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1.
BMJ Case Rep ; 17(3)2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38490712

RESUMO

An obliterated Eustachian tube (ET) is a rare occurrence that can lead to chronic otitis media (OM) and aural fullness even with treatment. Our study presents a review of the literature on methods of stenting the ET. We additionally present a case of a man with mucoepidermoid carcinoma of the ET who underwent a radical nasal pharyngectomy with reconstruction and adjuvant radiation, and who had symptoms of intolerable otorrhea after tympanostomy tube placement to treat aural fullness and mucoid OM. We used a novel method of stenting the ET using a transnasal lighted guidewire catheter and steroid eluting stents placed along the entire medial ET. Previously described methods in the literature were unable to be used due to the complex middle ear anatomy filled with granulation tissue and the lack of a visible nasopharyngeal ET ostium available for straightforward placement of the stent. The procedure was successful, and postoperatively, the patient experienced decreased otorrhea.


Assuntos
Otopatias , Tuba Auditiva , Otite Média , Masculino , Humanos , Tuba Auditiva/cirurgia , Tuba Auditiva/patologia , Orelha Média , Otopatias/patologia , Stents , Cateteres , Ventilação da Orelha Média
2.
Int J Pediatr Otorhinolaryngol ; 178: 111904, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38432029

RESUMO

OBJECTIVE: The purpose of this study is to compare patient trends in otitis media with effusion (OME) symptoms and diagnoses before and after the COVID-19 pandemic in order to investigate the effects of the coronavirus disease of 2019 (COVID-19). METHODS: A retrospective, multi-center, observational study was carried out between January 2018 and December 2022 at hospitals in the Iwate Prefecture with full-time doctors. All patients were initially separated into two groups, one for the pre-COVID-19 era (from January 2018 to June 2020), and the other for the COVID-19 era (from July 2020 to December 2022). RESULTS: In the pre-COVID-19 era, 132 patients had tympanostomy tubes (TT) placed, while 64 patients had them placed in the COVID-19 era. Between the pre-COVID-19 and COVID-19 eras, there were no statistically significant differences in terms of age, sex, side, craniofacial deformity, or adenoidectomy. Children in elementary school showed a greater decline than those in preschool (42-11 patients in elementary school (74%) and 49 to 32 patients in preschool school (35%); p = 0.025). CONCLUSIONS: The percentage of TT placements for OME dropped to roughly half during the COVID-19 epidemic. This was particularly obvious in elementary school students.


Assuntos
COVID-19 , Otite Média com Derrame , Criança , Pré-Escolar , Humanos , Japão/epidemiologia , Ventilação da Orelha Média , Otite Média com Derrame/epidemiologia , Otite Média com Derrame/cirurgia , Pandemias , Estudos Retrospectivos , Masculino , Feminino
3.
Acta Otolaryngol ; 144(1): 7-13, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38375680

RESUMO

BACKGROUND: The treatment of refractory elderly Meniere's disease is a challenge. AIM: To investigate the efficacy of tympanostomy tube placement in elderly patients with Meniere's disease. METHODS: 31 patients over 60 years old with Meniere's disease who had failed medical treatment and underwent tympanostomy tube placement. Vertigo control, hearing level, tinnitus, and ear fullness were recorded and analyzed preoperatively and postoperatively. RESULTS: All patients completed a 6-month follow-up. At 6 months postoperatively,complete control, substantial control and limited control of vertigo were achieved in 10 (32%), 13 (42%), and 6 (19%) patients respectively. Two patients (6%) reported no substantial improvement. Twelve patients completed a 2-year follow-up. At 2 years postoperatively, complete control, substantial control and limited control of vertigo were achieved in 3 (25%), 5 (42%), and 1 (8%) patients respectively. Three (25%) patients showed no significant improvement in vertigo. The majority of patients reported significant improvement in the functional level scale, the Dizziness Handicap Inventory scores, and ear fullness at 6 months and 2 years postoperatively. CONCLUSIONS AND SIGNIFICANCE: Tympanostomy tube placement may reduce vertigo attacks and improved the quality of life in elderly patients with Meniere's disease.


Assuntos
Doença de Meniere , Zumbido , Humanos , Idoso , Pessoa de Meia-Idade , Doença de Meniere/complicações , Doença de Meniere/cirurgia , Ventilação da Orelha Média , Qualidade de Vida , Vertigem/cirurgia , Zumbido/cirurgia
4.
Sci Prog ; 107(1): 368504241231659, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38356273

RESUMO

OBJECTIVES: The purpose of this study was to investigate the fluctuations in the prevalence of individuals diagnosed with otitis media with effusion (OME) during the SARS-CoV-2 pandemic, while also evaluating the persistence of SARS-CoV-2 in middle ear effusion (MEE) and assessing the effectiveness of tympanocentesis as a treatment modality for OME in this specific period. METHODS: The total number of outpatients and patients diagnosed with OME in our department was recorded for January 2022 and January 2023. Thirty patients (aged 15-86 years) were categorized into two groups: group A (n = 12), who developed OME during their SARS-CoV-2 infection and group B (n = 18), who experienced OME after the resolution of SARS-CoV-2 infection. All patients underwent otoendoscopic tympanocentesis (without a ventilation tube), where MEE and nasopharyngeal secretions were simultaneously collected for SARS-CoV-2 detection by polymerase chain reaction. The time interval from SARS-CoV-2 infection to tympanocentesis, results of SARS-CoV-2 detection, preoperative and postoperative average hearing threshold, and Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores were documented. RESULTS: The proportion of outpatients with OME in January 2023 was higher than that in January 2022. There were five patients who had positive test results for SARS-CoV-2 on MEE after tympanocentesis. These 5 patients underwent tympanocentesis at a mean of 28 ± 7.28 days following confirmation of SARS-CoV-2 infection. The ETDQ-7 scores of group A exhibited a reduction from 21.85 ± 4.8 to 10.00 ± 4.07 following tympanocentesis, while the ETDQ-7 scores of group B also demonstrated a decrease from 21.22 ± 4.65 to 10.11 ± 3.68 after undergoing tympanocentesis. The tympanocentesis was effective in both groups. CONCLUSIONS: The study confirmed that the proportion of outpatients with OME in the Clinics of Otolaryngology during the SARS-CoV-2 epidemic increased significantly. SARS-CoV-2 RNA was detectable in MEE of COVID-19-related OME patients. Tympanocentesis was therapeutic for OME during SARS-CoV-2 infection, which facilitated viral clearance in MEE.


Assuntos
COVID-19 , Otite Média com Derrame , Adulto , Humanos , Otite Média com Derrame/epidemiologia , Otite Média com Derrame/cirurgia , Otite Média com Derrame/diagnóstico , SARS-CoV-2 , RNA Viral/uso terapêutico , COVID-19/epidemiologia , Ventilação da Orelha Média/métodos
5.
Otol Neurotol ; 45(3): e162-e169, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38361294

RESUMO

OBJECTIVES: This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). STUDY DESIGN: It was a prospective case-series study. SETTINGS: The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. SUBJECTS: We included 73 CI candidates performed via the PT approach. INTERVENTION: The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. MAIN OUTCOME MEASURE: We correlated this score with the intraoperative difficulty and surgical duration. RESULTS: The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). CONCLUSIONS: Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Estudos Prospectivos , Ventilação da Orelha Média , Mastoidectomia , Face
6.
Int J Pediatr Otorhinolaryngol ; 177: 111832, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38215661

RESUMO

BACKGROUND: One third of children require repeat ventilation tube insertion (VTI) for otitis media. Disease recurrence is associated with persistent middle ear bacterial biofilms. With demonstration that Dornase alfa (a DNase) disrupts middle ear effusion biofilms ex vivo, we identified potential for this as an anti-biofilm therapy to prevent repeat VTI. First, safety and tolerability needed to be measured. METHODS: This was a phase 1B double-blinded randomized control trial conducted in Western Australia. Children between 6 months and 5 years undergoing VTI for bilateral middle ear effusion were recruited between 2012 and 2014 and followed for two years. Children's ears were randomized to receive either Dornase alfa (1 mg/mL) or 0.9 % sodium chloride (placebo) at time of surgery. Children were followed up at 2 weeks post-VTI and at 3-monthly intervals for 2 years. Outcomes assessed were: 1) safety and tolerability, 2) otorrhoea frequency, 3) blocked or extruded ventilation tube (VT) frequency, 4) time to blockage or extrusion, 5) time to infection recurrence and/or need for repeat VTI. RESULTS: Sixty children (mean age 2.3 years) were enrolled with 87 % reaching study endpoint. Treatment did not change otorrhoea frequency. Hearing improved in all children following VTI, with no indication of ototoxicity. Dornase alfa had some effect on increasing time until VT extrusion (p = 0.099); and blockage and/or extrusion (p = 0.122). Frequency of recurrence and time until recurrence were similar. Fourteen children required repeat VTI within the follow-up period. CONCLUSION: A single application of Dornase alfa into the middle ear at time of VTI was safe, non-ototoxic, and well-tolerated. TRIAL REGISTRATION: ACTRN12623000504617.


Assuntos
Otopatias , Otite Média com Derrame , Otite Média , Criança , Humanos , Pré-Escolar , Otite Média com Derrame/cirurgia , Otite Média/tratamento farmacológico , Otite Média/cirurgia , Desoxirribonuclease I , Orelha Média , Otopatias/cirurgia , Ventilação da Orelha Média/efeitos adversos , Cloreto de Sódio , Proteínas Recombinantes
7.
J Laryngol Otol ; 138(2): 142-147, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37246511

RESUMO

OBJECTIVES: To describe how the retrotympanic structures could influence the visibility of the round window niche and the round window membrane during cochlear implant surgery, and to investigate if a round window approach is possible even in cases with unfavourable anatomy. METHODS: Video recordings from 37 patients who underwent cochlear implantation were reviewed. The visibility of the round window niche and round window membrane at different timepoints was assessed according to a modified version of the Saint Thomas Hospital classification. The structures that concealed the round window niche and round window membrane were evaluated. RESULTS: After posterior tympanotomy, 54 per cent of cases had limited exposure (classes IIa, IIb and III) of the round window niche. After remodelling the retrotympanum, round window niche visibility significantly increased, with 100 per cent class I and IIa cases. Following remodelling of the round window niche, visibility of more than 50 per cent of the round window membrane surface was achieved in 100 per cent of cases. CONCLUSION: Remodelling the retrotympanum and the round window niche significantly increased exposure of the round window niche and round window membrane respectively, allowing round window insertion in all cases.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Janela da Cóclea/cirurgia , Janela da Cóclea/anatomia & histologia , Ventilação da Orelha Média , Gravação em Vídeo
8.
Clin Otolaryngol ; 49(2): 199-206, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37964492

RESUMO

OBJECTIVES: Otitis media with effusion (OME) is common, affecting up to 90% of children. Around 25% will have a persistent effusion with conductive hearing loss which can impact their development. Ventilation tubes (VTs) can improve their hearing in the short term. This study aims to analyse the trends in VT insertion rates across Scotland. DESIGN: Retrospective observational study. SETTING: All mainland Scottish health boards. PARTICIPANTS: All children aged 0-16 who underwent a VT insertion procedure from 2001 to 2018 were included. MAIN OUTCOME MEASURES: Data were provided by the Scottish Public Health Observatory, using Scottish Morbidity Records. Mid-year population estimates were obtained from the National Records Office of Scotland. Socioeconomic deprivation was estimated based on area of residence using the Scottish Index of Multiple Deprivation. VT insertion rates were calculated and trends analysed. RESULTS: A total of 35 878 VT procedures were performed in total with a mean rate of 2.02 per 1000 children per year. The highest insertion rates were observed in children aged 4-6. VT insertion rates reduced during the study period (R = -0.729, p = .001). Variability in VT insertion rates between health boards reduced. There was a significant association between socioeconomic deprivation and VT insertion rate, with the most deprived children having the highest rate (p < .001). CONCLUSIONS: VT insertion rates and the variability between Scottish health boards have reduced over the past two decades, suggesting a more equitable system. Our data intimates that the decision to perform VT insertion is based upon disease prevalence rather than clinician preference.


Assuntos
Audição , Otite Média com Derrame , Criança , Humanos , Otite Média com Derrame/epidemiologia , Otite Média com Derrame/cirurgia , Perda Auditiva Condutiva/cirurgia , Estudos Retrospectivos , Ventilação da Orelha Média/métodos , Escócia/epidemiologia
9.
Int J Pediatr Otorhinolaryngol ; 176: 111784, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37988918

RESUMO

OBJECTIVE: Otitis media with effusion (OME) is a common finding in pediatric cochlear implant(CI) candidates and may be managed by inserting ventilation tubes. This study aimed to compare postoperative complication rates in children who underwent CI without and with OME, including patients who were treated without and with ventilation tube insertion. METHODS: A population-based retrospective cohort study was conducted, including all CI patients, under ten years of age, at our institution, between 2007 and 2020. The study's population was divided into three groups based on their middle ear status at CI: 1) OME previously treated with VT, 2) untreated OME, and 3) normal-aerated ears. Postoperative complications of the groups were reviewed and served as our primary outcome measure. RESULTS: Of the 257 implanted ears included, 53, 42, and 162 ears belonged to the VT-treated OME, untreated OME, and aerated groups, respectively. Acute mastoiditis (AM) rate was significantly higher in the OME group compared to the aerated groups (9.5 % vs. 2.5 %, p = 0.0134) and in the VT-treated compared to the untreated OME groups (15.1 % vs. 2.3 %, p = 0.0356). Similarly, the rate of developing chronic suppurative otitis media without cholesteatoma (CSOMWC) was significantly higher in the OME compared to the aerated groups (12.6 % vs. 2.5 %, p = 0.0011) and in the VT-treated compared to the untreated OME groups (18.8 % vs. 4.7 %, p = 0.0366). Other complications rated were very low and similar between the groups. No other statistical difference was found between the groups. CONCLUSION: VT insertion in pediatric CI candidates with OME increased postoperative AM and CSOMWC. We believe that, at least in our population, VT introduction prior to CI, for OME, surgery should be avoided.


Assuntos
Implante Coclear , Mastoidite , Otite Média com Derrame , Otite Média , Criança , Humanos , Implante Coclear/efeitos adversos , Otite Média com Derrame/complicações , Otite Média com Derrame/cirurgia , Estudos Retrospectivos , Otite Média/complicações , Mastoidite/terapia , Ventilação da Orelha Média/efeitos adversos , Complicações Pós-Operatórias/etiologia
11.
Clin Otolaryngol ; 49(2): 191-198, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37944558

RESUMO

OBJECTIVE: Investigating the impact of early childhood ventilation tube insertion (VTI) on long-term language outcomes. DESIGN: Longitudinal cohort study. SETTING: A total of 2900 pregnant women participated in the Raine Study between 1989 and 1991 in Western Australia, and 2868 children have been followed up. PARTICIPANTS: Based on parental reports, 314 children had a history of recurrent otitis media but did not undergo VTI (rOM group); another 94 received VTI (VTI group); while 1735 had no history of rOM (reference group) in the first 3 years of childhood. Children with data on outcomes and confounders were included in analyses of PPVT-R at ages 6 (n = 1567) and 10 years (n = 1313) and CELF-III at 10 years (n = 1410) (approximately 5% in the VTI group and 15% in the rOM group). MAIN OUTCOME MEASURES: Peabody Picture Vocabulary Test-Revised edition and Clinical Evaluation of Language Fundamentals® Preschool-3. RESULTS: At 6 years, mean PPVT-R scores were significantly lower in the VTI group than the reference group (ß = -3.3; 95% CI [-6.5 to -0.04], p = .047). At 10 years, while the difference between the VTI and reference groups was less pronounced for PPVT-R scores, there was a small but consistent trend of lower measures, on average, across CELF-III scores (expressive: ß = -3.4 [-7.1 to 0.27], p = .069; receptive: ß = -4.1 [-7.9 to -0.34], p = .033; total: ß = -3.9 [-7.5 to -0.21], p = .038). There was no evidence to suggest that language outcomes in the rOM group differed from the reference group. CONCLUSION: Lower scores of language outcomes in school-aged children who received VTI in early childhood may suggest a long-term risk which should be considered alongside the potential benefits of VTI.


Assuntos
Otite Média , Gravidez , Criança , Pré-Escolar , Humanos , Feminino , Estudos de Coortes , Estudos Prospectivos , Estudos Longitudinais , Otite Média/cirurgia , Idioma , Ventilação da Orelha Média
12.
Ann Otol Rhinol Laryngol ; 133(2): 224-228, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37776283

RESUMO

INTRODUCTION: Persistent tympanic membrane perforation is a known complication of pressure-equalizing (PE) tube insertion. Conductive hearing loss and otorrhea can necessitate surgical repair of these perforations. Long-term tympanostomy tube placement can increase the risk of these complications. Patients with velocardiofacial syndrome (VCFS) typically require prolonged PE tube placement and are thought to have higher risk of requiring additional otologic interventions after PE tube placement. To date, no work has established rates of post-PE tube complications requiring myringoplasty or tympanoplasty in patients with VCFS. METHODS: A retrospective case review including all patients with VCFS at a single large children's hospital between the years 2000 and 2020 was performed. Number of PE tube insertions required and additional otologic interventions performed were the primary endpoints assessed. RESULTS: Of 212 total patients with VCFS, 66 (31%) underwent PE tube placement. Of these children, 46 (70%) required 2 or more sets of PE tubes. A total of 53 patients (80.3%) required no otologic interventions apart from PE tube insertions. Of the 13 patients (19.7%) requiring additional otologic surgery, 6 (9.5%) underwent myringoplasty, and 9 patients (13.6%) required tympanoplasty. There was no significant difference in tympanoplasty (P > 1), myringoplasty (P > 1), or other surgical intervention rates (P = .7464) between VCFS patients with any type of cleft palate versus those with anatomically normal palates. CONCLUSION: This work suggests that most VCFS patients that require tubes, require at least 2 sets of PE tubes, and that the rate of post-PE tube complications requiring further otologic surgery is an order of magnitude higher than the rate established at this institution. Counseling for PE tube placement in VCFS patients may require specific dialogue regarding the substantially increased risk of complications and effort to build appropriate expectations for surgical outcomes regardless of palatal status.


Assuntos
Fissura Palatina , Síndrome de DiGeorge , Criança , Humanos , Síndrome de DiGeorge/complicações , Síndrome de DiGeorge/cirurgia , Estudos Retrospectivos , Miringoplastia/efeitos adversos , Timpanoplastia/efeitos adversos , Fissura Palatina/cirurgia , Ventilação da Orelha Média/efeitos adversos
13.
J Laryngol Otol ; 138(3): 279-283, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37311736

RESUMO

OBJECTIVE: Otolaryngologists perform bilateral myringotomy and tube placement for surgical management for otitis media with effusion. This retrospective study aimed to address the extent to which the coronavirus disease 2019 pandemic and season impact the number of bilateral myringotomy and tube placement procedures performed at a tertiary care centre. METHODS: A total of 1248 charts of children who underwent bilateral myringotomy and tube placement from January 2018 through February 2021 were reviewed. RESULTS: The cohort included 41.6 per cent females and 58.4 per cent males, with 63.7 per cent having private insurance. The median age at surgery was 2.6 years. The spring season had the most bilateral myringotomy and tube placement procedures per week. The number of bilateral myringotomy and tube placement procedures performed per week after the onset of the coronavirus disease 2019 pandemic was significantly lower compared to the years prior. There was no difference in number of intra-operative effusions pre-pandemic versus after the pandemic onset. CONCLUSION: This study sheds light on the impact of the coronavirus disease 2019 pandemic and seasonality on the rates of tympanostomy tube procedures, vital for understanding the temporality of ear infections.


Assuntos
COVID-19 , Otite Média com Derrame , Criança , Masculino , Feminino , Humanos , Pré-Escolar , Otite Média com Derrame/epidemiologia , Otite Média com Derrame/cirurgia , Estudos Retrospectivos , Ventilação da Orelha Média/métodos , Pandemias , COVID-19/epidemiologia
14.
Laryngoscope ; 134(1): 439-442, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37204082

RESUMO

OBJECTIVES: In 2001, we instituted a protocol for the removal of retained tympanostomy tubes, delaying elective removal until 2.5 years after placement. It was hoped that this would decrease the number of surgeries without increasing the rate of permanent tympanic perforations compared to removal at 2 years. METHODS: Protocol: Fluoroplastic Armstrong beveled grommet tympanostomy tubes were placed by a single surgeon supervising the residents. The children were seen at 6-month intervals after placement. Children with a retained tympanostomy tube(s) at 2 years were seen again at 2.5 years, and the retained tubes were removed under general anesthesia with patch application. All were evaluated 4 weeks after surgery by otoscopy, otomicroscopy, behavioral audiometry, and tympanometry. STUDY: A computerized collection of patient letters and operative reports was queried to identify children treated according to the protocol between 2001 and 2022. Those with examinations at 2 years ± 1 month and 2.5 years ± 1 month and complete follow-up were included. RESULTS: Of the 3552 children with tympanostomy tubes, 497 (14%) underwent tube removal. One-hundred and forty seven children fit the strict inclusion criteria. Among those with retained tubes at 2 years, 67/147 (46%) had lost any remaining tube or tubes at 2.5 years and did not need surgery, 80/147 (54%) required unilateral or bilateral tube removal, 9/147 (6%) had a persistent perforation at 1-year follow-up, and 4/147 children (3%) required tympanic re-intubation after either spontaneous extrusion or removal and patching at 2.5 years. CONCLUSIONS: Delaying tympanostomy tube removal until 2.5 years can cut the need for surgery in half with, an acceptable (6%) incidence of persistent perforations. LEVEL OF EVIDENCE: Four case series-historical control Laryngoscope, 134:439-442, 2024.


Assuntos
Ventilação da Orelha Média , Otite Média com Derrame , Criança , Humanos , Ventilação da Orelha Média/métodos , Estudos Retrospectivos , Próteses e Implantes , Membrana Timpânica/cirurgia , Remoção de Dispositivo/métodos , Otite Média com Derrame/cirurgia
15.
Ann Otol Rhinol Laryngol ; 133(2): 229-238, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37553806

RESUMO

PURPOSE: We aimed to identify the role of bacterial biofilms in the chronicity of otitis media with effusion and its resistance to antibiotics. We illustrated this role by reviewing, analyzing, and correlating the findings with the results of the included studies to reach clear evidence. METHODS: A comprehensive search of electronic databases (Scopus, PubMed, Web of Science, Cochrane, and GHL databases) was performed for all studies using the following strategy till April 2021 with the search terms: Biofilm and Middle ear effusion. We found 935 references, 421 were duplicates, and 514 were needed for further screening, and it was as follows: PubMed 215, Scopus 18, Cochrane 130, Web of Science 136, and GHL 15. RESULTS: The pooled prevalence of culture-positive effusions was estimated to be 40% (95% CI [28%, 53%]) of the total OME population. Overall, the prevalence of PCR-positive effusions was estimated to be 97% (95% CI [95%, 99%]) of the total OME population. The pooled prevalence of EM-positive effusions was estimated to be 82% (95% CI [69%, 95%]) of the total OME population. CONCLUSION: The data presented in this study coincide with the significant role of bacterial biofilms in the pathogenesis of chronic otitis media with effusion. The involvement of bacterial biofilm as a component of the OME pathogenic process can help us to explain why antimicrobial therapy is not always effective in the eradication of the disease process and, also explain the recurrence of middle ear effusion after treatment with tympanostomy tubes either with or without adenoidectomy.


Assuntos
Otite Média com Derrame , Otite Média , Humanos , Otite Média com Derrame/epidemiologia , Otite Média com Derrame/microbiologia , Prevalência , Otite Média/epidemiologia , Otite Média/microbiologia , Biofilmes , Adenoidectomia , Ventilação da Orelha Média
16.
Am J Otolaryngol ; 45(1): 104024, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37647777

RESUMO

OBJECTIVE: To evaluate the efficacy of tympanomastoidectomy versus parenteral antibiotic therapy for otorrhea as a result of chronic suppurative otitis media (CSOM) without cholesteatoma in the pediatric population. METHODS: A retrospective review of 221 patients treated for otorrhea at a tertiary academic pediatric hospital was performed to evaluate the impact of tympanomastoidectomy versus parenteral antibiotic therapy on resolution of otorrhea. Inclusion criteria were age 0-18 years, prior treatment with otic and/or oral antibiotic, prior history of tympanostomy tube placement for recurrent otitis media, history of otorrhea, treatment with tympanomastoidectomy or parenteral antibiotic therapy, and follow-up of at least 1 month after intervention. Time to resolution was compared between the two modalities adjusting for age, bilateral ear disease status, and comorbidities using a Cox proportional hazard model. RESULTS: Eighty-three ears from 58 children met the inclusion criteria. Ears that initially underwent tympanomastoidectomy had a significantly shorter time to resolution of symptoms (median time to resolution) 9 months (95 % confidence interval CI: 6.2-14.8) vs. 48.5 months (95 % lower CI 9.4, p = 0.006). On multivariate analysis, however, only bilateral ear disease status was independently associated with time to resolution of symptoms (hazard ratio 0.4, 95 % CI 0.2-0.9, p = 0.03). There was no statistically significant difference in the rate of treatment-related complications when comparing tympanomastoidectomy to parenteral antibiotic therapy (p = 0.37). CONCLUSION: When adjusting for age, bilateral ear disease status, and comorbidities, there does not appear to be a significant difference in time to resolution of symptoms when comparing parenteral antibiotic therapy to tympanomastoidectomy. An informed discussion regarding risks and benefits of each approach should be employed when deciding on the next step in management for patients with CSOM who have failed more conservative therapies.


Assuntos
Otite Média Supurativa , Otite Média , Criança , Humanos , Recém-Nascido , Lactente , Pré-Escolar , Adolescente , Antibacterianos/uso terapêutico , Ventilação da Orelha Média/efeitos adversos , Otite Média Supurativa/complicações , Otite Média Supurativa/tratamento farmacológico , Otite Média Supurativa/cirurgia , Otite Média/complicações , Quimioterapia Combinada , Resultado do Tratamento
17.
Int J Pediatr Otorhinolaryngol ; 176: 111823, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38134590

RESUMO

OBJECTIVE: About 8.6 % of children in the United States undergo tympanostomy tube (TT) placement every year. Of these, 24.1 % require a second set of tubes. Adjuvant adenoidectomy in children over 4 years is thought to improve the efficacy of TT. The goal of this study is to characterize the efficacy of adjuvant adenoidectomy at the time of TT placement in children under 4 years, to further improve middle ear function. METHODS: All patients undergoing TT placement alone or TT placement with adenoidectomy from 2014 to 2016 were reviewed. The primary outcome was need for subsequent tube placement. RESULTS: A total of 409 patients were included in the study (60.6 % male, 39.4 % female). Median age at initial TT placement was 18 months (range 5-48 months); extreme outliers for age were removed from further analysis. Patients were followed for 1-8 years. 250 patients received TT alone while 159 received TT with adenoidectomy. 120 required a second set of tubes. There was a statistically significant benefit to those undergoing adjuvant adenoidectomy with TT placement: 33.6 % of those receiving TT alone required subsequent tubes, whereas only 22.6 % of patients who underwent TT with adjuvant adenoidectomy required reinsertion (X2 = 5.630, p = 0.018). Adjuvant adenoidectomy in patients 0-48 months was associated with decreased likelihood of requiring subsequent tube placement (OR = 0.578, p = 0.018). There was an increased likelihood of experiencing otorrhea in those receiving TT alone compared to the TT with adenoidectomy group (X2 = 4.353, df = 1, p = 0.0369). CONCLUSION: Adjuvant adenoidectomy at the time of initial TT placement may have a role in the management of chronic middle ear disease in patients younger than 4 years. However, further studies and prospective randomized studies are needed to explore if this benefit can also be seen in children without chronic rhinosinusitis or nasal obstruction. The benefit-risk ratio from adenoidectomy and modifications in anesthesia technique in the case of adjuvant adenoidectomy should also be further explored.


Assuntos
Otite Média com Derrame , Otite Média , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Adenoidectomia/métodos , Doença Crônica , Ventilação da Orelha Média/métodos , Otite Média/cirurgia , Otite Média com Derrame/cirurgia , Estudos Prospectivos , Recidiva , Medição de Risco
18.
Int J Pediatr Otorhinolaryngol ; 174: 111747, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37820571

RESUMO

OBJECTIVE: Children with cleft palate (CP) are at high risk of developing otitis media with effusion (OME) due to Eustachian tube (ET) dysfunction. Palatoplasty has been reported to decrease the frequency of middle ear disease and improve ET function, and although various techniques have been developed, there is no consensus on the differences in the impact of different techniques on the middle ear. The purpose of this study was to determine the differential effects of palatoplasty on middle ear function and hearing. METHODS: We performed a retrospective observational survey of pediatric patients who underwent palatoplasty for CP between June 2010 and October 2018 at Tohoku University Hospital. Cases were divided into three groups depending on the palatoplasty procedures performed: the push-back palatoplasty group, the two-flap palatoplasty group, and the Furlow double-opposing Z-plasty group. We examined the differences in clinical characteristics between patients who underwent each procedure. The primary outcome variable was tympanic membrane (TM) findings, and the secondary outcome was hearing test results. RESULTS: Children who underwent the two-flap palatoplasty had a higher tympanostomy tube (TT) insertion rate and a higher total number of TT insertions than those who underwent the Furlow double-opposing Z-plasty or the push-back palatoplasty. The TM retraction rate tended to be lower in the Furlow double-opposing Z-plasty group than in the push-back palatoplasty group or the two-flap palatoplasty group. The hearing test results at the last visit were not significantly different among the three groups. CONCLUSIONS: Children who underwent the two-flap palatoplasty had a higher rate of TT insertions, potentially increasing the risk of TM perforation. In contrast, the Furlow double-opposing Z-plasty group had a lower tendency for TM regression, possibly due to improved ET function and reduced incidence of OME. It is important to understand the advantages and disadvantages of each technique before selecting one suitable for the child's cleft and arch width. Additionally, it is important to conduct regular follow-up of TM findings and hearing test results even after palatoplasty.


Assuntos
Fissura Palatina , Otopatias , Otite Média com Derrame , Criança , Humanos , Fissura Palatina/cirurgia , Fissura Palatina/complicações , Otopatias/cirurgia , Audição , Testes Auditivos , Ventilação da Orelha Média , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/cirurgia , Otite Média com Derrame/etiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Membrana Timpânica/cirurgia
19.
Int J Pediatr Otorhinolaryngol ; 175: 111772, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37898011

RESUMO

OBJECTIVE: Tympanostomy tube insertion in children is commonly performed under general anesthesia, but there has been increasing interest in office-based alternatives. Although initial research comparing in-office versus operating room (OR) insertion of tubes looks promising, there are scant data available on long-term outcomes. The objective of this study is to compare long-term outcomes of tympanostomy tubes placed in-office versus the OR, with emphasis on the duration of tube function. METHODS: We reviewed electronic medical records in an academic pediatric otolaryngology practice of children under age 13 years who had tubes placed in-office or the OR between 2010 and 2021. Differences in time to unilateral and bilateral tube occlusion/extrusion were compared by Kaplan-Meier survival analysis with log rank comparison. Cox regression modeling was performed to identify predictors of tube occlusion/extrusion. RESULTS: 817 children were included (473 office tubes, 344 OR tubes). Tube placement was equally successful for both groups (98.3% for office and 98.9% for OR). Comparison of Kaplan-Meier plots for time to unilateral and bilateral tube occlusion/extrusion by location showed no significant difference (P = .842 for unilateral and P = .714 for bilateral). However, regression analysis indicated a strong interaction of location with operator status (resident vs attending). Median time to unilateral occlusion/extrusion and bilateral occlusion/extrusion was shorter for OR residents compared to OR attendings (15.0 vs 19.5 months, P = .002, and 22.1 vs 32.0 months, P = .030, respectively). There was no difference in the time to unilateral or bilateral tube occlusion/extrusion between the office attending and OR attending groups (16.8 vs 19.5 months, P = .057 for unilateral, and 23.0 vs 32.0 months, P = .320 for bilateral). There was no significant difference between groups in the need for tube removal, repeat tubes, tube medialization, or post-extrusion tympanic membrane perforation. CONCLUSION: The comparable long-term outcomes found for tubes inserted in-office versus the OR, including time to occlusion/extrusion, suggest that both settings are acceptable for the procedure, with choice based primarily on parental preference, clinician experience, and shared decision making with families.


Assuntos
Otite Média com Derrame , Perfuração da Membrana Timpânica , Criança , Humanos , Lactente , Adolescente , Otite Média com Derrame/cirurgia , Salas Cirúrgicas , Ventilação da Orelha Média/métodos , Próteses e Implantes
20.
Int J Pediatr Otorhinolaryngol ; 175: 111751, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37839293

RESUMO

OBJECTIVE: This study aims to evaluate the demographic characteristics, indications for surgery, clinical follow-up results and complication rates of pediatric patients who have received a Paparella Type 1 tympanostomy tube (TT) insertion. METHODS: Retropective review of 816 ears of 442 pediatric patients who received Paparella type 1 tympanostomy tube insertions was performed. The patients' age, indication for surgery, middle ear effusion, time to extrusion and postoperative complications were analyzed retrospectively. Ears operated for chronic otitis media with effusion (COME) and recurrent acute otitis media (RAOM) were included in the study. Ears that underwent tympanostomy tube insertion for middle ear atelectasis and suppurative complications of acute otitis media were excluded from the study. Ears with middle ear effusion mucoid and serous were included. Ears without middle ear effusion or with purulent effusion were excluded from the study. Patients with a cleft palate, Down syndrome, craniofacial anomalies and those without regular follow-up until their tubes were extruded, were excluded from the study. RESULTS: The mean age of surgery was 5.11 years. 54.3 % of the patients were male and 45.7 % were female. 734 (90 %) tube insertions were performed for patients with COME and 82 (10 %) for those with RAOM. Mucoid middle ear effusion was observed in 86.9 % and serous in 13.1 %. The mean extrusion time of the tubes was 7.16 months. 93.1 % of the tubes were extruded spontaneously within 1 year and 99.9 % within 2 years. Postoperative complications of patients that were included were 8.7 % with otorrhea, 7.7 % premature extrusion, 8.2 % tube occlusion, 0.2 % displacement into the middle ear, 8.2 % tympanic membrane changes (5.4 % sclerosis, 2.3 % retraction and 0.5 % atrophy), 1.2 % permanent perforation, 0.1 % cholesteatoma and 0.1 % retained their tube. Premature extrusion was found to be significantly higher in the RAOM group compared with the COME group (p = 0.042). Tube extrusion time did not affect tympanic membrane changes (p = 0.061). CONCLUSIONS: Complication rates after Paparella Type 1 tube insertion are low. The incidence of complications such as otorrhea and tube occlusion were not significantly different between the indication and middle ear effusion groups. Compared to COME group, premature extrusion were found more frequently in the RAOM group. Complications of displacement into the middle ear, permanent perforation, cholesteatoma and retained tube were much rarer.


Assuntos
Colesteatoma , Otite Média com Derrame , Otite Média , Criança , Humanos , Masculino , Feminino , Pré-Escolar , Otite Média com Derrame/cirurgia , Otite Média com Derrame/complicações , Estudos Retrospectivos , Resultado do Tratamento , Ventilação da Orelha Média/efeitos adversos , Ventilação da Orelha Média/métodos , Otite Média/cirurgia , Otite Média/complicações , Colesteatoma/cirurgia , Doença Crônica , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
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