Evaluation of vestibular function in patients with chronic suppurative otitis media.

OBJECTIVE: The objective of this study was to assess vestibular functions in patients with chronic suppurative otitis media (CSOM) with and without sensorineural hearing loss. STUDY DESIGN: This was a prospective case study performed at a tertiary referral university hospital. Sixty patients with CSOM were included, and patients with a history of head trauma, diabetes, hypertension, previous ear surgery, use of ototoxic drugs, neurological deficits and suspected fistulae were excluded. PATIENTS AND METHODS: The patients underwent basic audiological evaluation, and clinical and instrumental vestibular evaluation. The incidence and extent of vestibular dysfunction in patients with CSOM were analyzed. RESULTS: A total of 42 males and 16 females with a mean age of 29.5 years were included in this study. Forty ears had tubotympanic disease and 19 had cholesteatoma. There were 14 ears with sensorineural hearing loss. A positive history of vertigo was reported in 53.5% of the cases. Rotatory chair abnormalities were found in 70% of the cases, caloric hypofunction was found in 61.6%, and vestibular myogenic evoked potentials were abnormal in 25%. The only positive correlation with vestibular dysfunction was the duration of disease. CONCLUSIONS: The vestibular system is significantly affected in cases with CSOM. Both semicircular canals and the saccule are affected. All patients with long-standing CSOM should be evaluated for vestibular dysfunction irrespective of their hearing levels.

Can vaccination against pneumococci prevent otitis media with effusion?

The most common cause of hearing loss in early childhood is otitis media with effusion (OME). Prevention of OME in preschool children will improve quality of life. The authors aimed to determine, by the best available published evidence, whether vaccination against pneumococci effectively prevents OME. The study design was based on systematic review (SR) of randomized controlled trials (Level 1a evidence). The medical literature available through searching Medline database was reviewed using the following keywords "Otitis media with effusion," "secretory otitis media," or "glue ear," and "vaccination" limiting the search to randomized controlled trials (RCTs) conducted on children (0-18 years), published in English, in the last 10 years. Results of effects of vaccination on prevention of OME from the included RCTs were utilized to conduct a meta-analysis to find out the preventive value of antipneumococcal vaccination. Three RCTs were identified conforming to the inclusion criteria. Meta-analysis of results showed no significant preventive advantage for antipneumococcal vaccination. Based on the results it was confirmed that neither primary nor secondary prevention by antipneumococcal vaccination has a beneficial impact on OME. More RCTs should be conducted to study the effect of vaccination on OME.

Gastroesophageal reflux/laryngopharyngeal reflux disease: a critical analysis of the literature.

Despite the wealth of publications on the topic of gastroesophageal reflux and its variants, there are still many unsettled questions before one accepts the prevalent cult of "reflux disease". This study is summarizing the results of the critical analysis of the literature, 436 articles,during the last 30 years. The golden test to identify the patient group suffering from this rather common phenomenon is still lacking. The claimed extra-esophageal manifestations especially in the larynx are non-specific and may be caused by other factors well-known within the domain of vocology. The response to therapeutic intervention still lacks serious well-controlled studies to allow drawing reasonable conclusions. An outstanding feature of the publications is that most of them fall in the category of "review". It seems that there is a tendency to perpetuate the concept without objective criticism. Following the analysis, a recommendation for anew plan of original well-controlled multi-center studies is highlighted.