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PubMed1986

Objective diagnosis of otitis media in early infancy by tympanometry and ipsilateral acoustic reflex thresholds.

Otitis media in early infancy carries a high risk of recurrent otitis media and prolonged middle ear effusion. To fulfill the need for objective diagnostic methods in this age group, we investigated susceptance tympanograms and ipsilateral acoustic reflex thresholds in infants younger than 5 months of age. Tympanometry and acoustic reflex thresholds were performed with an otoadmittance meter using a 660 Hz probe tone. Tympanograms were interpreted using quantitative measures. These findings were compared with independent otoscopic diagnoses in 67 ears with middle ear effusion and 69 ears that were effusion free. Diagnoses were confirmed by tympanocentesis when clinically indicated. There was excellent agreement among otoscopy, peak tympanogram susceptance, and ipsilateral acoustic reflex thresholds (kappa 0.82 to 0.86, agreement 91% to 93%). We conclude that susceptance tympanograms and ipsilateral acoustic reflex thresholds are accurate diagnostic tests for otitis media in infants younger than 5 months of age.

Acoustic Impedance Tests↗
PubMed1990

The use of personal cassette players among youths and its effects on hearing.

To assess the prevalence of use of Personal Cassette Players (PCP) among youths in a residential community in Hong Kong, we interviewed 487 youths aged 15-24 years who attended various activities in eight Youth Centres in Shatin, Hong Kong. 394 (81%) reported using the Personal Cassette Player regularly. The mean duration of PCP use was 2.8 years with a median of 2 years. The mean time of listening to PCP was 4.5 hours per week. We further examined 124 subjects by otoscopy and of the 103 otoscopically normal individuals, audiometric tests were performed. Among the 78 PCP users and 25 non-users, no significant difference in the mean hearing threshold was observed for the frequencies tested. The mean ear canal sound level was 70.4 dBA. Four subjects were habitually exposed to sound levels higher than 85 dBA. One was exposed to 116 dBA and was found to have a 4000 Hz dip on his audiogram, suggestive of noise-induced hearing loss. In general, despite the high prevalence of PCP use, most youths used their PCP at relatively safe sound levels with low risk of hearing loss. However, education directed towards the youth with respect to the potential hazard on hearing due to improper and prolonged use of PCP is still warranted.

Adolescent↗
PubMed1981

Therapy of acute otitis media: myringotomy, antibiotics, or neither? A double-blind study in children.

In a double-blind study 171 children with acute otitis media (239 affected ears) were treated by four different methods: neither antibiotics nor myringotomy; myringotomy only; antibiotics only; or both antibiotics and myringotomy. All received symptomatic treatment. There were no significant differences in clinical course (pain, temperature, duration of discharge, otoscopic appearances, audiography, recurrence rate) between the four groups. In the groups treated without antibiotics, the ears discharge for slightly longer and the eardrums took a little longer to heal; these differences were not significant. No complications were seen. Symptomatic therapy with nosedrops and analgesics seems a reasonable initial approach to acute otitis media in children. Myringotomy and antibiotics can be reserved for cases in which the course of otitis is irregular, there are complications such as mastoiditis, or ear discharge continues beyond 14 days.

Acute Disease↗
PubMed1999

A feasibility study of chiropractic spinal manipulation versus sham spinal manipulation for chronic otitis media with effusion in children.

BACKGROUND: Pediatric otitis media with effusion is a common and costly condition. Although chiropractors have anecdotally claimed success in treating otitis media, there is little research to support their claims. OBJECTIVE: A pilot study was undertaken for the purpose of assessing the feasibility of conducting a full-scale randomized clinical trial investigating the efficacy of chiropractic spinal manipulative therapy (SMT) for children with chronic otitis media with effusion. METHODS: This study was a prospective, parallel-group, observer-blinded, randomized feasibility study. Twenty-two patients, ages 6 months to 6 years, received either active chiropractic SMT or placebo chiropractic SMT. Otoscopy and tympanometry were used to create a middle ear status profile, and daily diaries were collected. RESULTS: Five newspaper advertisements over 6 months generated 105 responses. Twenty patients subsequently qualified and were randomized into the study. Collection of tympanometric and otoscopic data proved to be challenging. Compliance with the treatment and evaluation protocols and daily diaries was excellent. There were no reports of serious side effects as a result of either the active or placebo chiropractic treatments. CONCLUSION: Recruitment for a randomized controlled trial is feasible and could be enhanced by medical collaboration. Patients and parents are able and willing to participate in a study comparing active SMT and placebo SMT. Parents were extremely compliant with the daily diaries, suggesting that similar quality-of-life and functional status measures can be successfully used in a larger trial. We found the objective outcomes assessment involving tympanometry and otoscopy extremely challenging and should be performed by experienced examiners in future studies.

Child↗
PubMed2001

Quantitation and prevalence of tympanosclerosis in a pediatric otolaryngology clinic.

OBJECTIVE: To determine the incidence and prevalence of tympanosclerosis (TS) in patients seen in a pediatric otolaryngology clinic. DESIGN: Prospective observational study. SETTING: Tertiary care, ambulatory care clinic. PATIENTS AND OTHER PARTICIPANTS: We conducted a prospective observational study to determine the incidence of TS in 218 patients seen consecutively in a pediatric otolaryngology clinic for otologic and nonotologic reasons. The patient age range was 3 weeks to 30 years; 63% were male and 37% female. Of the 218 patients, 37% (81) had undergone bilateral myringotomy and tube placement (BM&T), and 35% (21) of the 81 showed signs of TS; 63% (137) of the 218 patients had no history of otologic surgery, but 12% (15) of the 137 showed signs of TS. METHOD: The area of the tympanic membrane affected by TS was determined by otoscopy performed by one viewer, who drew the otoscopic findings on a standardized tympanic membrane template. The area of TS was quantified in terms of percentages by digital image analysis of the scaled drawings. RESULTS: There was a range of 0.5-59.9% involvement of the tympanic membrane with TS, with the median percentage of involvement being 4.95%. There was an increased percentage of TS with repeat BM&T. CONCLUSION: This observational study shows that patients who have had BM&T have a higher incidence of TS than those who have not had the surgery. However our findings also show that 38% of the patients in this study who had TS had never undergone BM&T.

Adolescent↗
PubMed2001

Prevalence and impact of chronic otitis media in school age children in Brazil. First epidemiologic study concerning chronic otitis media in Latin America.

OBJECTIVE: The first epidemiological study carried out in Latin America to investigate the prevalence of otological disease and its impact in a representative random sample of the school children population. METHODS: A cross sectional epidemiological survey to investigate the epidemiology of otitis in a representative random sample of 1119 children and adolescents from a total of 486166 elementary and high-school students, aged 6-18 years, regularly registered in one of the 521 public and private schools of the city of Belo Horizonte, in the state of Minas Gerais, southern Brazil. The interviews were conducted individually, in the school, by an otolaryngologist or a pediatrician. The interview included all of the personal data and also detailed questions regarding otological disorders and hearing. The otological examination was carried out with Mini-Heine otoscopes and the audiometric evaluation with the AudioScope 3 with 25dB intensity. The questionnaire and basic procedures for medical examination had been previously tested through a pilot test in two schools. RESULTS: The prevalence of chronic otitis media was 0.94%. Impacted wax was found in 12.3% of the students. The prevalence of abnormalities (excluding wax) in the otoscopy examination was 10.5%. It was found that 8.3% of students had a past history of otitis and 7.7% had a past history of otorrhea. These two special groups presented statistically significant associations with chronic otitis media, hearing loss and otolaryngological surgeries (when compared with the other school children). Parents and school children seemed significantly able to identify a special group of children with past history of otitis during childhood.

Adolescent↗
PubMed1983

A point prevalence of otitis media in a Nigerian village.

One hundred seventy children and 103 adults from a rural Nigerian village were examined for the presence of middle and external ear pathology. Ear, nose and throat examination included: (1) pneumatic otoscopic exam, (2) tympanometry and (3) contralateral acoustic reflex. A diagnostic algorithm was applied to these 3 findings for each subject and each ear. Our data showed a point prevalence of otitis media in children (less than or equal to 15 years) to be 21.2% compared to 4% in adults (greater than 15 years). Of the 36 children with otitis media, only 3 had perforation and otorrhea; a diagnosis of otitis media with effusion behind an intact tympanic membrane was made in the other 33 children. The prevalence of otitis media varied significantly with age and evidence of upper respiratory tract infection. There was no significant difference between sexes. External ear pathology was found as an independent variable in 24% of the 170 children; three-fourths of these children had concurrent middle ear pathology. The results are discussed in relation to the current understanding of the differences that exist in the epidemiology and pathogenesis of otitis media in different racial groups.

Acoustic Impedance Tests↗
PubMed1985

A longitudinal study of the detection of otitis media in the first two years of life.

A number (210) of children were followed longitudinally through the first two years of life with pneumatic otoscopy and electroacoustic immitance, tympanometry, at every physician encounter. Tympanometry proved to have a high predictive value (86%) for detecting normal ears but relatively poor predictive value (58%) for detecting abnormal ears when utilized as a routine screening procedure with every clinic visit. In part the tympanometrically abnormal ears which appeared normal in otoscopic exam were temporally related to recent episodes of otitis and concurrent upper respiratory congestion, but many were unrelated to detectable middle ear pathology. These observations detract from the utility of tympanometry as a screening tool for middle ear pathology.

Acoustic Impedance Tests↗
PubMed1986

Septal deviation in newborn infants.

Authors report an experiment performed in a randomized group of newborns to evaluate the frequency of post-partum septal deviations. A number of 423 subjects out of 1142 have been examined in a 17-month period. Newborns have been examined with an otoscope and two different kinds of nasal lesions have been considered: (1) pyramid deformation with septum dislocation and columella deviation; (2) deviation and subluxation of the septum. A number of 315 newborns were naturally delivered and 108 by cesarean section. In the former group, 10 pyramid deformations and 12 septal deviations have been found; in the latter, only septal deviations have been revealed (5 infants). Pyramid deformations may be related to delivery(labor)trauma while for septal deviations a developmental defect may be postulated.

Adult↗
PubMed1986

Prevalence of otitis media in children in a black rural community in Venda (South Africa).

During mid-winter in 1985, 480 residents from a remote rural community in Venda, South Africa, were examined for the presence of middle and external ear pathology. The children (less than 15 years) numbered 267. The otological examination consisted of (1) pneumatic otoscopic examination, (2) tympanometry, (3) contralateral acoustic reflex. A diagnostic algorithm as proposed by Cantekin et al. was applied to assess the findings. Our data showed the prevalence of otitis media in children to be 8.2%. The highest prevalence was found in the 0-23 months age group. Of 22 children with otitis media, only one had a perforation with otorrhea. Otitis media with effusion was found in 3.8% of the children. External otitis media as an independent variable was found in only 1.5% of the 267 children, while 6.7% presented with scarred tympanic membranes. Our data suggest the existence of considerable differences in the prevalence of otitis media in children between two comparable black rural communities from Nigeria and Venda.

Acoustic Impedance Tests↗
PubMed1997

Prevalence of otitis media with effusion amongst pre-school children in Malaysia.

A cross-sectional screening test was done to determine the prevalence of otitis media with effusion amongst, preschool children in two district in Malaysia, namely Kuala Lumpur an urban district and Kuala Selangor a rural district. It involved 1097 preschool children aged between 5 and 6 years old. Presence of otitis media effusion (OME) is based on abnormal otoscopic finding, Type B tympanogram and absence of ipsilateral acoustical reflex. The overall prevalence rate of OME was 13.8%. The prevalence in Kuala Lumpur was 17.9%, while in Kuala Selangor it was 9.48%. Bottle feeding during infancy and high socioeconomic status of the parents was statistically associated with higher incidence of OME. Other factors such as race, premature delivery, passive smoking, allergy, asthma and family size, had no influence on the prevalence of otitis media with effusion.

Child, Preschool↗
PubMed1998

Pathophysiological and therapeutic considerations of otitis media with effusion from viewpoint of middle ear ventilation.

Using nitrous oxide, we examined the gas exchange function through the middle ear mucosa in ears with otitis media with effusion (OME) in children, and found the function to be impaired in 50% of them. The size of the mastoid was significantly smaller in ears with negative gas exchange function than those with positive function, and the presence or absence of the function was even more significantly correlated with the presence or absence of aeration in the middle ear. Furthermore, the presence or absence of aeration in ears with OME was found to be significantly correlated with their prognosis (response of OME to antibiotics treatment) and also with the presence or absence of eardrum mobility examined by a pneumatic otoscope. Finally, after myringotomy and removal of effusion, the gas exchange function recovered in most of the ears with impaired function. These results indicate that the eardrum mobility test may serve as an appropriate indicator for the surgical treatment for OME.

Child↗
PubMed1998

Post-traumatic guitar-shaped deformity of the tympanic membrane.

We report a unique case of post-traumatic guitar-shaped deformity of the tympanic membrane in an 8-year-old boy. After a traffic accident, he exhibited bleeding from the ear, incomplete facial palsy and a conductive hearing loss on the left side. Although his symptoms gradually improved, the deformity of the tympanic membrane and external auditory canal persisted. The tympanic membrane appeared to be duplicated. Careful examination using an otoscope was required for accurate diagnosis. Without knowledge of the deformity, the physician could easily misinterpret the appearance of the tympanic membrane. Formation of cholesteatoma was not observed and the normal migration of the epithelium in the external auditory canal seemed to be maintained. However, we were concerned that tubal dysfunction could eventually induce the retraction and atrophy of the tympanic membrane to ultimately form a cholesteatoma. We therefore recommend patients such as this to be evaluated periodically because of the risk of tubal dysfunction and cholesteatoma.

Accidents, Traffic↗
PubMed1999

Predictive value of acoustic reflectometry (angle and reflectivity) and tympanometry.

OBJECTIVE: Tympanometry and acoustic reflectometry are suggested tools for confirmation of otoscopic diagnosis of secretory otitis media. The issues on sensitivity and specificity of both devices are contradictory. In this study, our purpose was to compare sensitivity and specificity of both devices and to look for whether it is possible to reach higher values by combining them. METHODS: This study included 150 normal ears and 150 ears with chronic effusion. In tympanometry, only B tracings were accepted as predictor of effusion. In acoustic reflectometry, reflectivity (cut point: 5) and curve angle with two cut-points (75 degrees and 90 degrees) were used. RESULTS: Acoustic reflectometry presented higher specificity by both reflectivity (cut point: 5) and by curve angle (cut point: 75 degrees) (99.33% by both) than tympanometry (92%) (chi2 analysis, P < 0.001). But, their sensitivities (65.33 and 78%) were lower than tympanometry (96%) (chi2 analysis, P < 0.001). With curve angle of 90 degrees, specificity of acoustic reflectometry decreased to 85.33%, sensitivity increasing to 97.33%, which was not different from tympanometry (chi2 analysis, P > 0.1). When data of curve angle and tympanometry were combined, specificity and sensitivity of the combined test were found to be 91.33 and 100%, respectively. CONCLUSIONS: (i) Acoustic reflectometry should not be proposed as a better device than tympanometry, because its test efficiency was not higher than tympanometry. (ii) The only advantage of AR (reflectivity > or = 5 and curve angle < or = 75 degrees) was its high specificity to effusion. In addition, higher curve angles than 90 degrees were found to be highly predictive for normal ears as much as tympanometry. But, predictivity of curve angle between 76 degrees and 90 degrees was low. (iii) When tympanograms and curve angle were combined, it was found that prediction of this combination for curve angles between 76 degrees and 90 degrees was perfect. (iv) We consider that both test devices provide complementary data to each other, which would be particularly important for screening studies and that they are good tools for confirmation of clinical impression, particularly for less experienced clinicians.

Acoustic Impedance Tests↗
PubMed2002

Feline nasopharyngeal polyps.

In summary, an ideal diagnostic plan for cats with suspected FNPs should include a thorough anesthetized oropharyngeal examination, otoscopic examination, and imaging studies, which may consist of a bulla radiographic series or specialized imaging studies such as CT or MR scans. In general, if signs indicative of otitis media are present, ventral bulla osteotomy should be advised. As a result of the distinct appearance of FNPs, a preoperative biopsy is not indicated in all instances but should be considered if there are atypical features to the history or presentation. Traction-avulsion of polyps through the external ear canal or auditory tube from the oropharynx may have a lower success rate than traction-avulsion combined with ventral bulla osteotomy. If the veterinarian opts to treat FNPs by traction-avulsion alone as a result of financial constraints imposed by the client, the client should be strongly cautioned regarding potential recurrence. Postoperative complications are possible with any treatment option, but neurologic impairment, including Horner's syndrome, facial neuropathy, and hypoglossal neuropathy, is significantly more likely after surgical intervention by ventral bulla osteotomy than after traction-avulsion alone. A high percentage of these complications are self-limiting. In all instances, appropriate culture and sensitivity and biopsy specimens should be collected so as to enable provision of appropriate postoperative care. Antibiotic therapy should be provided based on culture and sensitivity test results. The use of postoperative steroids to prevent recurrence is controversial.

Animals↗
PubMed1988

Preventive ear care for dogs and cats.

Prevention of ear disease in dogs and cats depends on early detection of factors that predispose these animals to otitis externa. This article reviews the conditions and diseases that place the dog and cat at risk for otitis externa. Routine care of the ears is discussed, and otoscopic examination and techniques for cleaning the external auditory canals are described. Avoidance of potentially harmful therapeutic procedures and irritating or ototoxic pharmacologic substances is emphasized.

Animals↗
PubMed1992

Prevention of hyperbaric-associated middle ear barotrauma.

STUDY OBJECTIVE: To determine the efficacy of topical nasal decongestant in the prevention of middle ear barotrauma in patients undergoing hyperbaric oxygen therapy. DESIGN: Prospective, parallel, double-blind, randomized trial. SETTING: University-affiliated community hospital emergency department with hyperbaric oxygen facilities. PARTICIPANTS: Sixty patients undergoing hyperbaric oxygen therapy; 30 subjects in each treatment arm. INTERVENTIONS: After randomization, consenting patients were given two sprays of oxymetazoline hydrochloride or sterile water, 15 minutes before hyperbaric oxygen therapy. Collected data included patient demographics, ear examinations before and after hyperbaric oxygen treatment, and subjective ear complaints. The otoscopic appearance of the tympanic membrane was graded according to the amount of hemorrhage in the eardrum, with Teed scores ranging from 0 (symptoms only) to 5 (gross hemorrhage and rupture). RESULTS: The treatment groups were similar with regard to age, sex, and medical history. Ear discomfort during hyperbaric oxygen therapy was present in 63% (19 of 30) of those receiving oxymetazoline versus 67% (20 of 30) of the control group (P = .99). Likewise, both groups had similar Teed scores after hyperbaric oxygen therapy (P = .88). No adverse effects were noted. CONCLUSION: The results of this pilot study suggest that topical decongestants may not be effective in preventing middle ear barotrauma during hyperbaric oxygen therapy.

Administration, Topical↗
PubMed1992

Pseudoephedrine for the prevention of barotitis media: a controlled clinical trial in underwater divers.

STUDY OBJECTIVE: To determine the efficacy and safety of decongestant prophylaxis among first-time underwater divers in the prevention of barotitis media (middle ear squeeze). DESIGN: Randomized, double-blind, prospective clinical trial. SETTING: Recreational diving schools in Panama City, Florida. TYPE OF PARTICIPANTS: One hundred twenty volunteer scuba divers under the supervision of certified instructors. INTERVENTIONS: After randomization, each subject received a 60-mg tablet of pseudoephedrine or placebo 30 minutes before diving. Prospective data were collected, including subject demographics, signs and symptoms of middle ear squeeze during the dive, and possible drug side effects. The otoscopic appearance of the tympanic membrane was graded according to the amount of hemorrhage in the eardrum, with Teed scores ranging from 0 (normal) to 5 (gross hemorrhage and rupture). chi 2 and t-tests were applied with significance set at P less than .05). The Mantel-Haenszel test was used to test the null hypothesis that the mean Teed scores of the two treatment groups were equal. RESULTS: A total of 116 subjects met the inclusion criteria and completed the study; 60 received 60 mg pseudoephedrine, and 56 received placebo. The treatment groups were similar with regard to age, sex, medical history, and depth of the first dive (P greater than .5). Ear discomfort and blockage during the dive were present in 8% (five of 60) of those receiving pseudoephedrine versus 32% (18 of 56) of the control group (P = .001). Similarly, the pseudoephedrine group had smaller Teed scores after diving than did the control subjects (P = .003). Adverse effects were minimal; two patients experienced dizziness and nausea. CONCLUSION: These results suggest that the use of an oral decongestant before diving decreases the incidence and severity of middle ear squeeze in novice divers.

Adult↗