A Longitudinal Study of Cellular Changes in Experimental Otitis Media

1979 ◽  
Vol 87 (5) ◽  
pp. 685-700 ◽  
Author(s):  
Marcos V. Goycoolea ◽  
Michael M. Paparella ◽  
Anna Mary Carpenter ◽  
S. K. Juhn
Keyword(s):  
Longitudinal Study ◽  
Otitis Media ◽  
Experimental Animal ◽  
Middle Ear ◽  
Defense System ◽  
Tube Obstruction ◽  
Defense Systems ◽  
Cellular Changes ◽  
Staining Techniques ◽  
The Continuum

A longitudinal sequential study of otitis media in an experimental animal (cat) using eustachian tube obstruction was done. Fifty animals were used. The continuum of mucoperiosteal changes from one day to six months after obstruction revealed gradual changes that were similar for each animal. Stages were defined, and by using different staining techniques, including immunocytochemistry, an overall middle ear defense system was postulated and documented. Nonspecific as well as specific defense systems, including localized immunity, were described. Effusions were studied in a continuum, and their pathogenesis was discussed.

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.

Patent Eustachian Tube in the Underaerated Middle Ear: A Paradox

1988 ◽  
Vol 97 (3) ◽  
pp. 219-221 ◽  
Author(s):  
Richard A. Buckingham
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Essential Factor ◽  
Secretory Otitis Media ◽  
Ear Diseases ◽  
Tube Obstruction ◽  
Middle Ear Pressure

Secretory otitis media, middle ear atelectasis, and retraction type cholesteatomas are the most frequently occurring chronic middle ear diseases; and eustachian tube obstruction and the generation of negative or less than atmospheric middle ear pressure is said to be an essential factor in the pathogenesis of these diseases. It has been found that habitual sniffing causes high degrees of negative middle ear pressure in diseased ears; this finding demonstrates eustachian tube patency rather than obstruction. Ears intubated for chronic secretory otitis media, middle ear atelectasis, and cholesteatoma were examined to identify patent eustachian tubes. More than one third of the patients aspirated a solution into the middle ear with one or more sniffs by aspirating air from their middle ears, demonstrating eustachian tube patency rather than obstruction.

scholarly journals Tympanometric changes following adenoidectomy in children with adenoid hypertrophy

2018 ◽  
Vol 4 (2) ◽  
pp. 391 ◽  
Author(s):  
Rashmi P. Rajashekhar ◽  
Vinod V. Shinde
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Maximum Size ◽  
Adenoid Hypertrophy ◽  
Tube Obstruction ◽  
Media Type ◽  
Middle Ear Pressure ◽  
Pressure Changes

<p class="abstract"><strong>Background:</strong> Adenoid Hypertrophy is the commonest disorder in children. The size of adenoids varies from child to child and also in the same individual as he grows and attains maximum size between age of 3 to 7 years. Adenoid hypertrophy plays a significant role in the pathogenesis of otitis media with effusion. Our objective was to study the tympanogram changes following adenoidectomy. i.e to find out the effect  of  adenoidectomy on Otitis Media with Effusion.</p><p class="abstract"><strong>Methods:</strong> Patients showing &gt;50% of airway obstruction by the adenoids were included in the study. 20 patients with adenoid hypertrophy underwent adenoidectomy. Pre-operative and postoperative tympanograms of 40 ears were studied.  </p><p class="abstract"><strong>Results:</strong> Type A curve (normal) was found in 12 ears. Type B Flat tympanogram – 12 ears s/o Gross Serous Otitis Media. Type C tympanogram – 8 ears s/o uncomplicated eustachian tube obstruction. 5 ears showed tympanogram s/o Eustachian tube block without significant collection of middle ear fluid. 3 ears showed tympanogram s/o uncomplicated eustachian tube obstruction. Post adenoidectomy, 32 ears showed normal tympanogram. 8 ears showed tympanogram s/o negative middle ear pressure with normal compliance.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows high prevalence of Otitis Media with Effusion in patients with adenoid hypertrophy. Otitis Media with Effusion is treated by adenoidectomy in most of the patients which is confirmed by post adenoidectomy tympanogram. Also, problem of decreased attention in school due to reduced hearing secondary to OME can be corrected by adenoidectomy. Hence, all patients should undergo pre and post-adenoidectomy tympanometry to know the compliance and pressure changes in the middle ear.</p>

Biochemical and Immunochemical Characteristics of Middle Ear Effusions in Relation to Bacteriological Findings

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 161-167 ◽  
Author(s):  
S. K. Juhn ◽  
John S. Huff ◽  
G. Scott Giebink ◽  
Elaine L. Mills
Keyword(s):  
Epithelial Cells ◽  
Otitis Media ◽  
Middle Ear ◽  
Pneumococcal Infection ◽  
Positive Culture ◽  
Middle Ear Mucosa ◽  
Tube Obstruction ◽  
Tissue Proliferation ◽  
Vascular Dilatation ◽  
Inflammatory Changes

Experimental otitis media was produced in chinchillas by eustachian tube obstruction or pneumococcal infection. Sequential changes in the histology of the middle ear mucosa and enzyme profile of the middle ear effusions (MEE) were studied. In serous otitis media (SOM) which followed tubal obstruction, the subepithelial space was widened by edema and capillary dilatation, and the middle ear space was filled with serous fluid. Slight hyperplasia of epithelial cells was also observed. The subepithelial space remained widened with mild fibrous change and capillary dilatation, and slight hyperplasia of epithelial cells persisted 42 days after obstruction. In purulent otitis media (POM), which followed inoculation of pneumococci into the middle ears, metaplasia of the epithelial layer from flat to columnar cells was observed. The subepithelial space was widened with loose fibrous connective tissue proliferation, vascular dilatation and inflammatory cell infiltration. Both lactate dehydrogenase (LDH) and lysozyme levels in MEE were higher in the POM group than in the SOM group. When bacterial enzymes, hyaluronidase and lipase activity were measured in MEE and plotted together with the percentage of positive culture of the MEE at different times after the experimental infection, the enzyme activities decreased with the clearing of bacteria and along with the resorption of inflammatory changes of middle ear mucosa evidenced by histology. In human MEE studies, immunoglobulins (IgG, IgA, IgM) of MEE were higher than in serum except IgM in serous MEE. The IgG content of MEE in the culture-negative group was higher than in the culture-positive group. Possible mechanisms for this difference were discussed.

Mucociliary Disease of the Middle Ear during Experimental Otitis Media with Effusion Induced by Bacterial Endotoxin

1989 ◽  
Vol 98 (6) ◽  
pp. 479-484 ◽  
Author(s):  
Yoshiaki Nakai ◽  
Hiroshi Ikeoka ◽  
Yoshihiro Ohashi ◽  
Hiroyuki Furuya ◽  
Shoko Kato ◽  
...  
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Laboratory Animals ◽  
Ciliary Activity ◽  
Defense System ◽  
Middle Ear Effusion ◽  
Epithelial Morphology ◽  
Mucociliary System ◽  
Ear Effusion

Lipopolysaccharide (10 μg/mL) derived from Klebsiella pneumoniae was injected into the middle ear of guinea pigs. The animals were killed painlessly on days 1, 3, and 7 after inoculation, and the mucosal samples from two sites within the tympanic cavity, close to the tympanic orifice and distal to the orifice, were examined for ciliary activity and epithelial morphology. At day 1 and day 3 serous effusion was observed and deterioration of ciliary activity and morphologic changes were observed. No effusion was recognized at day 7, when the ciliary activity in the distal mucosa was still diminished and that in the proximal mucosa had recovered to a normal level. Our data have shown that lipopolysaccharide extracted from K pneumoniae can produce otitis media with effusion in laboratory animals, and dysfunction of cilia due to lipopolysaccharide probably is responsible for the accumulation of middle ear effusion. The mucociliary system is indeed an important defense system and failure of such a system, especially in the mucosa close to the tympanic orifice, can cause the buildup of effusions.

Pathogenesis of Otitis Media

1977 ◽  
Vol 86 (4) ◽  
pp. 481-492 ◽  
Author(s):  
S. K. Juhn ◽  
Michael M. Paparella ◽  
Marcos V. Goycoolea ◽  
C. S. Kim ◽  
Scott Giebink
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Strong Relationship ◽  
Lactic Dehydrogenase ◽  
Tube Placement ◽  
Secretory Cells ◽  
Extrinsic Factors ◽  
Suppurative Otitis Media ◽  
Serous Otitis Media ◽  
The Continuum

Pathogenesis of otitis media was studied in humans and various animal models primarily from a pathological and chemical point of view. Findings were correlated and interpreted for various forms of otitis media in longitudinal and parallel studies, including acute purulent otitis media (POM), serous otitis media (SOM), mucoid or secretory otitis media (MOM), and chronic suppurative otitis media (COM), especially as regards the continuum or interrelated changes of various groups. Purulent otitis media was produced in chinchillas by direct inoculation of less than 100 pneumococci into the middle ear space. Serous otitis media was produced in chinchillas and cats following Eustachian tube obstruction with silicone. Mucoid otitis media followed the development of SOM in cats after two to four weeks of tubal occlusion. Samples of middle ear effusion (MEE) and serum, obtained from children with SOM and MOM after myringotomy for ventilation tube placement, were evaluated. The three components studied were MEE, epithelium and the subepithelial space (SES). Inflammatory changes in the SES were significant for all forms of otitis media, but especially for POM and SOM. Epithelial metaplasia to secretory cells was most prominent in MOM. Chemical factors involved in pathogenesis and defense were studied. Lactic dehydrogenase and lysozyme, chemical indicators of inflammatory activity, were greater in POM and MOM than in SOM. Immunoglobulins (A, G, & M) were greater in MOM than in SOM. The similarity of findings between the groups suggests a strong relationship between them. The ability of certain types of otitis media to evolve into another substantiates the concept of the continuum for some patients. Pathogenesis is dependent upon various extrinsic factors of etiopathogenesis, while the form that otitis media takes seems to rely mostly on relative activity of the SES and the epithelium.

Subannular Tubes in Children With Cleft Palate

2021 ◽  
pp. 105566562199017
Author(s):  
Sónia Pires Martins ◽  
Pedro Lopes Alexandre ◽  
Margarida Santos ◽  
Carla Pinto Moura
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Tube Obstruction ◽  
Tube Extrusion ◽  
Tertiary Center ◽  
Retraction Pockets ◽  
Middle Ear Disease

Objective: To investigate subannular tube (SAT) placement as an alternative treatment of chronic middle ear disease in children with cleft palate. Design: Retrospective cohort study. Participants: All children with cleft palate with intractable otitis media with effusion and/or with tympanic membrane retraction, operated for insertion of 1 or more sets of transtympanic tubes followed by SAT in a tertiary center. Main Outcome Measures: Audiological outcomes, average duration of tubes, and postoperative complications were analyzed. Results: This study included 21 children with cleft palate, aged 3 to 14 years. A total of 38 ears was evaluated. The median time of follow-up was 42 months. During follow-up, 69.2% of the patients had no complications. Observed complications were otorrhea (13.5%) and tube obstruction (7.7%). In 7.9% of the cases, otitis media with effusion relapsed after tube extrusion. By the end of the study, 76.3% of the tubes remained in situ and 68.4% of the tympanic membranes had the SAT in place and had no significant alterations. The mean duration of SATs was 16 months, which was significantly superior to transtympanic tube duration. A significant sustained improvement in the hearing of children with SATs was observed. Conclusion: Subannular tube insertion results in hearing improvement to normal range and tympanic retraction pockets reversion in children with cleft palate with persistent otitis media with effusion and tympanic retraction/atelectasis. This surgery appears to be safe and provides long-term efficient middle ear aeration. Strict postoperative follow-up is crucial for the success of the treatment.

Concepts on the Pathogenesis of Middle Ear Effusions

1976 ◽  
Vol 85 (2_suppl) ◽  
pp. 182-186 ◽  
Author(s):  
Charles D. Bluestone ◽  
Quinter C. Beery
Keyword(s):  
Fluid Flow ◽  
Pressure Gradient ◽  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Acute Otitis Media ◽  
Active Muscle ◽  
Secretory Otitis Media ◽  
Tube Obstruction ◽  
Narrow Neck

Several concepts related to the pathogenesis of middle ear effusions are postulated. The mechanisms proposed are based on an understanding of fluid mechanics. A flask with a long, narrow neck is presented as a model of the Eustachian tube-middle ear-mastoid system. Fluid flow into and out of the flask is dependent upon the pressure gradient, compliance of the narrow neck and whether or not the bulbous portion is intact. It is suggested that locking of the tube may be dependent upon the speed of the application of the negative pressure and the compliance. Eustachian tube opening appears to be related not only to active muscle forces but may also be dependent upon the presence of a pressure gradient which passively assists tubal function. It is proposed that middle ear effusions result from reflux, aspiration or insufflation of nasopharyngeal secretions (acute otitis media), or from persistent functional or mechanical Eustachian tube obstruction (secretory otitis media) or both.

Cells Involved in the Middle Ear Defense System

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 121-128 ◽  
Author(s):  
Marcos M. Goycoolea ◽  
S. K. Juhn ◽  
Michael M. Paparella ◽  
Anna-Mary Carpenter
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Plasma Cells ◽  
Round Window ◽  
Rational Approach ◽  
Ground Substance ◽  
Round Window Membrane ◽  
Defense System ◽  
Tube Obstruction ◽  
Temporal Bones

Despite the high incidence and prevalence of otitis media, its pathogenesis is not thoroughly understood. In the last decade, many efforts have been made to provide a better understanding, and abundant information has become available. At the same time the field of immunology has advanced at an extremely rapid pace. We have followed the gradual cellular events in the defense reaction of the middle ear, utilizing eustachian tube obstruction to induce otitis. Seventy-five cats were divided in groups and sacrificed at intervals between one day and six months, and their temporal bones were studied. During an initial phase of inflammation, polymorphonuclears appear at three days in connective tissue; at the same time active fibroblasts synthesize tropocollagen and ground substance while epithelial cells secrete mucus and lysozymes. These cells, together with those involved in the mucociliary transport system and a patent functional eustachian tube, constitute the nonspecific system of defense. The transition cells are the macrophages which appear at one week to interact with T and B cells to produce the specific immune response. Plasma cells appear at two weeks to peak at one month with synthesis of immunoglobulins A, G and M. A secretory immune system is observed. At three and six months, lymphocytes are the predominant cells and occasional accumulations of mononuclears are observed. The reaction involves the entire middle ear, including mucoperiosteum, middle ear muscles and round window membrane. We believe that a better understanding of the middle ear defense system will lead in time to a practical clinical assessment of the immunological status during the evolution of each particular process or disease involving the middle ear, and a more rational approach to the treatment and, hopefully, prevention of chronic ear disease.

Secretory Immunoglobulin a (SIgA) in Middle Ear Effusions; A Further Report

1974 ◽  
Vol 83 (1) ◽  
pp. 92-101 ◽  
Author(s):  
Goro Mogi ◽  
Shoichi Honjo ◽  
Shoichi Maeda ◽  
Toyoharu Yoshida ◽  
Noritake Watanabe
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Immunoglobulin A ◽  
Secretory Activity ◽  
Nasal Discharge ◽  
Subunit Structure ◽  
Secretory Immunoglobulin A ◽  
Defense System ◽  
Secretory Immunoglobulin

Immunochemical and immunofluorescent studies of secretory immunoglobulin A (SIgA) in otitis media with effusion were carried out to investigate the local immunologic defense system and secretory activity in the middle ear. SIgA was isolated from pooled middle ear effusions by an immunoadsorbents technique and its antigenicity and subunit structure compared with SIgA derived from other external secretions, such as saliva, nasal discharge, and colostrum. The antigenicity and subunit structure of the isolated SIgA from middle ear effusions were identical or very similar to those of SIgA obtained from other external secretions. Radioimmunodiffusion analysis revealed that SIgA was present in 43 of 47 (91.5%) cases of serous middle ear effusion, whereas the sera from only 3 of 47 (6.4%) of these patients was found to have SIgA. Immunoelectrophoresis, using anti-SIgA antiserum, and radioimmunoelectrophoresis detected free SC (secretory component) in 1 of 47 (2%) serous and 6 of 30 (20%) mucoid effusions. Apices of epithelial cells and glandular acinar cells of the middle ear mucosa obtained from patients with otitis media with effusion were stained specifically with anti-SC antibodies. Findings of the study would suggest: 1) that the middle ear maintains the local immunologic defense system, as do respiratory tracts and salivary glands, and 2) that while serous middle ear effusions are a mixture of normal middle ear secretions bathing the membrane surface and transudates from serum, mucoid effusions are the result of enhanced epithelial secretory activity and transudates.

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