Characterization of cytokines present in middle ear effusions.

Retention of inflammatory mediators and cells in the middle ear cleft during chronic otitis media with effusion (COME), results in ongoing inflammation with the potential for pathologic changes and hearing loss. Cytokines are glycoproteins produced by macrophages and other cells. Activities of cytokines include fever production, osteoclast, fibroblast, phagocyte and cytotoxic cell activation, regulation of antibody formation, and inhibition of cartilage, bone and endothelial cell growth. Using enzyme-linked immunospecific assays we measured levels of six cytokines in middle ear effusions (MEE) from children with COME. Significant levels of four cytokines: interleukin-1-beta (greater than 50 pg/ml), interleukin-2 (greater than 300 pg/ml), tumor necrosis factor-alpha (greater than 40 pg/ml), and gamma-interferon (greater than 6.25 pg/ml) were found in 51%, 54%, 63%, and 19% of MEE, respectively. In contrast, levels of a fifth cytokine, granulocyte-macrophage colony-stimulating factor, and a sixth cytokine, interleukin-4, were undetectable. Age was observed to have a significant effect on the levels of specific cytokines. Interleukin-1 (IL-1) correlated inversely (P less than .02) with age such that the younger the child, the higher the level of IL-1 in MEE. Tumor necrosis factor-alpha (TNF) correlated directly (P less than .005) with age such that the older the child, the higher the level of TNF in MEE. Children undergoing tympanostomy on multiple occasions had average MEE TNF levels (234.2 +/- 109.1 pg/mg total protein) that were nearly 14 times higher (P less than .005) than those from children undergoing their first tympanostomy (16.9 +/- 3.0 pg/mg total protein). Thus IL-1 correlated with the early stages of COME, while TNF correlated with persistence of disease. The presence of these cytokines in MEE may be responsible for the mucosal damage, bone erosion, fibrosis, and resulting hearing loss seen in some cases of COME.

Hamartoma of the larynx: an unusual cause for stridor in an infant.

An extremely rare laryngeal hamartoma causing inspiratory stridor in a 6-week-old infant is reported and the histology discussed. The tumor is benign and responds to simple excision. No other cases have been found in the 20th century American literature.

Management of tracheocutaneous fistula.

In our experience, recommended treatment of the closure of tracheocutaneous fistula has been disappointing. Complications associated with primary closure, which we have experienced, include pneumomediastinum, pneumothorax, and wound breakdown. The alternate method of treating tracheocutaneous fistula, which we recommend, consists of excision of the tract down to the level of the trachea and allowing healing to take place via secondary intention. Elective scar revision, if indicated, is scheduled at some time in the future.

Comparison of concentrations of amoxicillin and ampicillin in serum and middle ear fluid of children with chronic otitis media.

Twenty-eight children aged five to nine years with chronic serous otitis media received a single dose of either ampicillin or amoxicillin by the oral route 1-2 hr before the removal of middle ear fluid by ventilation tubes inserted through the tympanic membrane. At the time middle ear fluid was obtained, a sample of blood was drawn from the patient, and levels of antibiotic in both specimens were microbiologically assayed by a disk diffusion method. Levels of amoxicillin (mean+/-standard error [SE], 1.48+/-1.6 microng/ml) in middle ear fluid were consistently and significantly higher (P less than 0.05) than levels of ampicillin (mean+/-SE, 6.2+/-5.0 microng/ml).

Penetration of amoxicillin, cefaclor, erythromycin-sulfisoxazole, and trimethoprim-sulfamethoxazole into the middle ear fluid of patients with chronic serous otitis media.

Penetration into the middle ear of four antibiotics commonly used in treatment of otitis media was studied by administering a single oral dose of amoxicillin, cefaclor, erythromycin-sulfisoxazole, or trimethoprim-sulfamethoxazole to 83 children with chronic serous otitis media. The antibiotic was given 15-240 min before the removal of middle ear fluid (MEF) by ventilation tubes inserted through the tympanic membrane. At the time MEF was obtained, a sample of blood was drawn from the patient, and concentrations of antibiotic in both specimens were assayed either microbiologically by a disk diffusion method or by high-pressure liquid chromatography. Amoxicillin had the highest ratio of mean peak concentration in MEF to minimal inhibitory concentration (MIC) for the three most common pathogens of otitis media (Streptococcus pneumoniae, ampicillin-sensitive Haemophilus influenzae, and Streptococcus pyogenes), whereas trimethoprim-sulfamethoxazole had the highest ratio of mean peak concentration in MEF to MIC for ampicillin-resistant Haemophilus influenzae.