First Forty-Eight Hours of Developing Otitis Media: An Experimental Study

2003 ◽  
Vol 112 (6) ◽  
pp. 558-566 ◽  
Author(s):  
Per Olof Eriksson ◽  
Cecilia Mattsson ◽  
Sten Hellström
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Light And Electron Microscopy ◽  
Acute Otitis Media ◽  
Clinical Appearance ◽  
Filamentous Material ◽  
Type 3 ◽  
Inflammatory Changes

The early inflammatory changes in the tympanic membrane were explored in 2 rat models. Acute otitis media was induced by instillation of Streptococcus pneumoniae type 3 into the middle ear cavity, and otitis media with effusion was induced by blockage of the eustachian tube. Otomicroscopic examination was performed before the rats were painlessly sacrificed at 3, 6, 9, 12, 18, 24, or 48 hours after initiation of the otitis media conditions. The tympanic membrane was studied by light and electron microscopy. Both acute otitis media and otitis media with effusion caused early inflammatory changes of the tympanic membrane, and the pars flaccida was the portion that reacted first. The inflammatory alterations were most pronounced in the acute otitis media model. The course of inflammation showed a bimodal pattern with an early deposition of a filamentous material with a band pattern, typical of fibrin. Despite a fluid-filled middle ear cavity, the inflammatory changes in the otitis media with effusion model were moderate, as was consistent with the clinical appearance of the tympanic membrane.

Healing of Tympanic Membrane after Myringotomy during Streptococcus Pneumoniae Otitis Media an Otomicroscopic and Histologic Study in the Rat

1996 ◽  
Vol 105 (5) ◽  
pp. 397-404 ◽  
Author(s):  
Karin Magnuson ◽  
Ann Hermansson ◽  
Sten Hellström
Keyword(s):  
Streptococcus Pneumoniae ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Structural Changes ◽  
Light And Electron Microscopy ◽  
Acute Otitis Media ◽  
Collagen Structure ◽  
Histologic Study ◽  
Middle Ear Disease ◽  
Type 3

The purpose of our study was to elucidate the course of healing of the tympanic membrane (TM) when myringotomy was performed during acute otitis media. The early and long-lasting structural changes of the TM were studied in an animal model. Rats were inoculated with Streptococcus pneumoniae (PnC) type 3 in the bulla. When the infection was manifest, myringotomy was performed. On days 4 and 12, and 3 and 6 months after myringotomy, the TM status was checked by otomicroscopy and TMs were prepared for light and electron microscopy. Comparison was made with PnC-infected TMs that were not perforated, as well as myringotomized noninfected TMs. The infection resolved more slowly in myringotomized ears compared to PnC-infected ears that were left untouched. After 6 months, the pars tensa of the myringotomized infected ears was thickened and showed a disorganized collagen structure, compared with myringotomized noninfected ears, in which TMs were normalized. The PnC-infected TMs without myringotomy were completely normalized after 2 months. We conclude that a combination of bacterial infection and myringotomy causes long-lasting changes in TM structure. This impaired structure of the connective tissue could be of importance in chronic middle ear disease as a presumptive site for retraction and perforation of the TM.

Workshop on Effects of Otitis Media on the Child

PEDIATRICS ◽  
1983 ◽  
Vol 71 (4) ◽  
pp. 639-652
Author(s):  
Charles D. Bluestone ◽  
Jerome O. Klein ◽  
Jack L. Paradise ◽  
Heinz Eichenwald ◽  
Fred H. Bess ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Current Knowledge ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Signs And Symptoms ◽  
Middle Ear Effusion ◽  
Ear Effusion

GOALS, DEFINITIONS, AND CLASSIFICATION OF OTITIS MEDIA —Charles D. Bluestone, MD The goal of this Workshop was to assess current knowledge concerning the effects of otitis media on the child. Experts in pediatrics, infectious disease, otolaryngology, audiology, speech, linguistics, and psychology met in Chicago on Aug 25, 1982 to participate in this Workshop. A summary of the discussions is presented here. Otitis media is broadly defined as an inflammation of the middle ear without reference to etiology or pathogenesis.1 Otitis media with effusion is an inflammation of the middle ear in which a collection of liquid (i.e., middle ear effusion) is present in the middle ear space (no perforation of the tympanic membrane is present). Atelectasis of the tympanic membrane, which may or may not be associated with otitis media, is defined as either collapse or retraction of the tympanic membrane. Acute otitis media implies a rapid and short onset of signs and symptoms lasting approximately 3 weeks. From 3 weeks to 3 months, the process may be resolving or subacute. If middle ear effusion persists beyond 3 months, the condition is classified as chronic otitis media with effusion. Many terms have been used for acute otitis media, such as "suppurative," "purulent," or "bacterial" otitis media; however, a "serous" effusion may also have an acute onset. Otitis media with effusion unaccompanied by signs and symptoms of acute inflammation has also had a plethora of other names: "serous," "secretory," "nonsuppurative," and "glue ear" have been the most commonly used. EPIDEMIOLOGY AND NATURAL HISTORY OF OTITIS MEDIA

scholarly journals Nontypeable Haemophilus influenzae Gene Expression Induced In Vivo in a Chinchilla Model of Otitis Media

2003 ◽  
Vol 71 (6) ◽  
pp. 3454-3462 ◽  
Author(s):  
Kevin M. Mason ◽  
Robert S. Munson ◽  
Lauren O. Bakaletz
Keyword(s):  
Gene Expression ◽  
Haemophilus Influenzae ◽  
Otitis Media ◽  
Middle Ear ◽  
Fluorescent Protein ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Bacterial Gene ◽  
Nthi Strain

ABSTRACT The gram-negative bacterium nontypeable Haemophilus influenzae (NTHI) is the predominant pathogen in chronic otitis media with effusion and, with Streptococcus pneumoniae and Moraxella catarrhalis, is a causative agent of acute otitis media. To identify potential virulence determinants, bacterial gene expression was monitored by differential fluorescence induction during early disease progression in one specific anatomical niche of a chinchilla model of NTHI-induced otitis media. Genomic DNA fragments from NTHI strain 86-028NP were cloned upstream of the promoterless gfpmut3 gene. NTHI strain 86-028NP served as the host for the promoter trap library. Pools of 2,000 transformants were inoculated into the left and right middle ear cavities of chinchillas. Middle ear effusions were recovered by epitympanic tap at 24 and 48 h, and clones containing promoter elements that were induced in vivo and producing green fluorescent protein were isolated by two-color fluorescence-activated cell sorting. Insert DNA was sequenced and compared to the complete genome sequence of H. influenzae strain Rd. In a screen of 16,000 clones, we have isolated 44 clones that contain unique gene fragments encoding biosynthetic enzymes, metabolic and regulatory proteins, and hypothetical proteins of unknown function. An additional eight clones contain gene fragments unique to our NTHI isolate. Using quantitative reverse transcription-PCR, we have confirmed that 26 clones demonstrated increased gene expression in vivo relative to expression in vitro. These data provide insight into the response of NTHI bacteria as they sense and respond to the middle ear microenvironment during early events of otitis media.

Experimental Otitis Media with Effusion following Middle Ear Inoculation of Nonviable H Influenzae

1984 ◽  
Vol 93 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Thomas F. DeMaria ◽  
David J. Lim ◽  
Bruce R. Briggs ◽  
Nobuhiro Okazaki
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Animal Experiment ◽  
Otitis Media With Effusion ◽  
Type B ◽  
Negative Bacterium ◽  
Middle Ear Effusion ◽  
Sterile Saline ◽  
Inflammatory Changes ◽  
Ear Effusion

In order to test the hypothesis that nonviable bacteria can induce middle ear inflammation leading to persistent middle ear effusion (MEE), we conducted an animal experiment using formalin-killed Hemophilus influenzae, the bacterium reported to be the most common pathogen isolated from chronic MEEs. Over 70% of the chinchillas injected with formalin-killed H influenzae type b or a nontypeable isolate developed sterile, straw-colored serous MEEs, and exhibited histological evidence of extensive inflammatory changes of the middle ear mucosal connective tissue and epithelium. Control animals injected with pyrogen-free sterile saline did not exhibit any inflammatory changes or effusions in the middle ears. Our data suggest that endotoxin on the surface of H influenzae, a gram-negative bacterium, may be responsible for the induction of the otitis media with effusion. It is suggested that endotoxin (even when the organisms are no longer viable) may be responsible for the production of serous MEE and inflammatory changes in the middle ear.

Pseudomonas Otitis Media after Eustachian Tube Obstruction

1992 ◽  
Vol 107 (4) ◽  
pp. 511-515 ◽  
Author(s):  
Patrick J. Antonelli ◽  
Steven K. Juhn ◽  
Marcos V. Goycoolea ◽  
G. Scott Giebink
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Suppurative Otitis Media ◽  
Tube Obstruction ◽  
Colony Forming Units ◽  
Tube Function ◽  
Pseudomonas Infection

Previous experiments have shown that Pseudomonas aeruginosa may infect the middle ears of chinchillas by way of the eustachian tube and that chinchillas with acute otitis media (AOM) are more susceptible to pseudomonas infection than animals without AOM. The purpose of this experiment was to examine the effects of otitis media with effusion (OME), induced by means of eustachian tube obstruction, on middle ear susceptibility to nasal inoculation of P. aeruginosa. Chinchilla eustachian tubes were obstructed with silicone rubber sponge bilaterally; OME developed in eight animals (11 ears)—three bilaterally and five unilaterally—and persisted for 6 months. Ten chinchillas with normal eustachian tube function served as controls. All animals were nasally inoculated with 5 times 104 colony-forming units of P. aeruginosa. Pseudomonas otitis media developed in eight of 11 OME ears with effusion, none of five ears without OME, and four of 20 control ears (X2 = 11.782, p = 0.003). Therefore, P. aeruginosa can infect the middle ear by way of the eustachian tube. Tubal dysfunction may lead to the development of chronic suppurative otitis media by increasing tubotympanic susceptibility to opportunistic pathogens.

scholarly journals Acute Mastoiditis in Children: Susceptibility Factors and Management

2007 ◽  
Vol 7 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Slobodan Spremo ◽  
Biljana Udovčić
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Acute Otitis Media ◽  
Tympanic Membrane Perforation ◽  
Acute Mastoiditis ◽  
Middle Ear Mucosa ◽  
Susceptibility Factors ◽  
Intravenous Antibiotics ◽  
Intracranial Complications

The objective was to review our experience with clinical course, diagnostic and therapeutic profile of children treated for acute mastoiditis, and to investigate for possible susceptibility factors. Study was designed as retrospective review of pediatric patients presenting with acute mastoiditis secondary to acute otitis media over the last 6 years, from 2000 to 2006. The study involved children aged from 1 to 16 years treated for acute mastoiditis and subsequent intratemporal and intracranial complications in Clinic for otorhinolaryngology, Clinic Center Banja Luka. Selected clinical parameters, mastoid coalescence and risk factors for necessity of surgical intervention were analyzed. Medical history review of a total of 13 patients with acute mastoiditis was analyzed. Acute coalescent mastoiditis occurred 11 patients (84%) while noncoalescent form of acute mastoiditis occurred in 2 cases (16%). Intracranial complication occurred in 3 patients (2 meningitis and 1 peridural intracranial abscess), while 2 patients had intratemporal complication (subperiostal abscess) associated to coalescent mastoiditis. We observed clinical profile of acute mastoiditis in regard to pathology found on the tympanic membrane, middle ear mucosa and destructions on the bony wall of the middle ear and mastoid. The main signs of progressive infection were tympanic membrane perforation, pulsatile suppurative secretion from the mucosa, and intratemporal abscess. All patients with coalescent mastoiditis required mastoidectomy, while noncoalescent mastoiditis was treated conservatively with broad-spectrum intravenous antibiotics and myringotomy. In conclusion acute mastoiditis is uncommon but serious complication of acute otitis media in children associated with significant morbidity. Coalescent mastoiditis concomitant with subperiostal abscess, intracranial complications and mastoiditis not responsive after 48 hours to intravenous antibiotics should urge clinician to timely mastoid surgery.

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.

MIDDLE EAR EFFUSION CONCENTRATIONS OF CEFIXIME DURING ACUTE OTITIS MEDIA WITH EFFUSION AND OTITIS MEDIA WITH EFFUSION

1997 ◽  
Vol 16 (8) ◽  
pp. 816-817 ◽  
Author(s):  
Christopher J. Harrison ◽  
Stephen A. Chartrand ◽  
William Rodriguez ◽  
Richard Schwartz ◽  
Jay Pollack ◽  
...  
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Middle Ear Effusion ◽  
Ear Effusion

Comparative Treatment Trial of Augmentin Versus Cefaclor for Acute Otitis Media with Effusion

PEDIATRICS ◽  
1985 ◽  
Vol 75 (5) ◽  
pp. 819-826
Author(s):  
Carla M. Odio ◽  
Helen Kusmiesz ◽  
Sharon Shelton ◽  
John D. Nelson
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Middle Ear Effusion ◽  
Recurrent Acute Otitis Media ◽  
Potassium Clavulanate ◽  
Branhamella Catarrhalis ◽  
Viridans Group Streptococci ◽  
Ear Effusion

A total of 150 children with acute otitis media were randomly allocated to treatment with amoxicillin-potassium clavulanate (Augmentin) or with cefaclor. Each drug was given in a daily dosage of approximately 40 mg/kg in three divided doses for ten days. Tympanocentesis done before treatment yielded specimens that contained pneumococcus or Haemophilus sp or both in 67% of specimens. Viridans group streptococci were isolated from 10% of specimens and Branhamella catarrhalis from 6%. Patients were scheduled for followup examinations at midtreatment, end of therapy, and at 30, 60, and 90 days. Of the 150 children, 130 were evaluable. Five of 60 patients (8%) treated with cefaclor were considered therapeutic failures because of persistent purulent drainage and isolation of the original pathogen or suprainfection. There were no failures among patients treated with Augmentin (P = .019). Rates of relapse, recurrent acute otitis media with effusion, and persistent middle ear effusion were comparable in the two groups of patients. Diaper rash, or loose stools, or both were significantly more common in children treated with Augmentin (34%) than in those taking cefaclor (12%), but in no case was it necessary to discontinue medication because of these mild side effects (P = .002). Cefaclor therapy was discontinued in one patient because of severe abdominal pain and vomiting. In this study, treatment with Augmentin was superior to treatment with cefaclor in the acute phase of acute otitis media with effusion, but Augmentin produced more adverse effects. The rates of persistent middle ear effusion and recurrent acute otitis media with effusion were comparable with the two regimens.

Efficacy of Acoustic Reflectometry in Detecting Middle Ear Effusion

1986 ◽  
Vol 95 (5) ◽  
pp. 472-476 ◽  
Author(s):  
Christine A. Avery ◽  
George A. Gates ◽  
Thomas J. Prihoda
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Sensitivity And Specificity ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Lower Sensitivity ◽  
Middle Ear Effusion ◽  
Receiver Operator Characteristics ◽  
Ear Effusion

The acoustic otoscope measures the amount of sound reflected from the tympanic membrane. Since the amount of reflected sound is increased by fluid in the middle ear, it seemed likely that the acoustic otoscope could be used for detection of otitis media. We compared acoustic reflectometry with over 4,000 tympanometric and otoscopic examinations in 451 children who were examined at regular intervals following surgery for chronic otitis media with effusion. The data indicate a lower sensitivity and specificity of acoustic reflectometry than had been reported previously. The receiver-operator characteristics of this device are discussed.

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