Associated factors, health-related quality of life, and reported costs of chronic otitis media in adults at two otologic referral centers in a middle-income country.

BACKGROUND: Despite the high prevalence of chronic otitis media (COM) in low to middle-income countries, there are few studies regarding its associated factors, health-related quality of life, and treatment costs. This study aimed to identify associated factors of COM, assess its impact on the quality of life as well as estimate the patients' reported costs of COM treatment in Colombia. METHODS: Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Questionnaires focusing on sociodemographic and clinical associated factors, quality of life, and patients' reported costs were administered to 200 adults with COM diagnosis and 144 control adults. Otoscopic evaluation and audiometric data were collected. RESULTS: The mean age was 42.2 years (SD: 14.44). The median length of COM was 26.13 years (SD: 17.06), and 79.5% of the COM patients reported otorrhea during childhood (P-value: 0.01). The most frequently reported allergic disease among our study population was allergic rhinitis (26.5%). COM was less frequent in patients with a medium-high socioeconomic status (PR: 0.54; 95% CI: 0.39-0.72), and more frequent in patients who reported increased ear discharge due to upper respiratory tract infections (PR: 1.69; 95% CI: 1.68-1.70). The global score of the "Chronic Suppurative Otitis Media Questionnaire-12" showed a difference of 9 points between patients with active and inactive COM (P < 0.001). Patients spent between 12.07% to 60.37% of their household income on expenses related to COM. CONCLUSIONS: Associated factors found in this study are consistent with previous reports. COM has a significant financial impact and affects patients' quality of life. Worldwide research addressing these issues in poor-resource countries is scarce, further studies are needed.

Validation of a Spanish version of the health-related quality of life (HRQoL) measure for Chronic Otitis Media (COMQ-12).

BACKGROUND: Evaluation of health-related quality of life (HRQoL) is considered an important aspect of clinical assessment and health research. Chronic Otitis Media (COM) is related to the quality of life deterioration subsequent to COM symptoms, social communication impairments, and lower work performance. However, there is no reliable information regarding the impact of this disease on health and quality of life in many resource-poor countries. Therefore, we translated into Spanish the Chronic Otitis Media Questionnaire-12 (COMQ-12) for the evaluation of HRQoL of Chronic Otitis Media (COM) in adult patients. Also, we assessed the psychometric properties of the Spanish version of the questionnaire. METHODS: Two otology referral centers in Bogotá, Colombia were included. The Spanish version of COMQ-12 was applied twice to 200 adult patients with confirmed COM diagnosis and 31 healthy controls to perform the validation process and assess the internal consistency of this questionnaire. Psychometric characteristics (internal consistency, test-retest reliability, and construct validity) of the COMQ-12 were assessed. Exploratory Factor Analysis and Confirmatory Factor Analysis were conducted via structural equation modeling to test the questionnaire's structure. RESULTS: The Spanish version of the COMQ-12 showed good internal consistency (Cronbach's Alpha: 0.86, McDonald's Omega: 0.89). Coefficients corresponding to Lin's Concordance test and test-retest reliability were 0.95 and 0.83 respectively. Correlation between the Visual Analogue Scale (VAS) and the COMQ-12 was 0.68 (95% CI 0.59-0.75, p value < 0.001). Factor analysis of the Spanish version of the COMQ-12 indicated a questionnaire structure with three domains: smelly discharge related symptoms; hearing loss related symptoms; and impact on work, lifestyle, and health services. CONCLUSION: This Spanish version of the COMQ-12 showed high reliability and high internal consistency. This questionnaire can be used as an objective clinical tool to assess the HRQoL of patients who have a COM diagnosis. TRIAL REGISTRATION: Hospital Universitario Fundación Santa Fe, Ethical Committee Registration ID: CCEI-8807-2018. Hospital de San José, Ethical Committee: Record number 500, DI-I-0632-18.

Adaptation and validation of the chronic otitis media questionnaire 12 (COMQ-12) in the Mexican Spanish language (COMQ-12-Mx).

Background: Chronic otitis media (COM) questionnaire 12 (COMQ-12) is a specific-disease tool that evaluates COM patients.Objective: To validate COMQ-12 in the Mexican Spanish language (COMQ-12-Mx).Materials and methods: Mexican Spanish-speaking healthy volunteers and COM patients who attended a Secondary Care Center from May 2019 to October 2019. The COMQ-12 in Mexican Spanish was obtained by translation and back translation from an English-Spanish translator. All participants completed the COMQ-12-Mx questionnaire. COM patients were included regardless of their COM status. Control group completed the questionnaire twice. Participants were categorized into three groups: group 1 (COM), group 2 (volunteers first test) and group 3 (volunteers retest). Cronbach's alpha was used for internal consistency, Spearman's rank correlation coefficient was used for test-retest reliability and Mann-Whitney U test compared groups.Results: We included 78 Mexican Spanish-speaking participants (COM n = 37, healthy volunteers n = 41), 51 females and 27 males, mean age was 39.67 years (SD ± 18.32). Group 1 COMQ-12-Mx score was 22.108 ± 11.79, group 2 score was 3.561 ± 4.399 (p ≤ .001) and group 3 score was 3.683 ± 4.435. Cronbach's alpha was 0.828 and test-retest reliability achieved a 0.928 outcome.Conclusions: COMQ-12-Mx is a valid and reliable tool to evaluate quality life in Mexican Spanish-speaking patients with COM.

Validation of a Portuguese version of the health-related quality of life measure for active chronic otitis media (COMQ-12) / Validation of a Portuguese version of the health-related quality of life measure for active chronic otitis media (COMQ-12)

Abstract Introduction: Measuring the impact on quality of life, especially after the beginning of the treatment, is becoming increasingly important in healthcare. Objective: The aim of this study was to translate the Chronic Otitis Media Questionnaire-12 (COMQ-12) into Portuguese language and validate this version in a group of patients with chronic otitis media. Methods: The Portuguese version of COMQ-12 was obtained by translation and back translation. Portuguese speaking patients with a history of active chronic otitis media were asked to complete the COMQ-12 Portuguese version. Cronbach's α coefficient was calculated for an estimation of the internal consistency of the questionnaire. Results: A total of 100 patients were included in the study; 49 women and 51 men, with a mean age of 39 years (range 12-77 years, median 40 years). The average COMQ-12 score was 29, out of a maximum score of 60. Cronbach's α result for the Portuguese version of the COMQ-12 was 0.85, indicating a high internal consistency. The participants presented with different forms of chronic otitis media, and almost all domains of the COMQ-12 questionnaire were able to differentiate between patients with healed chronic otitis media and patients with cholesteatoma or wet tympanic membrane perforation. Showing that patients with healed chronic otitis media have a better quality of life, measured by the COMQ-12, is a first step to guarantee the questionnaire's validity. The next step will consist on routinely using the questionnaire in patients undergoing surgery for chronic otitis media in order to evaluate their quality of life after treatment. Conclusion: The COMQ-12 Portuguese version showed high reliability, and may be used as an assessment of quality of life in patients with chronic otitis media

Resumo: Introdução: Medir o impacto na qualidade de vida, especialmente após o início do tratamento dos pacientes, está se tornando cada vez mais importante nos cuidados da saúde. Objetivo: O objetivo deste estudo foi traduzir o Questionário de Otite Média Crônica-12 (COMQ-12) para a língua portuguesa e validar essa versão em um grupo de pacientes com Otite Média Crônica. Método: A versão em Língua Portuguesa do COMQ-12 foi obtida através de tradução e posterior retrotradução. Pacientes nativos da língua portuguesa com histórico de OMC ativa foram convidados a completar o COMQ-12 em Português. O coeficiente α de Cronbach foi calculado para estimar a consistência interna do questionário. Resultados: Um total de 100 pacientes foram incluídos no estudo; 49 eram mulheres e 51 eram homens, com média de idade de 39 anos (variação: 12 a 77 anos, mediana de 40 anos). O escore médio do COMQ-12 foi 29, de um escore máximo de 60. O resultado do coeficiente α de Cronbach para a versão em português do COMQ-12 foi de 0,85, indicando que sua consistência interna era alta. Os participantes apresentavam diferentes formas de otite média crônica e quase todos os domínios do questionário COMQ-12 foram capazes de diferenciar entre pacientes com otite média crônica curada e pacientes com colesteatoma ou perfuração úmida de membrana timpânica. Demonstrar que pacientes com otite média crônica curada apresentam uma melhor qualidade de vida, medida pelo COMQ-12 é o primeiro passo para garantir a validade do questionário. O próximo passo será utilizá-lo rotineiramente em pacientes submetidos à cirurgia para otite média crônica e avaliar a qualidade de vida após o tratamento. Conclusão: A versão em português do questionário COMQ-12 mostrou alta confiabilidade e pode ser utilizada como questionário de medida de qualidade de vida em pacientes com otite média crônica.

Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy / Efeitos da reconstrução da cavidade da timpanomastoidectomia com técnica aberta na morbidade e qualidade de vida

Abstract Introduction: Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure. Objective: To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction. Methods: In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory. Epithelial migration, air caloric testing, and the Glasgow Benefit Inventory were evaluated in the study and control groups. Results: The epithelial migration rate was significantly faster in study group (1.63 ± 0.5 mm/week) than control group (0.94 ± 0.37 mm/week) (p = 0.003, p < 0.05). The mean slow component velocity of nystagmus of the study group (13.33 ± 5.36°/s) was significantly lower when compared to control group (32.11 ± 9.12°/s) (p = 0.018). The overall the Glasgow Benefit Inventory score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively). Conclusions: Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.

Resumo Introdução: A timpanomastoidectomia com a técnica Canal Wall Down, ou técnica aberta, é comumente utilizada para tratar otite média crônica avançada ou colesteatoma. As vantagens da mastoidectomia pela técnica aberta são uma excelente exposição para a erradicação da doença e controle pós-operatório da doença residual; suas desvantagens incluem o acúmulo de detritos que requerem manutenção e limpeza otológica ao longo da vida, drenagem contínua da orelha, infecções fúngicas na cavidade e a ocorrência de tonturas e vertigem com alterações de temperatura ou pressão. Objetivo: Avaliar se os problemas induzidos pela cavidade podem ser eliminados e o conforto do paciente aumentado com a reconstrução da cavidade mastoide. Método: No total, 11 pacientes submetidos à reconstrução da cavidade mastoide entre março de 2013 e junho de 2013 constituíram o grupo de estudo, e 11 pacientes com cavidades secas e epitelizadas, operadas pela técnica aberta, foram recrutados como grupo controle. O estudo analisou três parâmetros: migração epitelial, prova calórica com estimulação a ar e o questionário Glasgow Benefit Inventory. A migração epitelial, a prova calórica e o Glasgow Benefit Inventory foram avaliados nos grupos de estudo e controle. Resultados: A taxa de migração epitelial foi significativamente mais rápida no grupo de estudo (1,63 ± 0,5 mm/semana) do que no grupo controle (0,94 ± 0,37 mm/semana) (p = 0,003, p < 0,05). A velocidade média do componente lento do nistagmo no grupo de estudo (13,33 ± 5,36°/s) foi significativamente menor se comparada ao grupo controle (32,11 ± 9,12°/s) (p = 0,018). O escore global do Glasgow Benefit Inventory foi de -7,21 e os escores da subescala geral, saúde física e social foram -9,71, -21,09 e +20,35, respectivamente, no grupo controle. Esses escores foram +33,93, +35,59, +33,31 e +29,61, respectivamente, no grupo de estudo. Todos, exceto o escore de saúde social, melhoraram significativamente (0,007, 0,008, 0,018 e 0,181, respectivamente). Conclusões: A reconstrução da cavidade melhora a migração epitelial, normaliza as respostas da prova calórica e aumenta a qualidade de vida. Assim, a reabilitação da cavidade elimina os problemas induzidos por cavidades abertas ao restaurar a anatomia funcional da orelha.

Validation of a Portuguese version of the health-related quality of life measure for active chronic otitis media (COMQ-12).

INTRODUCTION: Measuring the impact on quality of life, especially after the beginning of the treatment, is becoming increasingly important in healthcare. OBJECTIVE: The aim of this study was to translate the Chronic Otitis Media Questionnaire-12 (COMQ-12) into Portuguese language and validate this version in a group of patients with chronic otitis media. METHODS: The Portuguese version of COMQ-12 was obtained by translation and back translation. Portuguese speaking patients with a history of active chronic otitis media were asked to complete the COMQ-12 Portuguese version. Cronbach's α coefficient was calculated for an estimation of the internal consistency of the questionnaire. RESULTS: A total of 100 patients were included in the study; 49 women and 51 men, with a mean age of 39 years (range 12-77 years, median 40 years). The average COMQ-12 score was 29, out of a maximum score of 60. Cronbach's α result for the Portuguese version of the COMQ-12 was 0.85, indicating a high internal consistency. The participants presented with different forms of chronic otitis media, and almost all domains of the COMQ-12 questionnaire were able to differentiate between patients with healed chronic otitis media and patients with cholesteatoma or wet tympanic membrane perforation. Showing that patients with healed chronic otitis media have a better quality of life, measured by the COMQ-12, is a first step to guarantee the questionnaire's validity. The next step will consist on routinely using the questionnaire in patients undergoing surgery for chronic otitis media in order to evaluate their quality of life after treatment. CONCLUSION: The COMQ-12 Portuguese version showed high reliability, and may be used as an assessment of quality of life in patients with chronic otitis media.

Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy.

INTRODUCTION: Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure. OBJECTIVE: To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction. METHODS: In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory. Epithelial migration, air caloric testing, and the Glasgow Benefit Inventory were evaluated in the study and control groups. RESULTS: The epithelial migration rate was significantly faster in study group (1.63±0.5mm/week) than control group (0.94±0.37mm/week) (p=0.003, p<0.05). The mean slow component velocity of nystagmus of the study group (13.33±5.36°/s) was significantly lower when compared to control group (32.11±9.12°/s) (p=0.018). The overall the Glasgow Benefit Inventory score was -7.21, and the general subscale, physical and social health scores were -9.71, -21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively). CONCLUSIONS: Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.

A prospective observational cohort study to assess the incidence of acute otitis media among children 0-5 years of age in Southern Brazil

Abstract Objectives: To estimate acute otitis media incidence among young children and impact on quality of life of parents/caregivers in a southern Brazilian city. Methods: Prospective cohort study including children 0-5 years of age registered at a private pediatric practice. Acute otitis media episodes diagnosed by a pediatrician and impact on quality of life of parents/caregivers were assessed during a 12-month follow-up. Results: During September 2008-March 2010, of 1,136 children enrolled in the study, 1074 (95%) were followed: 55.0% were ≤2 years of age, 52.3% males, 94.7% white, and 69.2% had previously received pneumococcal vaccine in private clinics. Acute otitis media incidence per 1000 person-years was 95.7 (95% confidence interval: 77.2-117.4) overall, 105.5 (95% confidence interval: 78.3-139.0) in children ≤2 years of age and 63.6 (95% confidence interval: 43.2-90.3) in children 3-5 years of age. Acute otitis media incidence per 1000 person-years was 86.3 (95% confidence interval: 65.5-111.5) and 117.1 (95% confidence interval: 80.1-165.3) among vaccinated and unvaccinated children, respectively. Nearly 68.9% of parents reported worsening of their overall quality of life. Conclusion: Acute otitis media incidence among unvaccinated children in our study may be useful as baseline data to assess impact of pneumococcal vaccine introduction in the Brazilian National Immunization Program in April 2010.

A prospective observational cohort study to assess the incidence of acute otitis media among children 0-5 years of age in Southern Brazil.

OBJECTIVES: To estimate acute otitis media incidence among young children and impact on quality of life of parents/caregivers in a southern Brazilian city. METHODS: Prospective cohort study including children 0-5 years of age registered at a private pediatric practice. Acute otitis media episodes diagnosed by a pediatrician and impact on quality of life of parents/caregivers were assessed during a 12-month follow-up. RESULTS: During September 2008-March 2010, of 1,136 children enrolled in the study, 1074 (95%) were followed: 55.0% were ≤2 years of age, 52.3% males, 94.7% white, and 69.2% had previously received pneumococcal vaccine in private clinics. Acute otitis media incidence per 1000 person-years was 95.7 (95% confidence interval: 77.2-117.4) overall, 105.5 (95% confidence interval: 78.3-139.0) in children ≤2 years of age and 63.6 (95% confidence interval: 43.2-90.3) in children 3-5 years of age. Acute otitis media incidence per 1000 person-years was 86.3 (95% confidence interval: 65.5-111.5) and 117.1 (95% confidence interval: 80.1-165.3) among vaccinated and unvaccinated children, respectively. Nearly 68.9% of parents reported worsening of their overall quality of life. CONCLUSION: Acute otitis media incidence among unvaccinated children in our study may be useful as baseline data to assess impact of pneumococcal vaccine introduction in the Brazilian National Immunization Program in April 2010.

Quality of life of young patients with recurrent respiratory papillomatosis.

OBJECTIVE: To assess quality of life of children and teenagers with recurrent respiratory papillomatosis, according to the evidence of infection by human papillomavirus types 6 and 11, compared with healthy volunteers and patients with chronic otitis media. METHOD: Participants and their parents completed the Pediatric Quality of Life Inventory 4.0. RESULTS: Patients with recurrent respiratory papillomatosis and their parents reported lower quality of life than healthy subjects (p < 0.01), but similar quality of life to patients with chronic otitis media. Those with human papillomavirus type 11 showed the lowest scores among all participants (p < 0.05). CONCLUSION: Young Mexican patients with recurrent respiratory papillomatosis and their parents perceive a poor quality of life, and they may experience limitations in interactions with their peers. Infection by human papillomavirus type 11 may increase the impact of the disease on quality of life.

Otite média e a relaçäo familiar / Otitis media and familiar relations

O presente trabalho baseou-se na hipótese de que aspectos relacionados à comunicaçäo familiar poderiam interferir no desenvolvimento e manutençäo da patologia crônica de ouvido médio, mais especificamente a otite média com efusäo. Foram investigados, através de entrevistas e Procedimentos de Desenho de Família com Estórias, os membros de cinco famílias selecionadas através da identificaçäo de crianças com história de cronicidade em patologia de ouvido médio e portadoras de alteraçäo efetiva ou seqüela do quadro patológico ao momento da avaliaçäo atual. Os resultados foram analisados com base no referencial psicanalítico, priorizando-se os aspectos do relacionamento familiar e as concepçöes relativas à doença. Identificamos que as experiências de vida pessoal de pais e mäes em suas famílias de origem e a näo correspondente elaboraçäo das perdas vividas colaboraram para que repetissem, em suas famílias atuais, a mesma condiçäo de ausência na vida de seus filhos. Verificamos ainda que a relaçäo inicial entre a mäe e seu bebê, parece ter interferido no desenvolvimento da patologia em tenra idade, demonstrando, estas mäes, näo terem se apresentado disponíveis para o atendimento incondicional das necessidades de seus bebês. A näo satisfaçäo imediata às necessidades do bebê parece ter-lhes proporcionado a perda de referenciais básicos de identidade necessários à continuidade da condiçäo intra uterina. Em suas falas, as crianças deste estudo revelam conter, na doença física, os sentimentos de hostilidade relacionados à ausência de figuras parentais, em especial a da mäe. Revelam näo terem sido percebidos pelos pais em suas verdadeiras necessidades, mantendo-se, ainda hoje, em busca da relaçäo afetiva almejada. Sugerem que a comunicaçäo afetiva näo é facilitada e que esta condiçäo tende a se repetir pela falta de experiência