Nystagmus in adult patients with acute otitis media or otitis media with effusion without dizziness

The present study aimed to investigate the incidence and patterns of nystagmus in adult patients with acute otitis media (AOM) or otitis media with effusion (OME) without dizziness or vertigo, and discuss possible mechanisms. From February 2018 to November 2018, 34 consecutive patients with AOM or OME without dizziness were included. Nystagmus was examined with video Frenzel glasses. Of 34 adult AOM or OME patients without dizziness, nystagmus was observed in 28 patients (82%). In unilateral AOM or OME (n = 30), the most commonly observed nystagmus pattern was irritative-type direction-fixed nystagmus (n = 13), followed by paretic-type direction-fixed nystagmus (n = 8), and direction-changing positional nystagmus (n = 4). In bilateral AOM or OME (n = 4), direction-fixed nystagmus and direction-changing positional nystagmus were observed in two and one patients, respectively. Nystagmus was observed in as many as 82% of adult AOM or OME patients even though they did not complain of dizziness, and the pattern of nystagmus was either direction-fixed or direction-changing. Direct effect of inflammatory mediators penetrated from the middle ear and biochemical alteration in the inner ear fluids due to blood-perilymph barrier dysfunction may result in the presence of nystagmus in AOM or OME patients without dizziness.

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

Infection and Immunity ◽

10.1128/iai.71.6.3454-3462.2003 ◽

2003 ◽

Vol 71 (6) ◽

pp. 3454-3462 ◽

Cited By ~ 69

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.

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Niche- and Gender-Dependent Immune Reactions in Relation to the Microbiota Profile in Pediatric Patients with Otitis Media with Effusion

Infection and Immunity ◽

10.1128/iai.00147-20 ◽

2020 ◽

Vol 88 (10) ◽

Author(s):

Frida Enoksson ◽

Alicia Ruiz Rodriguez ◽

Chikondi Peno ◽

Carlos Balcazar Lopez ◽

Fredrik Tjernström ◽

...

Keyword(s):

Immune Responses ◽

Otitis Media ◽

Middle Ear ◽

Inflammatory Mediators ◽

Otitis Media With Effusion ◽

Bacterial Species ◽

Microbial Community Composition ◽

Low Grade ◽

Content Type ◽

Anti Inflammatory

ABSTRACT Otitis media with effusion (OME) is a common inflammatory disease that primarily affects children. OME is defined as a chronic low-grade inflammation of the middle ear (ME), without any signs of infection and with effusion persisting in the ME for more than 3 months. The precise pathogenesis is, however, not fully understood. Here, we comprehensively characterized and compared the host immune responses (inflammatory cells and mediators) and the overall microbial community composition (microbiota) present in matched middle ear effusion (MEE) samples, external ear canal (EEC) lavages, and nasopharynx (NPH) samples from children with OME. Female patients had significantly increased percentages of T lymphocytes and higher levels of a wide array of inflammatory mediators in their MEE compared to that of male patients, which were unrelated to microbiota composition. The relative abundances of identified microorganisms were strongly associated with their niche of origin. Furthermore, specific inflammatory mediators were highly correlated with certain bacterial species. Interestingly, some organisms displayed a niche-driven inflammation pattern in which presence of Haemophilus spp. and Corynebacterium propinquum in MEE was accompanied by proinflammatory mediators, whereas their presence in NPH was accompanied by anti-inflammatory mediators. For Turicella and Alloiococcus, we found exactly the opposite results, i.e., an anti-inflammatory profile when present in MEE, whereas their presence in the the NPH was accompanied by a proinflammatory profile. Together, our results indicate that immune responses in children with OME are highly niche- and microbiota-driven, but gender-based differences were also observed, providing novel insight into potential pathogenic mechanisms behind OME.

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Pseudomonas Otitis Media after Eustachian Tube Obstruction

Otolaryngology ◽

10.1177/019459989210700402 ◽

1992 ◽

Vol 107 (4) ◽

pp. 511-515 ◽

Cited By ~ 9

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.

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Tympanostomy Tube Selection: A Review of the Evidence

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1259 ◽

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.

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

The Pediatric Infectious Disease Journal ◽

10.1097/00006454-199708000-00016 ◽

1997 ◽

Vol 16 (8) ◽

pp. 816-817 ◽

Cited By ~ 5

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

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

PEDIATRICS ◽

10.1542/peds.75.5.819 ◽

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.

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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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Immunologic Characteristics of Cytokines in Otitis Media with Effusion

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489492101s1006 ◽

1992 ◽

Vol 101 (10_suppl) ◽

pp. 21-25 ◽

Cited By ~ 40

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.

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Workshop on Effects of Otitis Media on the Child

PEDIATRICS ◽

10.1542/peds.71.4.639 ◽

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

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Validity of Acoustic Reflectometry in Detecting Middle Ear Effusion

PEDIATRICS ◽

10.1542/peds.79.5.739 ◽

1987 ◽

Vol 79 (5) ◽

pp. 739-742

Author(s):

Daniel M. Schwartz ◽

Richard H. Schwartz

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Simple Technique ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Middle Ear Effusion ◽

Ear Effusion

Pneumootoscopy, tympanometry, and acoustic reflectometry were performed in 256 middleclass children seen in a surburban pediatric office. The results demonstrated that relectometry, when validated by otoscopic findings, detected middle ear effusion with 88% sensitivity and 83% specificity when a cut-off of 5 linear units was used. Corresponding values for tympanometry were 87% and 77.5%. These results are in keeping with those of earlier studies on acoustic reflectometry and demonstrate the usefulness of this simple technique in detecting chronic and acute otitis media with effusion.

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