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PubMed1987

Efficacy of acoustic otoscope in detecting middle ear effusion in children.

The sensitivity and specificity of the acoustic otoscope in detecting middle ear effusion (MEE) was determined for 200 children. Based upon results from otoscopy, tympanometry, pure tone audiometry, and myringotomy, 100 of the children (175 ears) had MEE. The remaining 100 (200 ears) had no MEE. Using acoustic otoscope reflectivity (AOR) units 4 through 9 to indicate pathologic ears, its sensitivity and specificity were found to be 93.14% and 83%, respectively. These findings led to the conclusion that the acoustic otoscope may provide a simple and cost-effective way of detecting MEE in children. Suggestions are provided for improving the effectiveness of this new device as a clinical tool.

Child↗
PubMed1994

Experimental study of CO2 laser myringotomy with a hand-held otoscope and fiberoptic delivery system.

CO2 laser myringotomy has previously been proven effective in patients with serous otitis media for short-term aeration of the middle ear. However, the system based on a microscope and a coaxially aligned laser is cumbersome and expensive. The advantage of CO2 laser energy is the high absorption coefficient in biological tissue, meaning minimal damage surrounding the desired lesion. The disadvantage is that conventional optical fibers do not transmit CO2 laser energy (lambda = 10.6 microns). We have developed a silver halide optical fiber of diameter 0.9 mm and lengths of several meters, with high transmission at 10.6 microns. Using a hand-held otoscope coupled to a fiberoptic delivery system, CO2 laser myringotomies were performed in guinea pigs. In the animal model the feasibility of the procedure was proven. Different irradiation parameters were studied and a "dose-dependent" relationship was found between the total energy used and the duration of a patent myringotomy. However, conventional histological studies failed to show a difference in circumferential damage with different energy parameters. CO2 laser myringotomy utilizing a hand-held otoscope coupled to an optical fiber capable of transmitting CO2 laser energy may prove simple and effective. The relationship between energy parameters and myringotomy patency may be instrumental in deciding on the optimal duration of aeration of the middle ear in secretory otitis media.

Animals↗
PubMed1998

[The CO2 laser otoscope. A new application device for paracentesis].

The CO2 laser myringotomy is a current low-pain procedure for middle-ear ventilation for secretory otitis media (SOM) that can be performed under topical anesthesia, even in children. The duration of middle-ear ventilation is essentially determined by the size of the perforation created. Perforations with a diameter greater than 2 mm ventilate the tympanic cavity for approximately 3 weeks, thus avoiding tympanic ventilation tubes. To date, the CO2 laser beam can only be reliably applied to the tymapanic membrane via a micromanipulator system coupled to an ear microscope. The CO2 laser otoscope is a new application system that markedly reduces the technical complexity of surgery and improves the mobility and availability of the system. The incorporation of a small inexpensive CO2 laser in the otoscope represents a significant development in SOM therapy.

Animals↗
PubMed1986

Otoscopic, impedance, and audiometric findings in glue ear treated by adenoidectomy and tonsillectomy. A prospective randomised study.

150 children aged between 2 and 9 years (mean 5.25 years) with chronic bilateral otitis media with effusion were randomly allocated to three groups who, in addition to unilateral myringotomy and grommet insertion, would have an adenotonsillectomy, an adenoidectomy, or neither. The contralateral ear was assessed. Otoscopic, impedance, and audiometric findings were recorded preoperatively and at six and twelve months postoperatively. Subtraction of the no-surgery results indicates that at twelve months adenoidectomy produces otoscopic resolution of OME in 41.7% and no-peak/peak conversion of impedance in 29.8%. The hearing gain from adenoidectomy alone was similar to that resulting from insertion of a grommet alone, but the children having adenoidectomy required fewer reinsertions to maintain adequate subjective hearing thresholds in the treated ear (26% versus 54%). Tonsillectomy conferred no additional benefit. Without treatment there was a small but significant improvement in all indices at twelve months but not at six months postoperatively.

Acoustic Impedance Tests↗
PubMedDate not supplied

Improved diagnosis of middle ear effusions employing the objective otoscope.

A new quantitative diagnostic otoscope presently under development supplements the conventional otoscopic examination with a quantitative pneumatic system and objective measurements derived from tympanometry. The instrument provides information to assist in the diagnosis of the presence of middle ear effusion (MEE), the middle ear pressure and tympanic membrane status during the visual examination. Uncertainty introduced by subjective judgement involved with traditional pneumatic otoscopy is eliminated enabling a more rapid and accurate diagnosis. Clinical evaluations were performed in which 92% accuracy was achieved for the diagnosis of the presence of MEE in 38 ears. The results were verified at myringotomy. The instrument is being designed for use by physicians and paraprofessionals.

Audiometry↗
PubMed1995

[Pathogenesis of cholesteatoma: contribution of otoscopic photography].

The filiation between otitis media with effusion, retraction pockets and cholesteatoma appears for most otologist to be very probable and logical but remains controversial. Some experts argue rigourously and they say fairly that it has not been so far strictly proven. Long term otoscopic observation supported by photography could bring indisputable evidences. During a 12 years period we have taken routinely otoscopic photography of every patient with chronic otitis media. We have been able to observe the appearance of cholesteatoma in ear apparently normal at the origin or which presented so-called simple chronic middle ear disease. We report some of the most characteristic observations.

Adolescent↗
PubMed2001

[Duration of middle ear ventilation after laser myringotomy with the CO2 laser otoscope Otoscan].

BACKGROUND: The most important principle in treating secretory otitis media (SOM) is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this via a self-healing perforation whose diameter essentially determines the duration of transtympanic ventilation. PATIENTS, METHODS: In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a homogeneous patient collective comprising 81 children (159 ears) suffering from SOM. The tympanic intervention was combined with an adenoidectomy or a CO2 laser tonsillotomy and therefore performed under general insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12-15 W and a pulse duration of 180 ms. RESULTS: None of the children showed postoperative impairment of inner ear function. Otomicroscopic and videoendoscopic monitoring documented the healing process. The mean closure time was found to be 16.35 days (8-34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later the laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes (1.6%) examined showed atrophic scar formation, one (0.8%) a perforation with a diameter of 0.5 mm. In 19 ears (14.7%) there was a recurrence of SOM within the observation period. CONCLUSIONS: Laser myringotomy competes with ventilation tube insertion in the treatment of SOM. It may be an useful alternative in the surgical management of secretory otitis media.

Child↗
PubMed2001

Cost-effective diagnostic nasal endoscopy with a modified otoscope.

We present 'Mishra's rhinoscope', a novel, cost-effective technique of zero-degree rigid nasoendoscopy with a modified otoscope, the results of which are comparable with the fibreoptic sinoscope. This is particularly suited for the developing world where financial constraints restrict the diagnosis of an occult nasal pathology.

Cost-Benefit Analysis↗
PubMedDate not supplied

Assessment of pediatric residents' otoscopic interpretive skills by videotaped examinations.

BACKGROUND: Accurate diagnosis of otitis media is essential to facilitate appropriate management. Few residency programs assess formally their residents' competency in diagnosing middle ear disease. OBJECTIVE: To evaluate the performance of pediatric residents' otoscopic interpretive skills by level of training, with a videotaped otoendoscopic examination (VOE). METHODS: A VOE was used to assess and compare the performance of a cross-sectional sample of 141 residents with one another by level of training as well as with novice and expert groups. Total score, sensitivity, specificity, and kappa coefficients were calculated for each subject by comparing the subject's answers on the 50-ear test with the VOE's expert panel-derived answers, and averages were determined for each training level. RESULTS: Each pediatric resident training group had moderate agreement (mean kappa coefficient range: .45-.56) with the VOE answers, compared with the novice group (mean kappa: .31, fair) and expert group (mean kappa: .80, substantial). Twenty-eight residents (20%) had fair or less agreement (kappa<.41) with the VOE answers. The mean total scores of all pediatric resident training levels were significantly (P<.05) lower than the expert group and significantly (P<.05) higher than the novice group (with exception of the early postgraduate year-1 group). Subjects with more training had higher kappa levels (r=.33,<.001, Spearman) when results were compared among novice, residents, and experts. CONCLUSIONS: We found the VOE to be a feasible and reliable instrument to accurately distinguish novice, resident, and expert level skills in the determination of middle ear effusion status.

Child↗
PubMed1976

Comparative study of pure-tone, impedance, and otoscopic hearing screening methods. A survey of native Indian children in British Columbia.

A survey of 1,109 native Indian children in five communities in British Columbia was conducted to determine incidence of middle ear pathologic features and to compare impedance and pure-tone audiometry as hearing screening methods. Survey teams included a public health nurse, two otologists, and two audiologists. On ear, nose, and throat (ENT) otoscopic examination, the incidence of middle ear disease requiring treatment was 12%. Disease was most prevalent in the preschool- and primary school-aged children. Pure-tone audiometry yielded 62% normal and 19% abnormal results. Nineteen percent of the children could not be tested by this method. Impedance audiometry yielded 54% normal and 38% abnormal results on the stringent criteria used to define the parameters of normality. Eight percent of the children could not be tested. Since there was a high incidence of middle ear pathologic features in the preschool group of children who could not be successfully evaluated by pure-tone audiometry, it is suggested that further investigation of impedance audiometry be undertaken in order to define parameters that will provide the most reliable referral criteria.

Adolescent↗
PubMed1978

Acoustic impedance and otoscopic findings in young children with Down's syndrome.

This study sought to determine the point incidence of middle ear pathologic conditions and to ascertain the value of acoustic impedance-admittance measurements in detecting otitic pathologic conditions in young children with Down's syndrome. Pneumo-otoscopy and acoustic impedance measures were performed on 38 children (mean age, 3.1 years) with Down's syndrome. Results indicated that more than 60% of the series demonstrated otoscopic and acoustic impedance evidence of middle ear effusion, which is in keeping with results reported previously for older children and young adults with Down's syndrome. Of particular interest was the large number of normal ears that displayed absent crossed and uncrossed acoustic reflexes,which suggested that measurement of the acoustic reflex may be an unreliable parameter for confirming the presence of middle ear effusion in children with Down's syndrome. To maximize the educational potential of these children, a careful examination to detect middle ear effusion must be performed at periodic intervals. If persistent effusion is detected, appropriate surgical management should be instituted without delay.

Acoustic Impedance Tests↗
PubMed1985

Otoscopic findings in a group of schoolchildren in Kuwait.

Middle ear diseases are the most common cause of hearing impairment in children. Therefore, we found it important to conduct a study to reveal the frequency of different middle ear conditions. Using an otoscope with a magnifying lens 826 children in their second grade of primary school were examined. Various kinds of ear canal and middle ear pathology were found. An extremely high percentage (41%) of the 1,652 examined ears did show significant pathology. The different findings will be presented and comparison with other similar studies will be done.

Child↗
PubMed2004

Otoscopic appearances and tympanometric changes in narghile smokers.

Narghile (water-pipe) smoking requires the generation of significant negative intrapharyngeal pressure, which may be transmitted to the middle ear through the Eustachian tube. A total of 80 ears from regular narghile smokers were examined otoscopically and by tympanometry. Seventy ears from heavy cigarette smokers were similarly examined and served as a control group. There was a highly significant increase in the prevalence of attic retractions (P < 0.01) in the narghile smokers. The tympanometric changes were not significantly different between the two groups (P > 0.05).

Acoustic Impedance Tests↗
PubMedDate not supplied

Incidence and progress of middle ear effusion in allergy practice as detected by acoustic otoscope reflectometry.

The incidence and progress of middle ear effusion (MEE) in allergy practice is not well established in prospective studies. A total of 393 patients were screened for MEE by history and physical including pneumatic otoscopy, prick and intradermal skin tests, acoustic otoscope reflectometry (AOR), impedance tympanometry (IT), and audiometry for those with established MEE. The primary diagnosis of the screened patients was intrinsic asthma in 70 or 18%, allergic rhinitis in 134 or 34%, allergic rhinitis and asthma in 80 or 21%, miscellaneous in 103 or 26%. Twenty patients were receiving immunotherapy (5%), and 89 (23%) had middle ear effusion (MEE). Among the MEE group were 52 males (58%), 37 females (42%), with an average age of 13 years, median of 8 years, and range of 6 months to 13 years. The MEE group was statistically different demographically from the initial group (P < .05) for age and history of recurrent otitis. The MEE group's primary diagnosis was similar to that of the initial group, except that there was a statistically significant difference in the number of patients on immunotherapy (P < .05) and those in the MEE group, with 11 (12%) versus 20 or 5% in the initial group. MEE resolved in 91% of cases which could be followed to resolution, with average duration of nasal steroid of 4 weeks, average duration of effusion 8 weeks, median 4 weeks, range 1 week to 6 months. Effusions in 8 patients (9%) were intractable with duration greater than 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Impedance Tests↗
PubMedDate not supplied

[Cavernous hemangioma of the tympanic membrane. Otoscopic image].

Cavernous hemangiomas of the tympanic membrane are extremely rare. Only 9 cases have been published in the literature. We describe a case with clinical characteristics, otoscopic image and diagnostic studies. Alternatives in treatment are discussed and a review of the literature was carried out.

Diagnostic Techniques, Otological↗
PubMed1989

Pediatricians and the pneumatic otoscope: are we playing it by ear?

The amount of positive pressure delivered during pneumatic otoscopy was recorded in 53 healthy pediatric patients. The pressures generated ranged from 338 to 1134 mm H2O. The mean pressure introduced was 748 mm H2O with the bulb and 502 mm H2O through the mouthpiece. The mean intraobserver variation in pressure delivered to each patient was 199 and 125 mm H2O with these two methods of insufflation, respectively. These data document the wide variation in pressures generated with the pneumatic otoscope and suggest that the feasibility of modifying this instrument into a standardized, objective pneumatic system should be explored.

Acoustic Impedance Tests↗