimethoprim sulphamethoxazole were least effective and cephalosporins, augumentin and sulbactum-ampicillin showed intermediate effectiveness

Bacterias aisladas de exudados óticos en pacientes pediátricos / Bacteria isolated from otic exudates of pediatrics patients

En el período comprendido entre el 1 de junio de 1989 y el 30 de diciembre de 1992, se estudiaron 290 exudados óticos en pacientes, cuyas edades oscilaban entre 2 meses y 16 años. De acuerdo con los microorganismos aislados, se dividieron en tres grupos: grupo 1 :microorganismos provenientes de orofaringe (90 casos); grupo 2: bacilos Gram negativos no fermentadores y fermentadores de glucosa (166 casos) y grupo 3: flora mixta (38 casos). En el grupo 1 se encontraron los niños con diagnóstico de otitis media aguda con efusión y los microorganismos más halados fueron Haemophilus influenzae, Streptococcus pneumoniae y Streptococcus pyogenes. En el grupo 2 los microorganismos más hallados fueron Pseudomonas aeruginosa y proteus mirabilis solos o acompañados. En el grupo 3 se aisló flora mixta (se entiende cocos Gram positivos, bacilos Gram positivos, Bacilos Gram negativos por lo menos tres tipos de microorganismos

Etiología de la otitis media aguda supurada en niños en el CPAP Revisión prospectiva datos previos 1992-1994 / Etiology of supurative otitis in children. Review of previous data 1992-1994

Es un trabajo prospectivo, preliminar, realizado en el Centro de Pediátria Albina R. Patiño, donde se estudiaron 56 niños con Otitis Media Aguda Supurada, comprendidos entre las edades de recien nacidos y escolares, durante el periódo de Enero 1992 hasta la fecha, en cada uno de ellos se efectuó un cultivo y antibiograma de secreción ótica. Dentro de los resultados obtenidos el 71.4 por ciento (40 casos) corresponden al servicio de consulta externa, el restante de los casos dentro del servicio de Hospitalización. En relación al sexo hubo un predominio el masculino con 60.7 por ciento (34 casos); según la procedencia de los niños, el área periférica conto con un 62.5 por ciento (35 casos), seguida por las áreas urbana y rural. La distribuición por edad muestra un predominio de casos en el grupo de lactantes con 69.6 por ciento (39 casos) seguido por el grupo de pre-escolares con 19.6 por ciento (11 casos). Respecto al resultado de los cultivos: fueron POSITIVOS el 92.8 por ciento (52 casos) y NEGATIVOS el restante número de pacientes. El gérmen mas frecuentemente identificado fue la Echerichia COLI con 23.2 por ciento (13 casos) seguido del grupo de los Streptococos con 21.4 por ciento (12 casos) posteriormente el Staphylococo Coagulasa (-) (11 casos) y en cuerto lugar encontramos al Staplylococo Aureus con 9 casos.

Causative organisms of acute suppurative otitis media versus chronic suppurative otitis media

One hundred forty patients suffering from acute suppurative otitis media [60 patients, Group I] for the first time with perforation and chronic suppurative otitis media with acute exacerbation [80 patients, Group II] were studied. In group I Streptococcus was isolated from 30 cases and Staph. aureus was isolated from 20 cases. In group II Pseudomonas aeruginosa was isolated from 40 cases, Staph. aureus was isolated from 26 cases and Proteus was isolated from 10 cases. As regards the antibiotic sensitivity test, in group I, Cephalosporin inhibited 18 cases out of 30 cases of Strept. infection and all cases of Staph. aureus infection [20 cases]. In group II quinolone group antibiotics inhibited all cases of Pseudomonas infection [40 cases] and 8 cases out of 20 cases of Proteus infection while cephalosporin inhibited 22 cases out of 26 cases of Staph. aureus infection

Alterations of hearing after myringoplasty

Pre and postoperative hearing functions of 30 patients with successful myringoplasties were compared. A preoperative screening examination as well as an audiological evaluation were done. The tympanic cavities were thoroughly explored during the operation. A postoperative clinical and audiological follow-up for 3 months was carried out for ears with successful myringoplasties. Pure tone audiometry, tympanometry, and stapedial reflex were encompassed. A comparison was held between the clinical data and the different audiological measurements. The size and site of the perforation as well as the technique of tympanoplasty affect postoperative compliance but does not affect postoperative air-bone gap and hearing gain. Compliance should not be taken as an absolute criteria to a corresponding wide air-bone gap unless it is associated with an intratympanic pathology. Absence of stapedial reflex can be associated with normal middle ear function and normal sensory neural function

Otite média tuberculosa: estado atual / Tuberculous otitis media: current status

Cinqüenta pacientes com otite média crônica, em fase infectada, foram escolhidos aleatoriamente no ambulatório de Otorrinolaringologia do Hospital de Clínicas da UFPR, no período de 1989 a 1990. Nestes pacientes foram realizados testes para surpreender uma possível origem tuberculosa da otite crônica. Realizamos exames específicos para BAAR no material do ouvido, testes específicos para tuberculose, complementados com exames inespecíficos. Constatamos dois casos positivos para tuberculose de ouvido (4%), incidência nesta amostragem maior do que a apresentada pela literatura (0,9%)

Ear infection and infant feeding practices.

Feeding practices were studied in 128 infants aged 18 months and below with middle ear infection, belonging to the low socio-economic group. By the age of one year, 117 (91.4%) had acquired the infection. At the onset of the first episode, 105 (82.0%) were breast-fed, 42 not receiving any other milk. There were no differences in the feeding practices between infants who had single and those who had multiple episodes. Ninety-six infants were being given water by spoon or bottle and 42, semisolids by spoon. Among the 105 breast-fed infants, in 93 (88.6%), the infants' heads were often flat during feeding. In contrast, in the 86 infants on 'top' feeds 53 (61.6%) of the mothers said that they kept the infants' head raised during feeding. The difference was significant (x2 = 53.18, P less than 0.001). Mothers should avoid feeding infants with the latter's head flat, although the former may adopt any comfortable position.