Ultrasound Characterization of Middle Ear Effusion

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P70-P70
Author(s):  
Rahul Seth ◽  
Christopher Discolo ◽  
Paul R Krakovitz
Keyword(s):  
Middle Ear ◽  
Ease Of Use ◽  
Tube Placement ◽  
Oral Antibiotic ◽  
Middle Ear Effusion ◽  
Exact Test ◽  
Pressure Equalization ◽  
Middle Ear Fluid ◽  
Specificity And Sensitivity ◽  
Ear Effusion

Objective To further 1) enhance and assess the ability to detect and characterize middle ear effusion using A-mode ultrasonography with miniature curved array transducers, and 2) identify bacterial presence in relation to effusion viscosity. Methods A prospective unblinded comparison study was performed to determine ultrasound efficacy in detecting effusion characteristics. Ultrasonographic examination using an ultrasound probe was performed on 107 patients (197 ears) scheduled to undergo bilateral myringotomy with pressure equalization tube placement. With the child anesthetized, the probe was placed into the external ear canal after sterile water was inserted. Ultrasound recordings from the tympanic membrane and middle ear space were recorded and analyzed for viscosity. Middle ear aspirate was sent for bacterial culture. Myringotomy was then performed. Results Computer-based algorithms analyzed the waveforms and were able to detect the presence of thick, thin, and lack of fluid with a sensitivity and specificity of greater than 90%. Thin effusions had a significantly higher infection rate (64% versus 12%, p<0.01, Fisher's exact test) when cultured from ears of children not taking oral antibiotic therapy. Similar results were obtained from cultures taken of middle ear fluid in children taking antibiotics (69% versus 12%, p<0.002). Conclusions The specificity and sensitivity of ultrasound middle ear fluid detection is greater than 90%, exceeding the accuracy of tympanometry and other devices. Moreover, it can accurately predict the viscosity of an effusion, which can give insight into its likelihood of infection. Further technologies to promote ease of use will be needed.

Evacuation of the Middle Ear by Sniffing: A Cause of High Negative Pressure and Development of Middle Ear Disease

1984 ◽  
Vol 92 (3) ◽  
pp. 312-318 ◽  
Author(s):  
Bernt Falk ◽  
Bengt Magnuson
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Negative Pressure ◽  
Experimental Studies ◽  
Eustachian Tube Function ◽  
Middle Ear Effusion ◽  
Pressure Equalization ◽  
Tube Function ◽  
Middle Ear Disease ◽  
Ear Effusion

Previous research on eustachian tube function has been devoted mainly to the study of the tubal opening ability and pressure equalization. This article summarizes a series of experimental studies focusing on the closing ability of the tube. Results support the belief that the purpose of the tube should be seen primarily as protecting the middle ear from the extensive pressure variations that physiologically take place in the nasopharynx. A number of studies of diseased ears have shown that tubal malfunction was characterized mainly by a reduced ability to withstand negative pressure in the nasopharynx. Sniffing can evacuate the middle ear, causing high negative intratympanic pressure. It seems likely that this mechanism is involved in the development of middle ear effusion and manifest retraction-type middle ear disease.

scholarly journals Tympanostomy Tube Selection: A Review of the Evidence

2016 ◽  
Vol 7 (1) ◽  
pp. 17-22
Author(s):  
Ho Sandra ◽  
David J Kay
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
The United States ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Middle Ear Effusion ◽  
Surgeon Experience ◽  
Ear Effusion

ABSTRACT Tympanostomy tube (TT) insertion for ventilation of the middle ear is one of most commonly performed procedures in the United States. Indications for tube insertion include otitis media with effusion, recurrent acute otitis media, hearing loss caused by middle ear effusion and persistent acute otitis media. In general, TTs are divided into two categories, short-term tubes and long-term tubes. Depending on the indications for tube placement and surgeon experience with the TT, different tubes can be used. A myriad of tubes have been created since their first documented use in 1845 in attempts to provide better middle ear ventilation, improve ease of placement and prevent complications, such as post-tube otorrhea, persistent perforation and tube occlusion. In order for a tube to be effective, it should be biocompatible with the middle ear to minimize a foreign body reaction. Teflon and silicone remain two of the most commonly used materials in TTs. In addition, the tube design also plays a role for insertion and retention times of TTs. Lastly, TTs can also be coated with various substances, such as silver-oxide, phosphorylcholine and more recently, antibiotics and albumin, in order to prevent biofilm formation and decrease the rate of post-TT otorrhea. Persistent middle ear effusion affects many children each year and can impact their quality of life as well as hearing and language development. With nearly 1 out of every 15 children by the age of 3 years receiving TTs, it is imperative that the right tube be chosen to facilitate optimal ventilation of the middle ear while minimizing complications. How to cite this article Ho S, Kay DJ. Tympanostomy Tube Selection: A Review of the Evidence. Int J Head Neck Surg 2016;7(1):17-22.

Evidence in Infants With Cleft Palate That Breast Milk Protects Against Otitis Media

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 853-860 ◽  
Author(s):  
Jack L. Paradise ◽  
Barbara A. Elster ◽  
Lingshi Tan
Keyword(s):  
Breast Milk ◽  
Cleft Palate ◽  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Tube Placement ◽  
Middle Ear Effusion ◽  
Feeding Mode ◽  
Initial Development ◽  
Ear Effusion

Objective. Most infants with cleft palate suckle unproductively and require feeding by artificial means. Most also have unremitting otitis media accompanied by (usually) nonpurulent middle-ear effusion, a complication generally attributed to impaired eustachian tube ventilatory function. We observed two infants with cleft palate in whom one or both ears appeared effusionfree on more than one occasion, and who also were receiving or previously had received breast milk feedings. This prompted us to analyze the relation between middle-ear status and feeding mode in a large series of infants with cleft palate. Our objective was to determine whether in these infants the receipt of breast milk mitigated the otherwise virtually invariable development and continued presence of otitis media. Methods. We reviewed and analyzed data concerning both feeding mode and the presence or absence of middle-ear effusion in 315 infants with cleft palate, as recorded systematically in the course of prospective studies at our Cleft Palate-Craniofacial Center. Analysis was limited to periods preceding the infants' receipt of tympanostomy-tube placement or palate repair, or their second birthday, whichever occurred first. Results. Freedom from effusion in one or both ears was found at one or more visits in only seven (2.7%) of 261 infants fed cow's milk or soy formula exclusively, but in 17 (32%) of 54 infants fed breast milk exclusively or in part for varying periods (P &lt; .0001). In virtually all instances, the breast milk had been harvested by the mother and fed to the infant via an artificial feeder. Baseline clinical and sociodemographic characteristics and surveillance in the two groups of infants were comparable. Conclusions. Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. This finding supports the likelihood of a similarly protective effect of breast milk in noncleft infants. The finding also suggests strongly that in infants with cleft palate, impaired eustachian tube function is not the only pathogenetic factor in the infants' initial development of middle-ear effusion.

Detection of Helicobacter Pylori in the Middle Ear Fluid of Patients with Otitis Media with Effusion

2005 ◽  
Vol 133 (5) ◽  
pp. 791-794 ◽  
Author(s):  
Setsuko Morinaka ◽  
Masayuki Tominaga ◽  
Hiroyuki Nakamura
Keyword(s):  
Helicobacter Pylori ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Rapid Urease Test ◽  
Middle Ear Effusion ◽  
Gram Staining ◽  
Middle Ear Fluid ◽  
Urease Test ◽  
Ear Effusion

OBJECTIVES: In patients with otitis media with effusion (OME), colonization of the middle ear effusion (MEE) by Helicobacter pylori (HP) was investigated. STUDY DESIGN: A prospective nonrandomized study with nonpaired, nonmatched controls. Smear preparations were immunostained with anti-HP antibody and were subjected to Gram staining and Giemsa staining. The rapid urease test (CLO) was done. RESULTS: Twelve of 15 smears for MEE were positive for HP by immunohistochemistry and 14 by Giemsa that were Gram-negative. In 3 with positive immunohistochemistry, the CLO was positive. CONCLUSION: The results suggest that HP may exist in the MEE of some patients with OME.

Impedance Tympanometry and Acoustic Reflectometry at Myringotomy

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 475-480
Author(s):  
Thomas R. Babonis ◽  
Michael R. Weir ◽  
Patrick C. Kelly
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Type A ◽  
Tube Placement ◽  
Clinical Impression ◽  
Type B ◽  
Middle Ear Effusion ◽  
Experienced Clinician ◽  
Ear Effusion ◽  
Higher Sensitivity

A total of 220 ears undergoing myringotomy and pressure-equalizing tube placement were studied with impedance tympanometry and acoustic reflectometry in a direct comparison for detection of middle-ear effusion. Impedance tympanometry and acoustic reflectometry were equally accurate, detecting the presence or absence of middle-ear effusion in 73% and 72% of ears, respectively. The presence of effusion in ears with tympanographic patterns other than type A and type B was not consistently and reliably predicted. The higher sensitivity of impedance tympanometry (90%) compared with that for acoustic reflectometry (58%) contrasted with the opposite findings for specificities (54% vs 88%). It is concluded that impedance tympanometry and acoustic reflectometry measure different events at the tympanic membrane and their utility lies in the fact that they complement each other. These instruments can aid the experienced otoscopist in confirming a clinical impression and assist the less experienced clinician in validating or improving otoscopic skills.

Effect of anaesthetic agents on tympanometry and middle-ear effusions

2000 ◽  
Vol 114 (5) ◽  
pp. 336-338 ◽  
Author(s):  
B. M. Fish ◽  
A. R. Banerjee ◽  
C. R. Jennings ◽  
I. Frain ◽  
A. A. Narula
Keyword(s):  
Middle Ear ◽  
General Anaesthetic ◽  
Parental Consent ◽  
Type B ◽  
Middle Ear Effusion ◽  
Anaesthetic Agents ◽  
Middle Ear Fluid ◽  
Type C ◽  
Ear Effusion ◽  
Informed Parental Consent

Following informed parental consent 93 children underwent bilateral grommet insertion. Tympanometry was performed pre-operatively, and immediately prior to myringotomy. A standardized anaesthetic was used. At myringotomy the presence or absence of fluid was recorded, as well as the time since induction of the general anaesthetic.A pre-operative type B tympanogram predicted a middle-ear effusion at myringotomy in 92 per cent of patients. A pre-operative type C2 tympanogram predicted a middle-ear effusion at myringotomy in 39 per cent of patients. Sixty tympanograms (30 per cent) changed following a general anaesthetic. Fourteen type B tympanograms changed to type A and eight of these had effusions. The duration of the general anaesthetic did not influence the probability of a middle-ear effusion being present at myringotomy. A pre-operative type B tympanogram is a good predictor of middle-ear fluid. The duration of the general anaesthetic is not significant in predicting the presence of a middle-ear effusion.

Pathogenesis of middle-ear effusion in nasopharyngeal carcinoma: a new perspective

1997 ◽  
Vol 111 (5) ◽  
pp. 431-434 ◽  
Author(s):  
W. K. Low ◽  
T. A. Lim ◽  
Y. F. Fan ◽  
A. Balakrishnan
Keyword(s):  
Magnetic Resonance ◽  
Nasopharyngeal Carcinoma ◽  
Middle Ear ◽  
Middle Ear Effusion ◽  
Exact Test ◽  
Cartilage Erosion ◽  
New Perspective ◽  
The Relationship ◽  
Ear Effusion

AbstractThe theory that middle-ear effusion (MEE) associated with nasopharyngeal carcinoma (NPC) is merely the result of tensor veli palatinus destruction is deficient because recent studies have shown that many patients with NPC have MEE but no tensor veli palatinus dysfunction. The present study evaluates the relationship between MEE and Eustachian cartilage erosion by NPC and examines the pathogenesis of NPC-associated MEE from a new perspective.Thirty-five patients with NPC were studied by magnetic resonance scans taken along the lengths of the Eustachian tubes. Twenty-four patients had tumour involvementof both sides of the nasopharynx so that 59 ears were available for study. Eighteen ears had MEE of which 12 had Eustachian cartilage erosion (p<00001, Fischer's Exact Test). In ears with MEE, Eustachian cartilage erosion was frequently but not necessarily associated with tensor veli palatinus destruction.We postulate that altered Eustachian tubal compliance as a result of cartilage erosion by tumour is an important reason why middle-eareffusions develop in patients with NPC.

scholarly journals A Study of Persistent Unilateral Middle Ear Effusion Caused by Occult Skull Base Lesions

2013 ◽  
Vol 92 (5) ◽  
pp. 195-200
Author(s):  
John P. Leonetti
Keyword(s):  
Skull Base ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Tertiary Care ◽  
Artery Aneurysm ◽  
Tube Placement ◽  
Middle Ear Effusion ◽  
Internal Carotid Artery Aneurysm ◽  
Skull Base Lesions ◽  
Ear Effusion

The goal of this article is to review a series of patients with persistent unilateral middle ear effusion (MEE) and to suggest a more contemporary diagnostic algorithm. The author conducted a retrospective chart review of adults with persistent unilateral MEE and normal findings on physical and nasopharyngoscopic examinations whose MEE was eventually found to be caused by a variety of occult skull base lesions. The study population was made up of 79 patients—52 women and 27 men, aged 21 to 83 (mean: 54.8) at presentation—who had been referred to an academic tertiary care medical center between July 1, 1988, and June 30, 2008. Follow-up ranged from 9 months to 19.5 years (mean: 8.7 yr). Of this group, 50 patients (63.3%) had a malignant tumor, 26 (32.9%) had a benign tumor, and 3 (3.8%) had an internal carotid artery aneurysm. Eustachian tube occlusion had been caused by diffuse invasion in 33 patients (41.8%), by intracranial pathology in 24 (30.4%), and by extracranial-infratemporal lesions in 22 (27.8%). Nasopharyngoscopy cannot identify a variety of rare skull base lesions that cause eustachian tube compression or tissue invasion that ultimately leads to MEE. Therefore, patients with unexplained persistent unilateral MEE should undergo coronal magnetic resonance imaging or computed tomography to look for any intra- or extracranial lesions before undergoing ventilation tube placement.

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