Effect of γ-secretase inhibitor on middle ear ultrastructures in ovalbumin-mediated otitis media with effusion in rats / 中华耳鼻咽喉头颈外科杂志

Objective: To study the effect of the inhibitor of Notch signaling pathway-γ-secretase inhibitor DAPT on the ultrastructures of middle ear in the ovalbumin (OVA)-mediated allergic OME in vivo. Methods: Male Sprague-Dawley (SD) rats, weighing 250-300 g, were completely and randomly divided into three groups (5 rats, 10 ears in each group):(1)Control group(2)OME group(3)OME+DAPT group. Rats in the OME group underwent systemic and local sensitization by intraperitoneal and intratympanic injection of ovalbumin to make the model of OVA-induced OME. Rats in the control group were sensitized with PBS. On the basis of establishing the OME model, OME+DAPT group were intraperitoneal injected with DAPT (10 mg/kg) for seven consecutive days and were administered before intratympanic injection of ovalbumin. After the model was successfully established, endoscopy,H&E staining and scanning electron microscopy were used to study the histology and mucous-ciliary ultrastructures of the non-ciliated and ciliated mucosa in the middle ear of each group. One-way ANOVA and Tukey methods were used for statistical analysis. Results: H&E staining showed that the three groups had statistically significant differences in submucosal thickness both in non-ciliated and ciliated regions (non-ciliated area:(6.83±1.47)μm, (38.58±9.57)μm, (32.17±11.89)μm, respectively. F=107.9;cilia area:(26.69±3.22)μm, (30.41±6.75)μm, (26.76±4.06)μm, respectively. F=5.62,both P<0.01). The thickness of the submucosa in the non-ciliated area and the cilia area of the OME group were significantly thicker than that of control group (F=42.08 and 4.40,both P<0.05); the thickness of the non-ciliated area and the ciliated area in OME+DAPT group were reduced compared to OME group(F=1.55 and 2.77,both P<0.05). Scanning electron microscopy showed that the array of cilia on the middle ear mucosa was disorderly arranged and inversed, this phenomenon was relieved in the OME+DAPT group. The number of goblet cells in the control group, OME group, and OME+DAPT group were 9.87±1.92; 15.67±5.77; 10.33±1.99 respectively and the difference between them was statistically significant (F=11.43, P<0.01). The number of goblet cells in the OME group were significantly higher than those in the control group (F=9.00,P<0.01) and the number of goblet cells in the OME+DAPT group were decreased compared to those of OME group (F=8.41, P<0.01). Conclusions: The study demonstrates the pathological changes of the ultrastructure in middle ear in OVA-induced OME and the effect of the γ-secretase inhibitor on it. In OME group, the cilia are disorderly arranged and inversed, the number of goblet cell is increased and they are swelled which suggest the hypersecretion of the mucus. DAPT can regulate OVA-induced allergic inflammation and relieve pathological changes of ultrastructure in middle ear mucociliary transport system through alleviating submucosal inflammation, reducing the hypersecretion of goblet cell and the morphological damage of cilia through the Notch signaling pathway.

Animal model analysis of secretory otitis media based on characteristics of clinical symptoms of traditional Chinese and Western medicine / 中国中药杂志

Based on the characteristics of clinical symptoms of secretory otitis media in traditional Chinese and Western medicine,by reference to clinical diagnostic criteria,efforts were made to analyze and establish the Western medical diagnostic criteria and traditional Chinese medicine( TCM) syndrome differentiation criteria for secretory otitis media,and summarize the modeling methods and model characteristics of secretory otitis media animal models. According to the clinical diagnostic criteria and symptom characteristics,the coincidence degree between the existing animal models and clinical symptoms was evaluated,and its advantages and disadvantages were defined. On the basis of the statistical results,there were fewer methods for modeling secretory otitis media animal models,and only a specific relevant pathogenic mechanism could be revealed. Among them,the model with a higher coincidence degree was genetic engineering technology modeling and injection into the middle ear vesicles. The two modeling methods of bacterial factors highly coincided with the clinical symptoms of Western medicine,but both failed to reflect the TCM syndrome type. Therefore,establishing an animal model that simultaneously reflects the characteristics of clinical symptoms of secretory otitis media in traditional Chinese and Western medicine,and improving the evaluation criteria of secretory otitis media based on animal models are the main tasks of future studies on secretory otitis media.

La otitis media con efusión como un proceso infeccioso relacionado a la microbiota de la amígdala faríngea / Otitis media with effusion as an infectious process related to the pharyngeal amygdala microbiote / Otitis media com efusão como um processo infeccião relacionadocom o microbiota do faríngea amígdala

Introducción: la otitis media con efusión es una patología muy prevalente en la infancia, frente a la cual se suele indicar tratamiento médico no antibiótico por 90 días. En caso de no revertir, se indica colocación de tubos transtimpánicos, que puede acompañarse de adenoidectomía. La terapéutica suele mejorar la evolución pero la refractariedad de esta patología hace pensar que no es un proceso estéril. Existen estudios que demuestran la presencia de ADN bacteriano en la efusión. El mismo se encontraría junto con la presencia de ARN y proteínas, los cuales son indicadores de metabolismo y actividad bacteriana. Los agentes patógenos más frecuentes, productores de infección de oído medio, incluyen a Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis, entre otros, los cuales podrían ser los responsables de la refractariedad de esta patología frente al tratamiento no antibiótico...

Introduction: otitis media with effusion is a very prevalent childhood pathology, usually nonantibiotic medical treatment is indicated for 90 days as its treatment. If there is no improvement, transthympanic tubes are indicated, which may be accompanied by adenoidectomy. These treatments most of the times improve the evolution, nevertheless the refractoriness of this pathology, suggests that it is not a sterile process. There are studies that demonstrate the presence of bacterial DNA in the effusion. Also RNA and proteins were found in it, which indicates metabolism and bacterial activity. The most common pathogens involved in middle ear infections include Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, among others, which could be responsible for the refractoriness of this pathology to non-antibiotic treatment...

Introdução: a otite média com efusão é uma patologia muito prevalente na infância, contra a qual geralmente o tratamento médico não antibiótico é indicado por 90 dias. Se não for revertido, é indicada a colocação de tubos transtimpânicos, que pode ser acompanhada de adenoidectomia. A terapêutica geralmente melhora a evolução, mas a refração desta patologia, sugere que não é um processo esté- ril. Existem estudos que demonstram a presença de DNA bacteriano no derrame. O mesmo seria encontrado junto com a presença de RNA e proteínas, que são indicadores de metabolismo e atividade bacteriana. Os agentes patogénicos mais comuns que causam a infecção da orelha média incluem Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis, entre outros, que podem ser responsáveis pela refractariedade desta patologia quando o tratamento não antibiótico é indicado...

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.

Microorganisms present in discharging otitis media in a group of patients in Kathmandu.

Discharge from the ear is one of the commonest symptoms of infections of the ear. To study the major strains of bacteria encountered in ear discharges, this study was conducted from July 1999, to June 2001 in the microbiology laboratory of Om Hospital. A total of 115 patients, of 6-35 years of age clinically diagnosed as discharging otitis media were studied. In 60.9% single organism and in 26.08% two organisms were isolated. Results revealed that, Staphylococcus aureus (34.3%), Klebsiella pneumoniae (24.3%), Pseudomons aeruginosa (22.8%), Enterobacter sps (7.1%), Esch coli (4.3%), Citrobacter sps (1.4%), Proteus sps (1.4%), Acinetobacter sps (1.4%) and Pneumococci (1.4%) were the common organisms in the discharge. Candida albicans (2.8%) was the pathogen in two cases. In 27.8% of cases the causative agent was not demonstrated. About sixty percent (65.9%), 64.8% and 56.0% of the isolates were sensitive to amikacin, ciprofloxacin and gentamycin respectively.

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

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

comparison of medical treatment versus surgical treatment for the management of otitis media with effusion

This study is designed: To assess outcome of the two modes of treatment [medical and surgical] of otitis media with effusion in terms of their effectiveness and patient compliance, and to compare in terms of side effects and complications. Forty patients who fulfilled the inclusion criteria included in the study. They were divided into two groups by random allocation of medical or surgical mode of treatment. Thus each group consisted of twenty patients. The study was conducted in the Department of ENT Jinnah Hospital, Lahore. In Medically Treated Twenty patients effusion did not resolve in most of the cases, and recovered after some time during the follow-up period. In remaining twenty patients treated surgically, there was immediate improvement in hearing in most of the patients. Complications rate is more in surgical treatment as compared to medical treatment. But in spite of this, surgical treatment is better option in our set-up r egarding effectiveness and patient compliance

Secretory otitis media in adults

The otitis media with effusion is not very rare in adults. This study was carried out to find etiology and assess different modes of treatment of secretory otitis media in adults. It was a reterospective study carried out at Allied Hospital Faisalabad from Jan 1998 to Dec 2002. Total 20 patients 13 male [65 percent] and 7 females [35 percent] between 20 to 60 years of age. The mean age was 30 years. In 15 patients [75 percent] glue ear was bilateral and in 5 patients [25 percent] it was unilateral. Tympanometery was performed in all the 20 patients which showed type-B tympanogram in all subjects [100 percent]. The most common etiological factor was upper respiratory tract infection [61 percent]. The most common presenting symptom was conductive deafness [90 percent]. The most common sign was immobile tympanic membrane [77 percent]. The severity of the hearing loss in majority of the cases was moderate [60 percent]. The treatment modalities used in majority of patients were antibiotic [35 percent] followed by grommet insertion [30 percent]. The otitis media with effusion in adults must be properly investigated to rule out any grave pathology in nasopharynx and treated properly to avoid further complications of otitis media with effusion such as adhesions, perforation etc

Otite média tuberculosa: dificuldade diagnóstica / Middle ear tuberculosis: difficulty diagnostic

A Otite Média Crônica Tuberculosa tem sido relatada desde o século passado, porém ainda é nítida a dificuldade diagnóstica existente nos dias atuais. Relatamos um caso, no qual isso é facilmente detectado; apesar da suspeita diagnóstica de Otite Média Tuberculosa desde o início, a confirmação só foi obtida após várias biópsias. Ressaltamos, também, que apesar de termos realizado biópsias em sítios diferentes, como, pulmão e linfonodo, a única que se mostrou positiva para a tuberculose foi a biópsia de colón. Apesar da literatura informar que múltiplas perfurações timpânicas são um achado extremamente sugestivo de tuberculose, este não é um achado comum. Nestes casos, temos observado, ao invés de disacusia condutiva, disacusia sensorioneural profunda, e é este achado que nos tem sugerido a investigação de tuberculose em nosso meio. Após instituída a terapêutica específica de tuberculose, obtivemos a melhora e regressão do quadro em todos os órgãos (orelha, pulmão, linfonodo e colón), confirmando que, apesar das biópsias negativas de pulmão, linfonodo e também na orelha, a tuberculose encontrava-se em atividade nestes órgãos.

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

Otitis media serosa. Estudio comparativo de carbinoxamina-pseudoefedrina vs astemizol-pseudoefedrina / Otitis media serous. Compartive study of carbinoxamina-pseudoefedrina vs astemizol-pseudoefedrina

Se estudiaron 48 niños de 3 a 8 años de edad, de uno y otro sexo(30 varones y 18 mujeres), que asistieron a la consulta externa de otorrinolaringología del Hospital del ISSSTE de Nuevo Laredo, Tamaulipas y a la consulta privada de la Clínica de Alergia y Otorrinolaringología en Nuevo Laredo, Tamaulipas, del mes de noviembre de 1995 a abril de 1996. Algunos de los efectos secundarios observados en los pacientes tratados en el grupo A (carbinoxamina-P) fueron: sedación leve y en algunos casos hiperexcitabilidad e irritabilidad. Sin embargo, no fue necesario suspender la medicación o modificar la dosis. En el grupo B (astemizol-P) se observó solamente excitación e irritabilidad en algunos casos por hipersensibilidad a la pseudoefedrina. Es muy importante considerar que el tratamiento adecuado y oportuno en un paciente con otitis media serosa permitirá evitar secuelas que pueden causar, a largo plazo, un impacto significativo en el lenguaje y desarrollo intelectual del niño

Conducta en niños atópicos respiratorios sin respuesta al tratamiento habitual / What to do with respiratory atopic children with standard therapy failure

Las afecciones alérgicas constituyen la patología crónica más frecuente en la infancia. El tratamiento requiere una detección precoz y la interconsulta con el alergista en los tiempos adecuados. El objetivo del estudio es determinar el tiempo transcurrido desde el inicio del tratamiento por parte del pediatra y la consulta con el alergista en pacientes atópicos (asma, rinitis, otitis serosa, etc.) en los que el tratamiento habitual ha fracasado y la forma en la que llegaron a la consulta con el especialista. Se estudiaron retrospectivamente 70 niños atópicos con fracaso del tratamiento (falta de disminución de la ausencia escolar, del número de episodios y de su intensidad). Se consideró tratamiento habitual: asma: broncodilatadores, cromoglicato y cursos cortos de corticoides vía oral; rinitis: antihistamínicos, cromoglicato y corticoides inhalatorios; otitis serosa: anthistamínicos, corticoides y antibióticos reiteradamente. El tiempo entre el inicio del tratamiento y la consulta especializada fue de 37 meses en el conjunto de patologías; en asmáticos 33 meses; en riníticos 50 meses; en otitis serosa 52,7 meses. El 37,14 por ciento de los pacientes fueron referidos por otro paciente; 27 por ciento por su pediatra; 20 por ciento por otro especialista (todas las otitis serosas); 11,82 por ciento por médicos no tratantes y 3,2 por ciento por otras fuentes. El 51 por ciento no fue referido por sus médicos. El diagnóstico y el tratamiento inicial del síndrome alérgico debe ser realizado por el pediatra de cabecera. Es fundamental la información y la educación del paciente. Cuando el tratamiento habitual fracasa en un lapso prudencial (18 meses), se debe realizar la interconsulta con el alergista para determinar el alergeno causante de la sintomatología y la eventual instauración de la inmunoterapia

Otites média secretora: tratamento clínico / Otitis media with effusion: clinical treatment

É apresentado estudo de 100 casos de crianças com OMS bilateral. Foram excluídos 10 casos com dados incompletos e/ou duvidosos com abandono do tratamento ou do seguimento. Quanto a terapêutica utilizada, os pacientes foram divididos em cinco grupos: 1. Quimioterápico (sulfametoxazol + trimetoprima) + prednisona. 2. Prednisona isolada. 3. Antihistamínico ñ antibiótico ou quimioterápico. 4. Antibiótico ou quimioterápico isolado. 4. Assepsia nasal. O critério para a escolha do tratamento foi baseado no quadro clínico, idade e fatores coadjuvantes. Os resultados foram tabelados quanto a idade, freqüência de otites, presença de obstruçäo de vias aéreas superiores, otoscopia e terapêutica. Foi demonstrado que uma grande porcentagem obteve cura com tratamento clínico (76,6%) e apenas 16,6% necessitaram tratamento cirúrgico (timpanotomia com colocaçäo de tubo de ventilaçäo). O trabalho fortalece a idéia do valor do tratamento clínico precedendo qualquer indicaçäo cirúrgica, discutindo-se o uso de quimioterápicos, antibióticos, antihistamínicos e costicosteróides associados ou näo entre si

Otitis media con efusión / Otitis media with effusion

Se efectuá una revisión retrospectiva de 205 pacientes con OME que atendimos de 1982 a 1983 y a quienes se les dió un seguimiento de dos a tres años. Durante este lapso se diagnosticaron 285 episodios de OME. Se observó una predominancia masculina de 1.5:1 y una incidencia de 49.8% durante la niñez. El 93.6% de los pacientes presentó uno o dos episodios de OME. La incidencia de los casos no varió con relación a los meses del año. La mayoría de los casos (152 pacientes), respondieron en forma satisfactoria al tratamiento médico; 133 casos requirieron de intervención quirúrgica para su mejoría; en 110 pacientes insertamos tubos de miringotomía. No se detectó ventaja alguna con la utilización de uno u otro tubo de miringotomía. El 77.8% de los tubos insertados emergieron espontáneamente, antes de los 9 meses. La más importante complicación fue la supuración ótica, que siempre respondió satisfactoriamente al tratamiento con medicamentos tópicos