Newborn Hearing Screening: Early Ear Examination Improves the Pass Rate.

BACKGROUND: Temporary conductive hearing loss due to vernix accumulation in the external ear canal may lead to a false-positive result in newborn hearing screening tests. The aim of this study was to evaluate whether ear examination and intervention may reduce the false-positive rate prior to hospital discharge. METHODS: A case series of 42 newborns who failed initial otoacoustic emissions screening were studied in our institution between May and December 2020. RESULTS: During the study period, a total of 735 neonates (1470 ears) were screened by otoacoustic emissions in our hospital. Forty-two newborns who failed otoacoustic emissions were included in our study. They constituted 3.9% (n=58 ears) of the total number of ears screened. Forty-four ears (75.9%) passed and 14 ears (24.1%) failed otoacoustic emissions rescreening performed shortly following vernix cleaning. Twelve of the remaining 14 ears passed at 10-day rescreening. The remaining 2 ears presented true bilateral hearing loss. During the study period, the general false-positive rate decreased from 56/735 (7.61%) to 12/735(1.63%) (P < .00001). CONCLUSION: Cleaning the vernix of infants who failed otoacoustic emissions prior to hospital discharge lowers the false-positive rate of universal neonatal hearing screening. We may assume that vernix cleaning will reduce significant healthcare workload, costs of unnecessary investigations, as well as parental anxiety.

Are Hounsfield Unit Measurements of Bony Absorption Changes in Cholesteatoma Helpful?

Abstract Introduction High-resolution computed tomography (HRCT) scans of the temporal bone are used to assess the bony erosion of the middle-ear structures whenever cholesteatoma is suspected. Objective To study the differences in HRCT Hounsfield unit (HU) index measurements of middle-ear bony structures between an ears with and without cholesteatoma. Methods A retrospective study of 59 patients who underwent surgery due to unilateral cholesteatoma. The HRCT HU index of the scutum, of three middle-ear ossicles, of the lateral semicircular canal (LSCC), and of the fallopian canal was measured in both ears. A comparison was made between the cholesteatoma and the non-cholesteatomatous ear (control). All measurements were conducted by an otolaryngologist. To assess the interobserver bias, 10% of the samples were randomly and independently assessed by another otolaryngologist and a neuroradiologist who were blinded. Results The average HU index was lower in the ear with cholesteatoma when compared with the non-cholesteatomatous ear. While the differences were statistically significant regarding the measurements of the scutum (516.02 ± 311.693 versus 855.64 ± 389.999; p = 0.001), the malleus (1049.44 ± 481.765 versus 1413.47 ± 313.376; p = 0.01), and the incus (498.03 ± 264.184 versus 714.25 ± 405.631; p = 0.001), the differences in the measurements of the LSCC (1042.34 ± 301.066 versus 1154.53 ± 359.609; p = 0.69) and of the fallopian canal (467.19 ± 221.556 versus 543.51 ± 263.573; p = 0.108) were not significantly different between both groups. The stapes was immeasurable in both groups due to its small size. Conclusion Hounsfield unit index measurements are a useful tool that may aid in the diagnosis of early-stage cholesteatoma.

Are Hounsfield Unit Measurements of Bony Absorption Changes in Cholesteatoma Helpful?

Introduction High-resolution computed tomography (HRCT) scans of the temporal bone are used to assess the bony erosion of the middle-ear structures whenever cholesteatoma is suspected. Objective To study the differences in HRCT Hounsfield unit (HU) index measurements of middle-ear bony structures between an ears with and without cholesteatoma. Methods A retrospective study of 59 patients who underwent surgery due to unilateral cholesteatoma. The HRCT HU index of the scutum, of three middle-ear ossicles, of the lateral semicircular canal (LSCC), and of the fallopian canal was measured in both ears. A comparison was made between the cholesteatoma and the non-cholesteatomatous ear (control). All measurements were conducted by an otolaryngologist. To assess the interobserver bias, 10% of the samples were randomly and independently assessed by another otolaryngologist and a neuroradiologist who were blinded. Results The average HU index was lower in the ear with cholesteatoma when compared with the non-cholesteatomatous ear. While the differences were statistically significant regarding the measurements of the scutum (516.02 ± 311.693 versus 855.64 ± 389.999; p = 0.001), the malleus (1049.44 ± 481.765 versus 1413.47 ± 313.376; p = 0.01), and the incus (498.03 ± 264.184 versus 714.25 ± 405.631; p = 0.001), the differences in the measurements of the LSCC (1042.34 ± 301.066 versus 1154.53 ± 359.609; p = 0.69) and of the fallopian canal (467.19 ± 221.556 versus 543.51 ± 263.573; p = 0.108) were not significantly different between both groups. The stapes was immeasurable in both groups due to its small size. Conclusion Hounsfield unit index measurements are a useful tool that may aid in the diagnosis of early-stage cholesteatoma.

Are Children Scheduled for Ventilation Tubes Insertion Overweight? A Cohort of Israeli Children.

OBJECTIVE: To study the hypothesis that children scheduled for ventilation tube insertion (VTI), a surrogate procedure reflecting otitis media (OM) presence, are overweight or obese. PATIENTS AND METHODS: Charts of Israeli children aged 0 to 9 years undergoing VTI with or without adenoidectomy between 9/1/17 and 3/31/19 in a secondary level hospital were retrospectively identified. We compared their mean body mass index (BMI, kg/m2) to the mean BMI of a control group comprised of children who underwent surgeries unrelated to OM (fracture fixation/reduction, inguinal/umbilical hernia repair, meatotomy, appendectomy). BMI measurements were plotted on gender- and age-matched curves to determine BMI percentile, and were also compared to the national pediatric overweight/obesity data. Normal weight was defined as BMI percentile <85%, overweight was BMI percentile between 85% and 97%, and obesity was BMI percentile >97%. RESULTS: The VTI group included 83 children (mean age: 3.5 ± 1.8 years). The control group included 77 children (mean age: 6.3 ± 1.9 years). No statistically significant difference was found in the mean BMI values between both groups (P = .22). When compared to age- and gender-adjusted 50th BMI percentile of the general pediatric population, the mean BMI of the VTI group was significantly higher: for boys, 16.9 versus 15.2 (P < .01), and for girls, 16.6 versus 15.3 (P = .03), but not in the control group: P = .16 (boys) and P = .11 (girls). CONCLUSION: Children undergoing VTI were overweight when compared to their age- and gender-matched peers. This observation was more noticeable in boys.

Pediatric nasal tip abscesses.

Nasal tip abscesses in children are uncommon. We report on 7 children/teenagers who presented with an advanced nasal tip abscess that required intravenous antibiotics and surgical drainage, despite adequate pre-admission antibiotic therapy with amoxicillin/clavulanic acid or cephalosporins. Cultures were positive for Staphylococcus aureus, that was clindamycin-resistant but TMP/SMX sensitive.

Emerging Technologies for the Diagnosis of Otitis Media.

OBJECTIVE: To review new experimental techniques for the diagnosis of otitis media (OM). DATA SOURCES: Literature search in English in the following databases: MEDLINE (via PubMed), Ovid Medline, Google Scholar, and Clinical Evidence (BMJ Publishing) between January 1, 2005, and April 30, 2018. Subsequently, articles were reviewed and included only if relevant. REVIEW METHODS: MeSH terms: ["diagnosis"] AND [all forms of OM] AND ["human"] AND ["ear"] and ["tympanic membrane"]. The retrieved innovative diagnostic techniques rely on and take advantage of the physical properties of the tympanomastoid cavity components: tympanic membrane (TM) thickness, its translucency and compliance; middle ear fluid characteristics; biofilm presence; increased tissue metabolic activity in OM states; and fluid presence in the mastoid cavity. These parameters are taken into account to establish OM diagnosis objectively. We review spectral gradient acoustic reflectometry, digital otoscopy, TM image analysis, multicolor reflectance imaging, anticonfocal middle ear assessment, optical coherence tomography, quantitative pneumatic otoscopy, transmastoid ultrasound, wideband measurements, TM thickness mapping, shortwave infrared imaging, and wideband acoustic transfer functions. CONCLUSIONS: New experimental techniques are gradually introduced to overcome the limitations of standard otoscopy. The aforementioned techniques are still under investigation and are pending widespread clinical use. The implementation of these techniques in the market is dependent on their success in clinical trials, as well as on their future cost. IMPLICATION FOR PRACTICE: New techniques for the diagnosis of OM can objectively evaluate the morphology of the TM, determine the presence of middle ear fluid and evaluate its content, and thus potentially replace standard otoscopy.