Un protocolo de investigación para la realización de un ensayo controlado aleatorizado que compare la acción de la homeopatía y la alopatía en la otitis media aguda y su recurrencia en niños / A research protocol for conducting a randomized controlled trial comparing the action of homeopathy and allopathy in acute otitis media and its recurrence in children

Antecedentes: la otitis media aguda (OMA) es una de las infecciones agudas más comunes en niños. La prescripción no juiciosa de antibióticos puede provocar un aumento de los casos resistentes a antibióticos. La Homeopatía puede proporcionar un tratamiento más seguro y más eficaz. Objetivo: anteriormente, un estudio piloto realizado por el Consejo Central de Investigación en Homeopatía (CCRH) en 80 pacientes, en un solo centro, mostró resultados de no inferioridad. Este estudio se realizará para corroborar los hallazgos anteriores. Métodos: será un ensayo controlado (con brazo paralelo), aleatorizado, de diseño abierto y de no inferioridad, que se realizará en niños de 2 a 12 años de edad, con una otitis media aguda. El ensayo incluirá 240 niños, de los que cada participante será seleccionado de forma aleatoria para recibir un medicamento homeopático individualizado, o bien, un medicamento alopático sintomático. En caso de que un niño no muestre una mejoría ≥50% con el tratamiento asignado en el día tres, recibirá un antibiótico. Los niños de ambos grupos serán tratados / seguidos durante 1 año para verificar la recurrencia, si la hay. Los parámetros principales serán los cambios en la Escala de examen de la membrana timpánica (Tympanic Membrane Examination Scale, TMES) y la escala Otitis media aguda-severidad de los síntomas (Acute Otitis Media-Severity of Symptoms, AOM-SOS), así como el tiempo para mejorar el dolor a través de la Escala de dolor de caras revisada (Facial Pain Scale-Revised) entre los grupos, y la recurrencia a un año (número de episodios, intensidad y duración) de la OMA en ambos grupos. Discusión: El estudio consolidará los hallazgos observados durante un estudio piloto realizado por el CCRH en Jaipur, India. Se propone que se compare el papel de la Homeopatía individualizada frente a la alopatía en el tratamiento de la OMA y que se evalúe su papel en el control de las recidivas. (AU)

Complete genome sequence of a methicillin-resistant Staphylococcus schleiferi strain from canine otitis externa in Korea

Deficiência de anticorpos específicos antipolissacarídeos / Specific polysaccharide antibody deficiency

A deficiência de anticorpos específicos antipolissacarídeos é um dos erros inatos da imunidade predominantemente de anticorpos, destacando-se entre os defeitos mais frequentes. É caracterizada por uma permanência de imaturidade da resposta imunológica a antígenos polissacarídeos, estando normais linfócitos B, classes e subclasses de imunoglobulinas. O paciente apresenta maior suscetibilidade a infecções por bactérias encapsuladas, especialmente Streptococcus pneumoniae e Haemophilus influenzae. As principais manifestações clínicas são otites, sinusites, traqueobronquites e pneumonias de repetição; pode haver meningite pneumocócica e septicemia. A investigação é feita por titulação de anticorpos antipolissacarídeos antes e após a aplicação da vacina pneumocócica não conjugada. Até dois anos, há imaturidade fisiológica desse setor da imunidade, por isso, o diagnóstico não pode ser feito antes desta idade. O tratamento, além de antibiótico precoce em vigência de quadros infecciosos, inclui antibióticos profiláticos, aplicação de vacina conjugada com proteínas e/ou reposição de imunoglobulina humana endovenosa ou subcutânea. O diagnóstico e o tratamento precoce melhoram a qualidade de vida do paciente, diminuindo o risco de sequelas e até de óbito por infecção, e quando não são precoces, é possível que haja sequelas como bronquiectasias, hipoacusia ou danos neurológicos.

Specific polysaccharide antibody deficiency is an inborn error of immunity predominantly affecting antibodies, being one of the most frequent primary immunodeficiencies of childhood. It is characterized by persistent immaturity of the immune response to polysaccharide antigens, with normal levels of B lymphocytes, immunoglobulin classes and subclasses. Patients are more susceptible to infections by encapsulated bacteria, especially Streptococcus pneumoniae and Haemophilus influenzae. The main clinical manifestations are recurrent otitis, sinusitis, tracheobronchitis and pneumonia; there may be pneumococcal meningitis and septicemia. The investigation is done by dosages of polysaccharide antibodies before and after unconjugated pneumococcal vaccination. As this area of immunity is physiologically immature until two years of age, diagnosis cannot be made earlier. Treatment, in addition to antibiotics as soon as infections are detected, includes prophylactic antibiotic therapy, use of pneumococcal vaccine conjugated to protein and/or replacement of intravenous or subcutaneous human immunoglobulin. Early diagnosis and treatment improve patients' quality of life, reducing the risk of sequelae and even death from infection, while lack of early measures can lead to sequelae such as bronchiectasis, hearing loss and neurological damage.

Rhabditis spp, in the Espírito Santo, State of Brazil and evaluation of biological control / Rhabditis spp, no Espírito Santo, estado do Brasil e avaliação do controle biológico

Abstract The objectives of this study were to describe occurrences of Rhabditis spp. causing parasitic otitis in dairy cattle of Gir breed in the state of Espírito Santo, southeastern Brazil, and to evaluate the biological control of this nematode using the nematophagous fungi Duddingtonia flagrans (AC001) and Monacrosporium thaumasium (NF34). After nematode detection and collection, three groups were formed: two groups that were treated, respectively, with the fungal isolates; and a control group, without fungus. The treatments were as follows: (a) Petri dishes containing the culture medium 2% water agar (WA) + 250 nematodes + AC001; (b) Petri dishes containing 2% WA + 250 nematodes + NF34; and (c) Petri dishes containing only 2% WA + 250 nematodes. After seven days at 27 °C the treatments with fungi were able to capture and destroy the nematodes, with percentages of 82.0% (AC001) and 39.0% (NF34) in relation to the control group. The results demonstrate the occurrence of Rhabditis spp. after animals physical examination and that there was efficacy of the in vitro predatory activity of both fungal isolates. Thus, these results are important because they can assist in future in vivo control of this nematode in cattle.

Resumo Os objetivos neste estudo foram descrever ocorrências do nematódeo Rhabditis spp., causando otite parasitária em bovinos leiteiros da raça Gir no estado do Espírito Santo, sudeste do Brasil, e avaliar o controle biológico desse nematódeo utilizando os fungos nematófagos Duddingtonia flagrans (AC001) e Monacrosporium thaumasium (NF34). Após a detecção e coleta dos nematódeos, três grupos foram formados: dois grupos que foram tratados com os isolados fúngicos, respectivamente; e um grupo controle, sem fungos. Os tratamentos foram os seguintes: (a) placas de Petri contendo o meio de cultura 2% ágar de água (WA) + 250 nematoides + AC001; (b) placas de Petri contendo 2% de WA + 250 nematoides + NF34; e (c) placas de contendo apenas 2% de nematódeos WA + 250. Após sete dias a 27 °C os tratamentos com fungos foram capazes de capturar e destruir os nematódeos, com porcentagens de 82,0% (AC001) e 39,0% (NF34) em relação ao grupo controle. Os resultados demonstram a ocorrência de Rhabditis spp., no Estado do Espírito Santo e a eficácia da atividade predatória in vitro dos isolados fúngicos utilizados. Assim, esses resultados são importantes, pois podem auxiliar no controle alternativo in vivo de Rhabditis spp. em bovinos com otite parasitária.

Outcomes of Modified Canal Wall Down Mastoidectomy and Mastoid Obliteration Using Autologous Materials

OBJECTIVES: The traditional canal wall down mastoidectomy (CWDM) procedure commonly has potential problems of altering the anatomy and physiology of the middle ear and mastoid. This study evaluated outcomes in patients who underwent modified canal wall down mastoidectomy (mCWDM) and mastoid obliteration using autologous materials. METHODS: Our study included 76 patients with chronic otitis media, cholesteatoma, and adhesive otitis who underwent mCWDM and mastoid obliteration using autologous materials between 2010 and 2015. Postoperative hearing air-bone gap and complications were evaluated. RESULTS: During the average follow-up of 64 months (range, 20 to 89 months), there was no recurrent or residual cholesteatoma or chronic otitis media. No patient had a cavity problem and anatomic integrity of the posterior canal wall was obtained. There was a significant improvement in hearing with respect to the postoperative air-bone gap (P<0.05). A retroauricular skin depression was a common complication of this technique. CONCLUSION: The present study suggests that our technique can prevent various complications of the classical CWDM technique using autologous tissues for mastoid cavity obliteration. It is also an appropriate method to obtain adequate volume for safe obliteration.

Decreased Expression of Aquaporins in Otitis Media: What About Chronic Otitis Media?

No abstract available.

Decreased Aquaporin 4 and 6 mRNAs in Patients With Chronic Otitis Media With Otorrhea

OBJECTIVES: Aquaporins (AQPs) are integral membrane proteins engaged in the modulation of water homeostasis, but the roles they play in chronic otitis media (COM) have not been well investigated. Accordingly, we undertook document relations between the mRNA expressions of AQPs and COM, and explored the relation between these expressions and otorrhea, which is one of the most common symptoms of COM. METHODS: Levels of the mRNAs of AQP 1, 2, 3, 4, 5, 6, 8, and 10 were assayed by real-time polymerase chain reaction in inflammatory tissue samples from 81 patients with COM with or without otorrhea. Relationships between AQP mRNA levels and the presence or absence of otorrhea, the presence or absence of bacteria, hearing threshold levels, types of hearing loss, and clinical manifestations were also evaluated. RESULTS: AQP 1, 2, 3, 4, 5, 6, 8, and 10 mRNAs were expressed in inflammatory tissues obtained from all 81 patients with COM with or without otorrhea. AQP 5 mRNA was most expressed in, followed in descending order by AQP 3, 1, 10, 6, 8, 2, and 4. There were no significant intergroup differences in terms of age, sex, duration of illness, levels of hearing loss in both ears, or incidences of conductive or sensorineural hearing loss. However, AQP 4 (P=0.035) and 6 (P=0.085) mRNA levels were significantly lower in the otorrhea group. In addition, bacteria culture positivity (P=0.014) and the incidence of sensorineural hearing loss (P=0.020) were higher in the otorrhea group. CONCLUSION: AQP 1, 2, 3, 4, 5, 6, 8, and 10 are involved in the development of COM. Specifically, it shows reductions in AQP 4 and 6 mRNA levels, as observed in the otorrhea group, have an effect on the clinical manifestations of COM.

Validation of Korean-Language Version of Chronic Otitis Media Questionnaire-12 to Reflect the Disease Activity of Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Chronic Otitis Media Questionnaire-12 (COMQ-12) was developed in the United Kingdom to assess disease specific Health-Related Quality of Life (HRQoL) of chronic otitis media (COM) patients. We assessed the validity of Korean version of COMQ-12 (K-COMQ-12) and its correlation with the disease activity of COM classified according to the type of surgery. MATERIALS AND METHOD: We translated the original COMQ-12 into Korean and also performed a back-translation of the translated text into English. Enrolled were 106 COM patients and 106 healthy subjects. Cronbach alpha was used to evaluate internal consistency, and factor analysis was performed to prove reliability. We compared K-COMQ-12 scores between normal subjects and COM patients to assess validity. The scores were also compared by dividing groups according to disease activity of COM. RESULTS: Cronbach's alpha showed good internal consistency (0.939). There was a significant difference in K-COMQ-12 scores between healthy subjects (1.99±4.34) and COM patients (22.69±12.41). Also, scores go higher as the disease activity of COM increased. A cut-off score of 6 of K-COMQ-12 sets 0.915 of sensitivity and 0.934 of specificity. CONCLUSION: The K-COMQ-12 is a reliable and valid tool to assess HRQoL in patients with COM. The K-COMQ-12 could be also used as an objective tool that reflects the disease activity of COM.

Change of Tympanogram after Chronic Otitis Media Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pre-operative eustachian tube function (ETF) is an important factor for the postoperative success after tympanoplasty, though much debates have been reported. In this study, we investigated the tympanogram changes after tympanoplasty, indirectly checking up ETF, to find out the relationship between tympanogram changes and associated factors of tympanoplasty. SUBJECTS AND METHOD: Included in this study were 238 cases of tympanoplasty (canal wall up mastoidectomy with tympanoplasty type I or tympanoplasty type I only) performed by one surgeon for chronic otitis media from January, 2012 to June, 2017. In all cases, tympanometric tests were undertaken at one month, three month, six month, and one year post-operatively, and pure tone audiometry tests were taken at 1 year, post operatively. RESULTS: The average hearing level and air-bone gap were 41.8±19.7 dB, and 17.1±9.3 dB, pre-operatively, and 29.9±21.1 dB, and 6.9±8.5 dB, 1 year post-operatively, respectively. Most of the cases showed improvement in hearing. The results of tympanometry showed that hearing improvement was greater for the A type than for the B or C type (p<0.001). The smaller the size of the tympanic membrane was, the higher, the type A tympanogram appeared to be (p=0.008). CONCLUSION: The estimation of pre-operative ETF using post-operative tympanogram changes can give insight to the degree and process of recovery of the normal middle ear after tympanoplasty.

Carriage of Staphylococcus schleiferi from canine otitis externa: antimicrobial resistance profiles and virulence factors associated with skin infection

The recent emergence of Staphylococcus schleiferi in dogs with otitis externa or skin and soft tissue infections has become a significant zoonotic issues. In the current study, we investigated 1) the carriage rates of S. schleiferi among major staphylococci in healthy dogs and dogs with otitis externa, 2) antibiotic susceptibility profiles of S. schleiferi, particularly methicillin resistance (MR), and 3) virulence factors associated with skin and soft tissue infections such as ability to form biofilm, resistance to cationic antimicrobial peptides (CAMPs), and carriage of staphylococcal enterotoxin genes. Among the 21 S. schleiferi isolates, 5 isolates (24%) were determined to be methicillin-resistant (MRSS). Staphylococcal cassette chromosome mec (SCCmec) typing revealed the presence of SCCmec type V in 4 MRSS isolates and type VII in one MRSS. Higher levels of antibiotic resistance, especially multidrug resistance, were observed in MRSS isolates compared to the methicillin-susceptible S. schleiferi (MSSS) isolates. In addition, MRSS isolates exhibited enhanced ability to form biofilm under static condition and all the 5 MRSS isolates carried three or more enterotoxin genes. However, there were no significant differences in resistance to CAMPs between MRSS and MSSS isolates. These findings suggest that coagulase-negative S. schleiferi is becoming more prevalent in canine otitis externa cases. Our results also highlight the presence of multidrug-resistant MRSS isolates with enhanced biofilm production and carriage of multiple enterotoxins.

The First Case of Otitis in Korea Caused by Brevibacterium otitidis

Brevibacterium spp. are gram-positive rods that are considered to be strictly nonpathogenic, and a very few cases of their infection in humans have been reported. In this study, we report a case of otitis caused by Brevibacterium otitidis. A 53-year-old woman, who visited the hospital, complained of symptoms, such as otorrhea from both ears, ear fullness, tinnitus, and hearing impairment, for several months. Ear discharge was cultured on blood agar for pathogen identification. Bacteria from the isolated colony were initially identified as Actinomyces odontolyticus by VITEK 2 (bioMerieux, France), whereas VITEK® MS (bioMerieux, France) identified them as Brevibacterium luteolum. Subsequently, bacteria from the isolated colony were confirmed as B. otitidis by 16S rRNA sequencing. Antimicrobial susceptibility testing confirmed their sensitivity to vancomycin and linezolid and resistance to clindamycin and penicillin. To our knowledge, this is the first reported case of otitis caused by B. otitidis in Korea.

Cistomatose ceruminosa em felino Persa: relato de caso / Feline ceruminous cystomatosis in a Persian cat: a case report

Neste trabalho, os autores relatam o caso de um gato Persa, macho, de cinco anos e meio de idade, atendido na Cidade do Rio de Janeiro apresentando nódulos auriculares diagnosticados por histopatologia como cistomatose ceruminosa. Por tratar-se de uma afecção pouco comum, de etiologia desconhecida e fácil resolução, os autores objetivaram divulgá-la, descrevendo os principais sinais clínicos e tratamentos. Como terapia, foi realizadaa excisão cirúrgica dos cistos com bisturi elétrico e não houve recidiva nos últimos três anos. Sugere-se que os cistos benignos podem malignizar, além de dificultarem o asseio do conduto auditivo levando ao acúmulo de cerúmen e, consequentemente, a infecções secundárias (otite externa) por proliferação microbiana.

In this case report the authors describe the presence of nodules in the concave pinna of a five years-old male Persian cat brought to veterinary clinic care in Rio de Janeiro in 2015, diagnosed by histopathology as ceruminous cystomatosis. As it is an uncommon disorder of unknown etiology and easy treatment, the authors aim to elucidate the main clinical signs associated and treatment used. The ablation of cysts was performed withan electric bistoury and no recurrency was reported within three years. It is suggested that benign cysts can progress to malignancy, besides, lesions can disrupt normal self-cleaning of the auditory canal leading to secondary otitis externa by microbial proliferation.

In vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infections in dogs / Uso in vitro e in vivo do óleo essencial de Melaleuca (Melaleuca alternifolia) em otites bacterianas e por leveduras

Otitis externa is a common complaint in dogs. Bacteria and yeasts are commonly involved and may perpetuate inflammatory reactions inside the ear canal. Otoscopy, cytological examination of secretion and microbiological culture embody forms of diagnosis. Cytology also has great use in accessing treatment evolution. Therapy usually consists of cleaning ear canals and subsequent use of antibiotics or antifungal products. As some of them may cause hypersensitivity and even ototoxicity, searching for new pharmacological bases is currently necessary and justifies this study, which aimed to evaluate in vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infections in dogs. Twenty-eight dogs from a particular shelter in Cuiabá (Mato Grosso, Brazil), presenting clinical signs of otitis externa, were enrolled in this clinical trial. In all of them, clinical and cytological evaluations, as well as culture and susceptibility testing of the affected ears were carried out. From each dog, one ear was treated with 5% tea tree essential oil lotion and the other with standard otic formulation, according to the type of infection (bacterial, yeast or both). In vitro susceptibility testings of all ear cultures, to the same drugs used in treatment, were also carried out. Culture results showed 62.5% bacterial and fungal infection, 33.9% bacterial infection and 3.6% fungal infection, from the 56 ear samples collected. The most common microorganisms isolated were Staphylococcus intermedius, Staphylococcus aureus, Proteus mirabilis and Malassezia pachydermatis. Gram-positive bacteria were susceptible to gentamycin in 60.5% and resistant in 16.3% of the samples. Five percent tea tree essential oil formulation produced a 5mm clear zone of inhibition around the disks in one of the 63 samples evaluated. Pure (100%) tea tree essential oil formulation produced a 10mm clear zone of inhibition around the disks in four of the 63 samples evaluated, a 9mm zone in three samples, an 8mm zone in 16 samples, a 7mm zone in seven samples, a 6mm zone in two samples and there was no clear zone in 31 samples. Inhibition zones were produced by strains of Staphylococcus intermedius, Staphylococcus hyicus, Corynebacterium sp., Proteus mirabilis and Enterobacter sp. tea tree essential oil ear solution significantly induced remission of clinical signs both in bacterial and yeast ear infections. It also reduced as much Malassezia pachydermatis ear infection as the nystatin solution used in this study, while gentamycin solution showed better antibacterial effect. More studies should be conducted to evaluate in vitro diffusion properties of tea tree essential oil. Good antimicrobial spectrum and the absence of adverse reactions confirm the importance of developing a tea tree formulation as an alternative therapy for ear infections in dogs.(AU)

Otite externa é queixa frequente em cães. Bactérias e leveduras estão comumente envolvidas e podem perpetuar as reações inflamatórias dentro do canal auditivo. Dentre as formas de diagnóstico, encontram-se a otoscopia, o exame citológico da secreção e a cultura microbiológica. Citologia também tem grande utilidade no acesso à evolução do tratamento. A terapia consiste de limpeza dos canais auditivos e posterior utilização de antibióticos ou produtos antifúngicos. Como alguns antimicrobianos utilizados no tratamento podem causar hipersensibilidade e até mesmo ototoxicidade, a busca por novas bases farmacológicas justifica a existência deste estudo, que teve como objetivo avaliar in vitro e in vivo a eficiência do óleo de Melaleuca alternifolia em otites bacterianas e fúngicas de cães. Vinte e oito cães, de um abrigo particular, apresentando sinais clínicos de otite externa, foram incluídos neste estudo clínico. Todos passaram por avaliação clínica, citologia e cultura de material das orelhas afetadas. De cada animal, uma orelha foi tratada com óleo de Melaleuca 5% e a outra com formulação ótica padrão, de acordo com a afecção (bacteriana, fúngica ou mista). As culturas também foram submetidas a testes de susceptibilidade in vitro aos mesmos agentes utilizados no tratamento in vivo. Os resultados da cultura mostraram 62,5% de infecção mista (bacteriana e fúngica), 33,9% de infecção bacteriana e 3,6%, de infecção fúngica a partir das 56 orelhas. Os micro-organismos mais isolados foram Staphylococcus intermedius, Staphylococcus aureus, Proteus mirabilis e Malassezia pachydermatis. As bactérias GRAM-positivas foram sensíveis à gentamicina em 60,5% e resistentes em 16,3% das amostras. A formulação com 5% de óleo essencial de Melaleuca produziu uma zona de inibição de 5mm em torno dos discos em uma das 63 amostras avaliadas. A formulação pura (100%) do mesmo produto produziu uma zona de 10mm de inibição em quatro das 63 amostras analisadas, uma zona de 9 mm em três amostras, uma zona de 8mm em 16 amostras, uma zona de 7mm em sete amostras, uma zona de 6mm em duas amostras e não havia nenhuma zona clara em 31 amostras. Zonas de inibição foram produzidas por estirpes de Staphylococcus intermedius, Staphylococcus hyicus, Corynebacterium sp., Proteus mirabilis e Enterobacter sp. Clinicamente, a formulação com o óleo essencial de melaleuca induziu significativamente uma melhora nas manifestações, tanto nas otites bacterianas quanto nas causadas por leveduras, sendo estatisticamente semelhante ao tratamento com nistatina (nas otites por levedura), mas menos eficaz que a solução de gentamicina nas otites bacterianas. Mais estudos devem ser realizados para avaliar as propriedades de difusão in vitro do óleo essencial de melaleuca. O bom espectro antimicrobiano, a boa resposta clínica e a ausência de reações adversas confirmam a possibilidade de desenvolvimento de formulação ótica com o óleo essencial de melaleuca, como uma alternativa para a terapia de infecções do ouvido em cães.(AU)

The Relation between Tympanostomy Tube Otorrhea and Types of Immune Cells in Middle Ear Effusion in Children with Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tympanostomy tube insertion is one of the most common surgical procedures in children. Despite aseptic procedures with prophylactic antibiotic treatment, postoperative otorrhea may be encountered in some patients. The purpose of this study is to identify the relation between the types of immune cells in otitis media with effusion (OME) and tympanostomy tube otorrhea (TTO) in children. SUBJECTS AND METHOD: Fifty-six patients underwent tympanostomy tube insertion with OME were analyzed retrospectively. Fluid from OME was harvested by suction via syringe connector after myringotomy. Light microscopic examination of middle ear effusion was performed by a pathologist after hematoxylin and eosin staining. We analyzed the relation between the types of immune cells from middle ear effusion and TTO. RESULTS: Of 56 children, 36 were male and 22 were female. The mean age for tympanostomy tube insertion was 3.56 (±2.63) years, with the average follow-up period of 12.56 (±9.96) months. Neutrophils were detected in 19, eosinophils in 14, lymphocytes in 22, mast cells in 2, plasma cells in 7, and histiocytes in 9. TTO occurred in 15 patients. In patients with early TTO, eosinophils were detected more frequently than in patients without TTO (p=0.006). Plasma cells were detected more frequently in patient with late TTO than without TTO (p=0.011). CONCLUSION: According to the analysis of different types of immune cells, eosinophils in the middle ear effusion related with the occurrence of TTO.

Efficacy of Tympanoplasty Without Mastoidectomy for Treating Chronic Otitis Media in Patients With Mastoid Cavity Opacification in Temporal Bone Computed Tomography Findings

OBJECTIVES: Combined mastoidectomy is generally preferred to tympanoplasty alone when treating patients with chronic otitis media (COM), particularly when temporal bone computed tomography (TBCT) shows that the mastoid cavity contains opacification of soft tissue density. However, in cases with Eustachian tube dysfunction, a mastoid cavity volume may be a burden to its function. We hypothesized that tympanoplasty alone might be better than tympanoplasty combined with mastoidectomy because soft tissue in the mastoid cavity is a sequel to a protective physiological response. Thus, we explored the efficacy of tympanoplasty without mastoidectomy in COM patients exhibiting mastoid air cell opacification on TBCT. METHODS: Between 2010 and 2014, a total of 33 patients, diagnosed with COM and with evidence of mastoid cavity opacification on TBCT, underwent tympanoplasty without mastoidectomy. All ears had been dry for ≥3 months before surgery. All procedures were performed by the same surgeon. We retrospectively analyzed the preoperative otoscopic findings, pre- and postoperative pure tone averages (PTAs; the mean of the values at 0.5, 1, 2, and 4 kHz), surgical procedures, and complications or recurrence. RESULTS: Of the 33 patients, 28 (84.8%) exhibited hearing improvement after surgery. The mean pre- and postoperative PTAs were 46.9±21.2 dB and 29.4±17.0 dB, respectively (P < 0.001). The air-bone gap decreased from 25.7±10.7 dB to 10.3±8.7 dB (P < 0.001). Thirty-two patients (97.0%) did not develop any COM recurrence or cholesteatoma; one patient developed attic retraction of the tympanic membrane. Other minor complications were transient otorrhea caused by myringitis (two cases) and a pinpoint perforation (one case). CONCLUSION: Tympanoplasty alone, i.e., without mastoidectomy, may adequately control COM, if it shows dry-up status for at least 3 months even though mastoid cavity opacification is detected in TBCT.

The First Case of Chronic Otitis Media due to Kerstersia gyiorum in Korea

No abstract available.

Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

The Allele 2 of the VNTR Polymorphism in the Gene That Encodes a Natural Inhibitor of IL-1β, IL-1RA Is Favorably Associated With Chronic Otitis Media

OBJECTIVES: Chronic otitis media (COM) is followed by irreversible tissue damage and destruction of the middle ear structures, with the possibility of complications under the maintenance of inflammation. Inflammatory mediators such as cytokines play a crucial role in the initial stage of inflammation. The aim of this study was to evaluate the association of the polymorphisms in two innate immunity/inflammation cascade genes from interleukin-1 (IL-1) gene cluster with COM with regard to cholesteatoma. METHODS: In the cross-sectional case-control study, DNA samples were collected from 189 patients with COM and 119 controls from a population of Serbia. The +3953 C/T (rs1143634), TaqI polymorphism in interleukin-1 beta (IL-1β) gene and 86 bp variable number tandem repeat (VNTR, rs2234663) polymorphism in the IL-1 receptor antagonist (IL-1RA) gene were analyzed by polymerase chain reaction. RESULTS: The IL-1β TaqI polymorphism was not significantly different in patients compared with the control group. The significant difference between patients and controls was observed for both, genotype and allele frequencies of IL-1RA VNTR polymorphism (chi-square P < 0.01). We found that carriers of IL-1RA allele 2 (odds ratio, 0.47; 95% confidence interval, 0.29 to 0.76; P=0.004) have a favorable association with COM, using multivariate logistic analysis that included both polymorphisms, age and sex. The IL-1RA allele frequency distribution was significantly different with regard to cholesteatoma. CONCLUSION: The carriers of allele 2 of VNTR IL-1RA polymorphism had a decreased odds ratio for COM, which is in agreement with findings in other inflammatory disease and its previous association with higher IL-1RA levels. Possible down-regulation of IL-1 mediated proinflammatory signaling pathways via IL-1RA in COM as well as results of our study should be further investigated and replicated.

Influence of Vitamin D Deficiency on Progression of Experimental Otitis Media in Rats

BACKGROUND: Vitamin D plays an important role in the immune response against infection. The purpose of the present study was to investigate the influence of vitamin D deficiency on the progression of otitis media (OM) using an experimental rat model. METHODS: Four-week-old male Sprague-Dawley rats (n=72) were divided into two groups based on their diet: a control diet group (n=36) and a vitamin D-deficient diet group (n=36). After 8 weeks of diet, experimental OM was induced by inoculation of non-typeable Haemophilus influenzae in the middle ear cavity. The rats were evaluated with otomicroscopy to determine the inflammation in the middle ear mucosa on days 1, 2, 4, 7, and 14 post-inoculation. Bullae from sacrificed rats were collected and analyzed histologically. RESULTS: The middle ear mucosa from rats with vitamin D deficiency showed a significantly higher thickness than that of controls during the course of OM. The maximum mucosal thickness was 56.0±9.1 µm in the vitamin D deficiency group, and 43.9±9.8 µm in the control group, although there was no significant difference in the tympanic membrane score between the two groups evaluated with otomicroscopy. An immunohistochemical study showed increased expression of interleukin 6 (IL-6) and tumor necrosis factor α in rats manifesting vitamin D deficiency and decreased expression of IL-10 compared with controls. CONCLUSION: Our results showed that vitamin D deficiency may exacerbate the pathophysiological changes of OM via altered cytokine production. Therefore, maintaining vitamin D status in the optimal range may be beneficial for proper management of OM.