Pseudomonas Otitis Media after Eustachian Tube Obstruction

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.

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Tympanometric changes following adenoidectomy in children with adenoid hypertrophy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180423 ◽

2018 ◽

Vol 4 (2) ◽

pp. 391 ◽

Cited By ~ 2

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

Background: 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.Methods: Patients showing >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. Results: 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.Conclusions: 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.

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Drug-Induced Changes in Eustachian Tube Function

Ear Nose & Throat Journal ◽

10.1177/014556139807700915 ◽

1998 ◽

Vol 77 (9) ◽

pp. 778-782 ◽

Cited By ~ 2

Author(s):

Lars Malm ◽

Örjan Tjernström

Keyword(s):

Otitis Media ◽

Eustachian Tube ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Eustachian Tube Function ◽

Drug Induced ◽

Tube Function ◽

Induced Changes

Many studies have shown that antihistamines and decongestants are of little use in the treatment of acute otitis media and otitis media with effusion, or in the prophylaxis of these disorders.1 However, because some drugs can improve otitis media with effusion (glycocorticosteroids)2–4 and some can impair the opening function of the eustachian tube (atropine),5 it seems justified to continue studies of eustachian tube function and medication.

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Eustachian Tube Function and Allergy in Otitis Media

PEDIATRICS ◽

10.1542/peds.61.5.753 ◽

1978 ◽

Vol 61 (5) ◽

pp. 753-760

Author(s):

Charles D. Bluestone

Keyword(s):

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Disease Process ◽

Exact Nature ◽

Protective Function ◽

Radiographic Technique ◽

Tube Function ◽

Glue Ear

Otitis media with effusion (OME) is one of the most common diseases of childhood. Acute OME is usually of the suppurative type, although it may be serous, while chronic OME has many synonyms, including "serous otitis media," "mucoid otitis," "nonsuppurative otitis media," "glue ear," and "allergic otitis media." The following discussion is a review of some of the factors that influence the etiology and pathogenesis of OME in general, and more specifically the role of Eustachian tube (ET) function and allergy in the disease process of OME. The pathogenesis of OME appears to be related to abnormal function of the ET. Investigation into the exact nature of this dysfunction requires an understanding of the system constituted by the palate, nasal cavity, nasopharynx, ET, middle ear, and mastoid air cells. Within this system the ET has at least three physiologic functions with respect to the middle ear: protection from nasopharyngeal sound pressure and secretions, clearance into the nasopharynx of secretions produced within the middle ear, and ventilation of the middle ear to equilibrate air pressure in the middle ear with atmospheric pressure and to replenish oxygen which has been absorbed (Fig. 1). ROENTGENOGRAPHIC STUDIES The protective and clearance functions of the ET have been assessed by a radiographic technique.1,2 Radiopaque material was instilled through the nose of patients in order to observe the retrograde flow of the medium from the nasopharynx into the ET. Patients were considered to have normal protective function when radiopaque material entered only the nasopharyngeal or isthmic portion of the tube but did not enter the bony portion of the tube or middle ear cavity.

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An Animal Model of Acute Otitis Media Consequent to β-Lactamase-Producing Nontypable Haemophilus Influenzae

Otolaryngology ◽

10.1177/019459988209000627 ◽

1982 ◽

Vol 90 (6) ◽

pp. 831-836 ◽

Cited By ~ 12

Author(s):

William J. Doyle ◽

John S. Supance ◽

Gabriel Marshak ◽

Erdem I. Cantekin ◽

Charles D. Bluestone ◽

...

Keyword(s):

Animal Model ◽

Haemophilus Influenzae ◽

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Protective Mechanism ◽

Colony Forming Units ◽

Direct Inoculation ◽

The Right

A chinchilla model of acute otitis media with effusion consequent to β-lactamase-producing nontypable Haemophilus influenzae was developed using the method of direct inoculation of 145 colony-forming units (CFU) or 252 CFU of β-lactamase—producing nontypable H influenzae into the right superior bullae of 40 chinchillas. The course of the disease was documented longitudinally by otomicroscopy, tympanometry, and periodic culturing of the middle ears. Onset of the disease occurred in 100% of the animals between two and six days postinoculation and resolution was complete in all ears by day 36. Results of rechallenge with the same organism support the combined effect of a local and weaker systemic middle ear protective mechanism rendering resistance to reinfection with a homologous organism in the chinchilla.

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Acute Otitis Media

Pediatrics in Review ◽

10.1542/pir.17.6.191 ◽

1996 ◽

Vol 17 (6) ◽

pp. 191-195

Author(s):

Suzanne Maxson ◽

Terry Yamauchi

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Clinical Signs ◽

Chronic Otitis Media ◽

Sudden Onset ◽

Purulent Discharge ◽

Suppurative Otitis Media ◽

Physician Visits

Definitions Acute otitis media with effusion (AOME) is a clinically identifiable, suppurative infection of the middle ear. The infection has a relatively sudden onset and short duration. It denotes inflammation of the mucoperiosteal lining of the middle ear. The inflamed tympanic membrane (TM) is bulging, opacified, or both. The condition chronic otitis media is poorly defined, but it may be categorized into two clinical entities for simplification: chronic otitis media with effusion (COME) and chronic suppurative otitis media (CSOM). COME, also known as serous or non-suppurative otitis media, is characterized by the presence of a middle ear effusion (MEE) behind an intact TM that persists for more than 2 to 3 months. It may be asymptomatic except for hearing loss. There generally are no acute clinical signs or symptoms, and the TM is not red or bulging. CSOM is characterized by chronic perforation of the TM, with purulent discharge, for a prolonged period of time, usually more than 6 weeks. There generally is an insidious clinical onset. Either COME or CSOM may follow AOME. Epidemiology Otitis media is one of the most frequent causes for physician visits by children. Approximately 25% of such visits during the first year of life are for middle ear disease; this increases to 40% for children 4 to 5 years of age.

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The middle ear

Oxford Handbook of ENT and Head and Neck Surgery ◽

10.1093/med/9780198725312.003.0006 ◽

2019 ◽

pp. 95-116

Author(s):

Rogan Corbridge ◽

Nicholas Steventon

Keyword(s):

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Acute Otitis Media ◽

Structure And Function ◽

Chronic Suppurative Otitis Media ◽

Management Options ◽

Suppurative Otitis Media ◽

Glue Ear ◽

And Function

The structure and function of the ear are documented, along with congenital abnormalities. The function of the Eustachian tube and symptoms caused by a blocked or patulous tube are discussed, along with possible treatments. Acute otitis media and its complications and management are explored. Strategies for managing glue ear and chronic suppurative otitis media with and without cholesteatoma are investigated. Surgical intervention is highlighted. The condition of otosclerosis and its diagnosis and management options are listed.

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Nebulized surfactant as a treatment choice for otitis media with effusion: an experimental study in the rabbit

The Journal of Laryngology & Otology ◽

10.1258/0022215011907848 ◽

2001 ◽

Vol 115 (5) ◽

pp. 363-368 ◽

Cited By ~ 11

Author(s):

Muhsin Koten ◽

Cem Uzun ◽

Recep Yaǧiz ◽

Mustafa Kemal Adali ◽

Ahmet Rifat Karasalihoglu ◽

...

Keyword(s):

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Physiological Saline ◽

Control Group ◽

Eustachian Tube Function ◽

Middle Ear Pressure ◽

Tube Function ◽

Experimentally Induced

Exogenous surfactant can improve eustachian tube function in experimentally induced otitis media with effusion (OME). Performing tympanometric recordings, the efficacy of inhaled nebulized surfactant, as compared with inhaled nebulized physiological saline was investigated, for the treatment of OME experimentally induced in the rabbit by intrabullar inoculation of heat-killed Streptococcus pneumoniae. In addition, the histological changes in middle ears after the treatment were investigated in order to establish whether the pathological findings correlated with the results.Middle-ear pressure values before, and after, treatment were analyzed by the Wilcoxon statistical method, and the Mann-Whitney U test was used to compare the post-treatment values between groups. In all ears with OME in the affected animals, which were treated with nebulized surfactant inhalation, a positively significant (p<0.05) increase of pressure more than 20 daPa was recorded. In the control group, after inhalation of nebulized physiological saline, there was no positive increase in the affected middle-ear pressures; on the contrary, more negative pressure changes were recorded. In the histological evaluation, middle-ear epithelia and sub-epithelial space were normal in surfactant-treated ears with OME, whereas mucosal thickening with an oedematous sub-epithelial space containing occasional inflammatory cells and increases in connective tissue and vascularity, and effusions on the epithelial surface were present in the ears with OME in the control group. The significant improvement in the negative middle-ear pressure after nebulized surfactant treatment and the histological findings shown in our study can support the theory that surface-active agents are of importance in eustachian tube function even under pathologic conditions, such as OME.

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Squamous Metaplasia of the Middle Ear Mucosa During Vitamin a Deprivation

Otolaryngology ◽

10.1177/019459987908700618 ◽

1979 ◽

Vol 87 (6) ◽

pp. 837-844 ◽

Cited By ~ 14

Author(s):

Richard A. Chole

Keyword(s):

Vitamin A ◽

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Vitamin A Deficiency ◽

Squamous Metaplasia ◽

Acute Otitis Media ◽

Control Group ◽

Albino Rats

Adult and juvenile albino rats were maintained on a vitamin A-free test diet for 2 to 28 weeks. Histologic study of the middle ear and eustachian tube mucosa of these animals showed extensive focal squamous metaplasia when compared with the control group. Keratinization of large areas of normally columnar, ciliated epithelium was observed without frank keratoma formation. In over half of the most vitamin A-deficient animals, acute otitis media with effusion was found. It is hypothesized that vitamin A deficiency disrupts the mucociliary clearing mechanism in the middle ear and eustachian tube, which may lead to effusion and otitis media.

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The middle ear

Oxford Handbook of ENT and Head and Neck Surgery ◽

10.1093/med/9780199550791.003.06 ◽

2009 ◽

pp. 89-108

Author(s):

Rogan Corbridge ◽

Nicholas Steventon

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Congenital Abnormalities ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Structure And Function ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Glue Ear ◽

And Function

Structure and function of the middle ear 90 Congenital abnormalities of the middle ear 92 Acute otitis media 94 Complications of acute otitis media 96 Glue ear/otitis media with effusion 97 Chronic suppurative otitis media without cholesteatoma 98 Chronic suppurative otitis media with cholesteatoma 100...

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Acute Otitis Media Increases Middle Ear Susceptibility to Nasal Injection of Pseudomonas Aeruginosa

Otolaryngology ◽

10.1177/019459989411000114 ◽

1994 ◽

Vol 110 (1) ◽

pp. 115-121

Author(s):

Patrick J. Antonelli ◽

Steven K. John ◽

Chap T. Le ◽

G. Scott Giebink

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Acute Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Fourth Group ◽

Middle Ear Infection ◽

Penicillin Treatment

Pseudomonas aeruginosa was injected intranasally into four groups of chinchillas to determine if these bacteria can invade the middle ear by way of the eustachian tube. One group completed penicillin treatment of bilateral penumococcal otitis media (POM), and the second group started penicillin treatment of bilateral POM at the time of P. aeruginosa injection. A third group had no POM, but completed a course of penicillin treatment before P. aeruginosa injection, and a fourth group had no POM and received no penicillin. Middle ear susceptibility to nasally injected P. aeruginosa was significantly higher in animals with POM (61%) than in animals without POM (32%, p = 0.001). Forced eustachian tube opening pressures did not correlate with P. aeruginosa susceptibility. Thus, P. aeruginosa, the principle pathogen of chronic suppurative otitis media, can invade the middle ear by way of the eustachian tube, and acute otitis media predisposes to middle ear infection by P. aeurginosa.

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