Destructive foreign body granuloma: A case report.

External auditory canal polyps are predominantly inflammatory processes but occasionally indicate more severe pathology. Prolonged conservative management may postpone accurate diagnosis and appropriate therapeutic intervention. This case report presents a 37-year-old woman, previously healthy with a normal ear, who underwent a right myringotomy with the insertion of a pressure-equalizing tube in one hospital after an upper respiratory tract infection. However, due to the pandemic era, she lost follow-up for 2 years and subsequently presented to another hospital with worsening hearing and persistent otorrhea. The attending physician found a large polypoid lesion occupying her right external ear canal. A computerized tomography scan revealed an irregular enhancement mass involving the right ear canal, the middle ear cavity, and mastoid air cells with multiple destruction of the skull base and intracranial involvement in the right middle cranial fossa. The possibility of malignancy was raised, prompting the patient to seek evaluation in a third hospital. A right tympanomastoidectomy was performed, and during a posterior tympanotomy, a pressure-equalizing tube was discovered in her middle ear. The pathological results confirmed the presence of foreign body granuloma. Following surgery, the patient's otorrhea improved.

Intra-operative Measurement of Eustachian Tube Orifice, and Its Correlation With Post-operative Surgical Outcome in Chronic Suppurative Otitis Media Patients.

Background Chronic suppurative otitis media (CSOM) is the inflammation of the middle ear mucosa for more than two weeks, resulting in ear discharge. It is associated with hearing loss and the presence of a perforation in the tympanic membrane. Tympanoplasty is performed to place a graft and clear the disease in the middle ear. Despite adequate disease clearance and proper graft placement, graft failure and disease persistence occur due to Eustachian tube (ET) dysfunction. The ET plays a significant role in the ventilation of the middle ear. Hence, this study was conducted to determine the significance of ET size for post-operative graft uptake. Methodology A total of 55 patients with inactive CSOM were included in the study. Their demographic data were recorded. Patients previously operated on for CSOM, cases with traumatic perforation of the tympanic membrane, congenital anomalies (e.g., cleft lip/cleft palate), and atticoantral disease were excluded. Thorough history taking and examination, including otoscopy and examination of the nose, throat, and oropharynx, were conducted. Once the patient was deemed fit for surgery, they underwent tympanoplasty. Intraoperatively, the ET size was measured using the tip of the suction cannulas. They were followed up after three months to assess graft uptake. Results Out of 55 patients included in the study, 42 (76%) had good graft uptake, while 13 (24%) had defects in graft uptake. Graft uptake failed in patients with an ET diameter of <3 mm. Post-operative graft uptake was observed in the majority of patients with a wider ET diameter, ranging between 3 mm and 6 mm, with a statistically significant p-value of 0.00 (0.05), as determined by Pearson's Chi-square test. Conclusion In our study, we found that there is an association between the ET diameter and post-operative graft uptake. Hence, a wider ET may improve middle ear ventilation and play an important role in post-operative graft uptake.

The disease burden of untreated chronic otitis media in Indigenous children from remote communities does not improve over time. A longitudinal study.

BACKGROUND: In Australia, middle ear disease disproportionately affects Indigenous children, leading to poor hearing outcomes. This study aimed to determine the natural history of untreated chronic otitis media in Indigenous children in remote South Australia. METHODS: Baseline and 3 year follow-up data was collected from Indigenous children aged 5-18 years living on the Anangu Pitjantjatjara Yankunytjatjara Lands. 4-frequency pure-tone audiometry was used to determine hearing levels. Middle ear pathology was determined by video-otoscopy with tympanometry and classified at baseline as group 1 (normal), group 2 (abnormal with intact tympanic membrane), or group 3 (perforated tympanic membrane). RESULTS: A total of 253 children were included in this study. Children in group 1 (20.6 ± 1.5 dBHL; Mean ± SD) had significantly better hearing outcomes at 3 year follow-up than children with abnormal ears (groups 2 and 3) (23.8 ± 7.0 dBHL), P < 0.001. The difference was greatest for group 1 versus 3 (27.6 ± 8.4 dBHL), P < 0.001, followed by 1 versus 2 (22.4 ± 5.8 dBHL), P = 0.009, and between 2 (22.4 ± 5.8 dBHL) and 3 (27.6 ± 8.4 dBHL), P < 0.001. CONCLUSION: Hearing in Indigenous children with untreated middle ear pathology remains poor at follow-up compared to those without pathology. Intervention is therefore critical to prevent persisting poor hearing outcomes.

Antimicrobial and antibiofilm effect of promethazine on bacterial isolates from canine otitis externa, an in vitro study.

Otitis externa is an inflammatory disease of the external ear canal of complex and multifactorial etiology associated with recurrent bacterial infection. This study aimed to assess the antimicrobial and antibiofilm activity of promethazine against bacterial isolates from dogs with otitis externa, as well as the effect of this compound on the dynamics of biofilm formation over 120 hours. Planktonic bacterial susceptibility to promethazine was evaluated to determine the minimum inhibitory concentrations (MIC). The minimum biofilm eradication concentration (MBEC) was also determined by broth microdilution. To evaluate the effect on biofilm growth, promethazine was tested at three concentrations MIC, MIC/2 and MIC/8, with daily readings at 48, 72, 96 and 120 h. The MICs of promethazine ranged from 48.83 to 781.25 µg mL-1. Promethazine significantly (P<0.05) reduced mature biofilm biomass, with MBECs ranging from 48.8 to 6250 µg mL-1 and reduced (P<0.01) biofilm formation for up to the 120-hours, at concentrations corresponding to the MIC obtained against each isolate. Promethazine was effective against microorganisms associated with canine otitis externa. The data suggest that promethazine presents antimicrobial and antibiofilm activity and is a potential alternative to treat and prevent recurrent bacterial otitis in dogs. These results emphasize the importance of drug repurposing in veterinary otology as an alternative to reduce antimicrobial resistance.

Our Experience in Endoscopic Button Tympanoplasty Providing High Success Rate in Varying Sizes of Perforation : A Case Series.

Cartilage tympanoplasty is a fast growing technique used to restore hearing in chronic suppurative otitis media. The technique has misnomers such as limited applicability in only small size perforations, interference with sound conducting mechanism and durability. Our experience in out tertiary care Institution with over 100 retrospective study cases prove that there is a scope of proving it to be well established technique. That could be used in par with other tympanoplasty techniques. Our retrospective case series of 100 operated between 2021 and 2024 were taken, having unilateral perforation convenience data collection purpose. The overall success rates of cartilage / button tympanoplasty of varying perforation sizes, having a wide range of pure tone audiometry statuses having successful results were discussed, which is indicated as a percentage format. In our retrospective case series, out of our 100 cases we had 90 successful graft uptake cases. The 10% cases were later followed up in our study. It was analysed and concluded that the technique was not the inhibiting factor but the post operative care had prevented the patients from having the desired results. Our results are in accordance with previous case studies for support. Pure tone audiometry were taken pre operatively and post operatively that support cartilage / button tympanoplasty. Cartilage tympanoplasty is a commonly misunderstood technique which if corrected has a wide scope to be used a s a common treatment modality. Data collected and inference were in concordance with previous studies conducted. Tragal cartilage due to its durability, low inflammatory reaction to tympanic membrane, lesser chances of retraction and long term assurance of withstanding environmental conditions has proven to be technique which can be used in regular basis. Cartilage / button tympanoplasty is a technique that has a shorter learning curve for surgeons. With a high demand of cases in chronic suppurative otitis media-Tubotympanic type, button tympanoplasty technique is an assest.

The Role of Mucociliary Clearance Function of Eustachian Tube as an Outcome Predictor for Type 1 Tympanoplasty.

OBJECTIVES: To evaluate the association between mucociliary function of the Eustachian tube using the Saccharin test preoperatively and its correlation with dynamic slow-motion video endoscopy on the outcome of Type-I Tympanoplasty in patients with inactive mucosal chronic otitis media. METHODOLOGY: Eighty patients diagnosed with inactive mucosal chronic otitis media who underwent Type-I Tympanoplasty were included in the study. Preoperative assessment of Eustachian tube function was conducted using the Saccharin test. Results of this test were categorized as normal, partial, or gross dysfunction. Dynamic slow-motion video endoscopy was performed to assess motion and pathological factors of the Eustachian tube. Results were evaluated based on a previously validated Visual Analogue Score (VAS). Patients were followed up postoperatively for 3 months. RESULTS: The proportion of patients with surgical failure at the end of the 1st and 3rd month postoperatively was significantly higher in cases of gross Eustachian tube dysfunction compared to those with normal and partial dysfunction (p-value < 0.0001 and p-value = 0.0001, respectively). Preoperative VAS scores in normal Eustachian tubes were significantly higher compared to those with partial dysfunction and gross dysfunction. CONCLUSION: The Saccharin test is a valuable tool for preoperative evaluation of mucociliary clearance of the Eustachian tube, and dynamic slow-motion video endoscopy serves as a useful adjunct in predicting the outcome of Type-I Tympanoplasty. Routine evaluation of mucociliary clearance function of the Eustachian tube should be included in the preoperative workup for patients undergoing Tympanoplasty to achieve optimal surgical outcomes.

Transcanal Endoscopic Management of Squamosal Type of Chronic Otitis Media.

Endoscopic middle ear surgery can be utilized to visualize and excise retraction pockets without the need for extensive bone work and removal of lateral bone. To evaluate the role of endoscope in the management of squamosal type of chronic otitis media. A total of 25 adults subjects (male = 12, female = 13) in the age group of 18-55 years suffering with chronic otitis media were operated by transcanal endoscopic approach. High resolution computed tomography of temporal bone was done to help identify the anatomy and underlying extent of disease. All patients were operated by transcanal endoscopic technique. The study concluded that the endoscope gives a better visualization of the middle ear and its hidden areas. The extensive bone work and associated cavity related problems can be avoided and normal anatomy can be preserved with the help of endoscopic ear surgery.

Microbiota of Chronic Suppurative Otitis Media and its Radiological Correlation in Severity of Disease.

Objective: The objective of the study was to find out the microbiota of cases of chronic suppurative otitis media and its radiological correlation in disease severity. Methodology: 50 patients with CSOM were prospectively studied. Swabs were taken and cultured for bacteria. HRCT temporal bone was done and microbiota relation with severity was studied. Result: We found the predominant organism to be staphylococcus aureus (44%) followed by psedumonas (22%). On radiological correlation maximum erosive property was seen with pseudomonas followed by methicillin sensitive staphylococcus aureus and Coagulase negative staphylococcus aureus.

Status and Depth of Mastoid Antrum and the Pattern of Mastoid Pneumatization in Cases of Large, Subtotal Perforations and Posterosuperior Retraction Pockets (PSRP).

The present study aimed to evaluate the pneumatization status of the mastoid air cells in general with the depth and status of mastoid antrum in particular, in patients of chronic otitis media (COM). This is an observational cross-sectional study in sample size of 60 participants with large, subtotal perforation and posterosuperior retraction pocket (PSRP). Mean age with large central and subtotal perforation combined was 35.78 years, compared to 32.13 years in PSRP. Granulations seen in antrum in 71.6% and cholesteatoma observed in 15%. Mean depth of the mastoid antrum was 17.27 mm. A well pneumatized mastoid in 21.6%, diploic 28.3% and sclerotic in 50% was noted in this study. Chronic otitis media affects temporal bone pneumatization, particularly the mastoid antrum. Our findings indicate that the depth of the mastoid antrum is slightly greater in cholesteatoma cases due to bone erosion. As early intervention enhances postoperative quality of life by preserving or restoring auditory function, understanding the mastoid pneumatization and antrum depth is crucial for managing chronic otitis media effectively.

Role of Tympanometric Ear Canal Volumes in Determining Outcome of Myringoplasty in Chronic Suppurative Otitis Media Patients.

Middle ear aeration is a predictive indicator of myringoplasty's successful outcome and tympanometric ear canal volume is a novel investigation that can estimate the volume of middle ear cleft and mastoid air cells. Our aim of this study is to determine the role of tympanometric ear canal volume on myringoplasty outcome in Chronic Suppurative Otitis Media Patients. Prospective analysis involving 50 patients of CSOM was performed on patients undergoing myringoplasty from April 2022 to December 2023. Smokers, Patients with squamosal COM, Bilateral COM, Otitis Externa, and Revision surgery were excluded from the study. The successful outcome of surgery was defined as no tympanic membrane perforation on postoperative follow-up. Analysis was carried out using SPSS. V. 25 and P-value less than 0.05 was considered significant. A total of 50 patients were included in the study with a mean age of 24.4 ± 8.965 and male predominance. Overall graft uptake was 64%. Graft uptake had no significant statistical correlation with age, gender, type, location, or size of perforation. However, there is a significant effect of tympanometric ear canal volume of pathological ear and interaural tympanometric ear canal volume difference on graft uptake with p-values of 0.023 and 0.033 respectively. Tympanometric ear canal volume can predict middle ear aeration and the higher the interaural tympanometric canal difference more are the chances of successful graft uptake.

Factors affecting fat myringoplasty in elderly patients with chronic otitis media: A case control study.

BACKGROUND: We compared and analyzed the surgical results of fat myringoplasty between elderly and young adult patients with chronic otitis media. We also investigated whether underlying diseases and other factors impact the surgical outcome. METHODS: We retrospectively reviewed the data of 141 patients who underwent fat myringoplasty for chronic otitis media for five years. They were compared by age, sex, underlying disease, perforation size, pre- and postoperative pure tone audiometry, postoperative otorrhea, postoperative re-perforation, and cause of re-perforation. RESULT: Postoperative re-perforation was more common in the elderly group, albeit with no significant difference (p = 0.072). The factors affecting re-perforation were insufficient fat graft (44.4%), postoperative infection (33.3%), and nasal blowing (22.2%). Our findings revealed no significant association between preoperative perforation size and re-perforation (p = 0.391). Additionally, we found no significant relationship between hypertension and re-perforation (p > 0.99), nor between age group and postoperative infection (p = 0.488). Diabetes was also not significant (p = 0.640). Following surgery, both groups exhibited a significant improvement in hearing. CONCLUSION: Although age and underlying conditions play significant roles in the healing process, our results suggest that external factors such as infection, nasal blowing, cough, and insufficient grafted fat tissue have a similarly significant impact on surgical outcomes in elderly patients with COM as they do in adults. In conclusion, the decision to perform surgery in elderly patients with COM should be based on a comprehensive assessment of the patient's overall health status, hearing, use of hearing aids, and the indications for surgery.

Quality of Life After Pediatric Tympanomastoidectomy.

OBJECTIVES: To assess quality of life (QOL) outcomes after canal wall up (CWU) and canal wall down (CWD) tympanomastoidectomy in the pediatric population. METHODS: A retrospective review tabulated pediatric patients undergoing CWU and CWD tympanomastoidectomy for cholesteatoma by 2 senior surgeons at a single tertiary academic referral center between March 2017 and March 2023. Chronic Ear Survey (CES) and cosmetic survey outcomes were collected post-operatively. RESULTS: A total of 77 ears in 75 patients were identified, with 35 undergoing CWU and 42 undergoing CWD as the most recent (index) otologic surgery. Seventeen patients (23%) participated in the survey. Of this cohort, the mean age was 14.6 years, 12 (71%) were male, and 10 (59%) had CWD as the most recent otologic surgery. The mean time from index surgery to survey completion was 3.4 years (range, 0.1-6.7 years). Regarding QOL outcomes, there were no statistically significant differences in total CES score, CES subscores, and cosmetic survey scores between groups when categorizing by gender or index surgery. Total CES, symptom subscale, medical resource subscale, and cosmetic survey scores showed a tendency to decrease with an increasing number of surgeries (R = -.18, -.28, -.53, and -.56, respectively). Pediatric total CES scores appeared comparable to those reported in the published adult literature. CONCLUSIONS: It does not appear that there are worse QOL outcomes for pediatric patients who undergo CWD tympanomastoidectomy compared to those who undergo CWU tympanomastoidectomy. There appears to be no difference in QOL outcomes between pediatric and adult patients undergoing tympanomastoidectomy.

Comprehensive management of chronic ear disease: Consecutive patient analysis at a tertiary children's hospital.

OBJECTIVE: To characterize medical complexity and advanced interventions necessary to treat pediatric patients with chronic ear disease. METHODS: A retrospective case review of children who received surgery for chronic otitis media, cholesteatoma, or tympanic membrane perforation at a tertiary children's hospital from 2020 to 2024 was performed. The frequency and type of medical complexities as well as distribution and success of advanced otologic interventions were recorded. RESULTS: Operations were performed on 80 ears. Forty-five percent were in medically complex patients. Twenty-five percent had a syndrome, 13 % had American Society for Anesthesiologists Severity Class 3 or more, and 38 % attended multi-disciplinary programs. Advanced audiology testing protocols were utilized in 53 % of patients, and multiple children received complex sleep and airway operations. Advanced surgical techniques were required in 58 %. Post-operatively, an intact tympanic membrane was achieved in 95 % of operated ears (p < 0.01). Residual and recurrent cholesteatoma were each present in 5 % of cases, with mean follow-up of 11.6 months. Otorrhea reduced from 64 % of patients pre-operatively to 2 % post-operatively (p < 0.01), including cessation in all individuals who reported social/bullying issues related to ear drainage/odor. Unrestricted water exposure was achieved in 99 % of individuals (p < 0.01). Patients showed a mean improvement after surgery of 7.6 dB, as measured by the change in air-bone gap (p < 0.05). CONCLUSIONS: Comprehensive treatment of otologic conditions included care that was holistic of all medical needs, integrated with other services, developmentally appropriate, encompassing of non-otologic procedures, technically advanced, effective, and functionally-focused. Surgical teams should endeavor together to provide this combination of services.

Skull base osteomyelitis due to bilateral acute otitis media: Case report and literature review.

Skull base osteomyelitis is a rare and serious condition that primarily affects immunocompromised individuals and can be life threatening if not treated promptly. It can have various origins, with the most common being an extension of necrotizing external otitis. It is difficult to diagnose due to a wide array of clinical presentations. Imaging plays an important role in the diagnosis, identification of the possible source of infection, the extent of the disease, the pattern of spread and identification of associated complications. Early diagnosis is crucial to promptly initiate appropriate treatment. We report here a rare case of a 68-year-old patient presenting with skull base osteomyelitis resulting from bilateral otitis media, which is a rare condition.

Nasopharyngeal and temporal bone abscess following necrotizing otitis externa: a case report.

Necrotizing otitis externa (NOE) is a severe infection primarily affecting the external auditory canal, seen mainly in immunocompromised individuals as patients with diabetes mellitus (DM). This case report highlights unusual complications of NOE: temporal bone and nasopharyngeal abscesses. These complications underscore the severity of NOE, particularly when caused by rare pathogens such as Klebsiella species. We detail the case of a 70-year-old male with uncontrolled DM who presented with severe right ear pain, purulent discharge, and significant postauricular swelling. Laboratory investigations revealed elevated inflammatory markers and poorly controlled diabetes. Cultures confirmed Klebsiella pneumoniae, and imaging showed diffuse edema and abscess formation in the temporal bone and nasopharynx. The patient was treated with intravenous Ceftazidime and ciprofloxacin for 6 weeks, followed by oral ciprofloxacin. Effective management of NOE necessitates a comprehensive, multidisciplinary approach. Early intervention, regular monitoring, and imaging are critical for promptly detecting and managing complications.

Efficacy of biologics for eosinophilic otitis media.

BACKGROUND: Eosinophilic otitis media (EOM) is an intractable condition primarily treated with steroids. Recently, biologics targeting IgE or IL-5 have been introduced. OBJECTIVES: This study aimed to evaluate the efficacy of biologics for EOM. MATERIALS AND METHODS: We retrospectively collected data on EOM patients treated from January 2008 to December 2020 from electronic medical records. Patients were classified into the steroid group, treated with systemic or local steroids, and the biologics group, treated with biologics with or without steroids. RESULTS: The otorrhea remission rate was 63.33% in the steroid group, comparable to 58.82% in the biologics group (p = 0.760). Before treatment, the steroid group showed better bone-conduction (BC) thresholds at 0.5 kHz and 1 kHz than the biologics group. Post-treatment, the steroid group improved in air-conduction (AC) threshold and air-bone gap (ABG) at 1 kHz and 2 kHz. The biologics group exhibited stable audiological results. No significant differences were observed post-treatment between the groups, except for the BC threshold at 0.5 kHz, which remained as pre-treatment. CONCLUSIONS AND SIGNIFICANCE: Biologics demonstrated similar efficacy in otorrhea remission as steroids and might help maintain hearing levels. Biologics can be considered for controlling EOM with active otorrhea and reducing systemic steroid use.

Comparative Study of Endoscopic Transcanal Tympanoplasty and Tympanoplasty by Conventional Postaural Approach in a Tertiary Care Hospital in Central India.

Background Chronic otitis media (COM) often necessitates tympanoplasty to repair the tympanic membrane. While conventional postaural tympanoplasty (PA) is well-established, endoscopic transcanal tympanoplasty (ET) is gaining traction for its minimally invasive benefits. This study aims to compare these two surgical techniques regarding their anatomical and functional outcomes and assess the role of platelet-rich plasma (PRP) in improving these outcomes. Material and methods This prospective comparative study was conducted at Acharya Vinoba Bhave Rural Hospital, involving 60 patients with COM. Participants were randomly assigned to receive either ET or PA, with each group further subdivided based on PRP use. Preoperative evaluations included auditory function tests and diagnostic endoscopy. Postoperative assessments were performed at seven days, one month, and three months to evaluate graft acceptance and hearing improvement using pure tone audiometry (PTA). Statistical analyses included the chi-square test, t-test, ANOVA, and paired t-test. Results The study included patients with a mean age of 38.1 years, predominantly female (71.67%). ET demonstrated superior anatomical outcomes compared to PA, with higher graft acceptance rates and better hearing improvements. The average hearing gain was 10.4 dB in the ET group versus 8.1 dB in the PA group. PRP uses enhanced graft acceptance and hearing restoration across both surgical approaches, contributing to better overall outcomes. Conclusion ET offers significant advantages over conventional postaural tympanoplasty in terms of anatomical and functional results. PRP further improves surgical outcomes, making ET a preferable option for tympanoplasty in COM patients. These findings support the broader adoption of ET and PRP to enhance patient outcomes in tympanoplasty procedures.

Pediatric Necrotizing Otitis Externa: A Scoping Review.

OBJECTIVE: This review sought to answer the following research question: What are the characteristics of pediatric necrotizing otitis externa (NOE)? Moreover, we wanted to highlight the clinical importance of the current limitations in the literature. METHODS: A scoping review was performed to determine what is known about NOE in the pediatric population. Four databases (COCHRANE Library, CINAHL, PubMed, and Scopus) were queried for articles published in English between 1976 to 2022. Variables extracted included comorbidities, demographics, outcomes, and treatment. RESULTS: A total of 20 studies (N = 439) reported sufficient measures to be included in the review. Patients with NOE had a mean age of 10.0 years (range 2 months to 14 years) with a male-to-female gender ratio of 1.1:1. Mean length of hospital stay was 2.9 days (95%CI: 2.7-3.0). Demographics included 45.4% Caucasian, 6.0% African American, and 2.7% Asian/Pacific Islander. Less than 5% of patients had diabetes, while other reported comorbidities included neutropenia (n = 6), anemia (n = 5), dehydration/malnutrition (n = 4), Stevens Johnson Syndrome (n = 2), some form of immunosuppression/organ transplantation (n = 2), thrombocytopenia (n = 2), and leukopenia (n = 2). There have been no reported deaths from NOE in children. CONCLUSIONS: In the adult population NOE most commonly affects patients with diabetes, but our review reveals that diabetes does not appear to play as big a role in children. The disease seems to commonly affect patients with immunosuppression or severe health conditions. Complications such as cranial nerve palsies appear to be more common in the pediatric population. Specifically, the role of biopsy and culture in the treatment of pediatric NOE is stressed as they are important in treatment decisions.

An economic evaluation of pneumococcal conjugate vaccines, PCV20 versus PCV15, for the prevention of pneumococcal disease in the Swedish pediatric population.

In September 2023, 10-valent pneumococcal conjugate vaccine (PCV) was replaced by 15-valent PCV (PCV15) in Sweden's pediatric national immunization program. Following European approval of 20-valent PCV (PCV20) in March 2024, we assessed the cost-effectiveness of PCV20 versus PCV15, both under 2 + 1 schedule, among Sweden's pediatric population. A Markov state-transition model evaluated the economic and health benefits of PCV20 versus PCV15 among all ages over a 10-year time horizon. The base case adopted a Swedish payer perspective with an annual cycle length and 3.0% discount rate for costs and outcomes. Country-specific data informed population size, epidemiology, costs, and quality of life estimates. PCV15/PCV20 effect estimates were informed by PCV13 clinical effectiveness and impact studies plus PCV7 efficacy studies. Sensitivity analyses evaluated model robustness, including PCV20 under a 3 + 1 schedule. PCV20 was associated with higher quality-adjusted life year gains versus PCV15, averting an estimated 3,116 invasive pneumococcal disease cases 21,109 inpatient pneumonia cases, 6,618 outpatient pneumonia cases, and 36,209 otitis media cases, plus 3,281 pneumococcal disease-related deaths. PCV20 yielded substantial cost savings exceeding 5.4 billion SEK over a 10-year time horizon, primarily attributed to reduced direct medical costs due to improved health outcomes compared with PCV15. The findings confirmed the dominance of PCV20 in the base case, which remained robust across deterministic and probabilistic sensitivity analyses as well as scenario assessments. PCV20 was the dominant strategy versus PCV15 over 10 years. The broader serotype coverage of PCV20 suggests superior clinical and economic advantages over PCV15, warranting inclusion in Sweden's pediatric immunization program.

Deciphering the mechanisms of the IL-6/CXCL1 and NOD-like receptor signaling pathways in otitis media with effusion in rodents.

BACKGROUND: Otitis media with effusion (OME) often leads to pediatric hearing loss and is influenced by innate and adaptive immune responses. Innate immunity serves as the non-specific first line of defense against OME. METHODS: We induced OME in rats using ovalbumin. We administered IL-6 monoclonal antibodies intranasally to inhibit IL-6, and we injected an NF-κB inhibitor intraperitoneally to explore the role of IL-6 in innate immunity and its interaction with the NOD-like receptor signaling pathway. We analyzed RNA-sequencing data with Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways to assess signaling pathways involved in OME. We also utilized Western blot, quantitative real-time PCR, and immunohistochemistry on middle ear samples and used microscopy to identify immune cells in ear wash fluids. RESULTS: Our study suggests a pivotal role for IL-6 in the immune pathways of rats with OME via the regulation of CXCL1-mediated pathways. Increased levels of IL-6 and CXCL1 were observed in the middle ear tissues, and activation of the NLRP3 inflammasome in OME rats led to an immune response via NF-κB, thus promoting IL-6 and CXCL1 production, which was reduced by IL-6 antibody treatment. CONCLUSIONS: Our findings confirm that IL-6 and CXCL1 play significant roles in the innate immune response in OME in rodents, predominantly via the NOD-like receptor signaling pathway and NLRP3 inflammasome activation. This research sheds light on OME pathogenesis and its immune-related mechanisms.