Otitis externa difusa: ¿una patología trivial?

Resumen La otitis externa es una patología frecuente en la consulta médica, se estima que 10% de las personas la padecerán al menos una vez en su vida, la presentación aguda cursa con afección del conducto auditivo externo de origen infeccioso en el 90% de los casos, llamada otitis externa difusa (OED). El presente artículo tiene como objetivo exponer la mejor evidencia actual que permita una descripción general de la patología, para ello se realizó una búsqueda de literatura científica en bases de datos reconocidas. Se encontró que la OED es caracterizada microbiológicamente por la presencia de Pseudomonas aeruginosa y Staphylococcus aureus, clínicamente los pacientes refieren otalgia lo que abre la puerta a una variedad de diagnósticos diferenciales y en el tratamiento se debe hacer una clasificación a partir de diversas variables (edad, compromiso auricular y estado inmunológico) a fin de determinar la vía terapéutica adecuada.

Abstract External otitis is a frequent pathology in the medical consultation, it is estimated that 10% of people will suffer it at least once in their life, the acute presentation compromises the external auditory canal of infectious origin in 90% of cases, called diffuse external otitis (DEO). The objective of this article is to present the best current evidence that allows a general description of the pathology, for which a search of scientific literature was carried out in recognized databases, finding that it was characterized microbiologically by the presence of Pseudomonas aeruginosa and Staphylococcus aureus, clinically, patients refer to otalgia generating a variety of differential diagnoses, and for treatment, a classification must be made based on various variables (age, atrial compromise, and immune status) in order to determine the appropriate therapeutic route.

Mucosal Grading And Its Use In The Management Of Chronic Otitis Media - Mucosal Disease

Aims and Objectives: This observational study is intended to identify the effectiveness of individual approach for each patient instead of a universal law of either Tympanoplasty alone or Cortical mastoidectomy with Tympanoplasty as a treatment for COM – mucosal type. Materials and Methods: This study comprises 100 consecutive patients who underwent surgery for the treatment of COM Mucosal type. We graded the Middle ear mucosa into six grades. All patients were followed up for a minimum of six months post operatively. Results:The graft uptake in our study was found to be 96% at the end of 6 months. Conclusion:Aconcomitant Mastoidectomy adds cost, surgical time and hospital stay to the patient among other things. However, Mastoidectomy should be done when there is evidence to suggest involvement of the mastoid compartment by the disease. The middle ear mucosa gives an indication of the disease status.

Usefulness of High Resolution Computed Tomography scans in depicting the status of the middle ear structures

Background: Prior to surgery it is very important that the surgeon is fully aware, and he should have the clear picture as to the extent of the disease and the nature of the disease to give satisfactory surgical outcomes for the patient. HRCT (High resolution computed tomography) is one such guiding tool for the surgeon. The objective was to study usefulness of HRCT scan in attico-antral disease in depicting the status of the middle ear structures.Methods: A total of 30 patients were studied. HRCT temporal bone was performed by using SIEMENS EMOTION 16 slice CT machine in axial plane and coronal images were reformatted. Findings of HRCT temporal bone were recorded. Findings of mastoid exploration surgery were recorded. Report of HRCT of temporal bone was correlated with surgical findings and tabulated using percentages.Results: Surgery showed cholesteatoma in 26 (86.6%) patients. Epitympanum was involved in 29 (96.6%) patients in HRCT and 30 (100%) patients at surgery. Extension beyond middle ear cleft was seen in 4 (13.3%) patients in HRCT and 5 (16.6%) patients at surgery. Tympanic segment of facial canal was the most commonly involved, showing erosion in 10 (33.3%) patients in HRCT and 12 (40%) patients at surgery. Lateral SCC was the most commonly involved in bony labyrinth seen in 4 (13.3%) patients in both HRCT and surgery. Erosion of dural plate was seen in 6 (20%) patients in HRCT whereas 9 (30%) patients showed dural plate erosion at surgery.Conclusions: HRCT of temporal bone plays a promising role in pre-operative assessment of cholesteatoma as it depicts the extent of the disease and integrity of most of the middle ear structures.

Autoimmune Inner Ear Disease Mimicking Bilateral Ménière's Disease: A Case Report / 대한평형의학회지

Autoimmune inner ear disease (AIED) is a rare disease, accounting for < 1% of all cases of hearing impairment or dizziness. It is characterized by sensorineural hearing loss (SNHL) or vestibular dysfunction that results from an immunemediated process. Clinical features of AIED is SNHL that progresses over weeks to month with fluctuating hearing symptoms. Because there are no diagnostic laboratory and clinical feature, response to immunosuppressive therapy were important for diagnosis of AIED. Many diseases such as sudden SNHL and Meniere disease may also mimic AIED, a broad differential must be maintained in patients suspected of having AIED. We report a case of a 46-year-old female who presented with sudden hearing loss and vertigo. We could diagnose her as AIED with systemic lupus erythematous. The symptoms were improved treated with steroids.

Presença de cerume impactado em deficientes mentais: análise de 400 pacientes / Presence of cerumen impaction in inttellectually disabled persons: analysis of 400 cases

Introdução: Cerume impactado pode causar sintomas como zumbidos, tontura, plenitude auricular e hipoacusia. Estima-se que de 2% a 6% da população adulta apresente cerume impactado ou em excesso, sendo maior a incidência em pacientes com deficiência mental. Este estudo visa avaliar a incidência de cerume impactado em 400 indivíduos com deficiência mental. Métodos: estudo de coorte, longitudinal e prospectivo. Fizeram parte desse estudo 400 pacientes com idade entre 13 e 51 anos, com diagnóstico de deficiência mental, associada ou não à deficiência física; considerando sexo, idade, grau de deficiência mental, deficiência física, presença de cerume e associação com alterações do meato acústico externo como otite externa aguda. Resultados: a presença de cerume impactado em orelha esquerda foi encontrada em 33,0% da amostra e em 32,75% em orelha direita. Em 31% dos indivíduos encontrou-se deficiência física e a paralisia espástica foi a de maior incidência (15,5%). Em relação ao grau de deficiência mental, a grave foi a mais incidente (41,5%). Entre os 165 pacientes com cerume impactado na orelha direita, 25,5% tinha deficiência física e 7,5% com otite externa aguda; e entre os 161 pacientes com cerume impactado na orelha esquerda, 27,3% e otite externa aguda em 8,25%. Conclusão: os indivíduos com deficiência mental possuem uma incidência de cerume impactado significativamente maior. Em ambas as orelhas, notou-se que quanto maior o grau de deficiência mental, maior a chance de cerume impactado e otite externa aguda.

Introduction: cerumen impaction can cause symptoms such as tinnitus, dizziness, ear fullness and hearing loss. It is estimated that from 2% to 6% of the adult population has impacted or excess cerumen, with a higher incidence in patients with mental deficiency. Objective: this study aims to evaluate the incidence of impaction cerumen in 400 individuals with mental disabilities. Methods: longitudinal and prospective cohort study. This study included 400 patients aged 13 to 51 years, with a diagnosis of mental disability, associated or not with physical disability; considering gender, age, degree of mental deficiency, physical disability, presence of earwax and association with external auditory canal alterations such as acute external otitis. Results: the presence of impacted earwax in the left ear was found in 33.0% of the sample and in 32.75% in the right ear. In 31% of the individuals found physical disability, spastic paralysis was the one with the highest incidence (15.5%). In relation to the degree of mental deficiency, the severe one was the most incident (41.5%). Among the 165 patients with impacted earwax in the right ear, 25.5% had physical disability and 7.5% had acute external otitis; and among the 161 patients with impacted earwax in the left ear, 27.3% and acute external otitis in 8.25%. Conclusion: mentally handicapped individuals have a significantly higher impact incidence of cerumen than the population. In both ears, it was noted that the higher the degree of mental deficiency, the greater the chance of impacted earwax and acute external otitis.

Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects / Avaliação da função da tuba de Eustáquio em pacientes com retração de membrana timpânica e em indivíduos normais

Abstract Introduction The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results. Objective To evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests. Methods An observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant. Results Mean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p = 0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p ≥ 0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction. Conclusion In this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction.

Resumo Introdução O diagnóstico das disfunções da tuba auditiva é essencial para o melhor entendimento da patogênese da otite média crônica. A literatura descreve uma série de testes que avaliam a função tubária; contudo, tais exames são metodologicamente heterogêneos, com diferenças que variam desde os protocolos de aplicação até a padronização dos exames e seus resultados. Objetivo Avaliar a variação na pressão na orelha média em pacientes com retração da membrana timpânica e em indivíduos normais durante os testes de função tubária e também avaliar a variação intraindividual desses testes. Método Estudo observacional do tipo transversal e contemporâneo, no qual o fator em estudo foi a variação na pressão na orelha média durante os testes de função tubária (manobra de Valsalva, Sniff Test e manobra de Toynbee) em indivíduos normais e em pacientes com retrações timpânicas leves e moderadas/graves. Foram incluídos 38 pacientes (76 orelhas). Os pacientes foram submetidos, em dois momentos diferentes, a testes de função tubária para determinar as medidas de pressão após cada manobra. A análise estatística foi feita com o programa SPSS, versão 18.0, e consideramos como estatisticamente significativos os valores de p < 0,05. Resultados A média ± desvio padrão da idade foi de 11 ± 2,72 anos; 55,3% dos pacientes eram do gênero masculino e 44,7% do feminino. A prevalência de curvas timpanométricas do tipo A foi mais alta entre os participantes com orelhas normais e naqueles com retrações leves, enquanto as curvas timpanométricas do tipo C foram mais frequentes no grupo com retrações moderadas/graves. Observamos pressões aumentadas na orelha média durante a manobra de Valsalva no primeiro momento da avaliação nos três grupos de orelhas (p = 0,012). A variação na pressão não foi significativa para o Sniff Test, nem para a manobra de Toynbee nos dois momentos de avaliação (p ≥ 0,05). Consideramos que a concordância entre as determinações obtidas nos dois momentos diferentes foi fraca a moderada para todos os testes nos três grupos de orelhas e as variações em termos de discrepância entre as medidas foram maiores nas orelhas com retrações timpânicas moderadas/graves. Conclusão Na população estudada, a média das pressões na orelha média apresentou variação significante apenas durante a manobra de Valsalva no primeiro momento de avaliação, nos três grupos de orelhas. As orelhas normais e aquelas que apresentavam retração leve se comportaram de maneira similar nos testes. As manobras testadas exibiram uma variação intraindividual fraca a moderada e a maior variação ocorreu nas orelhas com retrações moderadas/graves.

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.

The prevalence of chronic suppurative otitis media in children in Port Moresby public clinics

@#This prospective descriptive study aimed to determine the prevalence of chronic suppurative otitis media (CSOM) in children presenting to 5 urban clinics and the Children's Outpatient Department of the Port Moresby General Hospital. 395 children between the ages of 6 months and 12 years were included. 70 (18%) had some form of ear disease. Of the 28 children with CSOM (7%), 18 had unilateral and 10 had bilateral ear pathology. Only 8 of these children presented because of discharging ears. An additional 4 children had dry perforation, 1 had cholesteatoma and 2 had mastoiditis. The high prevalence of CSOM indicates that it is an issue of major public health importance. Risk factors for the development of CSOM were common in the children assessed. Prompt recognition of the problem and management by way of thorough and regular ear wicking should be stressed. Consideration should be given to making ciprofloxacin ear drops available. All clinics should have a functioning auriscope and front-line health workers should be trained to be able to diagnose and treat CSOM. Communities need education about the importance of early diagnosis and management of CSOM.

Local injection of the microRNA-146a recombinant lentiviral vector into the inner ear for immune-mediated inner ear disease in guinea pigs / 医学研究生学报

Objective Autoimmune inner ear disease is one of the inner ear diseases that can be effectively treated clinically, and researches on it have significant clinical and practical value.This study explored the immunoregulating and therapeutic effects of the mi-croRNA-146a recombinant lentiviral vector (RLV) on immune-medicated inner ear disease (IMIED) in guinea pigs so as to avoid the adverse reactions of the currently used immunodepressants. Methods IMIED models were established in 30 guinea pigs by immuni-zation with keyhole limpet hemocyanin and divided into three groups: microRNA-146a RLV, empty lentiviral vector ( ELV) control, and surgery simulation control, microinjected via the scala tympani with microRNA-146a RLV, ELV, and PBS, respectively.Before and after immunization and at 7 days after microinjection, the auditory function and the level of specific anti-KLH antibodies in the ser-um were measured by auditory brainstem response ( ABR) audiometry and ELISA, respectively.Seven days after microinjection, 3 ani-mals in each group were subjected to HE staining and light microscopy, another 3 to fluoro-autography for realizing the situations of the inner ear transfected by the lentiviral vector, and the other 4 to measurement of the contents of microRNA-146a in the inner ear tissue. Results Compared with the baseline, immunization significantly increased the level of specific anti-KLH antibodies in the serum (0.09 ±0.01 vs 1.90 ±0.74 in the RLV group, 0.11 ±0.02 vs 2.20 ±0.75 in the ELV group, and 0.11 ±0.02 vs 2.10 ±0.64 in the surgery simulation control) as well as the average threshold of the ABRⅢwave (left ear 11.67 ±2.58 vs 61.67 ±5.16 and right ear 12.50 ±2.73 vs 60.00 ±4.47 in the RLV group;left ear 14.16 ±3.76 vs 64.33 ±9.17 and right ear 13.33 ±2.58 vs 60.83 ± 4.92 in the ELV group;left ear 15.83 ±3.76 vs 64.17 ±10.2 and right ear 15.00 ±5.47 vs 62.50 ±9.35 in the surgery simulation control) .The average threshold of the ABRⅢwave was decreased after local injection into the inner ear as compared with that after immunization, with no statistically significant difference between the ELV and surgery simulation control groups.Fluoro-autographic ob-servation showed that the main parts of the inner ear transfected with microRNA-146a recombinant lentiviruses were the spiral limbus, spiral ganglion afferent fibers, basal cells of the spiral ligament, Corti organ, and psalterial cords.The immune inflammatory reaction of the inner ear was significantly reduced in the RLV group as compared with the ELV and surgery simulation control groups, while the content of microRNA-146a in the inner ear tissue was obviously increased in the former group than in the latter two. Conclusion The microRNA-146a recombinant lentiviral vectors are widely distributed and transfected in the inner ear tissue after injected via the scala tympani.Injecting recombinant microRNA-146a lentiviral vectors into the inner ear can significantly reduce pathological damage and auditory dysfunction caused by inner ear immune inflammatory reaction.

Demographic and Hearing Related Variables Important for Prediction of Disabling Hearing Impairment: A Community Based Survey.

Aim: The aim of this study was to estimate the prevalence of Disabling Hearing impairment and describe socio-demographic and hearing related risk factors as possible predictors of disabling hearing impairment. Study Design: This was a Cross-sectional and descriptive study Place and Duration of Study: A semi-urban district called Kumbotso in Kano state, Northern Nigeria. 3rd March 2013. Methodology: Data came from 58 participants, (39 females, 19 males; age range 5-50 years) who completed audiometric testing during the Ear diseases/Hearing impairment survey. Audiometric testing was performed on the participants, air-conduction hearing thresholds in decibels hearing level (dB HL) were obtained for each ear at frequencies of 0.5-4 kHz. Disabling Hearing loss was defined as pure-tone average of air conduction thresholds of ≥ 35dB HL for adults and children while identifying independent risk factors using logistic regression. Results: Out of 91 subjects, 58 subjects had pure tone audiometry giving a participation rate of 63.7% with a prevalence rate for disabling hearing loss of 31%. Controlling for gender, duration of hearing impairment, family history and relationship with subject with hearing loss, odds ratio for associations with Disabling Hearing impairment were 14.57 (95% CI: 2.14-99.44) for age and 61.55 (5.60-112.82) for aetiology of hearing loss. These variables particularly young age and ear diseases were the strongest predictors. Conclusion: Age, aetiology of hearing loss particularly, young age and the presence of ear disease are potential indicators for the development of disabling hearing impairment/loss during rural and/or community-based surveys.

Adenovirus-Mediated IL-10 Gene for the Treatment of Autoimmune Inner Ear Disease-an Experimental Study / 听力学及言语疾病杂志

Objective To evaluate therapeutic effects of transferring recombinant replication -defective ade‐novirus vector of interleukin 10(IL -10) gene into inner ear of guinea pig for the treatment of autoimmune inner ear disease .Methods The conspecific crude inner ear antigens (CIEAgs) were prepared and used to immunize guinea pigs with Freund's adjuvant that resulted autoimmune inner ear diseases (AIED) in 20 animals .Then they were ran‐domly divided into three groups .Through the way of round window membrane micro -injection ,adenovirus vector containing IL -10(Ad -IL -10) gene were implanted in group A(ten animals) ,recombinant adenovirus with yellow fluorescent protein(Ad -EYFP) marked was implanted in group B(five animals) ,and artificial perilymph were implanted in group C( five animals) .Seven days later ,auditory brain-stem response (ABR) thresholds were determined ,the guinea pig inner ears were obtained ,and the immunohistochemistry staining were perform for detec‐ting adenovirus vector transfection with immunofluorescence and the gene product interleukin 10 expressions with enzyme immunohistochemistry .Results Immunohistochemistry staining showed that the adenovirus carrying IL -10 gene could transfer the psalterial cord ,spiral ligament ,Corti organ ,spiral ganglion ,cochlear axis vessels and co‐chlear bone paries .It could generate gene product (IL -10 ) in same sites .The mean ABR thresholds were increased in each group after modeling .The differences were statistically significant .After injection of the inner ear ,the mean ABR thresholds of group A were lower than those of group B and group C .The light microscopic revealed the im‐munological inflammatory response were lighter than in group B and group C .Conclusion The adenovirus could transfer IL -10 gene into inner ear of guinea pig and express its products in many parts of inner ear .The immunity regulating gene can reduce the immunity damage and hearing functional impairment .

Gene Therapy of Inner Ear Injection with Bone -Marrow Mesenchymal Stem Cells Decorated with Interleukin-4 Gene on Immune-Mediated Inner Ear Disease in Guinea Pigs / 听力学及言语疾病杂志

Objective To evaluate the gene therapeutic effects of guinea pigs model with immune -mediated inner ear disease(IMIED)after locally injection of bone -marrow mesenchymal stem cells(BMSCs) decorated by in-terleukin-4 gene .Methods Guinea pigs were immunized with keyhole limpet hemocyanin (KLH) and caused 55 animal models ,divided into five groups ,each group with 11 animals :groupA(BMSCs carrier) ,group B(BMSCs emp-ty -carrier control group) ,group C(recombinent lentivirus IL -4 gene) ,group D(lentivirus empty -carrier control group) ,group E(simulation operation control group) .Groups were all injected with the corresponding suspension (20 μl)[includs BMSCs ceas of (1 .5~2 .0) × 106 ,the concentration of (entivirus) is 0 .5 × 108 pfu] by the scala tympani window into the inner ear .The fluorography immunohistochemistry test and enzyme immunohistochemistry test for the situation of IL -4 gene express and productive protein distribution in inner ear .Auditory functions and the KLH level of guinea pigs blood were monitored respectively by auditory brainstem responses (ABRs) and ELISA test .Results The threshold of ABR wave Ⅲ decreased in group A ,group B and group C .The result were more significant in group A and group B than that in group C ,but results in group A was more prominent (P<0 .05) . The results of immunohistochemistry test showed that fluorescence positive BMSCs mainly scattered in scala tymani and scala vestibule .The microscope results showed that for the group A ,B and C ,there were only few foccule and red and white blood cells in scala tympani floc ,but for group D and group E ,with different levels of labyrinthine hy-drops and some mononuclear cells around the spiral ganglion and small blood vessels .Conclusion Restructuring lentiviral vector with IL -4 gene can be successfully transfected into BMSCs in vitro ,compared to inplangting into inner ear in scala tympani approach ,the cells can migrate and generate gene product of IL -4 ,to significantly im-prove the auditory functions and inflammatory reaction of inner ear disease ,and BMSCs can be used as a carrier to migrate to the damaged part with therapeutic gene .

Pattern of Ear Diseases among Paediatric ENT Patient: An Experience from Tertiary Care Centre, Pokhara, Nepal.

Introduction: Ear diseases are common in children mainly due to altered anatomy of Eustachian tube which is straighter in children as compared to that in adults. However, the cause of hearing loss in children is more varied, including the etiologies. This study was done to find out the pattern of ear diseases in paediatric age group attending ear, nose and throat OPD in a tertiary care centre in Pokhara, Nepal. Materials and Methods: This is a prospective study done in paediatric patients attending ENT OPD over a period of one year from January 2010 to January 2011. The diagnoses were made on the basis of history and clinical examination. Results were expressed in numbers and percentages. Results: Out of 1632 Pediatric ENT patients, 944 had ear diseases, 59.2% were males and 40.8% females. Wax (33.4%) was the commonest diagnosis followed by Chronic suppurative otitis media (24.3%) and Acute ottitis media (13%). Conclusion: Ear diseases are most common condition in ENT OPD among paediatric age group. Wax, CSOM and ASOM were the three most common ear diseases.

Otoscopia: exame da orelha / Otoscopy: examination of ear

Otoscopia é o exame que permite ao médico avaliar o conduto auditivo e a membrana timpânica, além de diagnosticar enfermidades da orelha externa e da orelha média. A otoscopia, uma boa anamnese e um exame físico completo são fundamentais para o estudo das doenças da orelha. O presente trabalho faz uma revisão da otoscopia e de suas principais afecções.

Otoscopy is the examination of the external auditory meatus and the tympa nic membrane. It is used for the purpose of diagnosing diseases of the external and middle ear. The anmanesis and the clinical examination associated with ear examination (otoscopy) are essential in ear diaseases. The purpose of this study is to review the examination of the ear (otoscopy) and principal disease of the ear.

Otologic and Audiologic Characteristics in Children with Turner Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Turner syndrome (TS) is known to be caused by a total or partial deletion of one X-chromosome. Besides short stature and failure to enter puberty due to ovarian dysgenesis, auricular malformations, middle ear diseases and hearing impairment are also other clinical features of Turner syndrome. The goal of this study is to report otologic and audiologic characteristics in a group of children with Turner syndrome and correlate with these findings to karyotype. SUBJECTS AND METHOD: We retrospectively reviewed the outpatient charts of those who visited at our department for otologic and audiologic screening test between 2008 and 2011. All 23 TS children (46 ears) were enrolled under regular control of their pediatric endocrinologist for treatment with growth hormon and Estrogen. The mean age was 12.6 years (6-24 years). All children were evaluated by otologic history taking, otoscopy, pure tone audiometry and karyotyping. Furthermore, 16 children undertook auditory brain stem response (ABR) test and 10 children temporal bone computed tomography (CT). RESULTS: Abnormal otoscopic findings were found in 48% (22 ears), abnormal otologic history in 70% (16 children), and abnormal audiologic findings in 70% (32 ears). According to karyotyping, the total p-arm deletion group (74%) showed unfavorable audiologic results. ABR test and temporal bone CT did not show any unique findings, except five poor pneumatization of mastoid. CONCLUSION: Hearing impairment can be present at early age in Turner syndrome. Careful follow up during childhood is necessary to detect early ear and hearing problems for active intervention. Karyotype may be used as a predictor for future hearing impairment.

Model of immune-mediated inner ear disease and efficacy of dexamethasone by systemic application or round window administration / 上海第二医科大学学报

Objective To establish a model of immune-mediated inner ear disease(IMIED) and to compare the efficacy of dexamethasone between systemic application and round window adminstration. Methods The guinea pigs were injected with keyhole limpet hemocyanin(KLH) mixed with complete Freund's adjuvant subcutaneouly in the back,and were boosted with KLH mixed with incomplete Freund's adjuvant two weeks later.Meanwhile,a small piece of gelatin sponge full of KLH was delivered on the round window through operation.Thus established a model of IMIED.Micro-osmotic pumps were used to deliver dexamethasone through the round window(PBS control group also set),and systemic application was implemented by intraperitoneal injection.The efficacy was compared by recording auditory brain-stem response(ABR) before and after the treatment. Results None of the 6 guinea pigs in the control group experienced significant hearing loss,while 22 of the 39 guinea pigs in the experiment group suffered from hearing loss beyond 10 dB.Seventeen guinea pigs with hearing loss no less than 15 dB were divided into three groups randomly and were given different treatment.Those(n=6) treated by local application through the round window enjoyed the efficacy and the mean ABR threshold decreased 13.3 dB.Four out of the 6 treated by systemic application enjoyed the efficacy and the mean ABR threshold decreased 13.7 dB.No efficacy was observed in the PBS group. Conclusion The model of IMIED can be successfully induce by KLH through the round window,and dexamethasone administered through the round window is as efficacious as systemic application.

Recent trends in incidence and management of cleft lip and palate

Prognostic Implication of Associated Cleft Palate in Patients with Cleft Lip / 대한주산의학회잡지

OBJECTIVE: The objective of this study is to compare the pregnancy outcomes and postnatal developmental problems according to the types of cleft lip and/or palate, and to evaluate the increase of the risk of the presence of cleft palate. METHODS: Retrospective analysis was performed in 96 cases of cleft lip and/or palate that were delivered, aborted, or terminated at Seoul National University Hospital from January 1990 to July 2004. The cases of cleft lip and/or palate were categorized based on the Nyberg's classification, and cleft palate alone was added to it. According to the types, the frequencies of associated anomaly and chromosomal anomaly were assessed, and the frequencies of termination, spontaneous abortion, fetal death in utero, and infant death were compared. When long-term follow-up was possible among the surviving infants, we compared the frequencies of ventilatory tube insertion into the middle ear, hearing problem, and speech-language problem. We evaluated the increase of the risk in the presence of cleft palate. RESULTS: Associated anomalies were present in 23.7% (9/38) of cases with cleft lip alone and in 55.1% (32/58) of those with cleft palate. The most common associated anomaly was cardiac anomaly. The surviving infants with cleft palate showed significantly higher rates of ventilatory tube insertion (70.0% [14/20] vs 3.1% [1/32]) and speech-language problem (42.1% [8/19] vs 10.7 % [3/28]) than those with cleft lip alone. The presence of cleft palate increased the risk of occurrence of associated anomaly (OR 3.97), termination (OR 5.20), infant death (OR 12.96), ventilatory tube insertion (OR 72.33), and speech-language problem (OR 6.06). CONCLUSION: Associated cleft palate in patients with cleft lip has a poor impact on pregnancy outcomes, middle ear disease, and speech-language problem. Therefore, during the prenatal screening ultraso-nography, the careful examination should be directed for the detection of cleft palate in cases with cleft lip.