Medicine › Otorhinolaryngology

Ear Surgery and Otitis Media

Works Count: 52945

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Description

This cluster of papers focuses on the diagnosis, management, and complications of otitis media, including acute and chronic otitis media, middle ear infections, biofilm formation, eustachian tube dysfunction, cholesteatoma, and the impact on hearing loss. It also covers treatment methods such as tympanostomy tubes and bone-conducted sound for hearing rehabilitation.

Keywords

Otitis Media; Acute Otitis Media; Chronic Otitis Media; Middle Ear Infection; Hearing Loss; Tympanostomy Tubes; Biofilms; Eustachian Tube Dysfunction; Cholesteatoma; Bone-Conducted Sound

Epidemiology of Otitis Media in Children

1980-05-01

David W. Teele , Jerome O. Klein , Bernard Rosner

To determine the epidemiology of otitis media (OM) during the first three years of life, physicians participating in the Greater Boston Collaborative Otitis Media Program followed prospectively from birth 2,565 … To determine the epidemiology of otitis media (OM) during the first three years of life, physicians participating in the Greater Boston Collaborative Otitis Media Program followed prospectively from birth 2,565 children. At every visit we recorded results of pneumatic otoscopy and epidemiology data. By three years of age 71% of the children had had one or more episodes of acute otitis media including 33% who had three or more episodes. Features associated significantly with first episode of OM were: sibling with recurrent OM, race (white > black), and sex (male > female). Having a sibling with allergy disposed propositi to first episode. Features associated significantly with recurrent OM (≥ three episodes) were those noted above. A parent with recurrent OM disposed propositi to recurrent OM. Middle ear effusion (MEE) persisted for prolonged periods after OM; after the first episode of OM, 70% of children still had MEE at two weeks, 40% had fluid at one month, 20% had fluid at two months, and 10% had fluid at three months. The sole feature associated significantly with persistent effusion in the middle ear after the first episode of OM was the practice of giving a child a bottle in bed.

Evidence-based otitis media

1999-01-01

Richard M. Rosenfeld , Charles D. Bluestone

Part One Methodology 1. Critical Evaluation of Articles about Otitis Media 2. Design Considerations for Clinical Studies 3. Meta-analysis and Systematic Literature Review 4. Patient-Based Outcomes Research 5. Clinical Practice … Part One Methodology 1. Critical Evaluation of Articles about Otitis Media 2. Design Considerations for Clinical Studies 3. Meta-analysis and Systematic Literature Review 4. Patient-Based Outcomes Research 5. Clinical Practice Guidelines 6. Aftermath of the Otitis Media Clinical Practice Guideline Part Two Clinical Management 7. Definitions, Terminology, and Classification 8. Diagnosis 9. Epidemiology 10. Eustachian Tube Function and Dysfunction 11. Natural History of Untreated Otitis Media 12. What to Expect from Medical Therapy 13. What to Expect from Surgical Therapy 14. Prevention 15. Clinical Pathway for Acute Otitis Media 16. Clinical Pathway for Otitis Media with Effusion Part Three Consequences and Sequelae 17. Economic Costs and Consequences 18. Bacterial Resistance and Antimicrobial Drug Selection 19. Sequelae of Antibiotic Therapy 20. Tympanostomy Tube Care and Consequences 21. Impact of Otitis Media on Auditory Function 22. Impact of Otitis Media on Speech, Language, Cognition, and Behavior 23. Impact of Otitis Media on Child Quality of Life 24. Benchmarking Outcomes

Tympanometric Detection of Middle Ear Effusion in Infants and Young Children

1976-08-01

Jack L. Paradise , Clyde G. Smith , Charles D. Bluestone

Tympanometry, a test of middle ear status new to clinical pediatrics, was carried out on 280 subjects, 10 days through 5 years of age. The tympanograms obtained were compared with … Tympanometry, a test of middle ear status new to clinical pediatrics, was carried out on 280 subjects, 10 days through 5 years of age. The tympanograms obtained were compared with otoscopic findings and, in 107 of the subjects, with findings at myringotomy. Seven distinct tympanometric curve types were identified and defined, based on their degree of correlation with the presence or absence of middle ear effusion. In subjects 7 months of age and older, curves suggesting normal (high) tympanic membrane compliance in combination with atmospheric or near-atmospheric middle ear air pressure were rarely associated with effusion. Conversely, curves suggesting low tympanic membrane compliance were highly correlated with the presence of effusion. Curves suggesting intermediate compliance or reduced middle ear air pressure were also correlated with effusion, but the degree of correlation was dependent on the shape of the curve. In infants less than 7 months of age, many of the ears with effusion had "normal" tympanograms, presumably because external auditory canal walls in such infants tend to be highly distensible. Tympanometry is a simple, rapid, atraumatic, valid, and objective test, easily administered by paraprofessional personnel. Its use can result in improved detection of middle ear effusion and other middle ear abnormalities, and also appears to promote improvement in diagnostic acumen.

Exclusive Breast-Feeding for at Least 4 Months Protects Against Otitis Media

1993-07-01

Burris Duncan , John L. Ey , Catharine J. Holberg +3 more

This study was designed to assess the relation of exclusive breast-feeding, independent of recognized risk factors, to acute and recurrent otitis media in the first 12 months of life.Records of … This study was designed to assess the relation of exclusive breast-feeding, independent of recognized risk factors, to acute and recurrent otitis media in the first 12 months of life.Records of 1220 infants who used a health maintenance organization and who were followed during their first year of life as part of the Tucson Children's Respiratory Study were reviewed. Detailed prospective information about the duration and exclusiveness of breast-feeding was obtained, as was information relative to potential risk factors (socioeconomic status, gender, number of siblings, use of day care, maternal smoking, and family history of allergy). Acute otitis media and recurrent otitis media, defined as three or more episodes of acute otitis media in a 6-month period or four episodes in 12 months, were the outcome variables.Of the 1013 infants followed for their entire first year, 476 (47%) had at least one episode of otitis and 169 (17%) had recurrent otitis media. Infants exclusively breast-fed for 4 or more months had half the mean number of acute otitis media episodes as did those not breastfed at all and 40% less than those infants whose diets were supplemented with other foods prior to 4 months. The recurrent otitis media rate in infants exclusively breast-fed for 6 months or more was 10% and was 20.5% in those infants who breast-fed for less than 4 months. This protection was independent of the risk factors considered.These findings suggest that exclusive breast-feeding of 4 or more months protected infants from single and recurrent episodes of otitis media.

Breastfeeding and childhood acute otitis media: a systematic review and meta‐analysis

2015-08-12

Gayan Bowatte , Rachel Tham , Katrina J. Allen +4 more

To synthesise the evidence on the association between duration and exclusivity of breastfeeding and the risk of acute otitis media (AOM).Systematic review and meta-analysis following searching of PubMed, CINAHL and … To synthesise the evidence on the association between duration and exclusivity of breastfeeding and the risk of acute otitis media (AOM).Systematic review and meta-analysis following searching of PubMed, CINAHL and EMBASE electronic databases.Twenty-four studies, all from the USA or Europe, met the inclusion criteria. In the pooled analyses, any form of breastfeeding was found to be protective for AOM in the first 2 years of life. Exclusive breastfeeding for the first 6 months was associated with the greatest protection (OR 0.57 95% CI 0.44, 0.75), followed by 'more vs less' breastfeeding (OR 0.67; 0.59, 0.76) and 'ever vs never' breastfeeding (OR 0.67; 0.56, 0.80).This systematic review and meta-analysis provides evidence that breastfeeding protects against AOM until 2 years of age, but protection is greater for exclusive breastfeeding and breastfeeding of longer duration. Exclusive breastfeeding during the first 6 months was associated with around a 43% reduction in ever having AOM in the first 2 years of life. After 2 years of age, there is no evidence that breastfeeding protects against AOM; however, there were few studies and the evidence quality was low.

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The central projection of the nerve endings of the internal ear

1933-01-01

R. Lorente de Nó

Antibiotics for acute otitis media in children

2013-10-12

Roderick P Venekamp , Sharon Sanders , Paul Glasziou +2 more

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Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window

2006-01-01

Vittorio Colletti , Sigfrid D. Soli , Marco Carner +1 more

Early clinical findings are reported for subjects implanted with the Vibrant Med-El Soundbridge® (VSB) device. The present criteria for the VSB, limiting its application to patients with normal middle ear … Early clinical findings are reported for subjects implanted with the Vibrant Med-El Soundbridge® (VSB) device. The present criteria for the VSB, limiting its application to patients with normal middle ear function, have been extended to include patients with ossicular chain defects. Seven patients with severe mixed hearing loss were implanted with the transducer placed onto the round window. All had undergone previous surgery: six had multiple ossiculoplasties, and one had the VSB crimped on the incus with unsuccessful results. Round window implantation bypasses the normal conductive path and provides amplified input to the cochlea. Post-operative aided thresholds of 30 dB HL were achieved for most subjects, as compared with unaided thresholds ranging from 60–80 dB HL. Aided speech reception thresholds at 50% intelligibility were 50 dB HL, with most subjects reaching 100% intelligibility at conversational levels, while unaided thresholds averaged 80 dB HL, with only one subject reaching 100% intelligibility. These results suggest that round window implantation may offer a viable treatment option for individuals with severe mixed hearing losses who have undergone unsuccessful ossiculoplasties.

Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children

2010-09-28

George G. Browning , Maroeska M. Rovers , Ian Williamson +2 more

Otitis Media With Effusion

2004-05-01

The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline … The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline “Otitis Media With Effusion in Young Children,” which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children 1 to 3 years old with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced-practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media. The subcommittee made recommendations that clinicians should 1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME, 2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk, and 3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or diagnosis (if onset is unknown). The subcommittee also made recommendations that 4) hearing testing be conducted when OME persists for 3 months or longer or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME, 5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected, and 6) when a child becomes a surgical candidate (tympanostomy tube insertion is the preferred initial procedure). Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that 1) population-based screening programs for OME not be performed in healthy, asymptomatic children, and 2) because antihistamines and decongestants are ineffective for OME, they should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that 1) tympanometry can be used to confirm the diagnosis of OME and 2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery) and provide additional relevant information such as history of acute otitis media and developmental status of the child. The subcommittee made no recommendations for 1) complementary and alternative medicine as a treatment for OME, based on a lack of scientific evidence documenting efficacy, or 2) allergy management as a treatment for OME, based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed. The purpose of this guideline is to inform clinicians of evidence-based methods to identify, monitor, and manage OME in children aged 2 months through 12 years. The guideline may not apply to children more than 12 years old, because OME is uncommon and the natural history is likely to differ from younger children who experience rapid developmental change. The target population includes children with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for use by providers of health care to children, including primary care and specialist physicians, nurses and nurse practitioners, physician assistants, audiologists, speech-language pathologists, and child-development specialists. The guideline is applicable to any setting in which children with OME would be identified, monitored, or managed. This guideline is not intended as a sole source of guidance in evaluating children with OME. Rather, it is designed to assist primary care and other clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all children with this condition and may not provide the only appropriate approach to diagnosing and managing this problem.

Theory and practice of tympanoplasty

1956-08-01

H. L. Wullstein

Ten-year review of otitis media pathogens

1992-08-01

Charles D. Bluestone , JANET S. STEPHENSON , LILLIAN M. MARTIN

Data collected from 1980 to 1989 by investigators at the Pittsburgh Otitis Media Research Center were examined to detect changes over time in the prevalence of bacteria isolated from middle … Data collected from 1980 to 1989 by investigators at the Pittsburgh Otitis Media Research Center were examined to detect changes over time in the prevalence of bacteria isolated from middle ear effusions in patients with otitis media. The organisms isolated most commonly from the 7396 effusions cultured at the center were Streptococcus pneumoniae and Haemophilus influenzae. S. pneumoniae predominated in the subgroup of patients with acute otitis media, whereas H. influenzae was isolated most frequently from patients with otitis media with effusion. The most notable changes to occur during the 10-year period were a statistically significant increase in the prevalence of S. pneumoniae in patients with acute otitis media and a progressive rise in the percentage of betalactamase-producing strains of H. influenzae and Moraxella (Branhamella) catarrhalis. The latter finding suggests the need for therapeutic alternatives to amoxicillin, which is not active against beta-lactamase-producing organisms, when these organisms are suspected or cultured from the middle ear.

Cartilage tympanoplasty: Indications, techniques, and outcomes in A 1,000‐patient series

2003-11-01

John L. Dornhoffer

Abstract Objectives/Hypothesis : The purpose of this study was to analyze the anatomical and audiologic results in more than 1,000 cartilage tympanoplasties that utilized a logical application of several techniques … Abstract Objectives/Hypothesis : The purpose of this study was to analyze the anatomical and audiologic results in more than 1,000 cartilage tympanoplasties that utilized a logical application of several techniques for the management of the difficult ear (cholesteatoma, recurrent perforation, atelectasis). Our hypothesis was that pathology and status of the ossicular chain should dictate the technique used to achieve optimal outcome. Study Design : Retrospective clinical study of patients undergoing cartilage tympanoplasty between July 1994 and July 2001. A computerized otologic database and patient charts were used to obtain the necessary data. Methods : A modification of the perichondrium/cartilage island flap was utilized for tympanic membrane reconstruction in cases of the atelectatic ear, for high‐risk perforation in the presence of an intact ossicular chain, and in association with ossiculoplasty when the malleus was absent. A modification of the palisade technique was utilized for TM reconstruction in cases of cholesteatoma and in association with ossiculoplasty when the malleus was present. Hearing results were reported using a four‐frequency (500, 1,000, 2,000, 3,000 Hz) pure‐tone average air‐bone gap (PTA‐ABG). The Student t test was used for statistical comparison. Postoperative complications were recorded. Results : During the study period, cartilage was used for TM reconstruction in more than 1,000 patients, of which 712 had sufficient data available for inclusion. Of these, 636 were available for outcomes analysis. In 220 cholesteatoma cases, the average pre‐ and postoperative PTA‐ABGs were 26.5 ± 12.6 dB and 14.6 ± 8.8 dB, respectively ( P < .05). Recurrence was seen in 8 cases (3.6%), conductive HL requiring revision in 4 (1.8%), perforation in 3 (1.4%), and postand intraoperative tube insertion in 11 (5.0%) and 18 ears (8.2%), respectively. In 215 cases of high‐risk perforation, the average pre‐ and postoperative PTA‐ABGs were 21.7 ± 13.5 dB and 11.9 ± 9.3 dB, respectively ( P < .05). Complications included recurrent perforation in 9 ears (4.2%), conductive HL requiring revision in 4 (1.9%), postoperative and intraoperative tube insertion in 4 (1.9%) and 6 ears (2.8%), respectively. In 98 cases of atelectasis, the average pre‐ and postoperative PTA‐ABGs were 20.2 ± 10.9 dB and 14.2 ± 10.2 dB, respectively ( P < .05). Complications included 1 perforation (1.0%), conductive loss requiring revision in 2 cases (2.0%), and post‐ and intraoperative tube insertion in 7 (7.1%) and 12 ears (12%), respectively. In 103 cases to improve hearing (audiologic), the average pre‐ and postoperative PTA‐ABGs were 33.6 ± 9.6 dB and 14.6 ± 10.1 dB, respectively ( P < .05). Complications included 1 perforation (1.0%), conductive loss requiring revision in 11 (11%), and post‐ and intraoperative tube insertion in 6 (5.8%) and 2 (1.9%), respectively. Conclusions : Cartilage tympanoplasty achieves good anatomical and audiologic results when pathology and status of the ossicular chain dictate the technique utilized. Significant hearing improvement was realized in each pathological group. In the atelectatic ear, cartilage allowed us to reconstruct the TM with good anatomic results compared to traditional reconstructions, which have shown high rates of retraction and failure. In cholesteatoma, cartilage tympanoplasty using the palisade technique resulted in precise reconstruction of the TM and helped reduce recurrence. In cases of high‐risk perforation, reconstruction with cartilage yielded anatomical and functional results that compared favorably to primary tympanoplasty using traditional techniques. We believe the indications for cartilage tympanoplasty (atelectatic ear, cholesteatoma, high‐risk perforation) were validated by these results.

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Surgical Findings and Long-Term Hearing Results in 3,050 Stapedotomies for Primary Otosclerosis

2006-09-19

Robert Vincent , Neil M. Sperling , John Oates +1 more

Objective: To evaluate with a new otologic database the results of primary stapes surgery for otosclerosis with up to 14 years of follow-up in a consecutive series of 2,525 patients … Objective: To evaluate with a new otologic database the results of primary stapes surgery for otosclerosis with up to 14 years of follow-up in a consecutive series of 2,525 patients operated on by the same surgeon with the same technique (stapedotomy and vein graft interposition) and to provide online access to the complete data of this study for the reviewers. To study the effect of specific operative findings (obliterative otosclerosis and simultaneous malleus ankylosis) and age at the time of surgery on the long-term outcome. Study Design: Prospective clinical study using a new computerized otologic database. Setting: Tertiary referral center. Patients: Two thousand five hundred twenty-five patients who underwent 3,050 stapedotomies for otosclerotic stapes fixation were enrolled in this study from January 1991 to December 2004. Separate analyses were made for two unique pathologies (92 cases of obliterative otosclerosis and 19 cases of simultaneous malleus ankylosis) diagnosed during surgery and for patients in two age brackets (≤18 yr [28 patients] and ≥65 yr [302 patients]). Intervention: Stapedotomy with vein graft interposition and reconstruction with either a Teflon piston, a bucket handle prosthesis, or a total prosthesis. Main Outcome Measures: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap (ABG), bone-conduction thresholds, and air-conduction thresholds were all assessed. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months and then annually for 14 years. Results: Overall, the postoperative ABG was closed to 10 dB in 94.2% of cases. The mean four-frequency postoperative ABG was 1.7 dB compared with 25.6 dB preoperatively. The mean four-frequency bone-conduction thresholds were unchanged postoperatively. A significant postoperative sensorineural hearing loss (SNHL; >15 dB) was seen in 0.5% of cases in this series. Postoperative ABG was achieved to within 10 dB in 95% of cases of obliterative otosclerosis and in 64.7% of cases of simultaneous malleus ankylosis. A significant postoperative SNHL (>15 dB) was seen in 4.8% of cases of obliterative otosclerosis and was not observed in any cases of simultaneous malleus ankylosis. Postoperative ABG was achieved to within 10 dB in 93.5% of cases in the pediatric series and in 94.5% of cases in the senior series. A significant postoperative SNHL (>15 dB) was seen in 0.7% of cases in the senior group but was not observed in the children. Conclusion: Using a new otologic database, our series confirms that stapedotomy with vein graft interposition for otosclerotic stapes fixation is a safe and successful treatment for long-term hearing improvement. The deterioration in hearing with time after stapedotomy did not exceed the rate of hearing loss because of presbyacusis. Therefore, argon laser stapedotomy with vein graft interposition is our preferred surgical technique in the treatment of otosclerosis. Obliterative otosclerosis and simultaneous malleus ankylosis may be encountered during stapedotomy. Our study shows that reasonable success rates can still be expected in these situations. Stapedotomy results in the elderly and in children are comparable to those obtained in patients of other groups of age undergoing surgery for otosclerosis without an increased risk for complications.

The nerve supply of the human auricle

2002-01-01

Elmar T. Peuker , Timm J. Filler

Knowledge of the innervation of the outer ear is crucial for surgery in this region. The aim of this study was to describe the system of the auricular nerve supply. … Knowledge of the innervation of the outer ear is crucial for surgery in this region. The aim of this study was to describe the system of the auricular nerve supply. On 14 ears of seven cadavers the complete course of the nerve supply was exposed and categorized. A heterogeneous distribution of two cranial branchial nerves and two somatic cervical nerves was found. At the lateral as well as the medial surface the great auricular nerve prevails. No region with triple innervation was found.

Meta-Analytic Review of the Risk Factors for Acute Otitis Media

1996-06-01

M Uhari , K. Mantysaari , Marjo Niemelä

The occurrence of acute otitis media (AOM) has increased steadily during the last 15 years. The possible environmental risks associated with AOM should be well identified to prevent any further … The occurrence of acute otitis media (AOM) has increased steadily during the last 15 years. The possible environmental risks associated with AOM should be well identified to prevent any further increase in its occurrence. A meta-analysis of the studies evaluating the risk factors for AOM was performed. A MEDLINE search of the medical literature from 1966 to 1994 with the key words children, risk, acute otitis media, and recurrent acute otitis media was performed, and the references of the articles that were found served as the sources for the studies used in the meta-analysis. Sixtyone studies were identified. Twenty-two (36%) of these studies were accepted for the meta-analysis. Depending on the risk factor, there were two to seven different studies from which risk ratios (RRs) could be pooled. The studies were performed in six different countries. If any other member of the family had had AOM, the risk increased (RR, 2.63; 95% confidence interval [CI], 1.86–3.72; P = .00001). The risk of AOM increased with day care outside the home (RR, 2.45; 95% CI, 1.51–3.98; P = .0003) and family day care (RR, 1.59; 95% CI, 1.19–2.13; P = .002). The risk of AOM increased with parental smoking (RR, 1.66; 95% CI, 1.33–2.06; P < .00001). Breast-feeding for at least 3 months reduced the risk of AOM (RR, 0.87; 95% CI, 0.79–0.95; P = .003). The use of a pacifier increased the risk of AOM (RR, 1.24; 95% CI, 1.06–1.46; P = .008). Child care outside the home and parental smoking were the factors that most significantly increased the occurrence of AOM.

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Clinical Practice Guideline: Otitis Media with Effusion

2004-05-01

Richard M. Rosenfeld , Larry Culpepper , Karen Jo Doyle +7 more

The clinical practice guideline on otitis media with effusion (OME) provides evidence‐based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline … The clinical practice guideline on otitis media with effusion (OME) provides evidence‐based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline “Otitis Media With Effusion in Young Children,” which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology‐ Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media (AOM). The subcommittee made recommendations that clinicians should (1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME; (2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and (3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown). The subcommittee also made recommendations that (4) hearing testing be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME; (5) children with persistent OME who are not at risk should be reexamined at 3‐ to 6‐month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and (6) when a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that (1) population‐based screening programs for OME not be performed in healthy, asymptomatic children and (2) antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long‐term efficacy and should not be used for routine management. The subcommittee gave as options that (1) tympanometry can be used to confirm the diagnosis of OME and (2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech‐language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery), and provide additional relevant information such as history of AOM and developmental status of the child. The subcommittee made no recommendations for (1) complementary and alternative medicine as a treatment for OME based on a lack of scientific evidence documenting efficacy and (2) allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed. The purpose of this guideline is to inform clinicians of evidence‐based methods to identify, monitor, and manage OME in children aged 2 months through 12 years. The guideline may not apply to children older than 12 years because OME is uncommon and the natural history is likely to differ from younger children who experience rapid developmental change. The target population includes children with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for use by providers of health care to children, including primary care and specialist physicians, nurses and nurse practitioners, physician assistants, audiologists, speech‐language pathologists, and child development specialists. The guideline is applicable to any setting in which children with OME would be identified, monitored, or managed. This guideline is not intended as a sole source of guidance in evaluating children with OME. Rather, it is designed to assist primary care and other clinicians by providing an evidence‐based framework for decision‐making strategies. It is not intended to replace clinical judgment or establish a protocol for all children with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem. (Otolaryngol Head Neck Surg 2004;130:S95.)

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Diagnose yon Krankheitserscheinungen im Bereiche des Otolithenapparates

1920-01-01

Ernst H. Bárány

Bisher war es nicht möglich, die Diagnose einer Erkrankung im Bereiche des Otolithenapparates zn stellen. Vor kurzer Zeit gelang es mir, auf grund sehr einfaclier Überlegungen diese Diagnose zu stellen, … Bisher war es nicht möglich, die Diagnose einer Erkrankung im Bereiche des Otolithenapparates zn stellen. Vor kurzer Zeit gelang es mir, auf grund sehr einfaclier Überlegungen diese Diagnose zu stellen, und ich hoffe, dass damit ein neues Gebiet im Bereiche der Diagnostik der Erkrankungen des Vestibularapparates erschlossen ist.

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GRADING SYSTEM FOR THE SELECTION OF PATIENTS WITH CONGENITAL AURAL ATRESIA

1992-01-01

Robert A. Jahrsdoerfer , Joel W. Yeakley , Eugenio A. Aguilar +2 more

It is generally recognized that surgery for congenital aural atresia is difficult. In an effort to select those patients who have the greatest chance of success, we have developed a … It is generally recognized that surgery for congenital aural atresia is difficult. In an effort to select those patients who have the greatest chance of success, we have developed a grading scheme based on the preoperative temporal bone CT scan and the appearance of the external ear. Patients are graded on a possible best score of 10. The stapes is assigned the highest rating (2 points), while all other entrees on the scale are 1 point. The grade assigned preoperatively has been shown to correlate well with the patient's chance of success, herein defined as a postoperative speech reception threshold of 15 to 25 dB. A patient with a preoperative grade of 8/10 would, therefore, have a 80 percent chance of achieving this threshold. Patients with scores of 5/10, or less, are not considered surgical candidates, because the risk of the operation would outweigh the potential benefits. We have found that the grading system allows us to avoid impossible surgical cases while allowing for a reasonable prediction of the hearing outcome.

Otitis Media in Infancy and Intellectual Ability, School Achievement, Speech, and Language at Age 7 Years

1990-09-01

David W. Teele , Jerome O. Klein , Cynthia Chase +2 more

To determine intellectual and linguistic sequelae of middle ear disease, 207 children were randomly selected from a cohort of 498 followed prospectively from birth until age 7 years. After controlling … To determine intellectual and linguistic sequelae of middle ear disease, 207 children were randomly selected from a cohort of 498 followed prospectively from birth until age 7 years. After controlling for confounding variables, estimated time spent with middle ear effusion (MEE) during the first 3 years of life was significantly associated with lower scores on tests of cognitive ability, speech and language, and school performance at age 7 years. The adjusted mean full scale WISC-R were 113.1 for those with least time with NEE, 107.5 for those with moderate time, and 105.4 for those with most time. Similar significant differences were found for verbal and performance IQ scores. For the Metropolitan Achievement Test, we found that middle ear disease in the first 3 years of life was associated with significantly lower scores in mathematics and reading. Similar differences were found for articulation and use of morphologic markers. After considering time spent with MEE during the first 3 years of life, time spent after age 3 years was not a significant predictor of scores on any of the tests administered.

Natural history of untreated otitis media

2003-10-01

Richard M. Rosenfeld , David B. Kay

Data from cohort studies and untreated groups in randomized controlled trials can be identified through systematic literature review and synthesized with meta-analysis to estimate natural history of acute otitis media … Data from cohort studies and untreated groups in randomized controlled trials can be identified through systematic literature review and synthesized with meta-analysis to estimate natural history of acute otitis media (AOM) and otitis media with effusion (OME).Systematic literature review and meta-analysis.Source articles were identified by MEDLINE search through August 2002 plus manual crosschecks of bibliographies and published meta-analyses. Data were abstracted independently by two investigators and combined with random effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI), and heterogeneity. Sensitivity analysis was performed.Sixty-three articles met inclusion criteria. AOM symptoms improved within 24 hours without antibiotics in 61% of children (95% CI, 50-72%), rising to 80% by 2 to 3 days (95% CI, 69-90%). Suppurative complications were comparable if antibiotics were withheld (0.12%) or provided (0.24%). Children entered recurrent AOM trials with a mean rate of 5.5 or more annual episodes but averaged only 2.8 annual episodes while on placebo (95% CI, 2.2-3.4). No AOM episodes occurred in 41%, and only 17% remained otitis prone (3 or more episodes). OME after untreated AOM had 59% resolution by 1 month (95% CI, 50-68%) and 74% resolution by 3 months (95% CI, 68-80%). OME of unknown duration had 28% spontaneous resolution by 3 months (95%, CI 14-41%), rising to 42% by 6 months (95% CI, 35-49%). In contrast, chronic OME had only 26% resolution by 6 months and 33% resolution by 1 year.The natural history of otitis media is very favorable. Combined estimates of spontaneous resolution provide a benchmark against which to judge new or established interventions. The need for surgery in children with recurrent AOM or chronic OME should be balanced against the likelihood of timely spontaneous resolution and the potential risk of learning, language, or other adverse sequelae from persistent middle ear effusion. Further research is needed to identify prognostic factors that can target children unlikely to improve spontaneously for earlier intervention.

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Studies in Impedance Audiometry: I. Normal and Sensorineural Ears

1972-12-01

James Jerger , Susan Jerger , L. Mauldin

Results of impedance audiometry were analyzed in 1,133 consecutive patients with either normal or sensorineural audiograms. The static compliance of the normal middle ear varies uniquely with both the age … Results of impedance audiometry were analyzed in 1,133 consecutive patients with either normal or sensorineural audiograms. The static compliance of the normal middle ear varies uniquely with both the age and sex of the patient. In the normal ear, the threshold of the stapedial reflex to pure tones is normally distributed around a mean of approximately 85 dB hearing threshold level (ISO-64) with a standard deviation of 8 dB. In the ear with sensorineural hearing loss, the sensation level (SL) of the stapedial reflex declines in proportion to increasing hearing loss to a limiting (SL) of approximately 25 dB. The frequency of 4,000 hertz appears to be atypical. Absent reflexes at this frequency do not necessarily have pathological significance.

Otitis Media in 2253 Pittsburgh-Area Infants: Prevalence and Risk Factors During the First Two Years of Life

1997-03-01

Jack L. Paradise , Howard E. Rockette , D. Kathleen Colborn +4 more

Objective. As part of a long-term study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we set out to delineate the occurrence and course … Objective. As part of a long-term study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we set out to delineate the occurrence and course of otitis media during the first 2 years of life in a sociodemographically diverse population of infants, and to identify related risk factors. Methods. We enrolled healthy infants by age 2 months who presented for primary care at one of two urban hospitals or one of two small town/rural and four suburban private pediatric practices. We intensively monitored the infants' middle-ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 2 years of life; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated infants for otitis media according to specified guidelines. Results. We followed 2253 infants until age 2 years. The proportions developing ≥1 episode of middle-ear effusion (MEE) between age 61 days (the starting point for data analysis) and ages 6, 12, and 24 months, respectively, were 47.8%, 78.9%, and 91.1%. Overall, the mean cumulative proportion of days with MEE was 20.4% in the first year of life and 16.6% in the second year of life. Tympanostomy-tube placement was performed on 1.8% and 4.2% of the infants during the first and second years of life, respectively. By every measure, the occurrence of MEE was highest among urban infants and lowest among suburban infants; these differences were greatest in the earliest months of life. Overall, unadjusted mean cumulative proportions of days with MEE were higher among boys than girls, higher among black than white infants, and higher among Medicaid than private health insurance enrollees. Cumulative proportions of days with MEE varied directly with the number of smokers in the household and with the number of other children to whom infants were exposed, whether at home or in day care, and varied inversely with birth weight, maternal age, level of maternal education, a socioeconomic index, and duration of breastfeeding. After adjustment, using multivariate analysis, the only variables that each remained independently and significantly related to the cumulative proportion of days with MEE were: during the first year of life, study site grouping, sex, the socioeconomic index, breastfeeding for ≥4 months, the number of smokers in the household, and an index rating the degree of exposure to other children at home or in day care; and during the second year of life, sex, the socioeconomic index, and the child exposure index. The duration of breastfeeding and the degree of exposure to tobacco smoke contributed little to the explained variance; most was attributable to differences in the socioeconomic index and the child exposure index. Conclusions. Contrary to findings in many previous reports, the prevalence of otitis media during the first 2 years of life among lower-socioeconomic-status black infants appears to be as high as, if not higher than among lower-socioeconomic-status white infants, and certainly higher than among middle-class white infants. Among middle-class white infants the prevalence may also be higher than commonly assumed. The most important sociodemographic risk factors for otitis media appear to be low socioeconomic status and repeated exposure to large numbers of other children, whether at home or in day care.

Clinical efficacy of antimicrobial drugs for acute otitis media: Metaanalysis of 5400 children from thirty-three randomized trials

1994-03-01

Richard M. Rosenfeld , Julia E. Vertrees , James L. Carr +4 more

Influenza A Vaccine Decreases the Incidence of Otitis Media in 6- to 30-Month-Old Children in Day Care

1995-10-01

Dennis A. Clements

<h3>Objective:</h3> To determine if the use of influenza vaccine in children in day care decreases the incidence of otitis media during the influenza season. <h3>Design:</h3> Prospective cohort study. <h3>Setting:</h3> Eight … <h3>Objective:</h3> To determine if the use of influenza vaccine in children in day care decreases the incidence of otitis media during the influenza season. <h3>Design:</h3> Prospective cohort study. <h3>Setting:</h3> Eight day-care centers in North Carolina. <h3>Participants:</h3> One hundred eighty-six children aged 6 to 30 months. <h3>Intervention:</h3> Half the participants received trivalent subvirion influenza virus vaccine. <h3>Measurements:</h3> Acute otitis media (AOM) and serous otitis media (SOM) were assessed biweekly from mid-November 1993 to mid-March 1994 by visual and tympanometric examinations performed by "blinded" observers. The winter season was divided into three periods—before, during, and after influenza season—and the number of children with AOM or SOM during each period was determined. Unadjusted and adjusted odds ratios (ORs) were computed, while controlling for race and sex using logistic regression methods. <h3>Results:</h3> Influenza vaccine was protective against AOM (OR=0.69, 95% CI, 0.49-0.98) during the influenza season. Although there may have been some protection against SOM (OR=0.75,95% CI, 0.54-1.02) statistical significance was not achieved. Myringotomy tubes were also significantly protective against AOM and SOM during all three time periods, with ORs between 0.34 and 0.52, but the greatest protection was seen during the influenza period. <h3>Conclusions:</h3> Influenza vaccination of 6- to 30-month-old children in day care was associated with a decreased incidence of otitis media during the influenza season. Myringotomy tubes protected against AOM and SOM during all 16 weeks monitored. (Arch Pediatr Adolesc Med. 1995;149:1113-1117)

Chronic suppurative otitis media: A review

2005-09-28

Monique Verhoeff , Erwin L. van der Veen , Maroeska M. Rovers +2 more

Meta‐Analysis of Tympanostomy Tube Sequelae

2001-04-01

David J. Kay , Magalie Nelson , Richard M. Rosenfeld

OBJECTIVE To estimate the incidence of tympanostomy tube sequelae based on systematic review of published case series and randomized studies. DATA SOURCES English‐language MEDLINE search from 1966 through April 1999 … OBJECTIVE To estimate the incidence of tympanostomy tube sequelae based on systematic review of published case series and randomized studies. DATA SOURCES English‐language MEDLINE search from 1966 through April 1999 with manual reference search of proceedings, articles, reports, and guidelines. STUDY SELECTION Cohort studies with otitis media as the primary indication for tube placement. DATA EXTRACTION Two reviewers independently extracted data from 134 articles. DATA SYNTHESIS Transient otorrhea occurred in 16% of patients in the postoperative period and later in 26%; recurrent otorrhea occurred in 7.4% of patients and chronic otorrhea in 3.8%. Sequelae of indwelling tubes included obstruction (7% of ears), granulation tissue (5%), premature extrusion (3.9%), and medial displacement (0.5%). Sequelae after tube extrusion included tympanosclerosis (32%), focal atrophy (25%), retraction pocket (3.1%), cholesteatoma (0.7%), and perforation (2.2% with short‐term tubes, 16.6% with long‐term tubes). Meta‐analysis showed that long‐term tubes increased the relative risk of perforation by 3.5 (95% CI, 1.5 to 7.1) and cholesteatoma by 2.6 (95% CI, 1.5 to 4.4). Similarly, intubation increased the relative risk of tympanosclerosis by 3.5 (95% CI, 2.6 to 4.9) and focal atrophy by 1.7 (95% CI, 1.1 to 2.7) over nonintubated control ears (baseline tympanosclerosis and atrophy rates of 10% and 14%, respectively). CONCLUSIONS Sequelae of tympanostomy tubes are common but are generally transient (otorrhea) or cosmetic (tympanosclerosis, focal atrophy). Nonetheless, the high incidence suggests a need for ongoing otologic surveillance of all patients with indwelling tubes and for a reasonable time period after tube extrusion. Long‐term tubes should be used on a selective and individualized basis.

Effectiveness of Adenoidectomy and Tympanostomy Tubes in the Treatment of Chronic Otitis Media with Effusion

1987-12-03

George A. Gates , Christine Avery , Thomas J. Prihoda +1 more

To study the effectiveness of adenoidectomy and of the placement of tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 children, aged four through … To study the effectiveness of adenoidectomy and of the placement of tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 children, aged four through eight years, to receive bilateral myringotomy and no additional treatment (Group 1), placement of tympanostomy tubes (Group 2), adenoidectomy (Group 3), or adenoidectomy and placement of tympanostomy tubes (Group 4). The 491 children who underwent one of these treatments were examined at six-week intervals for up to two years. The mean time spent with effusion of any type in either ear over the two-year follow-up in the four groups was 51, 36, 31, and 27 weeks, respectively (P less than 0.0001), comparing Group 1 with each of the other groups. Hearing was equivalent in Groups 2, 3, and 4, and was significantly better than in Group 1. The most frequent sequela, purulent otorrhea, occurred one or more times in 22, 29, 11, and 24 percent of the subjects in Groups 1, 2, 3, and 4, respectively (P less than 0.001). Adenoidectomy plus bilateral myringotomy lowered the overall post-treatment morbidity (as measured by hearing acuity in the most severely affected ear [P = 0.0174] and the number of surgical retreatments required [P = 0.009]) more than did tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. We conclude that adenoidectomy should be considered when surgical therapy is indicated in children four to eight years old who are severely affected by chronic otitis media with effusion.

Otitis Media with Effusion During the First Three Years of Life and Development of Speech and Language

1984-08-01

David W. Teele , Jerome O. Klein , Bernard Rosner

To determine the association between time spent with middle ear effusion and development of speech and language, 205 three-year-old children were studied. Each child had been followed prospectively from birth … To determine the association between time spent with middle ear effusion and development of speech and language, 205 three-year-old children were studied. Each child had been followed prospectively from birth to record the number of episodes of middle ear disease and to document time spent with middle ear effusion. Standardized tests of speech and language were administered at age 3 years to children who had spent much time with middle ear effusion and to children who had spent little or no time with middle ear effusion. Children who had spent prolonged periods of time with middle ear effusion had significantly lower scores when compared with those who had spent little time with middle ear disease. The correlation was strongest in children from higher socio-economic strata. Time spent with middle ear effusion in the first 6 to 12 months of life was most strongly associated with poor scores.

Otitis media and its consequences: beyond the earache

2010-02-24

Anne Vergison , Ron Dagan , Adriano Arguedas +7 more

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A New Standardized Format for Reporting Hearing Outcome in Clinical Trials

2012-08-29

Richard K. Gurgel , Robert K. Jackler , Robert A. Dobie +1 more

The lack of an adequate standardized method for reporting level of hearing function in clinical trials has hampered the ability of investigators to draw comparisons across studies. Variability in data … The lack of an adequate standardized method for reporting level of hearing function in clinical trials has hampered the ability of investigators to draw comparisons across studies. Variability in data reported and presentation format inhibits meta-analysis and makes it impossible to accumulate the large patient cohorts needed for statistically significant inference. Recognizing its importance to the field and after a widely inclusive discussion, the Hearing Committee of the American Academy of Otolaryngology-Head and Neck Surgery endorsed a new minimal standard for reporting hearing results in clinical trials, consisting of a scattergram relating average pure-tone threshold to word recognition score. Investigators remain free to publish their hearing data in any format they believe is interesting and informative, as long as they include the minimal data set to facilitate interstudy comparability.

Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis

2015-09-07

Anne GM Schilder , Mahmood F. Bhutta , Christopher Butler +7 more

A recent systematic review of treatments of Eustachian tube dysfunction commissioned by the UK NIHR Health Technology Assessment (HTA) Programme revealed that an important limitation with the available evidence is … A recent systematic review of treatments of Eustachian tube dysfunction commissioned by the UK NIHR Health Technology Assessment (HTA) Programme revealed that an important limitation with the available evidence is a lack of consensus on the definition and diagnosis of this disorder.1 The HTA report recommended that key to advancing research in this field is achieving consensus on diagnostic criteria for Eustachian tube dysfunction (to identify eligible patients for future trials) and on important clinical outcomes. To address this need, an international forum of scientists and physicians with expertise in the field of Eustachian tube disorders met at a workshop in Amsterdam on 21 June 2014 and was tasked to come to an agreement on the definition, clinical presentation and diagnosis of Eustachian tube dysfunction, and areas for future research. This study summarises the outcomes of that meeting. A purposive sample of International experts in the field was brought together, spanning primary to tertiary care, and across the translational research pathway, from molecular to implementation science specialists. The panel used the systematic review conducted for the UK NIHR HTA1 as the starting point. Consensus was achieved through a series of presentations by individual panel members and discussions around themes of function and dysfunction of the Eustachian tube, definitions, symptoms, signs and clinical investigation of Eustachian tube dysfunction. This study represents the consensus group opinion and was drafted and revised using an iterative process including all panel members. The contribution of Eustachian tube dysfunction to mucosal or squamous forms of otitis media and the effectiveness of treatments for Eustachian tube dysfunction were outside the remit of this workshop. We did not consider disease in childhood, and so this statement refers only to disease in adults. The panel agreed that the Eustachian tube has unique functions and can be thought of as an organ; failure of its functions comprises dysfunction. The functions of the Eustachian tube are as follows2: Pressure in the middle ear is maintained through two mechanisms: middle ear mucosal gas exchange and opening of the Eustachian tube to equilibrate pressure with that in the nasopharynx.3 The relative contribution of these two mechanisms to normal middle ear ventilation is not known. Recent evidence suggests that, in the healthy middle ear, pressure slowly decreases, and periodic opening of the Eustachian tube restores the middle ear towards atmospheric pressure.4 Clearance of middle ear secretions occurs through both a muscular peristaltic action in the Eustachian tube and through the mucociliary escalator. When functioning normally, the Eustachian tube protects the middle ear against inflammation and infection by viruses, bacteria and gastro-oesophageal reflux. The panel agreed that Eustachian tube dysfunction is a syndrome with a constellation of signs and symptoms suggestive of dysfunction of the Eustachian tube. This does not preclude that Eustachian tube dysfunction can also be a mechanism to middle ear disease. Although in a strict sense Eustachian tube dysfunction is a failure to perform any of the Eustachian tube functions, in clinical practice, Eustachian tube dysfunction usually refers to a problem with the ventilatory function of the Eustachian tube. As such, Eustachian tube dysfunction is defined by symptoms and signs of pressure dysregulation in the middle ear. The panel agreed to distinguish acute Eustachian tube dysfunction, transient with symptoms and signs for less than 3 months, from chronic dysfunction, symptoms and signs for more than 3 months. We agreed that there are three subtypes of Eustachian tube dysfunction: Dilatory Eustachian tube dysfunction can be broken down as follows: Current ICD-10 codes for Eustachian tube dysfunction include the following: H68.0 inflammatory dilatory dysfunction of the Eustachian tube, H68.1 obstruction of the Eustachian tube, H69.0 patulous Eustachian tube, H69.8 other defined Eustachian tube dysfunction and H69.9 non-defined Eustachian tube dysfunction. We propose that future coding should consider the new classification system suggested here. To diagnose Eustachian tube dysfunction, the patient must present with symptoms of pressure disequilibrium in the affected ear, specifically symptoms of 'aural fullness' or 'popping' or discomfort/pain. Patients may also report pressure, clogged or 'under water' sensation, crackling, ringing, autophony and muffled hearing. Acute dilatory Eustachian tube dysfunction is often preceded by an upper respiratory tract infection, or sometimes by an exacerbation of allergic rhinitis, which presumably causes inflammation in the Eustachian tube orifice or lumen. Some patients may have a prior history of otitis media. It is not clear whether the aetiology of chronic dilatory Eustachian tube dysfunction is an extension of the same pathology underlying acute dilatory Eustachian tube dysfunction, or whether other pathological mechanisms may underlie these symptoms. Some patients with dilatory Eustachian tube dysfunction may report repeated Valsalva or jaw-thrust manoeuvres in an attempt to equalise negative middle ear pressure; others describe altered hearing or tinnitus. In baro-challenge-induced Eustachian tube dysfunction, symptoms of aural fullness, popping or discomfort/pain occur, or are initiated, under conditions of alteration to the ambient pressure. Typically symptoms may manifest when scuba-diving or on descent from altitude, but can also occur under conditions of less marked ambient pressure fluctuation. Patients are typically asymptomatic once they return to ground level, although significant baro-challenge may cause temporary middle ear effusion or haemotympanum. Patulous Eustachian tube dysfunction presents with symptoms of aural fullness and autophony. Symptoms may be better in the supine position or during upper respiratory tract infection.4 They may worsen during exercise. Patulous Eustachian tube dysfunction is thought to be caused by an abnormally patent Eustachian tube; as such, it may be precipitated by recent weight loss, although in the majority of cases no underlying precipitating event is evident. Some patients with patulous Eustachian tube dysfunction will habitually sniff. Clinical assessment will vary depending upon what investigations are readily available (e.g. in primary care, tympanometry is rarely available). Ideally assessment should include the following: It was agreed that to diagnose dilatory Eustachian tube dysfunction, patient-reported symptoms should go together with evidence of negative pressure in the middle ear as assessed by clinical assessment, either as follows: An ability to auto-inflate the middle ear on Valsalva or Toynbee manoeuvre confirms some degree of patency of the Eustachian tube, but the panel felt that ability to auto-inflate is not sufficiently sensitive or specific for Eustachian tube dysfunction to have clinical utility. In baro-challenge-induced Eustachian tube dysfunction, otoscopy and tympanometry may be normal at normal ambient pressure, and so diagnosis relies on patient history. In some cases of baro-challenge-induced Eustachian tube dysfunction, middle ear effusion or haemotympanum may be evident. In Patulous Eustachian tube dysfunction, symptoms go together with evidence on otoscopy or tympanometry of tympanic membrane excursion with breathing.4 Tympanometry may not be available in a primary care setting, in which case diagnosis of Eustachian tube dysfunction is confirmed by abnormal otoscopy or may be presumptive. If symptoms of Eustachian tube dysfunction are chronic (more than 3 months) and/or troublesome, referral to secondary care should be considered to confirm the diagnosis and to determine its cause. Pure tone audiometry should include air and bone conduction thresholds. A mild or moderate conductive hearing loss may be found in some patients with Eustachian tube dysfunction. In primary care, tuning fork tests (Rinne's and Weber's tests) may be used as a substitute for audiometry, although these tests are less reliable. Nasopharyngoscopy is usually only available in secondary care. Examination may reveal a cause for Eustachian tube dysfunction, for example inflammation adjacent to the Eustachian tube orifice, or (rarely) neoplasms, scarring or other lesions. The panel agreed that radiological evaluation does not routinely play a role in diagnosis of Eustachian tube dysfunction, and should be reserved for cases where additional or alternate pathology is suspected based upon history or examination. The combination of clinical symptoms and signs enables a diagnostic algorithm for the diagnosis and subclassification of Eustachian tube dysfunction (Fig. 1). The panel agreed that at the current time, there is no universally accepted set of patient-reported symptom scores, functional tests or scoring systems to diagnose Eustachian tube dysfunction, and the diagnosis should therefore at this stage rely on the clinical observations (symptoms and signs) detailed above. A number of tests of the ventilatory function of the Eustachian tube have been devised, including tubomanometry, sonotubometry, nine-step inflation–deflation test and pressure chamber tests. At the current time, the equipment these tests require is not widely available, and their accuracy and validity is unclear,5 but they can be useful research tools. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7)6 scores symptoms of Eustachian tube dysfunction and is the only patient-reported outcomes tool to have undergone initial validation studies. The Eustachian Tube Score (ETS) and its extension the ETS-77 combine subjective (clicking sound when swallowing, Valsalva) and objective (tubomanometry, tympanometry) measures of Eustachian tube function. The panel agreed that there is a need for wider experience in the use of these instruments across centres, and for validation of these instruments using the criteria for diagnosis recommended in this study. The panel agreed that in any future clinical trials, clinical outcomes should be assessed at baseline and in the short term (defined as 6 weeks to 3 months) and the long-term term (defined as 6–12 months), and should include assessment of patient-reported symptoms, otoscopy, tympanometry and pure tone audiometry. Eustachian tube dysfunction should not be used to describe disease more properly classified as otitis media, including chronic otitis media with effusion (glue ear), chronic suppurative otitis media, tympanic membrane retraction and cholesteatoma. Whereas ventilatory dysfunction of the Eustachian tube may contribute to the onset or persistence of these types of otitis media, the relative importance of this contribution is a matter of debate and a debate outside of the remit of this work. A number of other disorders can present with symptoms similar to Eustachian tube dysfunction. Patients with cochlear hydrops may describe periodic unilateral pressure sensation associated with altered hearing that typically lasts a few hours. Patients with temporomandibular joint (TMJ) dysfunction describe discomfort in front of and around the ear, typically unilateral, and in some cases associated with clicking or popping noises and altered hearing or tinnitus. Although there are no clear diagnostic criteria for TMJ dysfunction, aggravation of pain by manipulation or function of the jaw is a cardinal sign. In diagnosing patulous Eustachian tube dysfunction, other causes of autophony should be considered, including a fistula of the inner ear, for example due to superior semicircular canal dehiscence. Tullio phenomenon may suggest an inner ear fistula, although in isolation this sign is not reliable for diagnosis. The definitions, diagnostic criteria and subclassification of Eustachian tube dysfunction presented in this consensus statement can be used to inform future research in this field. In particular, consensus and consistency in disease definition should enable better studies of the epidemiology of Eustachian tube dysfunction, and clear inclusion criteria and outcome measures for new clinical trials of treatments for Eustachian tube dysfunction. Areas for future research include the following: Acclarent Inc, California, funded this work, including the costs of the workshop and travel to the workshop, except for G Norman who was funded by the Centre for Reviews and Dissemination, University of York, UK. Scientific and clinical staff representing Acclarent were part of the consensus panel and writing team for this work.

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Direct Detection of Bacterial Biofilms on the Middle-Ear Mucosa of Children With Chronic Otitis Media

2006-07-11

Luanne Hall‐Stoodley , Fen Hu , Armin Gieseke +7 more

ContextChronic otitis media (OM) is a common pediatric infectious disease. Previous studies demonstrating that metabolically active bacteria exist in culture-negative pediatric middle-ear effusions and that experimental infection with Haemophilus influenzae … ContextChronic otitis media (OM) is a common pediatric infectious disease. Previous studies demonstrating that metabolically active bacteria exist in culture-negative pediatric middle-ear effusions and that experimental infection with Haemophilus influenzae in the chinchilla model of otitis media results in the formation of adherent mucosal biofilms suggest that chronic OM may result from a mucosal biofilm infection.ObjectiveTo test the hypothesis that chronic OM in humans is biofilm-related.Design, Setting, and PatientsMiddle-ear mucosa (MEM) biopsy specimens were obtained from 26 children (mean age, 2.5 [range, 0.5-14] years) undergoing tympanostomy tube placement for treatment of otitis media with effusion (OME) and recurrent OM and were analyzed using microbiological culture, polymerase chain reaction (PCR)-based diagnostics, direct microscopic examination, fluorescence in situ hybridization, and immunostaining. Uninfected (control) MEM specimens were obtained from 3 children and 5 adults undergoing cochlear implantation. Patients were enrolled between February 2004 and April 2005 from a single US tertiary referral otolaryngology practice.Main Outcome MeasuresConfocal laser scanning microscopic (CLSM) images were obtained from MEM biopsy specimens and were evaluated for biofilm morphology using generic stains and species-specific probes for H influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Effusions, when present, were evaluated by PCR and culture for evidence of pathogen-specific nucleic acid sequences and bacterial growth, respectively.ResultsOf the 26 children undergoing tympanostomy tube placement, 13 (50%) had OME, 20 (77%) had recurrent OM, and 7 (27%) had both diagnoses; 27 of 52 (52%) of the ears had effusions, 24 of 24 effusions were PCR-positive for at least 1 OM pathogen, and 6 (22%) of 27 effusions were culture-positive for any pathogen. Mucosal biofilms were visualized by CLSM on 46 (92%) of 50 MEM specimens from children with OME and recurrent OM using generic and pathogen-specific probes. Biofilms were not observed on 8 control MEM specimens obtained from the patients undergoing cochlear implantation.ConclusionDirect detection of biofilms on MEM biopsy specimens from children with OME and recurrent OM supports the hypothesis that these chronic middle-ear disorders are biofilm-related.

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The Diagnosis and Management of Acute Otitis Media

2013-02-26

Allan S. Lieberthal , Aaron E. Carroll , Tasnee Chonmaitree +7 more

This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It … This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM. In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships. The practice guideline underwent comprehensive peer review before formal approval by the AAP. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem.

Epidemiology of Otitis Media During the First Seven Years of Life in Children in Greater Boston: A Prospective, Cohort Study

1989-07-01

David W. Teele , Jerome O. Klein , Bernard Rosner

To determine the epidemiology of acute otitis media (AOM) and duration of middle ear effusion (MEE), we followed consecutively enrolled children from shortly after birth until 7 y of age. … To determine the epidemiology of acute otitis media (AOM) and duration of middle ear effusion (MEE), we followed consecutively enrolled children from shortly after birth until 7 y of age. Because some children dropped out of the study, data were analyzed for 877 children observed for at least 1 y; 698 were observed for at least 3 y, and 498 were observed until 7 y of age. By 1 y of age, 62% of the children had ⩾1 episode of AOM and 17% had ⩾3 episodes; by 3 y of age, 83% had ⩾1 episode of AOM and 46% had ⩾3 episodes. The peak incidence occurred during the second 6-mo period of life. Significantly increased risk (by multivariate analysis) for AOM was associated with male gender, sibling history of recurrent AOM, early occurrence of AOM, and not being breast fed. MEE persisted after onset of AOM for weeks to months; prolonged duration of MEE was associated with male gender, sibling history of ear infection, and not being breast fed.

The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations

2004-01-01

Jennifer R. Grandis , Barton F. Branstetter , Victor L. Yu

Antibiotics for acute otitis media: a meta-analysis with individual patient data

2006-10-01

Maroeska M. Rovers , Paul Glasziou , Cees L. Appelman +6 more

Burden of Disease Caused by Otitis Media: Systematic Review and Global Estimates

2012-04-30

Lorenzo Monasta , Luca Ronfani , Federico Marchetti +6 more

Background Otitis media (OM) is a leading cause of health care visits and drugs prescription. Its complications and sequelae are important causes of preventable hearing loss, particularly in developing countries. … Background Otitis media (OM) is a leading cause of health care visits and drugs prescription. Its complications and sequelae are important causes of preventable hearing loss, particularly in developing countries. Within the Global Burden of Diseases, Injuries, and Risk Factors Study, for the year 2005 we estimated the incidence of acute OM, chronic suppurative OM, and related hearing loss and mortality for all ages and the 21 WHO regional areas. Methods We identified risk factors, complications and sequelae of OM. We carried out an extensive literature review (Medline, Embase, Lilacs and Wholis) which lead to the selection of 114 papers comprising relevant data. Data were available from 15 of the 21 WHO regions. To estimate incidence and prevalence for all countries we adopted a two stage approach based on risk factors formulas and regression modelling. Results Acute OM incidence rate is 10.85% i.e. 709million cases each year with 51% of these occurring in under-fives. Chronic suppurative OM incidence rate is 4.76‰ i.e. 31million cases, with 22.6% of cases occurring annually in under-fives. OM-related hearing impairment has a prevalence of 30.82 per ten-thousand. Each year 21thousand people die due to complications of OM. Conclusions Our study is the first attempt to systematically review the available information and provide global estimates for OM and related conditions. The overall burden deriving from AOM, CSOM and their sequelae is considerable, particularly in the first five years of life and in the poorest countries. The findings call for incorporating OM-focused action within preventive and case management strategies, with emphasis on the more affected.

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Clinical Practice Guideline: Otitis Media with Effusion (Update)

2016-02-01

Richard M. Rosenfeld , Jennifer J. Shin , Seth Schwartz +7 more

Objective This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology—Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, … Objective This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology—Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence‐based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME. Purpose The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients <2 months or >12 years old. Action Statements The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME. The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow‐up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at‐risk children for OME at the time of diagnosis of an at‐risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time); (4) should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow‐up, and the possible sequelae; (6) should obtain an age‐appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at‐risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3‐ to 6‐month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old ; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old ; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.

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Otitis Media in Children

1995-06-08

Stephen Berman

The frequency of otitis media is one of a number of factors causing physicians to seek out the most cost-effective clinical strategies for managing the condition. It is estimated that, … The frequency of otitis media is one of a number of factors causing physicians to seek out the most cost-effective clinical strategies for managing the condition. It is estimated that, by the time they reach two years of age, all the children in the United States currently under that age will have had a total of 9.3 million episodes of acute otitis media,1 and that approximately 17 percent of children have three or more episodes during a six-month period.2 Frequent episodes of otitis disrupt child-care arrangements and work schedules and generate parental anxiety and stress. The annual cost of the . . .

LXVIII Fenestration of the Oval Window

1958-12-01

John J. Shea

Otosclerosis is a compound metabolic disease characterized by the proliferation of abnormal bone in the otic capsule and hearing loss. It is unique to the human temporal bone. Basic Concepts … Otosclerosis is a compound metabolic disease characterized by the proliferation of abnormal bone in the otic capsule and hearing loss. It is unique to the human temporal bone. Basic Concepts of Surgery The proliferation usually begins in late adolescence, just anterior to the fissula ante fenestram, 1 continues for a number of years, and then stops. This proliferation follows a distinct pattern in that it is most frequently either confined to the anterior 30% of the footplate and oval window or widespread throughout the footplate and surrounding oval window. The purpose of surgery in otosclerosis is to create a permanent passageway for sound—from the middle to the inner ear—once again. The entire stapes can be mobilized at surgery in a large percentage of cases by various means, but the basic pathology remains essentially unchanged and all too often ankylosis of the stapes recurs. It has been demonstrated by Fowler

Clinical Practice Guideline: Tympanostomy Tubes in Children

2013-07-01

Richard M. Rosenfeld , Seth Schwartz , Melissa A. Pynnonen +7 more

Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent … Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. Despite the frequency of tympanostomy tube insertion, there are currently no clinical practice guidelines in the United States that address specific indications for surgery. This guideline is intended for any clinician involved in managing children, aged 6 months to 12 years, with tympanostomy tubes or being considered for tympanostomy tubes in any care setting, as an intervention for otitis media of any type.The primary purpose of this clinical practice guideline is to provide clinicians with evidence-based recommendations on patient selection and surgical indications for and management of tympanostomy tubes in children. The development group broadly discussed indications for tube placement, perioperative management, care of children with indwelling tubes, and outcomes of tympanostomy tube surgery. Given the lack of current published guidance on surgical indications, the group focused on situations in which tube insertion would be optional, recommended, or not recommended. Additional emphasis was placed on opportunities for quality improvement, particularly regarding shared decision making and care of children with existing tubes. ACTION STATEMENTS: The development group made a strong recommendation that clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. The panel made recommendations that (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration; (2) clinicians should obtain an age-appropriate hearing test if OME persists for 3 months or longer (chronic OME) or prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer (chronic OME) and documented hearing difficulties; (4) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who did not receive tympanostomy tubes until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (5) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (6) clinicians should offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (7) clinicians should determine if a child with recurrent AOM or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (8) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (9) clinicians should not encourage routine, prophylactic water precautions (use of earplugs, headbands; avoidance of swimming or water sports) for children with tympanostomy tubes. The development group provided the following options: (1) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) and symptoms that are likely attributable to OME including, but not limited to, vestibular problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life and (2) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is unlikely to resolve quickly as reflected by a type B (flat) tympanogram or persistence of effusion for 3 months or longer (chronic OME).

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The Diagnosis and Management of Acute Otitis Media

2021-04-07

The world report on hearing, 2021

2021-03-29

Shelly Chadha , Kaloyan Kamenov , Alarcos Cieza

Otitis media

2004-02-01

Maroeska M. Rovers , Anne GM Schilder , Gerhard A. Zielhuis +1 more

Otitis media

2016-09-08

Anne GM Schilder , Tasnee Chonmaitree , Allan W. Cripps +4 more

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Diagnosis and Management of Acute Otitis Media

2004-05-01

This evidence-based clinical practice guideline provides recommendations to primary care clinicians for the management of children from 2 months through 12 years of age with uncomplicated acute otitis media (AOM). … This evidence-based clinical practice guideline provides recommendations to primary care clinicians for the management of children from 2 months through 12 years of age with uncomplicated acute otitis media (AOM). The American Academy of Pediatrics and American Academy of Family Physicians convened a committee composed of primary care physicians and experts in the fields of otolaryngology, epidemiology, and infectious disease. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to AOM. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific definition of AOM. It addresses pain management, initial observation versus antibacterial treatment, appropriate choices of antibacterials, and preventive measures. Decisions were made based on a systematic grading of the quality of evidence and strength of recommendations, as well as expert consensus when definitive data were not available. The practice guideline underwent comprehensive peer review before formal approval by the partnering organizations. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem.

Exclusive Breast-Feeding for at Least 4 Months Protects Against Otitis Media

1993-05-01

Burris Duncan , John L. Ey , Catharine J. Holberg +3 more

Objective. This study was designed to assess the relation of exclusive breast-feeding, independent of recognized risk factors, to acute and recurrent otitis media in the first 12 months of life. … Objective. This study was designed to assess the relation of exclusive breast-feeding, independent of recognized risk factors, to acute and recurrent otitis media in the first 12 months of life. Methods. Records of 1220 infants who used a health maintenance organization and who were followed during their first year of life as part of the Tucson Children's Respiratory Study were reviewed. Detailed prospective information about the duration and exclusiveness of breast-feeding was obtained, as was information relative to potential risk factors (socioeconomic status, gender, number of siblings, use of day care, maternal smoking, and family history of allergy). Acute otitis media and recurrent otitis media, defined as three or more episodes of acute otitis media in a 6-month period or four episodes in 12 months, were the outcome variables. Results. Of the 1013 infants followed for their entire first year, 476 (47%) had at least one episode of otitis and 169 (17%) had recurrent otitis media. Infants exclusively breast-fed for 4 or more months had half the mean number of acute otitis media episodes as did those not breast-fed at all and 40% less than those infants whose diets were supplemented with other foods prior to 4 months. The recurrent otitis media rate in infants exclusively breast-fed for 6 months or more was 10% and was 20.5% in those infants who breast-fed for less than 4 months. This protection was independent of the risk factors considered. Conclusion. These findings suggest that exclusive breast-feeding of 4 or more months protected infants from single and recurrent episodes of otitis media.

Osseointegrated titanium implants in the temporal bone. A clinical study on bone-anchored hearing aids.

1981-04-01

Anders Tjellström , Johan Lindström , O. Hallén +2 more

The purpose of this study is to investigate the possibilities for attaching a new type of direct bone conduction hearing aid. Using a gentle surgical technique, titanium screws were inserted … The purpose of this study is to investigate the possibilities for attaching a new type of direct bone conduction hearing aid. Using a gentle surgical technique, titanium screws were inserted into the temporal bone of fourteen patients suffering from hearing impairment. The implants became integrated with the living bone tissue and have remained so for a follow-up period of, at present, two to four years. It is therefore concluded that titanium implants may be osseointegrated in the temporal bone in a similar manner to that previously described for long bones. The bone-anchored titanium screws were connected to a permanently skin-penetrating abutment, which in turn was used for attachment to a hearing aid. In this way a direct bone conduction without obstructing soft tissue layers is secured. The permanent skin penetration caused no adverse soft tissue effects. The new system has improved pure-tone hearing threshold by about 15 dB. Further research is aimed at the construction of a new hearing aid that is better adapted to the impedance situation existing in the directly bone-anchored cases.

Correction to “Evaluating the Antimicrobial and Antibiofilm Efficacy of Lavender Essential Oil and Linalool on Dual <i>Candida albicans</i> Biofilms With S<i>taphylococcus aureus</i> and <i>Staphylococcus epidermidi</i>s from Canine External Otitis”

2025-06-26

| Veterinary Medicine and Science

Current management of secondary acquired cholesteatoma – A scoping review

2025-06-25

Santosh Kumar Swain | Journal of Indira Gandhi Institute Of Medical Sciences

Abstract Chronic otitis media (COM) is a common disorder of middle ear cleft that can be complicated when associated with cholesteatoma. Aggressive atticoantral type of COM is an important cause … Abstract Chronic otitis media (COM) is a common disorder of middle ear cleft that can be complicated when associated with cholesteatoma. Aggressive atticoantral type of COM is an important cause of otogenic complications. Otogenic complications are mostly determined by the disease’s etiopathology, which is connected to the disease’s genesis and contributing factors. Although cholesteatoma-associated complications are uncommon in the current period, it is still a challenging clinical entity in developing countries. Acquired cholesteatoma in atticoantral disease of the middle ear may be primary or secondary. These two types of cholesteatomas differ by etiopathogenetic mechanisms. Cholesteatoma that results from tympanic membrane perforation is referred to as secondary acquired cholesteatoma (SAC). Although exact etiopathogenesis of SAC remains unclear, several possible mechanisms are there to explain the development of this variety of cholesteatoma. Histopathological examination shows that stratified squamous epithelium migrates from the lateral surface of the tympanic membrane via tympanic membrane perforation. The medical literature contains extremely few documented investigations on SAC. SAC is a rare clinical condition, but in cases where morbid otological illness manifests, practitioners need to be aware of its existence. The search for research papers on the current treatment of SAC was conducted by exploring online databases such as PubMed, Scopus, Medline, and Google Scholar. This review article’s goal is to go over the most current developments in the treatment of SAC.

Effect of Middle Ear Prosthesis Diameter in Platinotomy and Partial Platinectomy on Hearing Gain: A Finite Element Study

2025-06-25

Mario Ceddia , Nicola Quaranta , Vito Pontillo +3 more | Materials

This study investigates, for the first time, using finite element analysis (FEA), the differential impact of middle ear prosthesis diameter on hearing gain in two distinct surgical techniques: stapedotomy and … This study investigates, for the first time, using finite element analysis (FEA), the differential impact of middle ear prosthesis diameter on hearing gain in two distinct surgical techniques: stapedotomy and partial stapedectomy. The model represented the cochlea as two fluid-filled straight channels separated by the basilar membrane and considered pistons of 0.4 mm and 0.6 mm diameters. The results demonstrated that in stapedotomy, a 0.6 mm diameter piston yielded a significantly better reduction in ABG (8.31 dB) compared to the 0.4 mm piston (10.67 dB), indicating improved hearing gain. Conversely, in partial stapedectomy, the smaller 0.4 mm piston was more effective, reducing ABG to 11.2 dB versus 12.12 dB with the larger piston. These findings highlight that the optimal prosthesis diameter varies according to surgical technique, emphasizing the need for tailored prosthesis selection.

Navigation-Guided Cochlear Implantation in Complex Congenital Ear Anomalies: Pierre Robin Syndrome With External Aural Atresia and Middle Ear Agenesis

2025-06-23

Kyu-Yup Lee , Eun-Hye Kwon | Journal of Craniofacial Surgery

Cochlear implantation in patients with complex craniofacial anomalies such as Pierre Robin syndrome poses significant surgical challenges, particularly in the presence of external aural atresia and middle ear agenesis. The … Cochlear implantation in patients with complex craniofacial anomalies such as Pierre Robin syndrome poses significant surgical challenges, particularly in the presence of external aural atresia and middle ear agenesis. The authors present the case of a female patient diagnosed with Pierre Robin syndrome at 7 weeks of age, who exhibited glossoptosis, cleft palate, micrognathia, and multiple systemic anomalies. Audiological evaluation confirmed profound bilateral sensorineural hearing loss, and imaging revealed severe malformations of the external, middle, and inner ear. Sequential bilateral cochlear implantation was planned. At 20 months of age, left-sided cochlear implantation was successfully performed using anatomic estimation despite the absence of conventional landmarks. A second attempt for right-sided implantation was made at 26 months; however, the surgery was aborted due to the inability to localize the cochlea. At 4 years of age, right-sided implantation was successfully achieved using a navigation-guided transmastoid approach. High-resolution preoperative imaging with fiducial markers enabled accurate intraoperative localization, allowing for safe electrode insertion despite the complex anatomy. Postoperative follow-up demonstrated favorable auditory and language development. This case highlights the value of advanced surgical planning and navigation-assisted techniques in overcoming anatomic challenges in cochlear implantation for patients with severe congenital ear anomalies.

Role Of Butterfly Cartilage Tympanoplasty in Small to Medium Sized Perforations in Chronic Otitis Media Patients

2025-06-23

Priyanka Garg , Sanjeev Bhagat , Dimple Sahni +3 more | Indian Journal of Otolaryngology and Head & Neck Surgery

Sağlıklı Bir Yenidoğanın Omuz Ekleminde Metisiline Dirençli Stafilokok Aureus’a Bağlı Gelişen Septik Artrit ve Osteomyelit Olgusu

2025-06-23

Midhat Kuşkaya | Hitit Medical Journal

Akut septik artrit ve osteomyelit,yenidoğanlarda nadir görülen, sekel oluşmaması için hızlı tanı konulması ve tedavi edilmesi gereken hastalıklardır. 24 günlük, öncesinde sağlıklı olan yenidoğanda metisiline dirençli Staphylococcus aureus’a bağlı omuz … Akut septik artrit ve osteomyelit,yenidoğanlarda nadir görülen, sekel oluşmaması için hızlı tanı konulması ve tedavi edilmesi gereken hastalıklardır. 24 günlük, öncesinde sağlıklı olan yenidoğanda metisiline dirençli Staphylococcus aureus’a bağlı omuz ekleminde gelişen akut septik artrit ve osteomyelit olgusunu sunuyoruz. Fizik muayenesinde sağ omuzda lokal ısı artışı ve şişlik, sağ el spontan hareketlerinde kısıtlılık ve pasif el hareketlerinde ağrıya bağlı ağlama görüldü. Manyetik rezonans görüntülemede omuz ekleminde sıvı artımı ve yumuşak dokularda şişlik saptandı. Artrotomi ve sonrasında altı hafta devam eden parenteral antibiyotik tedavisine iyi cevap alındı. Yenidoğan döneminde öncesinde sağlıklı olup, omuz ekleminde metisiline dirençli Staphylococcus aereus’a bağlı gelişen çok nadir bir akut septik artrit ve osteomyelit olgusu olması nedeni ile bu olguyu sunuyoruz.

What is hidden under the mask of chronic suppurative otitis media? Clinical case

2025-06-21

В. М. Свистушкин , Г. Н. Никифорова , Е. А. Шевчик +2 more | Consilium Medicum

Chronic suppurative otitis media (CSOM) is a common pathology in the practice of an otolaryngologist. Modern conservative therapy and surgical correction methods have made it possible to achieve good functional … Chronic suppurative otitis media (CSOM) is a common pathology in the practice of an otolaryngologist. Modern conservative therapy and surgical correction methods have made it possible to achieve good functional results. However, in some cases, standard treatment is ineffective, then such a course of CSOM is usually called ”atypical”. Under its mask, a number of systemic diseases may be hidden, which are accompanied by inflammatory changes in the cavities of the middle ear. The article describes a clinical case of ”atypical” bilateral purulent otitis media in a female patient. During surgical treatment, morphological features were noted indicating a possible specific nature of inflammation in the middle ear. During further examination by a phthisiatrician, a tuberculoma of the right lung was detected, chemotherapy was started, during which, after 4 months, the symptoms of exacerbation of CSOM were stopped. Thus, an interdisciplinary approach is necessary for diagnosis and correct tactics of management of patients with ”atypical” sluggish CSOM.

Radiological Interrelations Between the Sigmoid Sinus and Mastoid Pneumatization in the Context of Diverse Middle Ear Pathologies: An Observational Study

2025-06-21

Priti S. Hajare , Akash Rai , Aditya Achyut Redkar | Indian Journal of Otolaryngology and Head & Neck Surgery

Edrophonium

2025-06-21

| Reactions Weekly

TYPE 1 TYMPANOPLASTY FOR CHRONIC TUBOTYMPANAL SUPPURATIVE OTITIS MEDIA

2025-06-20

I.I. Morozov , N.V. Gorbunova , A.V. Shirokayа | Bulletin of the Medical Institute of Continuing Education

Background. Chronic suppurative otitis media (CSOM) is a socially significant disease, the need for surgical treatment of which is beyond doubt. The most common surgery for CSOM is tympanoplasty. Purpose. … Background. Chronic suppurative otitis media (CSOM) is a socially significant disease, the need for surgical treatment of which is beyond doubt. The most common surgery for CSOM is tympanoplasty. Purpose. To conduct a comparative analysis of the results of type 1 tympanoplasty using three types of autografts: auricular cartilage, thin plates of auricular cartilage, and temporal fascia. Materials and methods. The study involved 60 patients with tubotympanic suppurative otitis media, who were divided into 3 groups of 20 people: group 1 underwent type 1 tympanoplasty using thin plates of auricular cartilage, group 2 underwent type 1 tympanoplasty using temporal autofascia, and group 3 underwent type 1 tympanoplasty with a graft of auricular cartilage with perichondrium. The patients underwent preoperative examination: collection of complaints and anamnesis, examination of ENT organs using microscopic and endoscopic equipment, clinical and laboratory examination, multispiral computed tomography (MSCT) of the temporal bones, hearing assessment using pure tone threshold audiometry at frequencies of 500-1000-2000-4000 Hz. The postoperative follow-up examinations were performed after 1, 3, 6 and 12 months. Results. In group 1 (13 men, 7 women), the average age was 36.1±7.7 years, the number of perforations no larger than 1 quadrant of the eardrum was 3 (15%), more than 1 quadrant but less than three were 12 (60%), total perforation was 5 (25%), the average air-bone gap (ABG) was 33.5±5.6 dB. In group 2 (14 men, 6 women), the average age was 39.2±6.8 years, the number of perforations smaller than 1 quadrant of the eardrum was 4 (20%), more than 1 quadrant but less than three was 13 (65%), total perforation was 3 (15%), the average ABG was 30.5±4.2 dB. In group 3 (15 men, 5 women), the average age was 37.2±7.3 years, the number of perforations smaller than 1 quadrant of the eardrum was 2 (10%), more than 1 quadrant but less than three was 12 (65%), total perforation was 5 (25%), the average ABG was 29.4±6.5 dB. One year after the surgery in group 1 the neotympanic membrane was competent in 95%, the average ABG was 11.1±4.9 dB. In group 2 the neotympanic membrane was competent in 85% (17 patients) with three residual perforations in patients with total perforations, ABG was 12.3±5.2 dB. In group 3, there was 1 case of failure with the formation of a slit perforation with a total success rate of the operation of 95%, ABG was 14.4±8.9 dB. In all groups there was a significant improvement in hearing compared to the preoperative results (p<0.05), while there was no significant difference in the degree of hearing improvement between the groups. However, in group 2, in contrast to groups 1 and 3, there was a retraction pocket formation in 2 cases (10%) and , in 1 case (5%), lateralization of the neotympanic membrane with the formation an atresia of the meatotympanic angle. Conclusion. The results of the study showed no statistically significant difference in the number of residual perforations of the tympanic membrane and the results of the hearing test after surgery according to the tonal threshold audiometry at frequencies of 500-1000-2000-4000 Hz. At the same time, in group 2, in contrast to groups 1 and 3, there were cases of retraction pockets formation and lateralization of the neotympanic membrane.

Comparative evaluation of machine learning models for enhancing diagnostic accuracy of otitis media with effusion in children with adenoid hypertrophy

2025-06-19

Xiaote Zhang , Qiaoyi Xie , Guangyong Wu | Frontiers in Pediatrics

Background Otitis media with effusion (OME) affects a significant proportion of children with adenoid hypertrophy (AH) and can lead to developmental sequelae when chronic. Current non-invasive screening modalities rely predominantly … Background Otitis media with effusion (OME) affects a significant proportion of children with adenoid hypertrophy (AH) and can lead to developmental sequelae when chronic. Current non-invasive screening modalities rely predominantly on acoustic immittance measurements, which demonstrate variable diagnostic performance. Given the urgent need for improved diagnostic methods and extensive characterization of risk factors for OME in AH children, developing diagnostic models represents an efficient strategy to enhance clinical identification accuracy in practice. Objective This study aims to develop and validate an optimal machine learning (ML)-based prediction model for OME in AH children by comparing multiple algorithmic approaches, integrating clinical indicators with acoustic measurements into a widely applicable diagnostic tool. Methods A retrospective analysis was conducted on 847 pediatric patients with AH. Five ML algorithms were developed to identify OME using demographic, clinical, laboratory, and acoustic immittance parameters. The dataset underwent 7:3 stratified partitioning for training and testing cohorts. Within the training cohort, models were initially optimized through randomized grid search with 5-fold cross-validation, followed by comprehensive training with optimized parameters. Model performance was evaluated in the testing cohort using discrimination, calibration, clinical utility metrics, and confusion matrix-derived statistics. The optimal ML model was subsequently analyzed through SHapley Additive exPlanations (SHAP) methodology for interpretability, with sequential ablation testing performed to identify critical predictive variables. Results Among 847 children with AH, 262 (30.9%) were diagnosed with OME. The Random Forest (RF) model demonstrated superior performance with the highest discrimination (area under the receiver operating characteristic curve = 0.919), balanced calibration (Brier score = 0.102), and optimal clinical utility across decision thresholds of 0.4–0.6. Confusion matrix analysis further confirmed RF as the optimal model, achieving 0.875 accuracy and robust inter-rater agreement (Cohen's kappa coefficient = 0.696) in the testing cohort. SHAP analysis identified the adenoid-to-nasopharyngeal ratio as the predominant diagnostic indicator, followed by tympanometric type and history of recurrent respiratory infections. Conclusion An RF-based diagnostic model effectively identifies OME in AH children by integrating anatomical, functional, and inflammatory parameters, providing a clinically applicable tool for enhanced diagnostic accuracy and evidence-based management decisions.

Surgical Outcomes of Malleus Head Interposition Ossiculoplasty During Canal Wall Down Tympano-Mastoidectomy in Cholesteatoma Patients

2025-06-19

Tarek Abdelrahman Abdelhafez , Ahmed Ragab , Ayman Ali Abdelfattah +2 more | Ear Nose & Throat Journal

Objective: To evaluate the hearing outcomes and complications of primary malleus head interposition ossiculoplasty during canal wall down (CWD) tympano-mastoidectomy surgery in patients with cholesteatoma. Background: Most ossiculoplasty techniques depend … Objective: To evaluate the hearing outcomes and complications of primary malleus head interposition ossiculoplasty during canal wall down (CWD) tympano-mastoidectomy surgery in patients with cholesteatoma. Background: Most ossiculoplasty techniques depend on interposition or reposition ossiculoplasty. Therefore, in cases where the Incus is eroded, the malleus becomes the only remaining ossicle and can be used for interposition ossiculoplasty. Patients and Methods: This prospective study included 27 patients with cholesteatoma. All patients received primary malleus head interposition ossiculoplasty during CWD tympano-mastoidectomy. Follow-up of patients carried out in an outpatient clinic through routine follow-up visits at 1, 3, and 6 months using a pure tone audiometer. Results: Postoperative air bone gab (ABG) closure had values of 11.03, 9.63, 8.96, and 10.7 dB at 500, 1000, 2000, and 4000 Hz, respectively. The mean postoperative ABG decreased from 33.81 ± 5.69 to 24.85 ± 3.08 dB with an improvement of 9 dB that was statistically significant ( P < .001). Conclusions: The malleus head interposition technique is simple and effective for ossiculoplasty in CWD tympano-mastoidectomy. This technique was considered effective in enhancing the stability of the graft and the efficacy of the overall ossiculoplasty procedure. It is characterized by availability, low cost, and low complication rate.

Congenital cholesteatoma of the middle ear with total atresia of the external auditory canal: two cases report

2025-06-18

И. А. Аникин , N. N. Khamgushkeeva , A.D. Knyazev +1 more | Russian Bulletin of Otorhinolaryngology

Congenital stenosis and atresia of the external auditory canal are the most common developmental anomalies of the external ear. Cases of combination of these malformations with cholesteatoma of the temporal … Congenital stenosis and atresia of the external auditory canal are the most common developmental anomalies of the external ear. Cases of combination of these malformations with cholesteatoma of the temporal bone have been repeatedly described in the world literature. This combined pathology is more typical of congenital stenosis of the external auditory canal. Total atresia of the external auditory canal is rarely associated with cholesteatoma. Cholesteatoma found behind the atretic plate is classified as congenital, excluding other possible mechanisms of it’s formation. The article presents two clinical cases of a combination of congenital cholesteatoma and complete atresia of the external auditory canal: in an 8-year old girl and a 19-year old boy without the development of intratemporal and extratemporal complications.

Performance evaluation results of an artificial neural network developed for the purpose of classifying otoendoscopic images

2025-06-18

Kriukov Ai , Е В Гаров , P A Sudarev +5 more | Russian Bulletin of Otorhinolaryngology

The article describes an attempt to implement an automated approach in the diagnosis of ear diseases using a convolutional neural network. In the course of the work, a dataset consisting … The article describes an attempt to implement an automated approach in the diagnosis of ear diseases using a convolutional neural network. In the course of the work, a dataset consisting of 8791 images obtained during human otoendoscopic examination was formed, labelled and uploaded. The neural network was trained and tested. To organize the work of the algorithm, a tree of diagnoses was created and classes of images were defined: normal, defect of the unstretched section of the tympanic membrane, adhesive otitis media, foreign body of the external auditory canal, neotympanic membrane, sulfur plug, shunt, exudative otitis media, exostoses and neoplasms of the external auditory canal, diffuse otitis media, defect of the unstretched section of the tympanic membrane. The developed and trained artificial neural network demonstrated an accuracy of 91.2% in recognising different nosological classes related to the middle ear and diseases of external auditory canal. The proposed technology can be further used in medical practice to control and improve the quality of diagnostics of ear pathologies.

Microbial Profile and Antimicrobial Resistance Patterns in Otitis Externa: A Clinical Study from a Tertiary Care Teaching Hospital

2025-06-18

Kanchan Garg , Meenakshi Sharma , Kumar Shubhanshu | Indian Journal of Otolaryngology and Head & Neck Surgery

Intratemporal and Extratemporal Complications in a Rare Case of Acute Mastoiditis: A Case Report and Literature Review

2025-06-17

Achraf Amine Sbai , Oumaima Essadqi , Drissia Benfadil +2 more | Radiology Case Reports

Otosclerose bilateral e estapedectomia: aspectos cirúrgicos e processo de enfermagem

2025-06-17

Pabloena da Silva Pereira , Maria João Silva , Renan Sallazar Ferreira Pereira +3 more | DELOS Desarrollo Local Sostenible

O propósito é examinar o papel da enfermagem no acompanhamento perioperatório da estapedectomia de pacientes com otosclerose bilateral que foram submetidos à estapedectomia, focando nos cuidados clínicos e cirúrgicos que … O propósito é examinar o papel da enfermagem no acompanhamento perioperatório da estapedectomia de pacientes com otosclerose bilateral que foram submetidos à estapedectomia, focando nos cuidados clínicos e cirúrgicos que garantem a segurança, a recuperação auditiva e a integralidade do atendimento. A abordagem utilizada foi um estudo de caso, baseado na avaliação do prontuário clínico, testes audiológicos, tomografia computadorizada de ossos temporais e no monitoramento em todas as fases operatórias de mulher diagnosticada com otosclerose bilateral. A pesquisa também apresentou uma revisão bibliográfica para situar os resultados clínicos observados. Os achados indicaram que a paciente sofria de perda auditiva progressiva e zumbido bilateral, sendo diagnosticada em estágio avançado da enfermidade. A estapedectomia foi recomendada e executada com êxito, mostrando uma melhoria considerável dos limiares auditivos no seguimento pós-cirúrgico. Também se destacou a relevância do diagnóstico antecipado e da execução de exames adicionais, como a audiometria e a radiografia, para a confirmação da doença e o planejamento da cirurgia. A conclusão ressalta a importância da estapedectomia como um método eficiente para a recuperação auditiva de pacientes com otosclerose bilateral, bem como a necessidade de espalhar o acesso a diagnósticos especializados e avaliações otológicas regulares para diminuir o avanço da perda auditiva e aprimorar a qualidade de vida dos pacientes impactados.

Management Strategies for Chronic Suppurative Otitis Media and Why They Fail

2025-06-16

Nanki Hura , Anping Xia , Peter L Santa Maria | Journal of the Association for Research in Otolaryngology

Prä- und postoperative Standards in der Ohrchirurgie – interne Umfrage der ADANO Otologie-Fachgruppe

2025-06-16

Julia Esser , Thomas Zahnert , Kristen Rak +7 more | Laryngo-Rhino-Otologie

Zusammenfassung Die perioperative Versorgung in der Ohrchirurgie spielt eine zentrale Rolle für den Behandlungserfolg. Dennoch bestehen möglicherweise erhebliche Unterschiede in den klinischen Standards, zumal evidenzbasierte Leitlinien fehlen. Angesichts der zunehmenden … Zusammenfassung Die perioperative Versorgung in der Ohrchirurgie spielt eine zentrale Rolle für den Behandlungserfolg. Dennoch bestehen möglicherweise erhebliche Unterschiede in den klinischen Standards, zumal evidenzbasierte Leitlinien fehlen. Angesichts der zunehmenden Komplexität ohrchirurgischer Eingriffe und der Bedeutung einer hochwertigen Nachsorge ist die Standardisierung von Maßnahmen essenziell, um Komplikationen zu minimieren und Ergebnisse zu verbessern. Dreißig Multiple-Choice-Fragen zu prä-, peri- und postoperativen Standards in der eigenen Klinik wurden den Mitgliedern der Otologie-Fachgruppe der Arbeitsgemeinschaft Deutschsprachiger Audiologen, Neurootologen und Otologen (ADANO) über einen Online-Fragebogen gestellt. Die Antworten der 14 Teilnehmenden zeigten teils erhebliche Heterogenität in der perioperativen Versorgung. Unterschiedliche Ansätze zeigten sich insbesondere bei der Verwendung von Tamponaden, der Gabe von Antibiotika und Glukokortikoiden sowie bei postoperativen Verhaltensempfehlungen (z.B. sportliche Aktivität, Schutz vor Lärm und Wasser). Postoperative Kontrolluntersuchungen wie der Stimmgabel-Test nach Weber oder die Nystagmusprüfung werden relativ einheitlich angewendet. Die Ergebnisse verdeutlichen die aktuelle Inhomogenität der prä-, peri- und postoperativen Versorgung in der Ohrchirurgie, selbst in spezialisierten Zentren. Die Umfrage liefert eine Übersicht über gelebte Praktiken im Sinne einer Expertenmeinung, bietet jedoch keine höhere Evidenz. Derzeit gibt es kaum Studien in ausreichender Qualität, die die diskutierten Standards systematisch untersucht hätten – hier besteht klinischer Forschungsbedarf. Von Interesse wäre zudem, die Umfrage auf internationale ohrchirurgische Zentren und Experten auszuweiten.

The Current Situation and Development of Endoscopic Ear Surgery in China

2025-06-16

M.Y. Shi , Ge Yin , Yu Sun | World Journal of Otorhinolaryngology - Head and Neck Surgery

Evaluation of Bone-Anchored Hearing Instruments in Chronic Otitis Media: A Multicenter Prospective Study

2025-06-16

Fazıl Necdet Ardıç , Mehmet İhsan Gülmez , Şemsettin Okuyucu +7 more | Turkish Archives of Otorhinolaryngology

This study aims to assess the effectiveness of bone-anchored hearing instruments (BAHIs) in patients with chronic otitis media (COM), using objective and subjective measures. It is a multicenter, prospective trial … This study aims to assess the effectiveness of bone-anchored hearing instruments (BAHIs) in patients with chronic otitis media (COM), using objective and subjective measures. It is a multicenter, prospective trial involving patients with COM who have undergone surgical treatment and have been rehabilitated using BAHIs. COM Questionnaire-12 (COMQ-12), Speech, Spatial, and Qualities of Hearing Scale (SSQ), World Health Organization (WHO) Quality of Life-BREF questionnaire, and audiometric tests were used for assessment. Twenty-eight patients were included. The average duration of COM was 20.1±13.32 years. Among the patients, 60.7% (17) were using hearing aids, with a mean usage duration of 10.8±10.7 years (ranging from 1 to 36 years). Seven patients received the PONTO device, two received the BAH aid (BAHA) connect system, and 19 were implanted with the BAHA attract system. COMQ-12, SSQ, WHO questionaries, and audiometric tests showed significant improvement, and the results were found stable during follow-up. This study reinforces the effectiveness of BAHIs in improving hearing thresholds and quality of life for patients with COM.

Evaluation of Endoscopic Cartilage Myringoplasty Using Push-Through Technique

2025-06-15

Islam Ghanim Mahmood , Awf A. Abdulmaged , Hassan Myasar Abdulwahid +3 more | Indian Journal of Otolaryngology and Head & Neck Surgery

Predictive Factors of Long-term Tympanoplasty Outcomes in Children with Cleft Palate

2025-06-13

Jamie L. Funamura , Travis T. Tollefson , Angela A. Colback +5 more | International Journal of Pediatric Otorhinolaryngology

Identify factors associated with long-term tympanoplasty success in children with cleft palate. All tympanoplasty procedures for chronic perforation in children with cleft palate at a single institution were reviewed over … Identify factors associated with long-term tympanoplasty success in children with cleft palate. All tympanoplasty procedures for chronic perforation in children with cleft palate at a single institution were reviewed over a 20-year period. Demographic and clinical characteristics were compared by tympanoplasty outcome - successful sustained repair versus reperforation or tympanostomy tube placement versus need for revision tympanoplasty - with univariate, survival, and multivariate analysis. A total of 50 initial tympanoplasty procedures for chronic perforation between 2004 and 2024 at a single institution met inclusion criteria of patients <18 years with a history of cleft palate, excluding revision and second-sided procedures. The overall success rate of primary tympanoplasty was 78 % with a mean length of follow-up of 5.7 (±3.6) years. Significant demographic and clinical predictors were not demonstrated by univariate analysis. However, survival analysis of time to tympanoplasty failure demonstrated differences in duration of successful tympanoplasty for children in which Eustachian tube function could be assessed by the status of the contralateral ear, with a mean time to failure of 10.7 [9.5-12.0] compared to 8.2 [5.3-11.0] years (p = 0.02). Ability to assess the contralateral ear was also associated with a 5.4 (1.1.-26.1) increased likelihood of a successful tympanoplasty outcome. The success rate of tympanoplasty in children with cleft palate is lower than would be expected in an adult or non-cleft population, but can still be largely successful at a mean age of <12 years. The ability to assess the contralateral ear may the most important predictive factor in determining success rather than age, cleft type, or other demographic and clinical factors.

Rising Incidence of Pediatric Otitis Media and The Role of Antibiotic Resistance

2025-06-13

Sayyed Muddasir Shah , Haider Zaman , Mubashar Ullah Jan +3 more | Journal of Neonatal Surgery

Background: Even adding this type of ear infection to the list of common childhood illnesses produces a lot of antibiotic prescriptions. Because of environmental risks and poor use of antibiotics, … Background: Even adding this type of ear infection to the list of common childhood illnesses produces a lot of antibiotic prescriptions. Because of environmental risks and poor use of antibiotics, more cases of antibiotic resistance are appearing all over the globe. As a result, there are more cases of drug-resistant bacteria and patients experience more recurrences, more complications and more hassles with medical care. Objectives: To evaluate current trends in pediatric otitis media, assess patterns of antibiotic resistance among causative organisms, and analyze associated outcomes and the risk factors for recurrent infections. Study Design: a cross-sectional study Place and duration of study. Department Of ENT Mardan Medical Complex,Bacha Khan Medical College Mardan, KPK During The Period From January To December 2024 Methods: 300 children ranging from 6 months to 12 years old who all had otitis media confirmed by a doctor. A culture of the middle ear fluids was done and the findings were tested against various bacteria. We recorded information about the person’s age, medicine history and any previous infections. All statistical analysis was carried out with SPSS v24.0 and the significance level was p<0.05. Results: 300 children the average age was 3.8 years with a standard deviation of 2.4 years. For every man there were 1.3 women in the country. Streptococcus pneumoniae (42%) and Haemophilus influenzae (35%) accounted for most of the findings. Among the cases, resistance to amoxicillin-clavulanate was recorded in 53% of them, whereas 28% of patients showed resistance to macrolides. Having taken antibiotics within the past 30 days made it much more likely to develop a resistant strain (p=0.02). Thirty-one percent of patients experienced a relapse, mostly those with multidrug-resistant forms of infection. Conclusion: An increase in pediatric otitis media is connected to a rising problem with antibiotic resistance. Because amoxicillin-clavulanate is highly resisted, using antibiotics wisely and treating with culture recommendations is very important. Expanding vaccination, helping caregivers and regular monitoring of microbes helps prevent the same disease from coming back and complications related to resistance.

Improved Cholesteatoma Removal with CADISS: A Quantitative Ultrastructural Comparison Using VP-SEM

2025-06-12

Michela Relucenti , Ubaldo Romeo Plastina , Pasquale Fino +3 more | Journal of Clinical Medicine

Background: Cholesteatoma is a destructive middle ear pathology requiring precise surgical removal to prevent recurrence and preserve auditory function. The chemically assisted dissection (CADISS) system (AuXin Surgery, Ottignies-Louvain-la-Neuve, Belgium), based … Background: Cholesteatoma is a destructive middle ear pathology requiring precise surgical removal to prevent recurrence and preserve auditory function. The chemically assisted dissection (CADISS) system (AuXin Surgery, Ottignies-Louvain-la-Neuve, Belgium), based on Mesna (5%), was introduced to enhance tissue separation and minimize residual disease. Objective: This study aimed to compare the cleaning efficiency of CADISS-assisted dissection versus the conventional manual dissection of cholesteatoma from incus bone surfaces using quantitative ultrastructural analysis. Methods: This retrospective study evaluated 67 human incus samples collected during cholesteatoma surgery—35 treated with manual dissection and 32 with CADISS. Samples were imaged using variable pressure scanning electron microscopy (VP-SEM) in hydrated conditions. Clean area/total area ratios were calculated and analyzed statistically using non-parametric tests. Postoperative MRI follow-up at 1 month was conducted to assess residual disease. Results: CADISS-assisted samples demonstrated significantly higher clean area/total area ratios (mean: 0.2095 vs. 0.0478, p < 0.0001). Qualitative imaging showed fewer residuals > 1 mm in the CADISS group (9% vs. 77%). MRI follow-up revealed a lower recurrence rate in the CADISS group (3.1%) compared to manual dissection (11.4%). Conclusions: CADISS-assisted dissection provides superior cholesteatoma debris removal compared to manual methods, as evidenced by VP-SEM imaging and clinical follow-up. This technique may improve surgical outcomes and reduce recurrence risk in middle ear surgery.

Chronic suppurative otitis media: understanding its prevalence, bacterial spectrum, and antimicrobial resistance patterns among patients presenting with middle ear infections at KCMC in 2022, Tanzania: A hospital-based crosssectional study

2025-06-12

Simon Manyata , Dhahiri Mnzava , Pudensiana Tarimo +6 more | medRxiv (Cold Spring Harbor Laboratory)

ABSTRACT Background The global incidence of chronic suppurative otitis media is as high as 4.76% i.e. 31million cases with 22.6% of these cases occurring in children under five years. With … ABSTRACT Background The global incidence of chronic suppurative otitis media is as high as 4.76% i.e. 31million cases with 22.6% of these cases occurring in children under five years. With a prevalence of 30.82 per ten-thousand, each year 21 thousand people die due to complications of chronic suppurative otitis media. Objective the objective of this study was to determine the prevalence of chronic suppurative otitis media, its bacteriological profile, and antimicrobial susceptibility pattern among patients presenting with middle ear infections at KCMC, 2022. Methodology This hospital-based cross-sectional study was conducted at KCMC, ENT department from 15-03-2022 to 30-05-2022 and enrolled 201 participants by convenient sampling. From those confirmed with CSOM, a discharge swab was collected for microbiological investigations. Antimicrobial susceptibility was performed using the Modified Kirby-Bauer disk diffusion method. Data was analyzed using SPSS. Results Of 201 participants, 23 (11.4%) were confirmed to have CSOM. Prevalence of CSOM was higher at 22.4% (13/58) in children under five years of age. The proportion of CSOM infection was higher among males 12.9% (11/85) compared to females 10.3% (12/116). CSOM prevalence was high among rural participants 15.7% (17/108) compared to urban 6.4% (6/93). Out of 23 CSOM discharge swabs, 82.6% (19/23) were culture-positive. S. aureus was the most common isolate 28.57% (6/23). Most isolates were Multi-drug resistant with the highest drug resistance found against penicillin antibiotics (60%-70%), lower to medium resistance (11-50%) against Cefotaxime, Meropenem, Ciprofloxacin, Chloramphenicol, Ceftazidime, Erythromycin, and Cefoxitin. At the same time, there was no resistance to Amikacin. Conclusion The high prevalence of CSOM and a high proportion of MDR bacteria among CSOM patients is a threat to patient management. Continuing empirical treatment could escalate the problem. We highly recommend microbiological analysis of middle ear discharge to study bacterial profile and drug susceptibility for the provision of proper and effective antibiotic treatment to CSOM patients.

Effect of Local Vitamin A Versus Local Dexamethasone in Prevention of Myringosclerosis

2025-06-12

Yasser Mandour , Mohamed Fahmy Shendy , Mohamed Elanany Elsaid Elanany +2 more | Indian Journal of Otolaryngology and Head & Neck Surgery

Mortality of malignant otitis externa: A prevalence meta-analysis

2025-06-11

Adham Aljariri , Ahmad R. Al‐Qudimat , Rani Hammoud +7 more | Qatar medical journal

Introduction: Malignant otitis externa (MOE) is an aggressive infection of the external auditory canal and the underlying bony structures of the skull base. Predominantly caused by Pseudomonas, the treatment has … Introduction: Malignant otitis externa (MOE) is an aggressive infection of the external auditory canal and the underlying bony structures of the skull base. Predominantly caused by Pseudomonas, the treatment has shifted from surgical to medical, with antimicrobial therapy being primary, although surgical intervention may still be required. This review aims to provide global prevalence and mortality data on MOE to help institutions establish treatment benchmarks. Methods: A systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Searches were completed in Scopus and PubMed Databases for articles on MOE mortality published between 1994 and 2022. Publications included data on MOE, mortality, and all genders. Results: A total of 22 studies involving 9,633 patients diagnosed with MOE were analyzed. The gender distribution was nearly equal, with 4,819 (50.1%) males and 4,814 (49.9%) females. The patients’ ages ranged from 18 to 90 years, with a mean age of 70.3 years. The pooled period prevalence of mortality due to MOE was estimated to be 18% (95% confidence interval: 6–30%), highlighting a significant mortality risk in patients with this condition. Heterogeneity across the studies was high (I = 99%, p < 0.001). Additionally, the prevalence of comorbidities was significant: 57.1% of patients were diabetic, 51% had hypertension, and other notable comorbidities included chronic pulmonary diseases (12.2%), liver disease (7.2%), and malignancies (3.4%). The most common microbiological cause was Pseudomonas aeruginosa (30%), followed by Staphylococcus aureus (10%). Surgical interventions were performed in 3.7% of cases, and cranial nerve involvement was reported in 9% of patients, primarily affecting the facial nerve (91%). Morbidity related to MOE was found to be 15.2%, and sepsis was a complication in 0.5% of cases. The results underscore the importance of addressing both comorbidities and mortality risks in managing MOE patients. Conclusion: This review highlights a significant global mortality rate of 18% in patients with MOE, with comorbidities like diabetes and hypertension contributing to worse outcomes. Despite current treatment advancements, mortality and morbidity remain substantial, stressing the need for early diagnosis, targeted interventions, and improved management strategies to enhance patient survival and outcomes.

Rapid Resolution of Acute Otitis Externa in a Young Female through Individualised Homoeopathic Management: A Case Report with Scientific Correlation

2025-06-11

Sushanth Bhat | International Journal of Science and Research (IJSR)