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1.
Vestn Otorinolaringol ; 84(4): 51-54, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31579059

RESUMO

Formation of labyrinth fistulas and destruction of the facial nerve canal in children with middle ear cholesteatoma is rare. Data of children with cholesteatoma of the middle ear, operated in the ENT department of MONIKI, is analyzed. Several clinical observations of multiple-aged patients with the presence of cholesteatoma intra-temporal complications are presented. The preoperative computer tomography made it possible to diagnose the presence of the labyrinth fistula and the destruction of the facial nerve channel, which was confirmed intraoperatively.


Assuntos
Colesteatoma da Orelha Média , Otite Média , Criança , Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/diagnóstico , Colesteatoma da Orelha Média/terapia , Doença Crônica , Orelha Média , Nervo Facial/patologia , Humanos , Otite Média/complicações , Otite Média/diagnóstico , Otite Média/terapia , Estudos Retrospectivos
2.
J Laryngol Otol ; 133(8): 662-667, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31267884

RESUMO

BACKGROUND: Retraction pocket theory is the most acceptable theory for cholesteatoma formation. Canal wall down mastoidectomy is widely performed for cholesteatoma removal. Post-operatively, each patient with canal wall down mastoidectomy has an exteriorised mastoid cavity, exteriorised attic, neo-tympanic membrane and shallow neo-middle ear. OBJECTIVE: This study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy. METHODS: All post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated. RESULTS: Twenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe. CONCLUSION: After more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.


Assuntos
Abscesso/cirurgia , Colesteatoma da Orelha Média/cirurgia , Mastoidectomia/métodos , Mastoidite/cirurgia , Otite Média/complicações , Abscesso/etiologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
3.
J Laryngol Otol ; 133(8): 658-661, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31270001

RESUMO

OBJECTIVE: This study aimed to evaluate the long-term results of ossiculoplasty using bone cement. METHOD: Forty patients (24 females and 16 males; mean age: 34.1 ± 11.8 years; range, 9-54 years) with chronic otitis media with perforation but without cholesteatoma who had undergone incudostapedial rebridging ossiculoplasty using bone cement were evaluated retrospectively. Pre-operative and post-operative audiograms were evaluated. Bone conduction, air conduction and air-bone gaps were calculated according to international guidelines. RESULTS: There was a mean reduction in pre-operative and post-operative air conduction (12.30 ± 11.98 dB), and this result was significant (p = 0.0001). There was a mean reduction in pre-operative and post-operative bone conduction (4.30 ± 6.69 dB), and this result was significant (p < 0.0001). The pre-operative air-bone gap was 27.65 dB and decreased to 19.65 dB during follow-up (p = 0.0001). No adverse reactions or complications were observed. CONCLUSION: Bone cement is reliable for the repair of incudostapedial-joint defects.


Assuntos
Perda Auditiva Condutiva/cirurgia , Substituição Ossicular/instrumentação , Otite Média/cirurgia , Cirurgia do Estribo/instrumentação , Adolescente , Adulto , Audiometria , Cimentos para Ossos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/complicações , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Artigo em Chinês | MEDLINE | ID: mdl-30991772

RESUMO

Objective: To analyze the therapeutic effect of endoscopic myringoplasty. Methods: A retrospective analysis of 523 patients with chronic otitis media who underwent endoscopic myringoplasty between June 2016 and June 2017 in eight tertiary hospitals in China. Among all the patients, 256 were male and 267 were female, aged from 18 to 68 years old. The grafts used to repair the tympanic membrane were all tragus cartilage-perichondrium complex. All patients were followed up at 1 month, 3 months, 6 months, 9 months, and 12 months after surgery, at least 3 months. The closure rate of tympanic membrane perforation by different factors, the hearing results, and the incidence of postoperative complications were analyzed. SPSS 21.0 software was used to analyze the data. Results: Three months after operation, the closure rates of anterior, inferior, posterior and subtotal perforation were 92.4% (109/118), 94.9% (93/98), 95.6% (129/135), and 89.0% (153/172) respectively, the difference was not statistically significant (χ(2)=5.779, P=0.123). The closure rates of small, medium and large perforations were 100.0% (82/82), 93.7% (178/190) and 89.2% (224/251) respectively. The difference was statistically significant (χ(2)=10.927, P=0.004). The closure rates of dry ear and wet ear tympanic membrane perforation were 93.1% (392/421), 90.2% (92/102), the difference was not statistically significant (χ(2)=1.011, P=0.915). The preoperative pure tone audiometry(PTA) was (38.4±5.3) dBHL, while, the 3-month postoperative PTA was (25.1±5.7) dBHL. The difference was statistically significant (t=39.079, P<0.001). The preoperative air bone gap (ABG) was (22.4±4.3) dB, while 3 months postoperative ABG was (9.1±3.8) dB. The difference was statistically significant (t=53.004, P<0.001). Of all 523 patients, 14 (2.7%) had middle ear infection, 8 (1.5%) had dislocated tympanic membrane, 12 (2.3%) had parageusia, 35 (6.7%) had tinnitus, 28 (5.4%) had hearing loss, 26 (5.0%) had vertigo,33 (6.3%) had reperforation, 2 (0.4%) had secondary cholesteatoma, and none had facioplegia. Conclusions: Endoscopic myringoplasty is a safe and effective surgical method with good postoperative outcome.


Assuntos
Miringoplastia/métodos , Cirurgia Endoscópica por Orifício Natural , Otite Média/complicações , Perfuração da Membrana Timpânica/cirurgia , Adolescente , Adulto , Idoso , China , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Biomed Res Int ; 2019: 8930904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31032365

RESUMO

Objectives: To analyze the central auditory nervous system function through behavioral and electrophysiological tests in children with a history of otitis media and subsequent bilateral tubes placement surgery. Methods: The participants were divided into two groups between eight and 14 years old: control group (CG) consisted of 40 children with no history of otitis media; experimental group (EG) consisted of 50 children with documented history of otitis media and undertook a surgery for bilateral tubes placement. All children completed audiological evaluation (audiometry, speech audiometry, and immittance audiometry), behavioral evaluation (tests: dichotic digits, synthetic sentence identification with ipsilateral competing message, gaps-in-noise, frequency pattern), and electrophysiological evaluation (Auditory Brainstem Response, ABR, Frequency Following Response, FFR (verbal), and Long Latency Auditory Evoked Potential, LLAEP). Results: The EG group showed significantly poorer performance (p<0.001) than the CG for all auditory abilities studied. The results revealed significant latency delays and reduced amplitude (p<0.05) of waves III and V for ABR; significant latency delay was seen of potentials P2, N2, and P300 for LLAEP; significant latency delays and reduced amplitude (p<0.05) were observed for FFR in children with a history of otitis media. Conclusion: The results demonstrate negative effect of otitis media in the auditory abilities and electrophysiological measures in children with a history of otitis media.


Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Central/fisiopatologia , Transtornos do Desenvolvimento da Linguagem/fisiopatologia , Otite Média/fisiopatologia , Adolescente , Audiometria de Tons Puros , Audiometria da Fala , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças do Sistema Nervoso Autônomo/cirurgia , Criança , Tuba Auditiva/fisiopatologia , Tuba Auditiva/cirurgia , Potenciais Evocados Auditivos , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Feminino , Humanos , Transtornos do Desenvolvimento da Linguagem/etiologia , Transtornos do Desenvolvimento da Linguagem/cirurgia , Masculino , Otite Média/complicações , Otite Média/cirurgia
6.
Int J Pediatr Otorhinolaryngol ; 122: 170-174, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31035175

RESUMO

OBJECTIVE: To modify a parent-reported scale we developed to follow symptoms of young children with acute otitis media (AOM-SOS) with the aim of improving its psychometric properties. STUDY DESIGN: We modified version 4.0 of the scale by increasing the number of response options from 3 to 6. We compared the distribution of scores, internal reliability, construct validity, and responsiveness of versions 4.0 and 5.0 in children diagnosed with acute otitis media (AOM) in 2 studies. For Version 5.0, we also estimated the minimal important difference (MID) and assessed its construct validity. RESULTS: 291 and 70 children were enrolled in the studies evaluating version 4.0 and 5.0, respectively. Version 5.0 had fewer items at the ceiling and better psychometric properties (responsiveness, internal reliability, and test-retest reliability). Changes in the score for Version 5.0 corresponded to changes in clinical status. Factor analysis supported a one-factor solution. Children whose parents reported only a small degree of improvement on the diary (compared to the day before) had a mean decrease in AOM-SOS score of approximately 20%. This value can be used as the MID for this version of the scale. CONCLUSIONS: Modification of the AOM-SOS improved its psychometric properties. Data presented here support the use of Version 5.0 of the AOM-SOS as a measure of change in symptom burden in clinical trials of children with acute otitis media.


Assuntos
Otite Média , Índice de Gravidade de Doença , Avaliação de Sintomas , Doença Aguda , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Diferença Mínima Clinicamente Importante , Otite Média/complicações , Pais , Psicometria , Reprodutibilidade dos Testes
7.
Int J Pediatr Otorhinolaryngol ; 121: 120-122, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30884342

RESUMO

INTRODUCTION: Endoscopic type 1 tympanoplasty is every day gaining numerous adepts for tympanic membrane repair. Due to the value of reducing postauricular approaches, decreasing postoperative morbidity and hospitalization time. The objective of this study is to present surgical results of endoscopic type 1 tympanoplasty in the pediatric population using fascia temporalis or cartilage butterfly graft. MATERIALS AND METHODS: Prospective study regarding the pediatric population, mean age of 10.7 years old. Patients diagnosed with chronic otitis media without cholesteatoma and intact ossicular chain. Tympanic membrane reconstruction using inlay cartilage butterfly graft or underlay fascia temporalis graft according to surgical needs. Audiograms were evaluated preoperatively and 6 months after surgery. No postauricular approaches were performed. RESULTS: A total of 54 ears were operated, 25 utilizing underlay fascia temporalis graft and 29 using inlay cartilage butterfly graft. Six months following surgery, dry and closed tympanic membranes were obtained in 54 cases (92.6%). Preoperative and postoperative air conduction (AC) thresholds, bone conduction (BC) thresholds and air-bone gaps (ABG) were assessed. Preoperative AC of 24.6 dB, BC of 8.9 dB and an ABG of 15.5 dB. Postoperative AC of 16.3 dB, BC of 8.9 and an ABG of 6.9 dB. A postoperative ABG reduction of 8.5 dB was reached. CONCLUSION: Transcanal endoscopic type 1 tympanoplasty can be achieved in every pediatric patient with chronic otitis media without cholesteatoma, and, is a safe and efficient procedure.


Assuntos
Cartilagem/transplante , Endoscopia/métodos , Fáscia/transplante , Otite Média/cirurgia , Timpanoplastia/métodos , Adolescente , Condução Óssea , Criança , Doença Crônica , Audição , Testes Auditivos , Humanos , Otite Média/complicações , Otite Média/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento
8.
Am J Case Rep ; 20: 175-178, 2019 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-30739122

RESUMO

BACKGROUND The Say-Barber-Biesecker-Young-Simpson (SBBYS) variant of Ohdo syndrome is characterized by congenital hypothyroidism, facial dysmorphism, postaxial polydactyly, and mental retardation. The SBBYS variant of Ohdo syndrome is extremely rare with only 19 cases previously reported in the literature. A case is presented of chronic otitis media associated with cholesteatoma in a six-year-old boy with the SBBYS variant of Ohdo syndrome. CASE REPORT A 6-year-old boy presented with perforation of the tympanic membrane and a cholesteatoma in the mesotympanic-attic region associated with chronic otitis media. The child had previously been diagnosed with the SBBYS variant of Ohdo syndrome. Following computed tomography (CT) and magnetic resonance imaging (MRI), tympanoplasty was performed with removal of the lesion. CONCLUSIONS This is the first case described in the literature of chronic otitis media associated with cholesteatoma in a patient with the SBBYS variant of Ohdo syndrome. This case demonstrates the importance of specialist otolaryngology referral for patient management.


Assuntos
Blefarofimose/complicações , Colesteatoma da Orelha Média/complicações , Hipotireoidismo Congênito/complicações , Cardiopatias Congênitas/complicações , Deficiência Intelectual/complicações , Instabilidade Articular/complicações , Otite Média/complicações , Criança , Colesteatoma da Orelha Média/diagnóstico por imagem , Doença Crônica , Facies , Humanos , Imagem por Ressonância Magnética , Masculino , Doenças Raras
9.
Eur Arch Otorhinolaryngol ; 276(5): 1301-1305, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30759279

RESUMO

PURPOSE: The aim of this study was to evaluate the ossicular chain erosions (OCE) in chronic otitis media patients with cholesteatoma (COM-C) or without cholesteatoma (COM). MATERIALS AND METHODS: The OCE and preoperative hearing levels of a total of 915 patients were evaluated retrospectively. Patients were divided into three groups. Of the 915 patients, 615 (67.2%) had COM, 234 (25.6%) had COM-C, and 66 (7.2%) had chronic otitis media with granulation tissue (COM-G). RESULTS: OCE was found in 291 (31.8%) of 915 patients. OCE was found in 192 (82%) of 234 patients with COM-C, 21 (31.8%) of 66 patients with COM-G, and 78 (12.7%) of 615 patients with COM. CONCLUSION: The most commonly seen OCE was incus erosion, followed by stapes and malleus erosions. The results of this study show that there are more OCE in the COM-C group than in the COM-G and COM groups. To our knowledge, this study has the widest patient population in the literature focused on the OCE relation with COM, COM-C, and COM-G and its effect on the preoperative hearing level.


Assuntos
Colesteatoma/complicações , Ossículos da Orelha/patologia , Tecido de Granulação , Otite Média/patologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/complicações , Estudos Retrospectivos , Adulto Jovem
10.
J Int Med Res ; 47(3): 1348-1352, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30669916

RESUMO

Gradenigo syndrome is associated with middle ear infection that extends to the petrous apex, leading to pain at the innervation site of the ophthalmic and maxillary branches of the trigeminal nerve and the development of abducens nerve palsy. Cerebral venous sinus thrombosis is a serious neurological complication of otitis media and occurs secondary to spread of the infection to the underlying bone. We herein report a pediatric case of otitis media associated with Gradenigo syndrome and ipsilateral sigmoid-transverse sinus thrombosis with magnetic resonance imaging findings.


Assuntos
Trombose do Seio Lateral/patologia , Otite Média/patologia , Petrosite/patologia , Doença Aguda , Adolescente , Feminino , Humanos , Trombose do Seio Lateral/complicações , Espectroscopia de Ressonância Magnética , Otite Média/complicações , Petrosite/complicações , Prognóstico
11.
Am J Otolaryngol ; 40(2): 230-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30661891

RESUMO

BACKGROUND: Tinnitus is a common disease in public. It is not only associated with neuronal, muscular, vascular pathologies, but also with related psychological parameters. In this study, we aimed to investigate the relationship between tinnitus, anxiety and depression in patients undergoing tympanoplasty. METHODS: Patients with tinnitus and operated for chronic otitis media were included in our study. Before and after the operation, tinnitus handicap inventory, beck anxiety and depression scales were filled and pre- and postoperative values were compared. In addition, our patients were divided into two groups as tinnitus improve and did not improve and differences between them were investigated. RESULTS: 148 patients were included in our study. Of 148 patients, 60 were male and 88 were female. There was no significant difference between the patients with and without tinnitus when the dermografic features, hearing levels and physical examination findings were compared. After the operation, the patients who did not improve tinnitus had higher levels of depression and depression than others (<0.001). CONCLUSION: As a result of our study, anxiety and depression scales of the patients whose tinnitus did not improve were found to be higher than the patients whose tinnitus improved.


Assuntos
Ansiedade , Depressão , Otite Média/cirurgia , Zumbido/psicologia , Zumbido/cirurgia , Timpanoplastia , Adolescente , Adulto , Ansiedade/epidemiologia , Doença Crônica , Depressão/epidemiologia , Feminino , Humanos , Masculino , Otite Média/complicações , Zumbido/etiologia , Resultado do Tratamento , Adulto Jovem
12.
J Binocul Vis Ocul Motil ; 69(1): 1-2, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30615575

RESUMO

Gradenigo syndrome is a rare complication of acute otitis media infections, and early diagnosis and treatment of the condition are imperative. In this report, we present a case of a 22-month-old girl who developed acute, acquired esotropia associated with recurrent episodes of otitis media, which resolved after antibiotic treatment. To our knowledge, our patient is one of the youngest children reported in the literature to present with presumed Gradenigo syndrome and the only case of recurrent episodes of acquired esotropia and concurrent otitis media within the short time span of 1 month. We hope to add new information to the existing literature and to aid in the understanding of the pathophysiology and management of this condition.


Assuntos
Esotropia/complicações , Otite Média/complicações , Petrosite/etiologia , Doença Aguda , Antibacterianos/uso terapêutico , Esotropia/diagnóstico , Esotropia/tratamento farmacológico , Feminino , Humanos , Lactente , Otite Média/diagnóstico , Otite Média/tratamento farmacológico
13.
Laryngoscope ; 129(4): 852-857, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30570749

RESUMO

OBJECTIVES/HYPOTHESIS: To investigate whether radiologist-produced imaging reports containing the terms mastoiditis or mastoid opacification clinically correlate with physical examination findings of mastoiditis. Additionally, to investigate whether and how often otolaryngology was unnecessarily consulted and inappropriate antibiotic therapy was initiated. STUDY DESIGN: Retrospective chart review within a large community hospital setting. METHODS: A retrospective review of 160 patients who had imaging tests performed for nonotolaryngology indications from January 2011 to March 2017 at our facility. Indications, patient demographics, otolaryngology consultations, and new antibiotics started were recorded. Physical examinations were documented. RESULTS: Physical examination revealed that only 14 of 160 patients (8.8%) had clinical evidence of otologic disease. However, of the 160 patients meeting the inclusion criteria, 18 (11.3%) received an otolaryngology consultation, and 18 (11.3%) had antibiotics started. Eleven of the 18 patients in each group (61.1%) had a normal physical examination, two (11.1%) had serous otitis media, one (5.6%) had chronic otitis media, and four (22.2%) had acute otitis media. No patients were found to have clinical mastoiditis. χ2 analysis revealed no significance in the radiologic diagnosis of mastoiditis versus mastoid opacification in relation to physicians requesting otolaryngology consultations (P = .241) or starting patients on antibiotics (P = .951). CONCLUSIONS: This study highlights the prevalence of incidental but clinically insignificant opacification of the mastoid cavity. We believe that nonotolaryngology physicians are, overall, competent to correlate such radiologic findings clinically and to prevent unnecessary consultations and inappropriate treatment, which add significant costs to our overstretched healthcare system. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:852-857, 2019.


Assuntos
Otopatias/diagnóstico por imagem , Mastoidite/diagnóstico por imagem , Otolaringologia/estatística & dados numéricos , Radiografia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Competência Clínica/estatística & dados numéricos , Otopatias/complicações , Feminino , Humanos , Masculino , Processo Mastoide/diagnóstico por imagem , Mastoidite/etiologia , Pessoa de Meia-Idade , Otite Média/complicações , Otite Média/diagnóstico por imagem , Exame Físico/estatística & dados numéricos , Estudos Retrospectivos , Procedimentos Desnecessários/estatística & dados numéricos , Adulto Jovem
14.
Vaccine ; 37(1): 1-6, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30497832

RESUMO

BACKGROUND: Complex otitis media (OM) may present with intact tympanic membrane or spontaneous otorrhea. We compared dynamics of intact tympanic membrane and spontaneous otorrhea OM following 7- and 13-valent conjugated vaccines (PCV7, PCV13) implementation, since differences in dynamics may imply different underlying mechanisms. METHODS: A prospective, population-based, active surveillance. Episodes with middle-ear fluid cultures in children < 3 years were included. Defined sub-periods were: pre-pneumococcal conjugated vaccines (PCV) (2004-2008); PCV7 (2009-2011); PCV13 (2014-2016). RESULTS: Of 7705 episodes, 57.2% had intact tympanic membrane, 16.8% spontaneous otorrhea, 26.0% unknown. In the pre-PCV period, the spontaneous otorrhea group was older and had higher proportions of factors associated with recurrence/chronicity. During the PCV7 period, spontaneous otorrhea and intact tympanic membrane episodes caused by PCV13 serotypes decreased significantly (43% and 51%, respectively) and those caused by non-PCV13 serotypes and culture-negative episodes increased significantly. However, rates increases were steeper in the spontaneous otorrhea group for both non-PCV13 serotypes (117% vs. 38%) and culture-negative (720% vs. 69%). In the spontaneous otorrhea group, nontypeable Haemophilus influenzae rates increased non-significantly by 10% and all-cause OM rates increased significantly by 56%, while in the intact tympanic membrane group the respective rates decreased significantly by 22% and 11%. These trends were especially pronounced in ages 24-35 months. Despite these differences, after PCV13 introduction, both spontaneous otorrhea and intact tympanic membrane rates declined for all outcomes. CONCLUSIONS: Spontaneous otorrhea was associated with older age, frequent history of complex OM and delayed PCV impact, suggesting a higher proportion of advanced-stage complex OM.


Assuntos
Otite Média/complicações , Otite Média/patologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Membrana Timpânica/patologia , Fatores Etários , Pré-Escolar , Vacina Pneumocócica Conjugada Heptavalente/uso terapêutico , Humanos , Lactente , Israel/epidemiologia , Otite Média com Derrame/etiologia , Infecções Pneumocócicas/epidemiologia , Vigilância da População , Estudos Prospectivos , Sorogrupo , Streptococcus pneumoniae/isolamento & purificação , Timpanocentese
15.
BMC Pediatr ; 18(1): 392, 2018 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-30572868

RESUMO

BACKGROUND: The assessment of ear pain is challenging in young, mostly preverbal children. Our aim was to investigate whether pain scales are useful tools for parents to detect pain in their young children with the suspicion of acute otitis media (AOM), and to assess associations between 16 symptoms and the severity of pain. METHODS: This cross-sectional study included 426 children (6-35 months) with symptoms suggestive of AOM. We surveyed symptoms and pain via parental interview. As part of the interview, parents assessed their child's pain by using two pain scales: The Faces Pain Scale-Revised (FPS-R) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The outcome of interest was moderate/severe pain. We used the χ2 test or Fisher's test as applicable to compare the severity of pain between three parental pain assessment methods (the parental interview, the FPS-R and the FLACC Scale). We also used multivariable logistic regression models to study the association between the severity of pain and AOM and to study the association between symptoms and the severity of pain. RESULTS: In children with AOM (n = 201), pain was assessed by parents as moderate/severe in 65% via interview; 90% with the FPS-R; and 91% with the FLACC Scale (P < 0.001). In children without AOM (n = 225), the percentages were 56, 83 and 88%, respectively (P < 0.001). Between children with and without AOM, the occurrence of moderate/severe pain did not differ with any of the pain evaluation methods. Of symptoms, ear pain reported by child and restless sleep were significantly associated with moderate/severe pain, regardless of the pain evaluation method. CONCLUSIONS: It seems that nearly all the children with respiratory tract infection, either with or without AOM, might suffer from moderate/severe pain. Without pain scales, parents may underestimate their child's pain. Of symptoms, ear pain reported by child and restless sleep might indicate pain in children with respiratory tract infection. We suggest that the adaptation of pain scales for parent observation is a possibility in children with respiratory tract infection which, however, requires further studies. TRIAL REGISTRATION: www.clinicaltrials.gov , identifier NCT00299455 . Date of registration: March 3, 2006.


Assuntos
Dor de Orelha/diagnóstico , Otite Média/complicações , Medição da Dor/métodos , Pais , Pré-Escolar , Estudos Transversais , Dor de Orelha/etiologia , Feminino , Humanos , Lactente , Masculino , Otite Média/diagnóstico , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/etiologia
16.
Int J Pediatr Otorhinolaryngol ; 113: 177-181, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30173980

RESUMO

OBJECTIVES: Management of otogenic cerebral venous thrombosis (OCVT) is controversial. Despite the modern antibiotic era OCVT still represents a potential life-threatening condition. This study aims to report the clinical presentation and management in a series of children with OCTV. The coexisting intracranial complications (ICC), the extent of the surgical treatment and the role of hypocoagulation were the analysed outcomes. MATERIAL AND METHODS: Retrospective chart review of patients aged less than 16 years and consecutively treated for OCVT at a tertiary university hospital between January 2007 and March 2015. RESULTS: Sixteen children with ages ranging between 25 months and 16 years (9 girls/7 boys) with OCVT were identified. Acute otitis media was the causative factor in the majority of cases (n = 13). The remaining cases resulted from chronic otitis media with cholesteatoma (COMC). Eleven patients were under antibiotic therapy prior to admission. Other ICC were simultaneously present: intracranial abscess (n = 6); otitic hydrocephalus (n = 3); and meningitis (n = 1). Thrombus extension correlated with the presence of additional ICC (p = 0.035). Treatment in all cases comprised of broad-spectrum antibiotics, mastoidectomy, and long-range hypocoagulation with warfarin. Transtympanic ventilation tubes were inserted in all cases but one with COMC. Perioperative sigmoid sinus exposure was performed in seven patients, with drainage of perisinus empyema in three cases. Five children underwent simultaneous craniotomy for intracranial abscess drainage. Follow-up imaging performed in 12 cases revealed partial or complete recanalization in three and seven cases, respectively. After a mean hypocoagulation duration of nine months, no hemorrhagic or major neurologic complications were observed. CONCLUSIONS: The clinical course of OCVT can be masked by previous antibiotic therapy. As such, a high suspicion index is needed for diagnosis. Simultaneous ICC appears to be more frequently found if an extensive thrombosis was present. The high recanalization rate in this series with low morbidity and no mortality can be obtained with a timely combination of antibiotics, mastoidectomy with transtympanic tube insertion and hypocoagulation. However, the decision to start hypocoagulation and its duration should be undertaken on an individual basis owing the possible adverse effects. Prospective and case-control studies are still needed to better clarify the role of the hypocoagulation treatment in OCVT.


Assuntos
Trombose Intracraniana/terapia , Trombose Venosa/terapia , Adolescente , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Abscesso Encefálico/etiologia , Abscesso Encefálico/terapia , Criança , Pré-Escolar , Colesteatoma da Orelha Média/complicações , Drenagem , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/terapia , Lactente , Trombose Intracraniana/etiologia , Masculino , Mastoidectomia , Meningite/etiologia , Meningite/terapia , Otite Média/complicações , Estudos Retrospectivos , Trombose Venosa/etiologia , Varfarina/uso terapêutico
17.
Int J Pediatr Otorhinolaryngol ; 113: 223-228, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30173991

RESUMO

OBJECTIVE: The present study aimed to assess the prevalence of otitis media and associated hearing loss among primary school students in the Solomon Islands. METHODS: A total of 604 primary school students (280 males, 324 females) aged 4-15 years were assessed in two primary schools (government, nongovernment) in the capital city Honiara. School-based ear examinations were performed, including otoscopy and tuning-fork tests. Students were referred to the ENT Clinic for medical intervention and/or pure-tone audiometry assessment. RESULTS: A total of 342 students (56.6%) did not pass their ear examination, with a significantly higher fail rate among younger students (p < 0.001). The most common ear pathology was Otitis Media with Effusion (OME) (34.2%), followed by impacted wax (22.8%), and Chronic Suppurative Otitis Media (3.1%). The follow-up attendance rate at the ENT Clinic was 81.1%. Among students with OME in at least one ear, 50% failed audiometry screening in the affected ear. While age was a significant factor for OME, it was not a significant factor for OME-associated hearing loss. CONCLUSIONS: Ear diseases with associated hearing loss are a significant public health problem among primary school students in the Solomon Islands. The implementation of routine School Ear and Hearing Programs could be beneficial, and should reduce the national burden of ear diseases.


Assuntos
Perda Auditiva/epidemiologia , Otite Média/epidemiologia , Adolescente , Audiometria de Tons Puros/métodos , Criança , Pré-Escolar , Feminino , Perda Auditiva/etiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Melanesia/epidemiologia , Otite Média/complicações , Otoscopia/métodos , Prevalência , Saúde Pública , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos
18.
Niger J Clin Pract ; 21(8): 1044-1049, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30074009

RESUMO

Background/Objectives: Tympanic membrane perforation is a common otological disorder with associated hearing impairment. This study aimed at determining the clinicoepidemiological pattern, etiological factors, clinical presentation, and management of tympanic membrane perforation in a tertiary hospital in Nigeria. Materials and Methods: This was a prospective, hospital-based study of patients with the clinical finding of perforated tympanic membrane. The study was carried out over a period of 5 years (September 2012 to August 2017). Interviewer-assisted questionnaire was administered to obtain the detailed history and clinical findings from consenting patients. Data collected were collated and analyzed using SPSS version 16.0. Results: : A total of 529 patients had tympanic membrane perforation, of which 368 (69.6%) were males and 161 (30.4%) were females with a male-to-female ratio of 2:1. The prevalence of tympanic membrane perforation in this study was 7.8%. The most common presenting symptom among the patients was otorrhea in 81.5%, otalgia in 72.8%, and tinnitus in 55.7%. Acute suppurative otitis media was a cause of tympanic membrane perforation in 28.4% of the patients while 55.7% of the patients proceed to chronic suppurative otitis media. Unilateral tympanic membrane perforation was 79.0%. The left ear tympanic membrane perforation was 43.9%. Grade 1 tympanic membrane perforation accounted for 39.3% while grade 2 accounted for 32.3%. The most common types of tympanic membrane perforation were central in 38.2%, anterior central in 32.3%, and posterior central in 19.3%. Conductive hearing impairment accounted for 61.6% while sensorineural hearing impairment 25.3%. The most common degrees of hearing impairment were mild and moderate and accounted for 47.1% and 25.1%, respectively. The most common complications of tympanic membrane perforation were hearing impairment in 52.6%. Majority of the patients (425) were treated conservatively, six had fat patches, while 98 were treated surgically. Tympanic membrane perforation healed at the end of 3 months in 81.5%, while 18.5% did not heal after 3 months. Conclusion: Tympanic membrane perforation arises mainly from middle ear infections and traumatic causes. At presentation, size and location of perforation vary which depend on duration of infection or the traumatic causes.


Assuntos
Orelha/lesões , Perda Auditiva/etiologia , Perfuração da Membrana Timpânica/complicações , Perfuração da Membrana Timpânica/etiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Otopatias/etiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Otite Média/complicações , Prevalência , Estudos Prospectivos , Distribuição por Sexo , Centros de Atenção Terciária , Perfuração da Membrana Timpânica/epidemiologia , Adulto Jovem
19.
Ear Nose Throat J ; 97(6): 163-166, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30036412

RESUMO

More studies are needed to investigate the side effects of steroids in tympanoplasty, owing to the paucity of such studies in the literature. This randomized, controlled clinical trial included 59 patients with chronic otitis media who underwent tympanoplasty and were randomized after surgery to a systemic steroid or no steroid treatment. Patients were randomized into two groups. Perforation size, graft outcome, and complications such as tinnitus and hearing loss were compared between the two groups. Postsurgical steroid injection had no effect on graft outcome (p = 0.927) or tinnitus (p = 0.478). Tympanic membrane perforation (p = 0.92), plaque size (p = 0.94), bleeding amount (p = 0.38), and mucosal status (p = 0.96) during surgery had no effect on graft outcome after the tympanoplasty. In conclusion, administration of steroids after tympanoplasty failed to improve outcome and may put the patient at risk of side effects.


Assuntos
Sobrevivência de Enxerto/efeitos dos fármacos , Esteroides/administração & dosagem , Perfuração da Membrana Timpânica/cirurgia , Membrana Timpânica/transplante , Timpanoplastia/métodos , Adulto , Doença Crônica , Feminino , Humanos , Injeção Intratimpânica , Masculino , Otite Média/complicações , Período Pós-Operatório , Resultado do Tratamento , Perfuração da Membrana Timpânica/etiologia
20.
Ear Nose Throat J ; 97(7): E17-E20, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30036441

RESUMO

Tympanometric volume is a useful tool for evaluating middle ear status in otitis media. However, its usefulness in chronic otitis media (COM) has not been well evaluated. This study aimed to investigate whether tympanometric volume reflects the status of the middle ear and mastoid or can provide clinical information about patients with COM and subsequent tympanic membrane perforation. A prospective cohort study including 50 adult patients with COM and subsequent tympanic membrane perforation was performed. The volumes of the middle ear and mastoid were preoperatively calculated using tympanometry and three- dimensional computed tomography (CT) reconstruction of the temporal bone, respectively. During surgery for COM, the patency of the middle ear and mastoid antrum was evaluated. The volumes of the middle ear and mastoid measured by tympanometry and CT were compared with the surgical findings. When the mastoid antrum was patent, the volumes of the middle ear and mastoid measured by tympanometry and CT were well correlated. Moreover, the difference in the volumes measured by tympanometry between the affected and unaffected ears was large. However, when the mastoid antrum was poorly aerated, the difference in the volumes measured by tympanometry between the affected and unaffected ears was small. Middle ear status can be evaluated according to the difference in tympanometric volume between the two ears. If the tympanometric volume suggests poor aeration of the middle ear and mastoid, clinicians should consider procedures for mastoid aeration.


Assuntos
Testes de Impedância Acústica , Orelha Média/patologia , Otite Média/diagnóstico , Perfuração da Membrana Timpânica/diagnóstico , Adulto , Doença Crônica , Orelha Média/diagnóstico por imagem , Feminino , Humanos , Masculino , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/patologia , Pessoa de Meia-Idade , Otite Média/complicações , Otite Média/patologia , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Membrana Timpânica/diagnóstico por imagem , Membrana Timpânica/patologia , Perfuração da Membrana Timpânica/etiologia , Perfuração da Membrana Timpânica/patologia
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