Surgical Management of Acute Otitis Media and Chronic Otitis Media with Effusion

2011 ◽  
Keyword(s):  
Otitis Media ◽  
Surgical Management ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media

Delayed Onset Post-Tympanotomy Otorrhea

1988 ◽  
Vol 98 (2) ◽  
pp. 111-115 ◽  
Author(s):  
George A. Gates ◽  
Christine Avery ◽  
Thomas J. Prihoda ◽  
G. Richard Holt
Keyword(s):  
Health Care ◽  
Surgical Treatment ◽  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Secretory Otitis Media ◽  
Delayed Onset ◽  
Tympanostomy Tubes ◽  
Care Costs

Otorrhea is the most frequent complication of the use of tympanostomy tubes. When it occurs after the immediate postoperative period, otorrhea is probably the result of external contamination of the middle ear or acute otitis media. We analyzed data from 627 operations upon 1248 ears of 491 children with chronic secretory otitis media and found that delayed onset (longer than 7 weeks) postoperative otorrhea occurred after 26.4 percent of the 382 operations in which tympanostomy tubes were used. The average number of episodes of otorrhea per case was 1.46 and ranged from 1 to 9. The rate of otorrhea occurrence in patients with tubes in place was significantly higher in the summer months. Otorrhea also occurred after 9.0 percent of 245 myringotomy procedures. The average number of episodes was 1.32 and ranged from 1 to 3. Treatment of postoperative otorrhea increases the health care costs of surgical treatment of chronic otitis media with effusion; this problem should be included in the calculation of cost-effectiveness.

Management of Otitis Media Using Agency for Health Care Policy and Research Guidelines

1998 ◽  
Vol 118 (4) ◽  
pp. 437-443 ◽  
Author(s):  
Griffith S. Hsu ◽  
Samuel C. Levine ◽  
G. Scott Giebink
Keyword(s):  
Health Care ◽  
Otitis Media ◽  
Health Care Policy ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Care Policy ◽  
Research Guidelines ◽  
Recurrent Acute Otitis Media ◽  
History Of

Increased costs of managing otitis media and its complications may result from delays in diagnosis and treatment. The Agency for Health Care Policy and Research developed guidelines to assist in the management of chronic otitis media with effusion. We examined the medical care adherence to Agency for Health Care Policy and Research guidelines in 59 consecutive patients referred because of chronic otitis media with effusion and recurrent acute otitis media. Patient history and examination data were collected prospectively. In the group with chronic otitis media with effusion, the rate of adherence to Agency for Health Care Policy and Research guidelines was 0%; in those with recurrent acute otitis media, adherence was 5%. Delayed referral occurred in 34% of patients; 25% of patients were referred early. The average duration of effusion in patients with chronic otitis media with effusion was 5.2 months; the duration of recurrent acute otitis media immediately before referral was 9.3 months. Eighteen patients (47%) in the chronic otitis media with effusion group had a history of recurrent chronic otitis media with effusion spanning an average of 22.7 months. On referral, hearing loss was discovered in 92% of all patients, and in 69% the tympanogram was flat. The complication and sequelae rate was 49.1%, and speech delay was the most frequent at 16.9%. We conclude that in our study patients there is a significant referral delay, long history of chronic otitis media with effusion in patients before referral, high rate of hearing loss, and high complication rate. Continued efforts should be directed toward improving education of all clinicians so that diagnostic tools and timely otolaryngologic referral are better used.

Chronic Secretory Otitis Media: Effects of Surgical Management

1989 ◽  
Vol 98 (1_suppl2) ◽  
pp. 2-32 ◽  
Author(s):  
George A. Gates ◽  
J. C. Cooper ◽  
Christine A. Avery ◽  
Thomas J. Prihoda
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Surgical Management ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Secretory Otitis Media ◽  
Tympanostomy Tubes ◽  
The Mean ◽  
First Recurrence

To study the effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 4- to 8-year-old children to receive one of the following: Bilateral myringotomy and no additional treatment (group 1), tympanostomy tubes (group 2), adenoidectomy and myringotomy (group 3), or adenoidectomy and tympanostomy tubes (group 4). The 491 who accepted surgical treatment were evaluated at 6-week intervals for up to 2 years. Treatment effect was assessed by four main outcomes: Time with effusion, time with hearing loss, time to first recurrence of effusion, and number of surgical re-treatments. For the groups (in order), the mean percent of time with any effusion in either ear was 49, 35, 30, 26 (p < .0001); the mean percent of time with hearing thresholds 20 dB or greater was 19, 10, 8, and 7 (p < .0001) in the better ear; and 38, 30, 22 and 22 in the worse ear (p < .0001); the median number of days to first recurrence was 54, 222, 92, and 240 (p < .0001); and the number of surgical re-treatments was 66, 36, 17, and 17 (p < .0001). The most notable adverse sequela, purulent otorrhea, occurred in 22%, 29%, 11%, and 24% of the patients assigned to groups 1 through 4, respectively (p < .001). In severely affected children who have chronic otitis media with effusion resistant to medical therapy, adenoidectomy is an effective treatment. Adenoidectomy plus bilateral myringotomy lowered posttreatment morbidity more than tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. Adenoidectomy appears to modify the underlying pathophysiology of chronic otitis media with effusion. This effect is independent of the preoperative size of the adenoid. Tympanostomy tube drainage and ventilation of the middle ear provide adequate palliation so long as the tubes remain in place and functioning. We recommend that adenoidectomy be considered in the initial surgical management of 4- to 8-year-old children with hearing loss due to chronic secretory otitis media that is refractory to medical management and, further, that the size of the adenoid not be used as a criterion for adenoidectomy. Concomitant bilateral myringotomy with suction aspiration of the middle ear contents also should be done, with or without placement of tympanostomy tubes at the discretion of the surgeon.

scholarly journals Qualidade de Vida das Crianças com Otite Média e Impacto da Colocação de Tubos de Ventilação Transtimpânicos numa População Portuguesa

2018 ◽  
Vol 31 (1) ◽  
pp. 30 ◽  
Author(s):  
Ana Rita Lameiras ◽  
Deodato Silva ◽  
Assunção O´Neill ◽  
Pedro Escada
Keyword(s):  
Quality Of Life ◽  
Hearing Loss ◽  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Portuguese Version ◽  
Physical Suffering ◽  
Recurrent Acute Otitis Media

Introduction: Quality of life is an important measure for health-outcome evaluation. Although otitis media is one of the most common childhood diseases, its impact on Portuguese children’s quality of life is unknown. The aim of this study is to determine the quality of life of Portuguese children with chronic otitis media with effusion and/or recurrent acute otitis media and the short-term impact of transtympanic ventilation tubes, using the Portuguese version of the OM-6 questionnaire, a valid, reliable and sensitive instrument to evaluate the health-related quality of life in children with otitis media.Material and Methods: This study was conducted in a tertiary referral center, to where children are referred from primary care and hospital pediatric consultations. The Portuguese version of the OM-6 questionnaire was applied to children with chronic otitis media with effusion and/or recurrent acute otitis media. The instrument was re-administered at two months postoperatively to a group of children who underwent tympanostomy tube placement, to evaluate the change in quality of life with the surgical procedure.Results: The study involved a sample of 169 children, aged between 6 months and 12 years (mean: 4.20 ± 2.05 years). The average score in the survey was 3.3 ± 1.47, of a maximum of 7 (worst quality of life). The domains ‘caregiver concerns’, ‘hearing loss’ and ‘physical suffering’ had the highest scores. The domain ‘hearing loss’ was correlated with the domain ‘speech impairment’ (rs = 0.41; p < 0.001) and the domain ‘physical suffering’ correlated with the domain ‘activity limitation’ (rs = 0.47; p < 0.001). There was a correlation between the score on ‘hearing loss’ and the presence of conduction hearing loss (χ2 (6) = 24.662; p = 0.022). Children with chronic otitis media with effusion had lower scores on the domain ‘physical suffering’, while children with recurrent acute otitis media had lower scores in the domain ‘hearing loss’ and higher scores in the domain ‘emotional distress’. There was an improvement in the quality of life in all the dimensions studied by the questionnaire after surgery. The improvement was large in 55%, moderate in 15% and small in 10% of the cases. The presence of otorrhea postoperatively did not decrease the quality of life improvement achieved with surgery.Conclusion: Otitis media has a negative impact on Portuguese children quality of life. Tympanostomy tubes improve quality of life related to the middle ear in most children. The application of validated disease-specific questionnaires allows an enhanced understanding of the impact of otitis media on Portuguese children quality of life and of the success of therapeutic measures.

scholarly journals Ear diseases in school going children of Sunsari and Morang districts of Nepal

2017 ◽  
Vol 7 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Sanjeev Kumar Thakur ◽  
Rabin Acharya ◽  
Sanjay Kumar Singh ◽  
Nisha Ghimire
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Health Care Facilities ◽  
Cross Sectional ◽  
Ear Diseases ◽  
Important Health ◽  
Tube Dysfunction ◽  
Ear Wax

This study was carried out to find the prevalence of ear diseases in school-going children of the Sunsari and Morang district of Eastern Nepal. This is a prospective, cross sectional, clinical study in 3729 school going children of up to 15 years of the Sunsari and Morang district of eastern Nepal done in year 2014 and 2015 AD. Informed consent was obtained. 1346 (36.09%) children had different ear ailments. Ear wax 616 (45.76%) and otitis media with effusion 226 (16.79%) were the commonest diseases found. Chronic otitis media mucosal type was found in 104 (7.73%) children. Chronic otitis media squamous 6 (0.45%), Otomycosis 155 (11.51%), otitis externa 16 (1.19%), acute Otitis media 119 (8.84%), Eustachian tube dysfunction 92 (6.84%), Perichondritis 4(0.29%), Foreign body in the ear 2 (0.15%), Preauricular sinus 2 (0.15%) and sensorineural hearing loss 4 (0.29%) were the other diseases found. Ear diseases are important health problems among school-going children of the Sunsari and Morang district of eastern Nepal. Health education,nutrition, improvement of socioeconomic status and health care facilities should be helpful in reducing the prevalence of ear diseases.

Immunologic Characteristics of Cytokines in Otitis Media with Effusion

1992 ◽  
Vol 101 (10_suppl) ◽  
pp. 21-25 ◽  
Author(s):  
Tetsuo Himi ◽  
Toshio Suzuki ◽  
Hiroyuki Takezawa ◽  
Hiroyuki Kodama ◽  
Akikatsu Kataura
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Inflammatory Cells ◽  
Enzyme Linked Immunosorbent Assay ◽  
Gm Csf ◽  
Cytologic Analysis ◽  
Macrophage Colony

Levels of cytokines, interleukin (IL)–1α, IL-1β, tumor necrosis factor (TNF), and granulocyte-macrophage colony-stimulating factor (GM-CSF) were investigated in samples of the middle ear effusions (MEEs) from 144 ears with otitis media with effusion (OME) by enzyme-linked immunosorbent assay, followed by cytologic analysis. Middle ear effusions of the acute purulent type contained a significantly higher concentration of cytokines compared with normal control sera (p < .001). Cytokines were observed at lower levels in MEE in adults than in children. Tests of children at the chronic stage of MEE showed higher levels of TNF than IL-1 and GM-CSF. Meanwhile, IL-1β showed significantly higher concentrations in acute purulent types than in serous and mucoid types (p < .01). In cytologic analysis, the mean level of IL-1β was significantly higher in the neutrophil-rich group than in other groups (p < .05). Cytokines possess several biologic properties, some of which are associated not only with acute otitis media but also with chronic otitis media. This study showed that cytokines, especially IL-1β, contribute to infiltration into the middle ear by inflammatory cells. This implies that the persistent presence of cytokines in MEE could be a factor in prolonged OME.

scholarly journals Comparative Analysis of the Humoral Immune Response to Moraxella catarrhalis and Streptococcus pneumoniae Surface Antigens in Children Suffering from Recurrent Acute Otitis Media and Chronic Otitis Media with Effusion

2012 ◽  
Vol 19 (6) ◽  
pp. 914-918 ◽  
Author(s):  
Suzanne J. C. Verhaegh ◽  
Kim Stol ◽  
Corné P. de Vogel ◽  
Kristian Riesbeck ◽  
Eric R. Lafontaine ◽  
...  
Keyword(s):  
Immune Response ◽  
Otitis Media ◽  
Humoral Immune Response ◽  
Moraxella Catarrhalis ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Content Type ◽  
Humoral Immune ◽  
Recurrent Acute Otitis Media

ABSTRACTA prospective clinical cohort study was established to investigate the humoral immune response in middle ear fluids (MEF) and serum against bacterial surface proteins in children suffering from recurrent acute otitis media (rAOM) and chronic otitis media with effusion (COME), using Luminex xMAP technology. The association between the humoral immune response and the presence ofMoraxella catarrhalisandStreptococcus pneumoniaein the nasopharynx and middle ear was also studied. The levels of antigen-specific IgG, IgA, and IgM showed extensive interindividual variation. No significant differences in anti-M. catarrhalisand anti-S. pneumoniaeserum and MEF median fluorescence intensity (MFI) values (anti-M. catarrhalisand antipneumococcal IgG levels) were observed between the rAOM or COME groups for all antigens tested. No significant differences were observed forM. catarrhalisandS. pneumoniaecolonization and serum IgG levels against theMoraxellaand pneumococcal antigens. Similar to the antibody response in serum, no significant differences in IgG, IgA, and IgM levels in MEF were observed for allM. catarrhalisandS. pneumoniaeantigens between OMM. catarrhalis-orS. pneumoniae-positive and OMM. catarrhalis-orS. pneumonia-negative children suffering from either rAOM or COME. Finally, results indicated a strong correlation between antigen-specific serum and MEF IgG levels. We observed no significantin vivoexpressed anti-M. catarrhalisor anti-S. pneumoniaehumoral immune responses using a range of putative vaccine candidate proteins. Other factors, such as Eustachian tube dysfunction, viral load, and genetic and environmental factors, may play a more important role in the pathogenesis of OM and in particular in the development of rAOM or COME.

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