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PubMed1979

Brain stem evoked potential findings in children with otitis media.

Sixty-three children from 2 to 12 years of age were studied by means of brain stem evoked potentials (BEP) and otoscopic evaluation in a preliminary assessment of the sensitivity of BEP latency measures to middle ear abnormality. Wave I proved to be the most sensitive component; 81.25% of subjects with acute suppurative otitis media and 62.50% of subjects with secretory otitis media demonstrated latencies prolonged by more than 1 SD beyond the values observed in normal control subjects. Of the same subject groups, 86.21% and 93.31% demonstrated wave I latencies within normal limits upon retesting after the otitis had resolved. The BEP technique permitted identification of several subjects with abnormal audiometric findings despite normal otoscopy. There are implications for use of the BEP as a clinical adjunct to traditional methods of auditory assessment.

Acute Disease↗
PubMed1979

Pediatric otoscopy and photography of the tympanic membrane.

A further miniaturization of the lens telescopes (Hopkins Rod) has resulted in a telescope (length, 6 cm; diameter, 2.7 mm) that is suitable for pediatric otoscopy. The adaptation of otoscopic specula, a lightweight motor-driven remote flash camera, and movie and video photography to this telescope has resulted in a system that represents a significant advance in the examination of the ear. In this study, we document ear diseases in children with the use of color photographs.

Child↗
PubMed1982

Hearing loss in minor head injury.

A prospective otological and audiological study was made of 130 consecutive persons with head injuries. A comparison was made with 87 consecutive persons with traumatic injuries but without head injuries. Five (4%) of the persons with head injuries had an unsuspected temporal bone fracture evident on otoscopy but not on routine skull roentgenography. These persons had a significant sensorineural hearing loss at 4 and 8 kHz compared with other patients with head injuries. Routine otoscopic examination is considered advisable in all persons with head injuries. No significant difference in the hearing was detected in persons with head injuries without a temporal bone fracture compared with control subjects.

Adolescent↗
PubMed1985

Hearing acuity of children with otitis media with effusion.

Hearing levels are reported for a cohort of 222 infants (aged 7 to 24 months) and 540 older children (aged 2 to 12 years) with otitis media with effusion (OME). The infants had an average speech awareness threshold of 24.6 dB hearing level (HL). The older group had mean bone conduction thresholds less than 10 dB HL, and air conduction thresholds averaged 27 dB HL; however, acuity was 7 dB less impaired at 2,000 Hz. The mean three-frequency pure tone average and speech reception threshold were 24.5 and 22.7 dB, respectively. Hearing acuity was not significantly related to age or previous duration of OME. The otoscopic observation of an air-fluid level or bubbles was associated with less hearing impairment; however, a predictive relationship between hearing levels and tympanogram characteristics could not be demonstrated.

Acoustic Impedance Tests↗
PubMed1987

Mongolian gerbil tympanic membrane. Normal and with induced otitis media.

Otoscopic observation of the tympanic membrane is the most effective noninvasive means of diagnosing and following the course of experimental otitis media in animal models of the disease in both short-term and in longitudinal studies. Because of the difficulty of viewing the entire tympanic membrane of the gerbil model of otitis media without manipulation, we present methods of visualizing and color illustrations of the normal tympanic membrane of the Mongolian gerbil, Meriones unguiculatus. These are compared with illustrations of animals with acute experimental otitis media. An artist's rendition of the entire normal gerbil tympanic membrane is presented. These methods and illustrations will enable investigators to more rapidly and easily adopt the Mongolian gerbil as an animal model for studies of otitis media.

Acute Disease↗
PubMed1990

Three-dimensional images of the temporal bone and experimental otitis media in Japanese monkeys.

Since the middle ear structure of animals commonly used for experimental study is different from that of humans, we used the Japanese monkey (Macaca fuscatus) as an animal model for otitis media with effusion (OME). The exact similarities and differences of the ear structure between humans and Japanese monkeys were studied by the use of computer-aided three-dimensional reconstruction, in addition to light and electron microscopy. Otitis media with effusion was repeatedly induced by direct intratympanic inoculation of one of the following: keyhole limpet hemocyanin; following systemic immunization with keyhole limpet hemocyanin, Streptococcus pneumoniae; or endotoxin. The temporal bones were serially sliced with a diamond band saw, after which the histologic findings were examined by light and electron microscopy on the basis of macroscopic observations. Each substance induced OME equally, 2 to 3 days after inoculation. Inflammatory reaction of the middle ear mucosa extended to all of the air cells; subsequently, the inflamed mucosa returned to normal in each case along with normalization of both the tympanometric and otoscopic findings. No remarkable architectural change remained, even after OME was induced repeatedly. These findings are applicable to acute otitis media and acute mastoiditis. The development of chronic middle ear effusion was not observed in this study. The usefulness of the diamond band saw and computer-aided analysis for temporal bone histologic evaluations is emphasized.

Acute Disease↗
PubMed1991

Age-related morphologic changes in the human tympanic membrane. A light and electron microscopic study.

To our knowledge, the normal changes that occur in the tympanic membrane after birth have not been described, despite several reports that their otoscopic appearance in healthy, full-term infants is different from that in adults. To provide such a description, the tympanic membranes of 54 temporal bones that had no pathologic evidence of otologic diseases, from patients aged 33 weeks' gestation to 91 years, were examined with light or electron microscopy. The changes encountered in thickness, cellularity, vascularity, collagen, and elastin indicated beyond the first year of life and into old age.

Adolescent↗
PubMed1993

External and middle ear status related to evoked otoacoustic emission in neonates.

OBJECTIVE: Screening auditory status prior to neonatal hospital discharge to identify newborns with severe hearing impairment is an important pediatric care priority. Evoked otoacoustic emission (OAE) testing is a quick noninvasive method. The purpose of this study was to determine the relationship between external auditory canal and middle ear status with click-evoked OAE. It was hypothesized that vernix caseosa, debris in the ear canal, and middle ear fluid contribute to the OAE fail rate. DESIGN: All neonates had an initial OAE examination. A second investigator, "blinded" to the results, examined all ears otoscopically, cleaned any obstructing debris, and repeated with a second OAE test. SETTING: All neonates were tested in a designated nursery at a mean age of 43 +/- 21 hours. PATIENTS: Forty-one full-term neonates were prospectively enrolled. INTERVENTION: The ear canals with debris were cleaned under direct vision with a pediatric swab dampened by an alcohol wipe. OUTCOME MEASURE: The primary outcome measure was the postcleaning OAE pass rate. RESULTS: The preotoscopic examination pass rate of 82 ears was 76%. The OAE pass rate improved to 91% after debris removal. CONCLUSIONS: The results indicate that the examination and cleaning of the external ear canal are important components of the neonatal screening process.

Acoustic Stimulation↗
PubMed1993

The concept of transtympanic injection of fibrin caulk.

Cerebrospinal fluid otorhinorrhea after basilar skull trauma poses a difficult management problem. When conservative techniques fail, more aggressive neurosurgical and otologic procedures are required to control cerebrospinal fluid leakage. We assessed a less invasive method for the repair of traumatic cerebrospinal fluid fistulas. Thirty-one adult Sprague-Dawley rats were used to develop an animal model for the treatment of cerebrospinal fluid leakage. A fistula was created by removing a thin plate of bone from the superior aspect of the rat bulla. The bulla was then plugged with a transtympanic injection of fibrin caulk. Otoscopic and histologic data were collected at selected intervals. Transtympanic injection of fibrin caulk failed to alter significantly the rate of healing of cerebrospinal fluid fistulas. Coagulum retraction, rapid fibrinolysis, and other reasons for failure are explored.

Animals↗
PubMed1997

Shrapnell membrane and mastoid pneumatization.

OBJECTIVE: To assess whether a correlation exists between the degree of pars flaccida (PF) retraction and the degree of mastoid pneumatization. DESIGN: The degree of PF retraction was defined by means of an operating microscope and a pneumatic otoscope. Degree of mastoid pneumatization was assessed planimetrically, using mastoid x-rays. SETTING: Private otologic clinic. PARTICIPANTS: A total of 595 ears, with intact pars tensa, of 332 adult patients. RESULTS: The degree of PF retraction was found to be inversely correlated to the level of mastoid pneumatization. Poorly pneumatized mastoids were associated with PF retractions. The poorer the pneumatization, the deeper the retraction. Well-pneumatized mastoids were associated with normal position of the PF. CONCLUSIONS: This study lends further support to the possibility that the mastoid pneumatic system functions as a middle ear pressure buffer. This possibility gives further explanation as to why ears with poorly pneumatized mastoids tend to develop tympanic membrane retractions and perforations, incus necrosis, or retraction pocket cholesteatoma, while ears with a large pneumatic system are rarely at such risk.

Adult↗
PubMed1997

Quality of life for children with otitis media.

OBJECTIVE: To evaluate changes in health-related quality of life for children with otitis media. DESIGN: Cohort study using a 6-item quality-of-life survey (OM-6) representing the domains of physical suffering, hearing loss, speech impairment, emotional distress, activity limitations, and caregiver concerns. SETTING: Hospital-based pediatric otolaryngology practice in a metropolitan area. PATIENTS: One hundred eighty-six children aged 6 months to 12 years (median age, 3.4 years) with chronic otitis media with effusion or recurrent acute otitis media. INTERVENTION: The OM-6 was completed at entry by the child's caregiver and again at least 4 weeks after routine clinical care. Otoscopic findings, static admittance, tympanometric width, audiometric thresholds, and ear-related global quality of life (10-point visual scale) were recorded concurrently. MAIN OUTCOME MEASURES: Test-retest reliability, construct validity, and responsiveness to longitudinal change of the OM-6 survey score (mean value of the 6 items). RESULTS: Excellent test-retest reliability was obtained for the survey score (R=0.87) and individual survey items (R> or =0.71). The median survey score was 2.8 (95% confidence interval, 2.7-3.0) of a maximum 7.0, with higher values indicating poorer quality of life. Construct validity was shown by significant correlations between the survey score and global ear-related quality of life (R=-0.64), between physical suffering and physician visits in the past month (R=0.47), and between caregiver concerns and antibiotics consumed in the past month (R=0.26). The mean change in survey scores after tympanostomy tubes was 1.7, with a standardized response mean of 1.7 (95% confidence interval, 1.4-2.0), indicating large responsiveness to change. The change score was reliable (R=0.82) and correlated well with the degree of reported clinical change (R=0.66). CONCLUSIONS: The OM-6 is a valid, reliable, and responsive measure of quality of life for children with otitis media. The brevity and ease of administration make the OM-6 ideal for use in outcomes studies, clinical trials, and routine clinical care.

Activities of Daily Living↗
PubMed1985

Erythromycin-sulfisoxazole vs amoxicillin in the treatment of acute otitis media in children. A double-blind, multiple-dose comparative study.

A fixed combination of erythromycin ethylsuccinate and sulfisoxazole acetyl (erythromycin-sulfa) was compared with amoxicillin for the treatment of acute otitis media (AOM) in children. Of 145 patients studied, 76 boys and 69 girls were compliant and were evaluated for drug efficacy (72 amoxicillin, 73 erythromycin-sulfa). Based on otoscopic and tympanometric results, cure rates at ten to 14 days for AOM due to all organisms were 83% (63/72) for amoxicillin and 89% (65/73) for erythromycin-sulfa; for Haemophilus species (including mixed infections), they were 84% for amoxicillin (26/31) and 83% for erythromycin-sulfa (20/14). Cure rates for ampicillin-resistant Haemophilus were 1/1 for amoxicillin and 7/8 (88%) for erythromycin-sulfa; one patient (12%) had persistent AOM at day 10. Of the patients with AOM due to Streptococcus pneumoniae, 82% (29/35) in the amoxicillin-treated group and 98% (39/40) in the erythromycin-sulfa-treated group were cured. Patients with S pneumoniae as the initial infecting organism who were treated with amoxicillin had significantly more clinical recurrences then their erythromycin-sulfa-treated counterparts, 66% (8/12) vs 33% (3/9). There was no difference between treatment groups in recurrence rates for patients with Haemophilus as the initial infecting organism. On the treatment day indicated, the following number of patients had middle ear effusion: by days 10 to 14, 38% (27/72) amoxicillin-treated patients and 48% (35/73) erythromycin-sulfa-treated patients; by day 28, 10% (7/71) amoxicillin-treated patients and 16% (11/70) erythromycin-sulfa-treated patients. There were no significant differences in adverse reactions. The erythromycin-sulfa combination is safe and effective treatment for AOM, including ampicillin-resistant Haemophilus.

Acute Disease↗
PubMed2003

Screening and management of adult hearing loss in primary care: scientific review.

CONTEXT: Hearing loss is the third most prevalent chronic condition in older adults and has important effects on their physical and mental health. Despite these effects, most older patients are not assessed or treated for hearing loss. OBJECTIVE: To review the evidence on screening and management of hearing loss of older adults in the primary care setting. DATA SOURCES AND STUDY SELECTION: We performed a search from 1985 to 2001 using MEDLINE, HealthSTAR, EMBASE, Ageline, and the National Guideline Clearinghouse for articles and practice guidelines about screening and management of hearing loss in older adults, as well as reviewed references in these articles and those suggested by experts in hearing impairment. DATA EXTRACTION: We reviewed articles for the most clinically important information, emphasizing randomized clinical trials, where available, and identified 1595 articles. DATA SYNTHESIS: Screening tests that reliably detect hearing loss are use of an audioscope, a hand-held combination otoscope and audiometer, and a self-administered questionnaire, the Hearing Handicap Inventory for the Elderly-Screening version. The value of routine screening for improving patient outcomes has not been evaluated in a randomized clinical trial. Screening is endorsed by most professional organizations, including the US Preventive Services Task Force. While most hearing loss in older adults is sensorineural and due to presbycusis, cerumen impaction and chronic otitis media may be present in up to 30% of elderly patients with hearing loss and can be treated by the primary care clinician. In randomized trials, hearing aids have been demonstrated to improve outcomes for patients with sensorineural hearing loss. Nonadherence to use of hearing aids is high. Prompt recognition of potentially reversible causes of hearing loss, such as sudden sensorineural hearing loss, is important to maximize the possibility of functional recovery. CONCLUSION: While untested in a clinical trial, older adults can be screened for hearing loss using simple methods, and effective treatments exist and are available for many forms of hearing loss.

Aged↗
PubMed2002

Sonographic findings in glomus tympanicum tumor.

A glomus tympanicum tumor that is associated with a visible retrotympanic mass is the most frequent cause of pulsatile tinnitus. The preoperative diagnostic approach to this lesion includes a meticulous physical examination as well as high-resolution CT, magnetic resonance angiography, and digital angiography, which can also be used for preoperative embolization. We report the use of color transcranial Doppler sonography in the evaluation of glomus tympanicum tumor in a 67-year-old woman with a 3-year history of left tinnitus. An otoscopic examination revealed a reddish pulsatile mass behind an intact tympanic membrane. No lesions were visualized on gray-scale sonography. Contrast-enhanced color transcranial Doppler sonography showed a vascular ovoid mass that measured 2 x 1 x 1 cm; spectral analysis of the lesion revealed arterial flow with a low resistance index. Color transcranial Doppler sonography helped define the dimensions and vascular characteristics of the lesion.

Aged↗
PubMed1980

Tuberculous otitis media: a series of 22 patients.

A series of 22 cases of tuberculous otitis media is reviewed to assess the diagnostic features of the disease. Significant clinical features are the presence of abundant pale granulations, an unexpectedly severe hearing loss, facial paralysis, the presence of normal mastoid cellular develpment and a past or family history of tuberculosis of any site. The otoscopic appearances of the tympanic membrane, and the symptom of painless otorrhea are not considered suspicious features. Histological examination of operative material was the diagnostic procedure in 20/22 cases, thus underlining the difficulty of diagnosis in a non-tuberculous general population. Treatment with antituberculous chemotherapy and surgery gives good results and recent indications are that tympanoplastic surgery may be useful.

Adolescent↗
PubMed1993

Keratosis of the tympanic membrane and deep external auditory canal. A defect of auditory epithelial migration.

We have previously described the pathways of movement of epithelium on the tympanic membrane, showing that there are two discrete and separate zones. Four cases of keratosis of the tympanic membrane and deep external auditory canal are here reported. All patients complained of tinnitus and other aural symptoms. Sequences of otoscopic photography of daubs of dye placed on the tympanic membrane showed an abnormal anterior movement over the whole tympanic membrane in two cases and complete paralysis of movement in the two others. These findings suggest that the disorder arises from damage to basal epidermal cells caused by inflammation, which is probably due to infection. Treatment is by suction-stripping of keratin from the eardrum. Careful examination of the eardrum under magnification is required in all cases of tinnitus so as to detect this condition.

Aged↗
PubMed1989

Pure-tone hearing thresholds in otologically healthy 5-year-old children in Finland.

We measured the pure-tone air and bone conduction hearing of 359 randomly selected otologically normal urban preschool children in Finland at the average age of 5.2 years. Children with otoscopically verified middle ear pathology or abnormal impedance audiometry were not included in this sample. The mean air conduction thresholds varied from 16.6 dB at 0.125 kHz to 6.6 dB at 2 kHz, and the mean bone conduction thresholds from 6.0 dB at 0.25 kHz to 0.7 dB at 4 kHz. The pure-tone average (of air conduction thresholds at 0.5, 1 and 2 kHz) of all the ears was 7.6 dB. The distribution of single air conduction hearing thresholds at the frequencies from 0.25 kHz to 4 kHz showed that 66%-75% were at the 5-10 dB level.

Auditory Threshold↗
PubMed1992

Subclinical psoroptic otocariasis in Brazilian sheep with comments on a technique for mite collection.

Subclinical psoroptic otocariasis associated with Psoroptes cuniculi (Delafond) was diagnosed in four out of ten herds of sheep. Transmission of mites between sheep and goats and vice versa was detected in herds kept on the same pastures for over 2 years. Flushing the ear canals of sheep and goats with approximately 50 ml of water appeared to be more efficient than swabbing or otoscopic examination for diagnosis and/or mite collection.

Animals↗