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PubMed2005

The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study.

BACKGROUND: It is unclear why some children with acute otitis media (AOM) have poor outcomes. Our aim was to describe the clinical course of AOM and the associated bacterial nasopharyngeal colonisation in a high-risk population of Australian Aboriginal children. METHODS: We examined Aboriginal children younger than eight years who had a clinical diagnosis of AOM. Pneumatic otoscopy and video-otoscopy of the tympanic membrane (TM) and tympanometry was done every weekday if possible. We followed children for either two weeks (AOM without perforation), or three weeks (AOM with perforation), or for longer periods if the infection persisted. Nasopharyngeal swabs were taken at study entry and then weekly. RESULTS: We enrolled 31 children and conducted a total of 219 assessments. Most children had bulging of the TM or recent middle ear discharge at diagnosis. Persistent signs of suppurative OM (without ear pain) were present in most children 7 days (23/30, 77%), and 14 days (20/26, 77%) later. Episodes of AOM did not usually have a sudden onset or short duration. Six of the 14 children with fresh discharge in their ear canal had an intact or functionally intact TM. Perforation size generally remained very small (<2% of the TM). Healing followed by re-perforation was common. Ninety-three nasophyngeal swabs were taken. Most swabs cultured Streptococcus pneumoniae (82%), Haemophilus influenzae (71%), and Moraxella catarrhalis (95%); 63% of swabs cultured all three pathogens. CONCLUSION: In this high-risk population, AOM was generally painless and persistent. These infections were associated with persistent bacterial colonisation of the nasopharynx and any benefits of antibiotics were modest at best. Systematic follow up with careful examination and review of treatment are required and clinical resolution cannot be assumed.

Acute Disease↗

PubMed2005

Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey.

BACKGROUND: Middle ear disease (otitis media) is common and frequently severe in Australian Aboriginal children. There have not been any recent large-scale surveys using clear definitions and a standardised middle ear assessment. The aim of the study was to determine the prevalence of middle ear disease (otitis media) in a high-risk population of young Aboriginal children from remote communities in Northern and Central Australia. METHODS: 709 Aboriginal children aged 6-30 months living in 29 communities from 4 health regions participated in the study between May and November 2001. Otitis media (OM) and perforation of the tympanic membrane (TM) were diagnosed by tympanometry, pneumatic otoscopy, and video-otoscopy. We used otoscopic criteria (bulging TM or recent perforation) to diagnose acute otitis media. RESULTS: 914 children were eligible to participate in the study and 709 were assessed (78%). Otitis media affected nearly all children (91%, 95%CI 88, 94). Overall prevalence estimates adjusted for clustering by community were: 10% (95%CI 8, 12) for unilateral otitis media with effusion (OME); 31% (95%CI 27, 34) for bilateral OME; 26% (95%CI 23, 30) for acute otitis media without perforation (AOM/woP); 7% (95%CI 4, 9) for AOM with perforation (AOM/wiP); 2% (95%CI 1, 3) for dry perforation; and 15% (95%CI 11, 19) for chronic suppurative otitis media (CSOM). The perforation prevalence ranged from 0-60% between communities and from 19-33% between regions. Perforations of the tympanic membrane affected 40% of children in their first 18 months of life. These were not always persistent. CONCLUSION: Overall, 1 in every 2 children examined had otoscopic signs consistent with suppurative ear disease and 1 in 4 children had a perforated tympanic membrane. Some of the children with intact tympanic membranes had experienced a perforation that healed before the survey. In this high-risk population, high rates of tympanic perforation were associated with high rates of bulging of the tympanic membrane.

Australia↗

PubMed1985

Clinical-histopathological correlations in experimental otitis media: implications for silent otitis media in humans.

Clinical-histopathological correlations were sought in an experimental animal model of otitis media. Among 20 chinchillas inoculated intranasally with wildtype influenza A/Alaska virus (H3N2) and type 7F Streptococcus pneumoniae, 15 animals (18 ears) developed otoscopic and tympanometric signs of otitis media with middle ear effusion. Middle ear inflammation was most intense 10 days after virus inoculation. Twenty-two days after virus inoculation, eight ears showed diffuse middle ear histopathology and contained effusion, which cultured pneumococcus, five ears showed focal histopathology, and four of the five contained no effusion. Clinical manifestations of otitis media had disappeared in four of the 13 ears with pathology at sacrifice; otoscopy was normal in all four ears, tympanometry was normal in three ears, and both otoscopy and tympanometry were normal in one ear. All four of these ears with clinically "silent" middle ear histopathology had shown abnormalities of ear drum appearance or tympanometry between 7 and 14 days after inoculation. Discordance between histopathology and the clinical examination performed at sacrifice was greatest for ears with focal pathology.

Acoustic Impedance Tests↗

PubMed2002

Tele-otology: planning, design, development and implementation.

The view of the tympanic membrane of the ear provides the specialist with important information for the assessment of ear disease and for treatment planning. In rural and remote areas, the incidence of ear disease is high but access to ear specialists is limited. As part of a project to deliver tele-otoscopy services to remote Western Australia, we have investigated various aspects of a tele-otoscopy system. We found that the MedRX video-otoscope is relatively safe to use and produces images of very good quality. A confident diagnosis could be made from still images compressed to 20 kByte. Video sequences could be compressed to a ratio of 1:300. Furthermore, a software package has been developed, and we are developing a training course for health-care workers in remote areas.

Journal Article↗

PubMed1980

Diagnosis of perilymph fistula using ENG and impedance.

The presence of perilymph fistula has been difficult to determine because of the lack of efficient and reliable testing methods. The condition is suspected on the basis of history alone and confirmed by surgery. This paper details a quick, reliable procedure called the ENG fistula test, using impedance bridge for pressure change and electronystagmography to aid the establishment of nystagmus and dizziness. To evaluate this procedure, a combination of tests were performed, including Valsalva maneuver, tragal compression, and pneumatic otoscopy, which were previously considered helpful in the diagnosis of fistula. Of them, Valsalva maneuver and tragal compression proved inconclusive; pneumatic otoscopy proved to be helpful. In comparison, however, the ENG fistula test proved most valuable, with results surgically confirmed in 90.8% of cases in this series. This study involved 74 patients whose primary complaint was dizziness. Only some patients simultaneously experienced hearing lows. Included are 5 patients whose positive ENG fistula test results and 15 whose negative test results were confirmed by surgery. Selected case histories are presented.

Acoustic Impedance Tests↗

PubMed1988

Otitis media, auditory sensitivity, and language outcomes at one year.

The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1-year-old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the children's ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as "otitis free") and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated "otitis positive"). In comparison to the otitis free infants, the group of otitis positive babies demonstrated reduced auditory sensitivity as measured by auditory brain stem response (ABR) and poorer expressive language abilities. However, differences in receptive language were not detected. These results suggest that otitis media may have an impact on auditory sensitivity and developing language as early as 1 year of age.

Audiometry, Evoked Response↗

PubMed2004

A randomized clinical trial to assess the effects of tympanometry on the diagnosis and treatment of acute otitis media.

OBJECTIVES: Acute otitis media (OM) is the most common indication for the use of antibiotics among children. Otoscopy alone is an imprecise method for the diagnosis of OM, which may lead to inappropriate antibiotic use. We sought to determine whether tympanometry, as an adjunct to otoscopy, would significantly change physician prescribing behavior and whether physicians overprescribe antibiotics for OM, using independently graded tympanometry results as a standard. METHODS: A randomized, clinical trial was conducted among children 6 to 35 months of age who presented to a pediatric emergency department with either fever or upper respiratory infection symptoms. Children were randomized into 2 groups, in which the attending physician evaluated tympanometry results (Tymp Aware) or the attending physician was blinded to the tympanometry findings (Tymp Unaware). Tympanometry curves were graded independently by using a modified version of the Jerger scale. RESULTS: Of the 698 patients enrolled, tympanometry was performed successfully for 99.3%. Antibiotics were prescribed for OM for 27.9% of all patients. No statistically significant difference in antibiotic prescription rates for OM between the Tymp Aware group (28.8%) and the Tymp Unaware group (26.8%) was found. Of all patients for whom antibiotics were prescribed for OM, 14% had normal curves for both ears and 40% had some tympanographic movement bilaterally. CONCLUSIONS: Tympanometry did not seem to change diagnoses or prescribing behavior in the group of physicians studied. Antibiotics were commonly prescribed for presumed OM in the absence of effusions documented with tympanometry.

Acoustic Impedance Tests↗

PubMedDate not supplied

The diagnosis of negative middle ear pressure in children. The accuracy of symptoms and signs assessed by tympanometry.

Over a period of one year, we studied 352 children at random in order to determine whether or not a diagnosis of negative middle ear pressure can be made reliably without using tympanometry. Each child was tested repeatedly by screening audiometry at 20 dB and by tympanometry, and was examined once by otoscopy. Information about upper respiratory tract infections, feelings of oppression in the ears, and the parents' opinion of the child's hearing ability were obtained from questionnaires. Otoscopy correlated poorly with the tympanometry, while screening audiometry and the parents' opinion of the child's hearing ability were more reliable measures. It is concluded that tympanometry is an absolutely necessary tool in the clinical diagnosis of negative middle ear pressure.

Acoustic Impedance Tests↗

PubMedDate not supplied

Hearing, middle ear pressure and otopathology in a cleft palate population.

A population of 261 cleft-palate patients from western and northern Norway was evaluated by means of otoscopy, tympanometry and audiometry. Normal otoscopy was associated with middle ear pressure less negative than -150 mmH2O and with hearing better than 20 dB PTA. Flat tympanograms were found in 85% of cases with secretory otitis media. Secretory otitis media was dominant below the age of 3 years. Between 3 and 5 years of age changes in otoscopic and tympanometric findings were frequently observed. From 6 years of age a stable normalization took place. The close association between age and frequency of abnormal findings, makes age an important factor in the treatment of patients. A restricted use of ventilating tubes is advocated due to the possible occurrence of problems with otorrhea in infants and the possibility of provoking tympanosclerotic changes.

Acoustic Impedance Tests↗

PubMedDate not supplied

Use of otoacoustic emissions to screen for hearing loss in critically ill patients.

As part of a continuing quality improvement program, this project was undertaken to define the frequency of hearing loss in patients admitted to a surgical intensive care unit in order to identify patients at risk for impaired communication. The study evaluated 168 consecutive admissions over a ten week period to a ten bed adult surgical intensive care unit in a university hospital. Patients were screened as close to admission to the ICU as possible with otoscopy, tympanometry, and distortion product otoacoustic emissions. A total of 113 patients (226 ears, mean age 58.0+/-15.8 years) were screened within 1.5+/-1.4 days of ICU admission; 55 of the 168 admissions could not be screened (48 out of 55 due to short ICU stays). Of the 226 ears evaluated, 6.6 per cent had abnormal otoscopy and 43.2 per cent abnormal tympanograms. OAE failure occurred in 58.4 per cent of ears while OAE results were uninterpretable due to high ambient noise in 2.7 per cent of ears, and technical difficulty in 3.5 per cent of ears. Mean time for screening was 9.3 minutes. OAEs provide an efficient screening modality for hearing impairment in critically ill adults. The results suggest a significant prevalence of hearing impairment in the population studied. More definitive testing should be considered when clinically indicated in patients who fail OAE screening.

Acoustic Impedance Tests↗

PubMed1981

The significance of acoustic admittance procedures in the audiologic evaluation of multiply-handicapped children.

The specific contribution of admittance procedures in the diagnosis of hearing impairment was studied in a group of 53 handicapped children. The value of admittance procedures was assessed in relation to that of otoscopy and pure tone audiometry. Admittance procedures and otoscopy were successfully performed in all but one of the children and indicated conductive pathology in about 40% of the subjects, whereas pure tone audiometry was not feasible or inconclusive in 30.2% of the subjects. In 5.7% of the subjects admittance procedures proved the only diagnostic tool.

Acoustic Impedance Tests↗

PubMed2000

Diagnostic assessment of otitis media.

Accurate diagnosis of OM is important but often difficult. To enhance the likelihood of accurate diagnosis, pneumatic otoscopy is the preferred method of examination generally available to clinicians. Findings by pneumatic otoscopy should be coupled with the presence or absence of symptoms and signs to delineate a diagnosis of AOM or OME. Tympanometry can be a useful adjunct in the clinical assessment of middle ear effusion. Audiometry is particularly important for patients with recurrent or chronic middle ear disease.

Acoustic Impedance Tests↗

PubMed2001

[Compliance of family physicians with the recommendations of 'Hearing Impairment' guideline by the Dutch College of General Practitioners in treatment of simulated paper cases of hearing loss].

OBJECTIVE: To assess the extent to which the practice of general practitioners (GPs) in dealing with adult hearing-impaired patients complies with the recommendations in the NHG standard on 'Hardness of hearing', one year after its publication. DESIGN: Descriptive. METHOD: Eight paper cases concerning hearing-impaired patients were presented to 10 GPs. The compliance of the GPs' approach with the NHG standard was recorded, and the differences found were motivated by the GPs. RESULTS: Compliance was low for 'anamnesis' (27%), reasonable for 'supplementary examination'--'audiography' (42%) and 'whispered voice test' (12%)--and 'evaluation' (65%), and high for 'physical examination' ('otoscopy' 82%). Adapted questioning for the purpose of establishing the case history was observed. The questioning was adapted in so far as it took into account the information that had already been obtained. 'Management' gave high scores for 'instruction' (85%) and 'referral' (72%). For mostly practical reasons, the whispered voice test, recommended in the NHG standard was scarcely used (12%) whereas the tuning fork tests, which are not advocated in the NHG standard, were often used (43%). CONCLUSION: For the aspects 'otoscopy', 'instruction' and 'referral' the GPs' practice reflected the recommendations contained in the NHG standard 'Hardness of hearing'.

Adult↗

PubMed2001

[Check ups after acute otitis media should be revised. What are we looking for and why?].

The latest Swedish consensus conference (May 2000) on treatment of acute otitis media (AOM) states that a check-up should be made three months after an episode of AOM. In order to find out how these recommendations are implemented 36 general practitioners were asked about their management of AOM check-ups. Almost all GPs checked children below 5 years of age by otoscopy but only 66 percent checked the mobility of the tympanic membrane. The follow-up procedure varied considerably. In a study of 129 ears (99 children) three months after an episode of AOM the diagnostic accuracy of pneumatic otoscopy, tympanometry and audiometry performed at a health care center was studied. The tympanometry performed by a nursing assistant had a very high sensitivity (93 percent) regarding secretory otitis media and could be used as a check-up after AOM. Thus there seems to be no need for the GP to examine ears where tympanometry is normal, but concentrate on the cases with pathologic tympanometry.

Acoustic Impedance Tests↗

PubMed2002

Tele-otology: planning, design, development and implementation.

Diagnostic Imaging↗

PubMed1992

[Cholesteatoma behind an intact ear drum--an overlooked disease?].

On the background of increasing international interest for early diagnosis, pathogenesis and treatment of cholesteatoma in children, a sub-group is described and termed primary cholesteatoma, congenital cholesteatoma in the middle ear or cholesteatoma in the middle ear behind an intact ear-drum. This review is based on a retrospective review of cholesteatoma in children submitted to operation in Hjørring Hospital during a period of five years from 1986 to 1991. All of the children were under the age of 16 years. Out of 22 cholesteatoma treated operatively in children, the authors found six cases (27%) of congenital cholesteatoma. The symptomless congenital cholesteatoma in the middle ear is recognized clinically by otoscopy where it appears as a white shadow, most frequently in the anterior upper quadrant, behind an intact ear-drum. Early diagnosis is important and may be established by general practitioners, paediatricians and otologists at routine otoscopy.

Child, Preschool↗

PubMed1976

Otitis media of guinea pigs.

Otitis media occurred in 177 of 1373 guinea pigs necropsied during a six-year period. Streptococcus pneumoniae (20%), Streptococcus zooepidemicus (15%), Bordetella bronchiseptica (12%), and Pseudomonas aeruginosa (11%) were the most common bacteria isolated from affected tympanic bullae. Radiology and otoscopy were tested as means of antemortem screening for affected guinea pigs. Radiology gave 96% accuracy in diagnosing otitis media and proved to be a more satisfactory technique than otoscopy.

Animals↗

PubMedDate not supplied

[Miticidal efficacy of thiabendazole against Otodectes cynotis (Hering, 1838) in dogs].

The aim of the present study was to evaluate the efficacy of thiabendazole on the treatment of Otodectes cynotis infestations in dogs. Ten naturally infested beagle dogs were used. The mites were diagnosed through otoscopy. Dogs were examined three days before treatment (day -3) and on the treatment day (day 0). They were randomly divided into two groups, five animals for the control group and five for the treated. During seven days, was applied in both ears of the treated dogs 1ml of the thiabendazole 5% solution, which correspond to 50mg of the product. All animals were reexamined through otoscopy on days +1, +3, +7, +10, +17, +24 and +31. The dogs on the control group showed mites in both ears during the whole period of observation. On the treated group the efficacy varied from 20% on the left ear to 80% on the right ear, on the first day after treatment. On days +3, +7, +10, +17, +24 and +31 the medium efficacy was 100% on both ears. The thiabendazole was efficient on the elimination of O. cynotis in dogs when used on the dose of 50mg per ear during seven following days.

Animals↗