Therapeutic Effect of Tympanoplasty on Patients with Chronic Otitis Media with Tinnitus and Influencing Factors.

Objective: This research was conducted to investigate the therapeutic effects of tympanoplasty on patients with chronic otitis media with tinnitus and analyze the possible influencing factors for patient prognosis. Methods: This is a pre-post control group study, 86 patients with chronic otitis media were included as the subjects and enrolled into tinnitus group (n = 46) and the non-tinnitus group (n = 40). All patients underwent tympanoplasty under microscope or ear endoscopy. A tinnitus severity and efficacy assessment scale was employed for the evaluation of the severity of tinnitus among the subjects. In addition, tinnitus handicap inventory (THI) was utilized to evaluate disease alleviation. Results: Before treatment, the proportions of the patients with tinnitus at grades I, II, III, IV, and V amounted to 15.22%, 32.61%, 21.74%, 17.39%, and 13.04%, respectively, while they were 30.43%, 45.65%, 13.04%, 8.71%, and 2.17%, respectively 3 months after treatment (P < .05). THI scores for the patients in the tinnitus group before and 3 months after treatment amounted to 17.96 ± 3.66 and 16.21 ± 3.29, respectively (P < .05). After treatment, the air conduction (AC) and bone conduction (BC) thresholds and air-bone gap (ABG) of the two groups apparently declined (P < .05). No statistical significance was detected in the differences in disease classification, disease courses, and whether an electric drill was used among the patients between effective and invalid groups (P > .05). Conclusion: To some extent, tympanoplasty alleviated tinnitus among patients with chronic otitis media and promoted the restoration of hearing. Hence, it is worthy of application in clinical treatment.

Improvement of Suspected Eosinophilic Otitis Media with Targeted Biologic Therapy.

OBJECTIVE: To compare the responses of suspected eosinophilic otitis media to treatment with or without a targeted biologic therapy against interleukin-4 (IL-4), IL-5, or IL-13 signaling. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: Subjects with type 2 chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and otitis media who underwent treatment between 2005 and 2021. INTERVENTION: Treatment with targeted biologic therapy. MAIN OUTCOME MEASURES: Pre- and posttreatment nasal endoscopy, ear examination, and audiologic evaluation. RESULTS: Four hundred seventy-seven subjects with type 2 CRSwNP were treated between 2005 and 2021. Sixty-two had otitis media with pre- and posttreatment evaluation. Retrospective chart review assessed pre- and posttreatment exam findings, nasal endoscopy, audiometry, and tympanometry. Nineteen subjects received a biologic therapy, whereas 43 did not. Exam, endoscopy, and tympanometry were graded for severity and compared pre- and posttreatment. Subjective ear exam and tympanometry were significantly improved with biologic therapy (control = 0.05, biologic = 0.84, p = 9.3 × 10 -5 ; control = -0.1, biologic = 0.62, p = 0.0002). Conductive hearing loss as assessed by air-bone gaps did not change between groups (control = 1.2 dB better, biologic = 1.2 dB worse, p = 0.32). Nasal endoscopy findings improved with biologic therapy relative to the control group, although not statistically significant (control = 1.04, biologic = 1.36, p = 0.22). CONCLUSIONS: Biologic therapies targeting interleukin-4 (IL-4), IL-5, and IL-13 signaling are potential new treatments for eosinophilic otitis media. This is the largest study demonstrating improvement in subjects with suspected eosinophilic otitis media in response to biologic therapy, and immune modulation represents a novel treatment strategy for this challenging condition. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED: Current treatment strategies for otologic symptoms in eosinophilic disease are not tremendously effective or durable, resulting in a need for improved treatment options. LEARNING OBJECTIVE: To determine if targeted biologic therapy, often used for eosinophilic asthma and type 2 chronic rhinosinusitis with nasal polyposis, improves coexistent suspected eosinophilic otitis media. DESIRED RESULT: Treatment of suspected eosinophilic otitis media with targeted biologic therapy will result in improvement of otologic symptoms with a durable response compared with current treatment options. LEVEL OF EVIDENCE: Level IV. INDICATE IRB OR IACUC: Exempt. HUM00182703.

Otoendoscopic Tympanic Repair of Tympanic Perforations Secondary to Chronic Otitis Media Using Porcine Small-intestine Membrane.

Context: The most common cause of hearing loss is chronic otitis media. Patients often exhibit ear tightness, ear plugging, conductive hearing loss, and even secondary perforation of the tympanic membrane. Patients require antibiotics to improve symptoms, and some patients need surgical repair of the membrane. Objective: The study intended to examine the effects of two methods of surgical transplantation using porcine mesentery under an otoscope on the surgical outcomes of patients with tympanic-membrane perforation secondary to chronic otitis media, with the intent to provide a basis for clinical practice. Design: The research team conducted a retrospective case-controlled study. Setting: The study took place at the Sir Run Run Shaw Hospital of the College of Medicine at Zhejiang University in Hangzhou, Zhejiang, China. Participants: Participants were 120 patients with tympanic membrane perforations that were secondary to chronic otitis media who had been admitted to the hospital between December 2017 and July 2019. Intervention: The research team divided the participants into two groups according to the surgical indications for repair of their perforations: (1) for patients with the central type of perforations with a rich residual tympanic membrane, the surgeon used the internal implantation method, and (2) for patients with a marginal or central perforation with a low residual tympanic membrane, the surgeon used the interlayer implantation method. Both groups received the implantations under conventional microscopic tympanoplasty, and the Department of Otolaryngology Head & Neck Surgery at the hospital provided the porcine mesenteric material. Outcome Measures: The research team compared the differences between the groups in operation time, blood loss, changes in the level of hearing loss between baseline and postintervention, air-bone conductivity, treatment effects, and surgical complications. Results: The operation time and blood loss of the internal implantation group were significantly greater than those of interlayer implantation group (P < .05). At 12 months postintervention, one participant in the internal implantation group had perforation recurrence, and two participants in the interlayer implantation group had infections and two had perforation recurrence. No significant difference existed between the groups in the complication rate (P > .05). Conclusions: Endoscopic repair of tympanic membrane perforations that were secondary to chronic otitis media, using porcine mesentery as the material for implantation, is a reliable treatment with few complications and good postoperative hearing recovery.

Sequential Biotherapy Targeting IL-5 and IL-4/13 in Patients with Eosinophilic Asthma with Sinusitis and Otitis Media.

Type 2 (T2) inflammation plays an important role in the pathogenesis of allergic diseases such as asthma, eosinophilic chronic rhinosinusitis (ECRS), or eosinophilic otitis media (EOM). Currently, in severe asthma with the T2 phenotype, biologics targeting mediators of T2 inflammation dramatically improve the management of severe asthma. While treatment with a single biologic is common, little is known about cases of the sequential use of two biologics. Here, we report a case of severe asthma with refractory ECRS and EOM in which total control of these allergic diseases could not be achieved with a single biologic but could be achieved via the sequential use of the anti-IL-5 receptor antibody and human anti-IL-4/13 receptor monoclonal antibody. It is suggested that it is necessary to control multiple T2 inflammatory pathways to achieve total control of severe allergic diseases. Sequential biotherapy may help solve the clinical challenges associated with single-agent molecular-targeted therapies.

Combined Electric acoustic stimulation in a patient with otitis media with antineutrophil cytoplasmic antibody-associated vasculitis.

There are few reports of the treatment for severe hearing loss due to otitis media with antineutrophil cytoplasmic antibody-associated vasculitis (OMAAV) achieved by cochlear implantation (CI). Here, we have reported the case of a patient with severe bilateral sensorineural hearing loss with low-frequency residual hearing by OMAAV. CI was performed in her right ear based on the results of contrast-enhanced magnetic resonance imaging (CE-MRI) and promontory stimulation test (PST). The residual hearing in her right ear was preserved after CI and utilized for combined electric acoustic stimulation (EAS). The combined EAS was used for 3 years until the residual hearing became stabilized. However, the usable hearing in low frequency worsened gradually, and the fitting strategy of cochlear implant was changed from combined EAS to CI alone 4 years after CI. Even when the speech discrimination score with CI no longer exceeds 50 %, the patient continued using CI because of its advantages in maintaining the quality of life of the patient. The combined EAS was found to be a feasible option even in an OMAAV patient with residual hearing. CE-MRI and PST may thus be helpful in deciding the side of CI surgery in a patient with OMAAV.

Evaluación de la eficacia de la técnica de bombeo para la trompa de eustaquio en otitis media y su relación con la mejora de la hipoacusia / No disponible

Introducción: La otitis media (OM) es la inflamación del oído medio caracterizada por la presencia de edema y exudado inflamatorio en esa cavidad. La OM puede ser asintomática, cursar con fiebre y dolor de oído y, en cualquier caso, puede desencadenar hipoacusia. Objetivos: Describir las características de la patología de OM, su relación con la hipoacusia y las alternativas al tratamiento quirúrgico (TQ). Material y métodos: Se realizó una revisión sistemática usando las palabras clave otitis media children, otitis media treatment, otitis media acute y osteopathic manipulative treatment for otitis media, realizamos una búsqueda bibliográfica en la base de datos Pubmed (MEDLINE) complementado con búsquedas de información en las secciones de fisiología, anatomía, patología y microbiología de la biblioteca biosanitaria de la Facultad de Medicina de la Universidad Complutense de Madrid (UCM).Resultados: Se incluyeron en la revisión 47 artículos (n=47) que cumplieron los criterios de selección en dos fases de análisis, lo cual supone el 23,97 % del total de artículos seleccionados (n=196) y el 55,95 % de los artículos que cumplieron los criterios de selección (n=84) (inclusión y exclusión). La OM es una enfermedad con etiología diversa en la cual la Trompa de Eustaquio (TE) puede obstruirse por múltiples causas. Los síntomas más frecuentemente observados son la aparición de dolor, fiebre e hipoacusia, ya que pueden modificarse de modo permanente las características tisulares de la membrana timpánica afectando con ello a la capacidad auditiva del sujeto. Dicha patología tiene alta prevalencia durante la infancia. En la actualidad los criterios diagnósticos dependen de la presencia de sintomatología asociada así como de los resultados obtenidos en los exámenes al otoscopio y las audiometrías. Conclusiones: Habitualmente el tratamiento de la OM es médico y se basa en disminuir la intensidad de los síntomas y la infección mediante la administración de antibióticos. Ante el fracaso del tratamiento farmacológico la medicina recurre al TQ. La administración de antibióticos resuelve la infección pero no consigue desobstruir la TE para que el exudado estancado en el oído medio drene hacia la orofaringe. La osteopatía plantea alternativas con técnicas de abordaje manual que pretenden restablecer la funcionalidad de la TE evitando así la administración repetida de fármacos o llegar al TQ

No disponible

Risk factors affecting human traumatic tympanic membrane perforation regeneration therapy using fibroblast growth factor-2.

OBJECTIVE: The use of growth factors to achieve closure of human traumatic tympanic membrane perforations (TMPs) has recently been demonstrated. However, pretreatment factors affecting healing outcomes have seldom been discussed. The objective of this study was to evaluate pretreatment factors contributing to the success or failure of healing of TMPs using fibroblast growth factor-2 (FGF-2). DESIGN AND PARTICIPANTS: A retrospective cohort study of 99 patients (43 males, 56 females) with traumatic TMPs who were observed for at least 6 months after FGF-2 treatment between March 2011 and December 2012. Eleven factors considered likely to affect the outcome of perforation closure were evaluated statistically using univariate and multivariate logistic regression analysis. INTERVENTIONS: Each traumatic TMP was treated by direct application of FGF-2. MAIN OUTCOME MEASURES: Complete closure versus failure to close. RESULTS: In total, 99 patients were analyzed. The total closure rate was 92/99 (92.9%) at 6 months; the mean closure time was 10.59 ± 6.81 days. The closure rate did not significantly differ between perforations with or without inverted edges (100.0% vs. 91.4%, p = 0.087), among different size groups (p = 0.768), or among different periods of exposure to injury (p = 0.051). However, the closure rate was significantly different between the high- and low-dose FGF-2 groups (85.0% vs. 98.3%, p = 0.010) and between perforations where the umbo or malleus was or was not involved in perforation (85.4% vs. 98.3%, p = 0.012). Additionally, univariate logistic regression analysis tests showed that it was difficult to achieve healing of these perforations with a history of chronic otitis media or residual TM calcification (p = 0.006), the umbo or malleus was involved in perforation (p = 0.038), and with a high dose of FGF-2 (p = 0.035) compared with control groups. Multivariate logistic regression analysis showed that only a history of chronic otitis media and residual TM calcification and perforation close to the umbo or malleus were associated with non-healing of the TM perforation (p = 0.03 and p = 0.017, respectively) with relative risk factors. CONCLUSIONS: Direct application of FGF-2 can be used in all traumatic TMPs, the size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dose was sufficient to keep the residual eardrum environment moist, but without adding liquid. Additionally, multivariate logistic regression analysis revealed that a large perforation was not a major risk factor for nonhealing of TM perforations. However, a history of chronic otitis media, residual TM calcification and involvement of the umbo or malleus in perforation were significant risk factors.

Serum vitamin D levels in children with recurrent otitis media.

The aims of this study were to evaluate serum vitamin D levels in cases of recurrent otitis media and investigate the effect of vitamin D therapy on the risk of re-occurrence of the disease. This prospective study was performed by comparing serum vitamin D levels in children with recurrent otitis media and healthy children. Eighty-four children between 1 and 5 years of age and diagnosed with recurrent otitis media were enrolled as the study group. One hundred-and-eight healthy children with similar demographic characteristics were enrolled as the control group. Patients were divided into groups according to their serum 25(OH) vitamin D levels. In patients with low initial serum vitamin D levels, vitamin D therapy was administered in addition to conventional treatment for otitis media. Mean serum 25(OH) vitamin D level in the study group was 11.4 ± 9.8 ng/mL Serum 25(OH) vitamin D levels were below 20 ng/mL in 69 % (n = 58) of cases in this group. In the control group, mean serum 25(OH) vitamin D level was 29.2 ± 13.9 ng/mL and was below 20 ng/mL in 30 % (n = 32) of cases. Comparison of serum 25(OH) vitamin D levels and PTH in the study and control groups revealed a statistically significant difference (p < 0.05). Treatment was initiated in cases diagnosed with vitamin D deficiency, and patients were followed up in due course. The only episodes detected over the course of 1-year follow-up were one attack in five patients and two attacks in two. We believe that co-administration of supplementary vitamin D together with conventional treatments is appropriate in the management of upper respiratory infections such as otitis media.

[Gustatory loss: causes, consequences and treatment]. / Smaakverlies: oorzaken, gevolgen en behandeling.

The loss of taste is a common symptom and may have serious somatic and psychological consequences. Little attention is paid to the condition in doctors' practices, however, and the topic is also hardly mentioned in scientific publications. It is important to distinguish between isolated gustatory loss and gustatory loss in combination with other neurological symptoms. Isolated gustatory loss can be the result of a laesion of the chorda tympani of the facial nerve caused by otitis media or damage to the taste buds, for example. Treatment is aimed at removing the cause, e.g. medication or chronic otitis media, but the treatment options are often limited. Zinc supplementation in patients with zinc deficiency has not been proven to be effective. Gustatory loss in combination with other neurological symptoms is caused by damage to one or more cranial nerves, to the brain stem or cerebral cortex, and is an indication for referral to a neurologist. Early detection of the loss of taste, good patient counselling, diagnostics and possible treatment may limit the negative consequences of this condition.

Otitis media aguda / Acute otitis media

We review differents topics about acute otitis media without complication. There is a frequent cause of visit to pediatric office. We showed risk factors, to consider how to prevent it. As viral infection are frequent cause there is not necessary to start antibiotics. Finally we describe complications as otitis effusion.

Se revisan diversos aspectos de la otitis media aguda no complicada, causa muy frecuente de consulta en nuestra práctica pediátrica. Se mencionan sus factores de riesgo, que constituyen los principales elementos a considerar para su prevención. Debido a la frecuente etiología viral, la conducta terapéutica actual considera en ciertas situaciones postergar el inicio del tratamiento antibiótico. Finalmente se describen sus complicaciones, siendo la más frecuente la efusión en oído medio.

Otitis media.

Acute otitis media (AOM) is diagnosed based on visualization of a full or bulging tympanic membrane with middle ear effusion. The distribution of bacteria causing AOM in North America under the influence of pneumococcal conjugate vaccination and antibiotic selection pressure has resulted in a predominance of ß-lactamase-producing Haemophilus influenzae followed by penicillin-resistant Streptococcus pneumoniae. Although guidelines continue to endorse amoxicillin as the preferred treatment, amoxicillin/clavulanate in high dosage would be the preferred treatment based on the otopathogen mix currently. Antibiotic prophylaxis has fallen into disfavor as a preventative strategy for AOM recurrences.

[Comparative characteristic of the local application of anti-inflammatory agents for the treatment of otitis externa and otitis media].

The objective of the present work was the clinical study of candibiotic exhibitic antibacterial, antimycotic, anti-inflammatory, and anesthetic properties when applied for the treatment of otitis externa and otitis media. This agent was included together with traditionally used systemic medications in the combined treatment of 26 patients. It was applied in the form of endoaural drops, transtubal administration through a catheter, and transtympanic pumping by the Politzer balloon technique (in case of perforation). In the patients with otomycosys, the preparation was used for the treatment of the external acoustic canal after the removal of fungal masses thrice daily for 1 month. Good clinical effect achieved in all the patients was manifest as the normal otoscopic picture and less frequent complaints on days 8-10 after the onset of therapy. Its maximum duration was 21 days. Positive dynamics (pain relief) was apparent within the first 2 days of the treatment. Fungal mycelium was absent after 14-16 days of the treatment in 100% of the patients initially presenting with yeast-like fungi.

Homeopathic ear drops as an adjunct to standard therapy in children with acute otitis media.

OBJECTIVE: To assess the effectiveness of a homeopathic ear drop for treatment of otalgia in children with acute otitis media (AOM). METHODS: Children with AOM were enrolled in the study at the time of diagnosis and randomized to receive either standard therapy alone or standard therapy plus a homeopathic ear drop solution that was to be used on as needed basis for up to 5 days. Parents of children in both treatment groups rated the severity of 5 AOM symptoms twice daily for 5 days in a symptom diary. A symptom score was computed for each assessment with lower scores denoting less severe symptoms. Parents of children randomized to receive ear drops also recorded information regarding symptoms being treated and response to treatment. RESULTS: A total of 119 eligible children were enrolled in the study; symptom diaries were received from 94 (79%). Symptom scores tended to be lower in the group of children receiving ear drops than in those receiving standard therapy alone; these differences were significant at the second and third assessments (P = 0.04 and P = 0.003, respectively). In addition, the rate of symptom improvement was faster in children in the ear drop group compared with children in standard therapy alone group (P = 0.002). The most common reason for administration of ear drops was ear pain, recorded for 93 doses; improvement was noted after 78.4% of doses for this indication. There were no significant side effects related to use of the ear drops. CONCLUSIONS: This study suggests that homeopathic ear drops were moderately effective in treating otalgia in children with AOM and may be most effective in the early period after a diagnosis of AOM. Pediatricians and other primary health care providers should consider homeopathic ear drops a useful adjunct to standard therapy.

Effect of Ginkgo biloba extract on endotoxin-induced labyrinthitis.

OBJECTIVE: There are no reports on the therapeutic effect of Ginkgo biloba extract (GBE) on otitis media-induced labyrinthitis. The present study examined whether GBE can protect against cochlear damage induced by intratympanic instillation of lipopolysaccharide (LPS)-induced labyrinthitis. MATERIALS AND METHODS: Experiments were performed in 20 healthy young male guinea pigs. The control group (n=10) received an intratympanic instillation of LPS (20 µl, 3mg/ml). The experimental group (n=10) received intratympanic instillation of LPS immediately after instillation of GBE (10mg/kg) and then experimental groups received GBE (100mg/kg) by intraperitoneal injection every day for 3 days. Instillation of LPS or LPS immediately after GBE was done in the right ear; the untreated left ear was considered normal. Physiological and morphological changes were evaluated. RESULTS: Statistical analysis of treatment of GBE revealed significantly less hearing loss than LPS group (p<0.05). The ratio of the value of cochlear blood flow (CBF) compared to untreated left side was significantly higher in the GBE treated group than in the LPS-treated group (p<0.05). This result indicated the recovery of CBF in GBE treated group compared to LPS treated group. In the LPS group, scanning electron microscopy revealed hair cell damage with edema. Missing stereocilia in the third layer of the outer hair cell was revealed. However, both the inner hair cells and the outer hair cells had normal appearance in the GBE group. LPS group showed that cochlear Evans blue extravasation was increased strongly in the stria vascularis, spiral limbus, and in the spiral ligament compared with the GBE treated group. CONCLUSION: GBE significantly minimizes cochlear damage against LPS-induced otitis media with labyrinthitis in a guinea pig model. GBE has potential as an adjunctive therapy to antibiotics in the treatment of acute otitis media with complicated labyrinthitis.

Predictors of surgical and hearing long-term results for inlay cartilage tympanoplasty.

OBJECTIVE: To determine the prognostic factors that affect surgical and audiologic outcomes in inlay tympanoplasty after long-term follow-up. DESIGN: Case series study. SETTING: Tertiary referral center. PATIENTS: Sixty-two patients who underwent 71 procedures were enrolled in the study. Patient ages ranged from 31 to 87 years (mean [SD] age, 61.2 [12.9] years). Mean (SD) follow-up was 635.7 (284.7) days. The inclusion criteria were (1) inlay cartilage tympanoplasty performed using local anesthesia via a transcanal route, (2) chronic otitis media with stable perforation, and (3) dry ear without middle ear disease. MAIN OUTCOME MEASURES: The success rate and hearing change at the last follow-up visit. RESULTS: The overall success rate was 87.3% at the last visit. Using multivariate analysis, sex, age, size of perforation, side of perforation, and the presence of diabetes mellitus and external auditory canal otomycosis did not affect the success. Smoking was the only independent factor for the prognosis of surgical outcome (odds ratio [OR], 8.16; 95% confidence interval [CI], 1.74-36.89; P < .006). On the other hand, age (OR, 6.62; 95% CI, 1.13-38.47; P = .03) and perforation size (OR, 0.11; 95% CI, 0.10-0.79; P = .03) were independent factors for the prognosis of audiologic outcomes. CONCLUSIONS: The frequency of failure was significantly higher for smokers than for nonsmokers. To quit smoking is highly recommended preoperatively for individuals scheduled for chronic otitis media inlay tympanoplasty intervention. Younger patients and those with larger perforations (>50%) were more likely to benefit from this operation.

Partial ossicular reconstruction: comparison of three different prostheses in clinical and experimental studies.

OBJECTIVE: To compare the reconstruction results of a long incus process defect using 3 different partial ossicular replacement prostheses (PORP). STUDY DESIGN: Temporal bone experiments and retrospective case review. SETTING: Tertiary referral center. EXPERIMENTAL MATERIAL AND PATIENTS: The experimental study was performed on 18 temporal bones; 66 patients with retraction pockets, chronic otitis media with or without cholesteatoma. INTERVENTIONS: Ossiculoplasty using 3 different PORP: titanium angle prosthesis, autologous incus interposition, and titanium clip prosthesis. MAIN OUTCOME MEASURES: Laser Doppler vibrometry in temporal bones measured transmission properties of the PORP. Patients were retrospectively assessed up to 5 years after surgery. Audiologic data were analyzed for preoperative and postoperative air conduction and air-bone gap at 0.5, 1, 2, 3, and 4 kHz. Statistical analyses compared the outcome in the experimental and clinical setting. RESULTS: Experimentally, the titanium PORP showed similar transmission properties because the overall difference to the intact specimen was -4.14 +/- 0.59 dB for the titanium angle prosthesis and -4.61 +/- 0.57 dB for the titanium clip prosthesis. The transmission after an autologous incus interposition was significantly worse (-9.32 +/- 0.39 dB, p < or = 0.001) compared with the other prostheses. Patients' mean postoperative air-bone gap was 25.5 +/- 1.2 dB and less than 20 dB in at least 66% of cases without any significant differences between the groups. CONCLUSION: In the clinical setting, the confounding factors that influence the acoustic outcome after partial ossiculoplasty obscure the prosthesis-related transmission factors that can otherwise be derived in the experimental setting. The results do not generally favor the use of 1 specific prosthesis, rather they suggest that the correct choice of a prosthesis be based on the anatomic and pathophysiologic conditions found in the individual patient.

Petroleum: a series of 25 cases.

This study is based on 25 well documented reports of cases which responded well to treatment with Petroleum. Materia medica data were compared with results in contemporary clinical practice. Many patients had characteristic skin problems; children often had recurrent or chronic upper respiratory tract problems. The most prominent mental feature is a quiet, withdrawn or stubborn disposition. The mental symptoms may be difficult to recognise. Detailed documentation in daily practice can be helpful for preserving data of the effect of a medicine; confirmation of statements given in materia medica; improving understanding of homeopathic medicines and differentiating the indications for medicines.

Diagnosis and treatment of otitis media.

Diagnostic criteria for acute otitis media include rapid onset of symptoms, middle ear effusion, and signs and symptoms of middle ear inflammation. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial isolates from the middle ear fluid of children with acute otitis media. Fever, otalgia, headache, irritability, cough, rhinitis, listlessness, anorexia, vomiting, diarrhea, and pulling at the ears are common, but nonspecific symptoms. Detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis. Observation is an acceptable option in healthy children with mild symptoms. Antibiotics are recommended in all children younger than six months, in those between six months and two years if the diagnosis is certain, and in children with severe infection. High-dosage amoxicillin (80 to 90 mg per kg per day) is recommended as first-line therapy. Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in penicillin-sensitive children and in those with resistant infections. Patients who do not respond to treatment should be reassessed. Hearing and language testing is recommended in children with suspected hearing loss or persistent effusion for at least three months, and in those with developmental problems.

Initial experiments to develop a MEMS transducer for a new implantable audioprosthesis to substitute the tympanic-ossicular system.

CONCLUSION: We tested one prototype of a new audioprosthesis including the audioprocessor, the implemented algorithms and fitting platform in a small group of selected patients with mixed hypoacusis due to earlier bilateral radical mastoidectomy. It was effective to compensate the conductive and the neurosensory components of those patients. Results regarding the energy, frequency and other requirements of the output transduction make it possible to develop a suitable actuator with the available Micro-Electromechanic-Machine-System (MEMS) technology to substitute the conventional transducer of the prototype. OBJECTIVES: The objectives were: a) to evaluate the effectiveness of the whole fitting system, and b) to obtain information about the required energy to design the MEMS actuator. MATERIALS AND METHODS: The experiments were conducted with the A prototype of the prosthesis equipped with an output transducer coupled to the oval window. Two algorithms and three cases were tested. RESULTS: The audioprocessor with the implemented FIR filter-67 coefficients paradigm algorithms, and the fitting system were shown to be adequate for clinical use. Effectiveness parameters were: pure tone average gains 20-33.3 dB; gap closure 25.5-31.8 dB; speech reception thresholds improvement 15-20 dB. Required gain: 5-40 dB. Subjectively, patients considered the results very satisfactory.

Topical analgesia for acute otitis media.

BACKGROUND: Acute otitis media (AOM) is a spontaneously remitting disease for which pain is the most distressing symptom. Antibiotics are now known to have less benefit than previously assumed. OBJECTIVES: To assess the effectiveness of topical analgesia for AOM. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May Week 3 2006), EMBASE (1990 to December 2005) and LILACS (1982 to September 2005) without language restriction, and the reference lists of articles. We also contacted manufacturers and authors. SELECTION CRITERIA: Double-blind randomised or quasi-randomised controlled trials comparing an otic preparation with an analgesic effect (excluding antibiotics) versus placebo or an otic preparation with an analgesic effect (excluding antibiotics) versus any other otic preparation with an analgesic effect, in adults or children presenting at primary care settings with AOM without perforation. DATA COLLECTION AND ANALYSIS: Potential studies were screened independently and trial quality was assessed by three authors, and differences were resolved by discussion. Data was then independently extracted from the trials selected by two authors. We contacted the authors of three trials to acquire additional information not available in published articles. MAIN RESULTS: Our searches yielded 356 records; four trials met our criteria. One trial with 54 participants compared treatment with anaesthetic ear drops versus an olive oil placebo immediately at diagnosis. All patients were also given paracetamol. There was a statistically significant pain reduction of 25% in those receiving anaesthetic drops 30 minutes after instillation. Three trials (with one common co-author) compared anaesthetic ear drops with naturopathic herbal ear drops in 274 patients. One of these trials also used antibiotics in both groups. There were statistically significant differences at instillation of drops, or 15 or 30 minutes after the instillation (or both) on one to three days after diagnosis, always favouring the naturopathic group in each trial. AUTHORS' CONCLUSIONS: The evidence from these four randomised controlled trials, only one of which addresses the most relevant question of primary effectiveness, is insufficient to know whether ear drops are effective or not.