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1.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 598-607, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747152

RESUMO

Each person experienced an unpleasant sensation of congestion of the ear during a flight or in rhinorrhea, which is caused by dysfunction of the Eustachian tube (ET). People with persistent ET dysfunction live with this sensation for months and years. Persistent ET dysfunction in children reaches 40%, in adults it is up to 5%. Most of the pathological conditions of the middle ear, leading to socially significant hearing loss, and the main reasons for failures in hearing-improving operations are associated with persistent ET dysfunction. The effectiveness of various methods of treating this pathology, despite their large quantity, still remains doubtful due to the lack of clear criteria and golden standard for diagnosis, indications for specific methods and long-term results of treatment. According to the aim of the study a diagnostic and treatment algorithm was developed for persistent ET dysfunction in adults and children. We researched this problem for more than 10 years, and the effectiveness of the proposed diagnostic and therapeutic measures has been statistically proven, both by a large sample of patients and by a long period of observation. Researchers of L. I. Sverzhevsky Research Institute of Otorhinolaryngology have developed a diagnostic algorithm for persistent ET dysfunction, optimized the treatment of persistent dysfunction and recurrent concomitant secretory otitis media, and also determined the indications and methods for conducting ET balloon dilatation in adults and children with persistent ET dysfunction. We improved the functionality results of hearing-improving operations (tympanoplasty) in patients with persistent ET dysfunction. All of the above allowed us to reduce the treatment time for this group of patients by up to 50%, to achieve high clinical efficacy in up to 100%, and to obtain a lasting functionality in hearing-improving operations in 93% of cases.


Assuntos
Tuba Auditiva , Otite Média com Derrame , Otite Média , Adulto , Criança , Humanos , Otite Média/terapia , Otite Média com Derrame/terapia , Resultado do Tratamento , Timpanoplastia
2.
Vestn Otorinolaringol ; 84(3): 12-15, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31486420

RESUMO

The study involved 172 patients with otitis media with effusion. All patients as a method of early diagnosis of otitis media with effusion conducted multislice computer tomography (MSCT). This made it possible to check the effectiveness of conservative treatment and timely perform surgical treatment, including sanitizing intervention on the middle ear with the erased clinical picture of acute mastoiditis, and to avoid complications. With the help of MSCT of the temporal bones with the dynamic observation of patients with high accuracy, you can confirm the full restoration of pneumatization of the middle ear cavities or identify possible recurrences of exudate accumulation. Patients who underwent surgery were randomly divided into 2 groups, depending on the duration of the laser myringotomy: on the 3rd day of hospital treatment (first group) or on the 7th day of hospital treatment (second group). Absence of otorrhea from the tympanic cavity and return of hearing in patients of the first group was significantly in a shorter period (p<0.05). CO2-laser myringotomy for patients with otitis media with effusion without positive dynamic by conservative therapy is most effectively in the early stages of the disease.


Assuntos
Otite Média com Derrame/diagnóstico , Testes Auditivos , Humanos , Mastoidite , Ventilação da Orelha Média , Otite Média , Otite Média com Derrame/terapia , Recidiva
3.
Curr Allergy Asthma Rep ; 19(10): 47, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31486909

RESUMO

PURPOSE OF REVIEW: To examine the role of allergy medications in the treatment of otitis media with effusion (OME), focusing on use of intranasal steroids and antihistamines. RECENT FINDINGS: There has been ongoing controversy regarding the role of allergy in the development of OME. Treatment of OME with medications commonly used for allergic symptomatology has been studied. Proposed treatment options include decongestants, mucolytics, oral steroids, topical steroids, antihistamines, and antibiotics. We begin by evaluating the proposed association between allergy and OME, and then evaluate intranasal steroids and oral antihistamine therapy in the treatment of OME. The role of the adenoid and concurrent nasal symptomatology is also addressed. The preponderance of data suggests that neither intranasal steroids nor antihistamines improve the long-term clearance of isolated OME and are therefore not recommended. However, data are notably limited with regard to improvement rates in OME in patients specifically with concurrent allergy and/or adenoid hypertrophy. Future studies of medications for OME would ideally incorporate study designs controlling for both allergic rhinitis and adenoid hypertrophy, to better understand the impact of these medications on OME in these subgroups of patients.


Assuntos
Administração Intranasal/métodos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Otite Média com Derrame/terapia , Esteroides/uso terapêutico , Antagonistas dos Receptores Histamínicos/farmacologia , Humanos , Esteroides/fisiologia
4.
Int J Pediatr Otorhinolaryngol ; 126: 109632, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31419743

RESUMO

OBJECTIVE: For children with a history of persistent Eustachian tube dysfunction (ETD) or otitis media with effusion presenting with recurring tympanic membrane (TM) perforation, surgeons must often balance the treatment goals of correcting the perforation and maintaining ventilation to the middle ear to prevent future perforation formation. A partial gelfoam myringoplasty with ventilation tube placement is a previously unreported procedural option for addressing these goals. The objective of this study is to describe the partial myringoplasty technique and report preliminary outcome data for the procedure. METHODS: Retrospective cohort study of 29 children <18 years old undergoing partial myringoplasty at a tertiary care children's hospital or satellite location. Size and course of initial perforation, time to tube extrusion, audiogram findings, and need for future otological procedures were studied. RESULTS: During a partial myringoplasty, a tympanostomy tube is placed in a TM perforation larger than the tube itself. The edges of the perforation are freshened, a tube is placed, and a piece of gelfoam is inserted to support the tube and to cover any remaining perforation. Out of 32 ears in 29 patients, 23 procedures were completed to correct existing perforations. The remainder were indicated in placement (n = 7) or replacement (n = 2) where the myringotomy or existing perforation was deemed too large to retain the tympanostomy tube without further support due to atelectatic or monomeric tympanic membranes. Thirteen tubes extruded within 1 year, of which 12 were Armstrong tubes and 1 was a T-tube. Out of 25 TM perforations corrected, 4 shrank in size and 2 did not close. For patients who underwent pre-surgical audiograms with findings indicating conductive hearing loss and had post-operative audiograms at follow-up, 8/10 showed improvement and 2/10 showed no change in hearing. CONCLUSION: A partial myringoplasty is a simple procedure to close existing TM perforations while maintaining ventilation to the middle ear that can potentially improve hearing, provide ongoing ventilation, and eventually result in TM closure without the need for more complex repair. It may serve as a reasonable first line treatment for repair of perforations, reserving tympanoplasty for patients who fail this procedure.


Assuntos
Esponja de Gelatina Absorvível , Ventilação da Orelha Média , Miringoplastia/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/terapia , Humanos , Lactente , Masculino , Otite Média com Derrame/terapia , Estudos Retrospectivos , Perfuração da Membrana Timpânica/terapia
5.
Trends Hear ; 23: 2331216519858303, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464177

RESUMO

The recommended management for children with otitis media with effusion (OME) is 'watchful waiting' before considering grommet surgery. During this time speech and language, listening skills, quality of life, social skills, and outcomes of education can be jeopardized. Air-conduction (AC) hearing aids are problematic due to fluctuating AC hearing loss. Bone-conduction (BC) hearing is stable, but BC hearing aids can be uncomfortable. Both types of hearing aids are costly. Given the high prevalence of OME and the transitory nature of the accompanying hearing loss, cost-effective solutions are needed. The leisure industry has developed relatively inexpensive, comfortable, high-quality BC headsets for transmission of speech or music. This study assessed whether these headsets, paired with a remote microphone, improve speech discrimination for children with OME. Nineteen children aged 3 to 6 years receiving recommended management in the United Kingdom for children with OME participated. Word-discrimination thresholds were measured in a sound-treated room in quiet and with 65 dB(A) speech-shaped noise, with and without a headset. The median threshold in quiet (N = 17) was 39 dB(A) (range: 23-59) without a headset and 23 dB(A) (range: 9-35) with a headset (Z = -3.519, p < .001). The median threshold in noise (N = 19) was 59 dB(A) (range: 50-63) without a headset and 45 dB(A) (range: 32-50) with a headset (Z = -3.825, p < .001). Thus, the use of a BC headset paired with a remote microphone significantly improved speech discrimination in quiet and in noise for children with OME.


Assuntos
Condução Óssea , Auxiliares de Audição/normas , Perda Auditiva Condutiva/terapia , Otite Média com Derrame/terapia , Percepção da Fala , Criança , Pré-Escolar , Feminino , Auxiliares de Audição/economia , Humanos , Idioma , Masculino , Qualidade de Vida , Resultado do Tratamento , Reino Unido
6.
Int J Pediatr Otorhinolaryngol ; 123: 26-32, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31055204

RESUMO

OBJECTIVE: To assess the capacity of two parental report questionnaires, OMQ-14 and ECLiPS, to support clinical-decision making in children affected by Otitis Media with Effusion (OME). DESIGN: OMQ-14 and ECLiPS were administered twice to 90 children aged 2-12 years, three months apart, or 3 months after surgery to insert ventilation tubes (VT). Children were subdivided according to clinical diagnosis into VT (n = 25) and Active Observation (AO; n = 20), and compared with healthy control children (n = 45). Data were analyzed at group level using repeated measures ANOVA, and at individual level using Receiver Operator Characteristics (ROC) curves and confusion matrices. RESULTS: Both OMQ-14 and ECLiPS were sensitive to the presence of OME, and also to improvements in hearing post-surgery. Both were also good at classifying children into their clinically-established diagnostic groups based on score cut-offs determined using Receiver Operator Characteristics (ROC) curves. However, outputs from confusion matrices suggest only around 50% of children after VTs would be indistinguishable from controls following VT surgery. Differences were observed in which children were identified as still having problems according to the questionnaires. OMQ-14 is more sensitive to disease-related hearing loss, while the ECLiPS is more sensitive to developmental difficulties. CONCLUSIONS: Despite being developed with different aims in mind, the OMQ-14 and ECLiPS were similarly sensitive both to symptoms of disease-related hearing difficulty and also to treatment-related improvements in hearing. A significant number of VT children continue to have poor OMQ-14 and ECLiPS scores relative to control children. ECLiPS scores do not always change in a way that hearing improvements would predict, suggesting the ECLiPS is sensitive to wider developmental difficulties. Parental report in the form of narrow or broad-based questionnaires may complement history-taking and audiometry to enhance the quality of discussion between carers and clinicians about OME management.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Perda Auditiva/diagnóstico , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/terapia , Inquéritos e Questionários , Audiometria , Criança , Pré-Escolar , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Deficiências do Desenvolvimento/etiologia , Feminino , Perda Auditiva/etiologia , Humanos , Masculino , Ventilação da Orelha Média , Otite Média com Derrame/complicações , Pais , Curva ROC , Conduta Expectante
7.
J Laryngol Otol ; 133(2): 157-160, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30898187

RESUMO

BACKGROUND: Autoinflation devices are commonly used for otitis media with effusion and Eustachian tube dysfunction. Generally, these are very safe devices, with few or no complications.Case reportThis paper presents a case study of pneumocephalus and orbital emphysema, associated with the use of an autoinflation device, in a 73-year-old woman with Eustachian tube dysfunction and otitis media with effusion, and a history of extensive endoscopic sinus surgery 13 years previously. CONCLUSION: A literature review showed autoinflation-related pneumocephalus in patients with skull base defects relating to cranial surgery or tumours; however, this has not been described previously with the Otovent system or its use in relation to functional endoscopic sinus surgery. Given the theoretical risk of undetected bony abnormalities in post-operative functional endoscopic sinus surgery patients, it is suggested that autoinflation devices are used cautiously in patients with a history of sinus surgery.


Assuntos
Ventilação da Orelha Média/efeitos adversos , Doenças Orbitárias/etiologia , Otite Média com Derrame/terapia , Pneumocefalia/etiologia , Enfisema Subcutâneo/etiologia , Testes de Impedância Acústica , Idoso , Endoscopia , Tuba Auditiva , Feminino , Humanos , Ventilação da Orelha Média/instrumentação , Doenças Orbitárias/diagnóstico , Pneumocefalia/diagnóstico , Autocuidado , Enfisema Subcutâneo/diagnóstico , Tomografia Computadorizada por Raios X
8.
Artigo em Chinês | MEDLINE | ID: mdl-30808144

RESUMO

Objective: Eosinophilic otitis media(EOM) is a rare,refractory otitis media.This article summarizes the clinical manifestations and diagnosis and treatment experience of EOM. Method: Retrospective analysis of 3 cases of EOM patients with medical history, clinical manifestations, and related auxiliary examinations.Discuss the EOM clinical features,diagnosis and treatment in conjunction with the literature. Result: The clinical features of 3 patients with EOM were summarized as: a large amount of yellowish white secretions or polyps formation, obvious itching symptoms; polyp biopsy showed a large amount of eosinophil infiltration;topical use of hormone-containing ear drops treatment is effective.Conclusion: EOM is a new type of chronic otitis media.It has characteristic clinical manifestations,a comprehensive treatment based on glucocorticoids should be given..


Assuntos
Eosinofilia , Otite Média com Derrame , Otite Média , Eosinofilia/diagnóstico , Eosinofilia/terapia , Glucocorticoides , Humanos , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/terapia , Estudos Retrospectivos
9.
Otolaryngol Head Neck Surg ; 160(6): 1071-1080, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30721112

RESUMO

OBJECTIVE: Eustachian tube dysfunction (ETD) prompts >2 million adult visits in the United States annually. While disease prevalence and health care utilization are established for children, practice patterns for adults remain unknown. Our objective was to determine national resource utilization for adult ETD. STUDY DESIGN: Cross-sectional study. SETTING: National database sample. SUBJECTS AND METHODS: The Truven Health MarketScan Databases (2010-2014) analytic cohort included health care encounters of patients ≥18 years of age with a diagnosis of ETD, otitis media with effusion, or tympanic membrane retraction. Visits associated with recent diagnoses of acute upper respiratory infection, head and neck cancer, or radiation therapy were excluded. Acute ETD (<3 months) and chronic ETD (≥3 months) were subgroups. Medication usage was quantified by class. RESULTS: ETD was diagnosed for 1,298,987 patients, 11% of which was chronic. Over 92% of patients were seen in outpatient clinics, most often by otolaryngology (57%) for chronic ETD and by general medicine (49%) for acute ETD. Medications were frequently utilized, as 530,146 (53.7%) patients received ≥1 prescription. Top prescriptions for chronic ETD included intranasal corticosteroids (22%), antibiotics (22%), oral corticosteroids (13%), and analgesics (6%). The overall annual cost of prescribed medications associated with visits in which either acute or chronic ETD was diagnosed exceeded $8.5 million for a mean of $80.78 per patient who filled a prescription. CONCLUSION: Adult ETD is frequently treated with several medication classes by a variety of provider types. Understanding the potential adverse effects and cost associated with these practices should be a priority.


Assuntos
Tuba Auditiva , Custos de Cuidados de Saúde , Otite Média com Derrame/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Padrões de Prática Médica/economia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média com Derrame/economia , Estados Unidos
10.
Acta otorrinolaringol. esp ; 70(1): 36-46, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-178438

RESUMO

La incidencia y prevalencia de la otitis media secretora infantil (OMS) son elevadas, sin embargo, existen evidencias de que solo una minoría de profesionales sigue las recomendaciones de las guías para su manejo clínico. Con objeto de mejorar el diagnóstico y el tratamiento de la OMS, para prevenir y/o reducir sus consecuencias sobre el desarrollo del niño, la Comisión para la Detección Precoz de la Hipoacusia (CODEPEH) ha realizado una amplia revisión de la literatura científica sobre la materia y ha elaborado un documento de recomendaciones para una correcta actitud clínica ante la OMS, abordando métodos diagnósticos y tratamiento médico y quirúrgico. Entre otros, no usar ninguna medicación, especialmente corticoides y antibióticos, siendo la espera vigilada la primera medida a tomar durante 3 meses. Si persiste la OMS, el otorrinolaringólogo valorará el tratamiento quirúrgico. En niños que presentan comorbilidades de diversa entidad, el impacto de la OMS es superior por lo que hay que actuar de forma inmediata, sin espera vigilada


The incidence and the prevalence rates of otitis media with effusion (OME) are high. However, there is evidence that only a minority of professionals follow the recommendations provided in clinical practice guidelines. For the purpose of improving diagnosis and treatment of OME in children to prevent and/or reduce its impact on children's development, the Commission for the Early Detection of Deafness (CODEPEH) has deeply reviewed the scientific literature on this field and has drafted a document of recommendations for a correct clinical reaction to of OME, including diagnosis and medical and surgical treatment methodology. Among others, medication, in particular antibiotics and corticoids, should not be prescribed and 3 months of watchful waiting should be the first adopted measure. If OME persists, an ENT doctor should assess the possibility of sugical treatment. The impact of OME in cases of children with a comorbidity is higher, so it requires immediate reaction, without watchful waiting


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/terapia , Diagnóstico Precoce , Perda Auditiva/epidemiologia , Fatores de Risco , Comissão Para Atividades Profissionais e Hospitalares/normas , Conhecimentos, Atitudes e Prática em Saúde , Triagem Neonatal , Desenvolvimento Infantil/fisiologia , Otoscopia , Otite Média com Derrame/tratamento farmacológico
11.
Adv Healthc Mater ; 8(3): e1801409, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30624860

RESUMO

Otitis media with effusion (OEM) is a common pediatric pathology treated with topical fluoroquinolones (ear drops) and tympanoplasty tube, also referred to as ear tube, implantation for middle ear drainage. Commercially available ear tubes are fabricated using poly (lactic-co-glycolic acid) synthetic materials that are associated with long-complications due to premature extrusion. Resorbable materials have emerged as desirable alternatives to reduce extrusion-related complications, but often limited by fast resorption rates. Therefore, resorbable tubes with long-term functional integrity are required for future clinical translation. In this communication, a proof-of-concept study is reported on a bioresorbable and drug-eluting silk ear tube device. Preliminary in vitro assessments reveal time-dependent drug elution and antimicrobial properties, while maintaining long-term functional integrity in vivo. This report provides evidence of a silk ear tube with potential for future clinical translation and OEM treatment.


Assuntos
Implantes Absorvíveis , Antibacterianos , Fluoroquinolonas , Otite Média com Derrame , Timpanoplastia , Animais , Antibacterianos/química , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Criança , Chinchila , Implantes de Medicamento/química , Implantes de Medicamento/farmacocinética , Implantes de Medicamento/farmacologia , Fluoroquinolonas/farmacocinética , Fluoroquinolonas/farmacologia , Humanos , Otite Média com Derrame/metabolismo , Otite Média com Derrame/patologia , Otite Média com Derrame/terapia , Seda/química , Seda/farmacologia , Fatores de Tempo
12.
Br J Gen Pract ; 69(678): e24-e32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30510093

RESUMO

BACKGROUND: Nasal balloon autoinflation is an effective, non-surgical treatment for symptomatic children with glue ear, although uptake is variable and evidence about acceptability and feasibility is limited. AIM: To explore parent and healthcare professional views and experiences of nasal balloon autoinflation for children with glue ear in primary care. DESIGN AND SETTING: Qualitative study using semi-structured interviews with a maximum-variety sample of parents, GPs, and practice nurses. The study took place between February 2013 and September 2014. METHOD: Semi-structured face-to-face and telephone interviews were audiorecorded, transcribed verbatim, and analysed using inductive thematic analysis. RESULTS: In all, 14 parents, 31 GPs, and 19 nurses were included in the study. Parents described the nasal balloon as a natural, holistic treatment that was both acceptable and appealing to children. GPs and nurses perceived the method to be a low-cost, low-risk strategy, applicable to the primary care setting. Good instruction and demonstration ensured children mastered the technique and engaged with the treatment, but uncertainties were raised about training provision and potential impact on the GP consultation. Making nasal balloon autoinflation part of a child's daily routine enhances compliance, but difficulties can arise if children are unwell or refuse to cooperate. CONCLUSION: Nasal balloon autoinflation is an acceptable, low-cost treatment option for children with glue ear in primary care. Provision of educational materials and demonstration of the method are likely to promote uptake and compliance. Wider use of the nasal balloon has the potential to enhance early management, and may help to fill the management gap arising from forthcoming changes to care pathways.


Assuntos
Atitude do Pessoal de Saúde , Clínicos Gerais , Enfermeiras e Enfermeiros , Otite Média com Derrame/terapia , Pais , Atenção Primária à Saúde , Atitude Frente a Saúde , Criança , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa
13.
Acta Otorrinolaringol Esp ; 70(1): 36-46, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29033123

RESUMO

The incidence and the prevalence rates of otitis media with effusion (OME) are high. However, there is evidence that only a minority of professionals follow the recommendations provided in clinical practice guidelines. For the purpose of improving diagnosis and treatment of OME in children to prevent and/or reduce its impact on children's development, the Commission for the Early Detection of Deafness (CODEPEH) has deeply reviewed the scientific literature on this field and has drafted a document of recommendations for a correct clinical reaction to of OME, including diagnosis and medical and surgical treatment methodology. Among others, medication, in particular antibiotics and corticoids, should not be prescribed and 3 months of watchful waiting should be the first adopted measure. If OME persists, an ENT doctor should assess the possibility of sugical treatment. The impact of OME in cases of children with a comorbidity is higher, so it requires immediate reaction, without watchful waiting.


Assuntos
Otite Média com Derrame/diagnóstico , Otite Média com Derrame/terapia , Testes de Impedância Acústica , Adenoidectomia/estatística & dados numéricos , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Audiometria , Criança , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Fissura Palatina/epidemiologia , Comorbidade , Contraindicações de Medicamentos , Anormalidades Craniofaciais/epidemiologia , Deficiências do Desenvolvimento/etiologia , Síndrome de Down/epidemiologia , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Humanos , Lactente , Recém-Nascido , Transtornos da Linguagem/etiologia , Ventilação da Orelha Média/estatística & dados numéricos , Triagem Neonatal , Otite Média com Derrame/epidemiologia , Otoscopia/métodos , Fatores de Risco , Conduta Expectante
14.
Auris Nasus Larynx ; 46(1): 34-37, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29914826

RESUMO

OBJECTIVE: This pilot study was performed to investigate the therapeutic effect of Valsalva maneuver on otitis media in adults and to evaluate the prognostic factors for the good response. METHODS: Thirty nine ears of 32 adult patients who were diagnosed as otitis media with effusion and managed by one-week Valsalva maneuver (>20/day) without any other medication were included in this study. Its therapeutic efficacy was evaluated and the prognostic factors which predict the response of Valsalva maneuver were analyzed by comparing various clinical and audiological factors between success and failure groups. RESULTS: Mean duration of otitis media in the study subjects was 30.9 days (SD 31.6 days). A success rate of 1-week Valsalva maneuver as a single therapeutic modality was up to 64.1% (25/39 ears) and hearing was significantly recovered in success group. No recurrence or side effects were observed. Successful Valsalva maneuver checked and confirmed as bulging of the tympanic membrane by otoendoscopic examination was an excellent indicator of therapeutic response in a week (p<0.05). Age, sex, duration of otitis media, history of previous upper respiratory tract infection, initial hearing levels and type of audiogram were not significant prognostic factors for the therapeutic efficacy of Valsalva maneuver. CONCLUSION: One-week Valsalva maneuver seems to be considered as a first line therapeutic modality in otitis media with effusion in adult patients who demonstrate the successful maneuver result on oto-endoscopic examination.


Assuntos
Otite Média com Derrame/terapia , Manobra de Valsalva , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação da Orelha Média , Otite Média com Derrame/fisiopatologia , Projetos Piloto , Prognóstico , Resultado do Tratamento , Membrana Timpânica , Adulto Jovem
15.
Vestn Otorinolaringol ; 84(6): 100-107, 2019.
Artigo em Russo | MEDLINE | ID: mdl-32027332

RESUMO

In recent years, OME in childhood tends to increase. The low efficiency of the currently used traditional methods of conservative therapy and the high rate of relapse of the disease make it necessary to develop new methods of treatment. It is important that there is a connection of development of OME and hypertrophy of the lymphoid tissue of the nasopharynx, which in childhood is considered as a response to the respiratory antigenic virus-bacterial load. The spread of the inflammatory process to the auditory tube with persistence of pathogenic microorganisms in the structure of lymphoid tissue leads to the further development of otitis media effusion; but it is still debatable. All living microorganisms that inhabit a certain anatomical niche (viruses, bacteria, fungi, etc.) are called 'microbiota'. This term includes both commensals and pathogens. 'Microbiome' means the totality of all genes of all microorganisms that inhabit the study area. Thus, the microbiome can be called the collective microbiota genome. Microbiota disorder is a change in the quantitative and qualitative composition of microorganisms, called dysbiosis, and is important in the development of inflammatory pathology. Some drugs (including antibacterial ones) adversely affect indigenous bacteria. Indigenous microbiota develops in abundance in the observed biotope and forms resistance to excessive growth of pathogenic microorganisms. Only NGS sequencing allows to analyze entire mixed bacterial communities ('microbiomes'), which cannot be performed by other diagnostic methods. The use of the NGS sequencing method has proved the important role of microbiota in the development of chronic adenoiditis and OME in children. One of the promising remedies is the inclusion of lysozyme in the treatment regimen. Recent studies indicate the antibacterial and antiviral effects of lysozyme. The use of NGS sequencing made it possible to identify the relationship of the composition of microbiota with the course of chronic adenoiditis and otitis media effusion in children. Inclusion of lysozyme-containing drug Lizobact into therapy promotes colonization of the nasopharynx by indigenous microbiota, while the clinical picture improves.


Assuntos
Microbiota , Nasofaringite , Otite Média com Derrame , Otite Média , Criança , Humanos , Nasofaringite/microbiologia , Nasofaringite/terapia , Nasofaringe , Otite Média/microbiologia , Otite Média/terapia , Otite Média com Derrame/microbiologia , Otite Média com Derrame/terapia
16.
Am J Audiol ; 27(3S): 455-461, 2018 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-30452749

RESUMO

Purpose: The aim of this study was to devise a grassroots-level strategy for identification and management of middle ear disorders in a community-based program for individuals with cleft lip and palate in 2 rural districts in the state of Tamil Nadu in South India. Method: Community workers underwent training to conduct video otoscopy using the ENTraview device. Community workers conducted video otoscopy on 160 individuals with cleft lip and palate between 3 and 35 years old in the community. Middle ear conditions were identified using store-and-forward telepractice. Diagnostic telehearing evaluation was conducted using synchronous pure tone audiometry and tympanometry for those who were identified with tympanic membrane (TM) and/or middle ear diseases (MEDs). A review of data collected over a 13-month period was carried out to assess coverage and follow-up intervention rates. Results: The program was successful in achieving 80% coverage for identification of TM and MEDs within 13 months of program implementation. TM and/or MEDs were identified in 26% (82/320 ears) of those who underwent video otoscopy. Telehearing evaluations were completed on 42 ears of individuals with TM and/or MEDs; 52% (22/42 ears) of these individuals had a minimal, mild, or moderate degree of hearing loss. Regarding follow-up for intervention, 78% qualified for surgical intervention, and 31% qualified for medication. Conclusions: This grassroots-level telemedicine approach was successful in achieving better coverage, and store-and-forward telepractice helped in providing remote diagnosis and recommendation by otolaryngologists to all individuals with TM/MEDs in the rural community. The follow-up for otological intervention significantly improved from that achieved in the previous years.


Assuntos
Cicatriz/diagnóstico , Fenda Labial/complicações , Fissura Palatina/complicações , Otite Média com Derrame/diagnóstico , Otolaringologia/métodos , Telemedicina/métodos , Perfuração da Membrana Timpânica/diagnóstico , Membrana Timpânica/patologia , Testes de Impedância Acústica , Adolescente , Adulto , Audiometria de Tons Puros , Criança , Pré-Escolar , Cicatriz/complicações , Cicatriz/terapia , Agentes Comunitários de Saúde , Feminino , Humanos , Índia , Masculino , Ventilação da Orelha Média , Otite Média com Derrame/complicações , Otite Média com Derrame/terapia , Otoscopia/métodos , Avaliação de Programas e Projetos de Saúde , População Rural , Esclerose , Vapor , Perfuração da Membrana Timpânica/complicações , Perfuração da Membrana Timpânica/terapia , Timpanoplastia , Gravação em Vídeo/métodos , Adulto Jovem
17.
Med Clin North Am ; 102(6): 1063-1079, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30342609

RESUMO

Chronic ear disease is composed of a spectrum of otologic disorders intrinsically tied to Eustachian tube dysfunction. Presentation can range from asymptomatic findings on physical examination to critically ill patients with intracranial complications. Internists represent the first line in diagnosis of these conditions, making awareness of the common signs and symptoms essential. With surgical management often required, partnership between internal medicine and otolaryngology is fundamental in the management of patients with chronic ear disease.


Assuntos
Otopatias/diagnóstico , Otopatias/terapia , Tuba Auditiva , Atenção Primária à Saúde/métodos , Doença Crônica , Humanos , Anamnese , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/terapia , Otite Média Supurativa/diagnóstico , Otite Média Supurativa/terapia
18.
Curr Opin Otolaryngol Head Neck Surg ; 26(6): 437-440, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30234663

RESUMO

PURPOSE OF REVIEW: One in two children treated with tympanostomy tubes, experience episodes of otorrhea whilst their tubes are in place. In this review, we present the results of the most recent publications on prevention and treatment of tympanostomy tube otorrhea (TTO). RECENT FINDINGS: Recent systematic reviews on water precautions for children with tympanostomy tubes support the American Academy of Otolaryngology - Head and Neck Surgery guideline recommendation against such preventive measures as there is no evidence that it protects against TTO. Studies on tympanostomy tube design and material suggest that silicone tubes have a lower TTO risk and that biofilms appear to be mainly located in the perpendicular junction of the T-tubes and the round rims of the Paparella-type tubes. Another study shows that the biofilm-component DNAB-II protein is present in otorrhea of half of children with TTO. Targeting this protein could lead to a collapse of the biofilm structure and as such a potential new treatment for chronic TTO. New systematic reviews show that antibiotic eardrops are the most effective first-line treatment of acute TTO and suggest that an antibiotic-corticosteroid combination is more effective than antibiotic only. Although in many countries, quinolone eardrops are the preferred choice because of being non-ototoxic, one study found a higher risk of persistent perforation after tube extrusion in children treated with quinolone eardrops as compared with children treated with aminoglycoside eardrops. SUMMARY: Recent evidence confirms that water precautions for children with tympanostomy tubes are not effective in preventing TTO. Antibiotic-corticosteroid eardrops are the most effective treatment of acute TTO.


Assuntos
Ventilação da Orelha Média/efeitos adversos , Otite Média com Derrame/terapia , Administração Tópica , Antibacterianos/administração & dosagem , Criança , Glucocorticoides/administração & dosagem , Humanos , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/etiologia , Otite Média com Derrame/prevenção & controle , Soluções Farmacêuticas/administração & dosagem
19.
Clin Otolaryngol ; 43(6): 1573-1577, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30160368

RESUMO

OBJECTIVES: To measure the diameter of inflated balloons at different pressures during Eustachian tube (ET) balloon dilation under fluoroscopic guidance. DESIGN: Prospective cohort study. SETTING: Tertiary academic referral centre. PARTICIPANTS: Eighteen patients who underwent ET balloon dilation with use of a balloon catheter, 20 mm long and 6 mm in diameter, under combined endoscopic and fluoroscopic guidance. MAIN OUTCOME MEASURES: Degrees of inflation at three different portions (proximal, middle and distal) of the balloon at controlled pressures (3, 5, 8 and 10 atmospheres [atm]) and at the maximum pressure manually applied. RESULTS: The mean proximal, middle and distal diameters of the inflated balloons were 5.3 ± 0.4 mm, 5.3 ± 0.4 mm and 4.9 ± 0.5 mm at 10 atm. The distal diameters were significantly smaller than middle and proximal diameters at all the pressures (P < 0.01). When compared to the distal diameter (100%, 4.9 ± 0.5 mm) at 10 atm, the distal diameters were 73% (3.6 ± 0.6 mm) at 3 atm, 88% (4.3 ± 0.5 mm) at 5 atm and 96% (4.7 ± 0.4 mm) at 8 atm. The distal diameter (4.1 ± 0.3 mm) at the maximum pressure manually applied was in between those at 3 and 5 atm. CONCLUSIONS: The distal diameter of the balloon increased significantly as a function of the pressure and most (88%) inflation occurred at a low pressure of 5 atm, which was sufficient to inflate the distal diameter of the balloon more than 3 mm. The manual pressurisation could inflate a balloon by as much as could be expected, at between 3 and 5 atm.


Assuntos
Cateterismo/instrumentação , Dilatação/instrumentação , Endoscopia/métodos , Tuba Auditiva/diagnóstico por imagem , Fluoroscopia/métodos , Otite Média com Derrame/diagnóstico , Adulto , Idoso , Doença Crônica , Desenho de Equipamento , Tuba Auditiva/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média com Derrame/terapia , Pressão , Estudos Prospectivos , Tomografia Computadorizada por Raios X
20.
Otol Neurotol ; 39(8): e671-e678, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30113562

RESUMO

OBJECTIVE: We classified eosinophilic otitis media (EOM) into three grades (G1-G3) based on the middle ear mucosal thickness and aimed to establish a treatment strategy for EOM based on these pathological categories. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: We evaluated 136 ears of 68 patients (38 women, 30 men; average age, 56.1 yr; range, 32-80 yr) with bilateral EOM, including 14 surgically treated ears. INTERVENTIONS: Diagnostics and treatment. MAIN OUTCOME MEASURES: Treatment responses to intratympanic instillation of triamcinolone acetonide (TA) and surgery. RESULTS: G1 (mild) cases of EOM responded well to intratympanic TA. G2 (moderate) cases required both TA and systemic glucocorticoids. G3 (severe) cases with granulation were unresponsive to but tolerated the treatment. In 14 ears, granulation tissue was surgically removed and the area was covered with a gelatin sponge containing TA. After the surgery, the severity level of EOM decreased from G3 to G2 in 12 ears, and hearing improved in 4 ears. Three ears showed normalization of the tympanic membrane, and seven ears had less otorrhea. Risk factors for granulation (G3) were the presence of bacterial infection (p = 0.017) and diabetes mellitus (HbA1c of ≥6.5%) (P = 0.039) (odds ratios of 4.55 and 3.95, respectively). CONCLUSIONS: This study showed that G3 EOM was unresponsive to conservative glucocorticoid treatment and required granulation tissue removal. Classification based on the middle ear pathology is useful for determining the most appropriate and successful treatment for EOM.


Assuntos
Otite Média com Derrame/patologia , Otite Média com Derrame/terapia , Procedimentos Cirúrgicos Otológicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Eosinofilia/patologia , Eosinofilia/terapia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeção Intratimpânica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Triancinolona Acetonida/administração & dosagem
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