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Ear Disease (ear + disease)
Kinds of Ear Disease Selected AbstractsNo Negative Outcomes of Childhood Middle Ear Disease in Adulthood,THE LARYNGOSCOPE, Issue 3 2007David Welch PhD Abstract Objectives/Hypothesis: To test the hypothesis that childhood middle-ear disease may have disadvantageous long-term psychosocial consequences in adulthood. Study Design: Prospective, longitudinal study of a general-population birth cohort. Methods: One thousand thirty-seven people born in 1972/73 were studied from birth to age 26 when 1,019 (96% of survivors) were followed up. Childhood otitis media was assessed, and effects of it have previously been observed in childhood and adolescence. We considered outcome measures that were plausible adult counterparts of the childhood constructs shown to be impaired by otitis media: socioeconomic status, employment status, educational outcomes, personality, mental health, antisocial and criminal behavior, and subjective ratings of personal health (SF-36). Results: No outcome measure was predicted by severity of childhood otitis media. Conclusions; Adult psychological and socioeconomic outcomes are not related to childhood otitis media when appropriate treatment is available. [source] Missed opportunities for a diagnosis of acute otitis media in Aboriginal childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2003KB Gibney Objective: Severe otitis media and its sequelae are common in rural and remote Aboriginal children. Identification of acute otitis media (AOM) is likely to reduce the number of children who go on to develop chronic suppurative otitis media and associated complications. The aim of this study was to compare the diagnoses made by researchers with that documented in the medical records of children admitted to the paediatric isolation ward of the Royal Darwin Hospital, Darwin, Northern Territory. Methods: Children aged <8 years admitted to Royal Darwin Hospital were eligible for assessment by pneumatic otoscopy, video-otoscopy and tympanometry. A diagnosis was made for each child according to the state of their worst ear. Comparisons were made between the researcher diagnoses of ear disease and those documented in the hospital notes by medical staff. Results: Thirty-one children were enrolled during 32 admissions. Most were aged <2 years, Aboriginal, and resided in remote communities. Sixty-one video-otoscopic assessments were attempted and sufficiently good images to allow diagnosis were obtained in 105 of 122 ears. Acute otitis media was diagnosed by the research team in 20 of 32 child admissions. Of 29 children who had ear examinations documented by hospital staff, only seven had a diagnosis of AOM recorded. Overall, the research team were almost three times more likely to make this diagnosis (relative risk 2.9, 95% confidence interval 1.6, 5.2). This difference was unlikely to have occurred by chance (P = 0.0002, McNemar's Chi-squared test). Conclusions: In this small study, young Aboriginal children with clear bulging of their tympanic membrane were not diagnosed with AOM by medical staff. Further training in diagnosis, including cleaning of the ear canal, may lead to more accurate assessment and appropriate recommendations for ongoing management. [source] Assessment of middle ear disease in the dog: a comparison of diagnostic imaging modalitiesJOURNAL OF SMALL ANIMAL PRACTICE, Issue 4 2007R. Doust Objectives: To compare radiography and ultrasound for the assessment of the tympanic bulla against computed tomography results. Methods: Thirty-one dogs had dorsoventral, left and right lateral oblique and rostrocaudal open mouth radiographs compared with ultrasound images and computed tomography scans of the tympanic bullae. Results: Radiography was superior to ultrasonography for the evaluation of the middle ear. However, computed tomography assessment was best predicted by a combination of radiographic and ultrasonographic findings. Clinical Significance: A combination of radiography and ultrasound can provide a more accurate assessment of the bulla than either of them alone. Ultrasound may have a role in the evaluation of middle ear disease in the dog. Results are operator dependent and not reproducible with current recording techniques. [source] Soluble CD14 at 2 yr of age: Gender-related effects of tobacco smoke exposure, recurrent infections and atopic diseasesPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 4 2006K. C. Lødrup Carlsen The endotoxin receptor soluble CD14 (sCD14) has been implicated in the ,hygiene hypothesis' suggesting reduced allergic sensitization with bacterial stimulation. However, the relationship between early life sCD14 and allergic diseases is conflicting. We aimed to investigate whether possible risk factors for allergic diseases were associated with sCD14 levels at 2 yr of age. In the nested case,control study of the birth cohort studies ,Environment and Childhood Asthma study in Oslo' 411 children selected with recurrent bronchial obstruction (rBO) (n = 241) and no bronchial obstruction (n = 170) by 2 yr were investigated with skin prick test and structured parental interview at age 2 yr. Exposure to tobacco smoke, pets and infections was recorded semi-annually by questionnaires (0,2 yr). The sCD14 was analysed from frozen, stored serum by ELISA technique. Regression analyses were performed in all subjects with complete data (n = 406, 180 girls), and in girls and in boys separately. Mean sCD14 (ng/ml) was significantly higher among girls 2035 (1973,2096) vs. 1947 (1890,2004) (boys). The sCD14 was significantly reduced among girls exposed to antenatal maternal smoking and with parental asthma, after adjusting for age, parental rhino-conjunctivitis, pet keeping and childhood infections. Recurrent otitis media (OM) increased and common colds significantly decreased sCD14 levels in girls. Boys with atopic dermatitis and rBO had reduced sCD14. Pet exposure was not significantly associated with sCD14. We report novel gender-related effects of sCD14 in early life and suggest that gender, tobacco smoke exposure, age and middle ear disease in particular should be accounted for when assessing the role of sCD14 in childhood allergic diseases. [source] Early lung disease in young children with primary ciliary dyskinesiaPEDIATRIC PULMONOLOGY, Issue 5 2008David E. Brown MD Abstract Primary ciliary dyskinesia (PCD) is an autosomal recessive disease in which ciliary dysfunction leads to chronic lung, sinus, and middle ear disease. PCD is often not diagnosed until late childhood due to its presumed rarity and the technical expertise necessary for diagnosis; as such, little is known about lung disease in young children with PCD. We report on 3 young children with PCD who had evidence of lung disease on infant pulmonary function testing, bronchoscopy, and/or computed tomography (CT) of the chest before 3 years of age. Pediatr Pulmonol. 2008; 43:514,516. © 2008 Wiley-Liss, Inc. [source] Endothelin-1 gene polymorphism and hearing impairment in elderly JapaneseTHE LARYNGOSCOPE, Issue 5 2009Yasue Uchida MD Abstract Objectives/Hypothesis: To investigate the association between the Lys198Asn (G/T) polymorphism (rs5370) in the endothelin-1 gene (EDN1) and hearing impairment in middle-aged and elderly Japanese. Study Design: Longitudinal study. Methods: Data were collected from community-dwelling Japanese adults who participated in the Longitudinal Study of Aging biennially between 1997 and 2006. The participants at baseline were 2,231 adults aged 40 years to 79 years. An average hearing threshold level of 25 dB or better in the better ear for frequencies 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz was defined as no hearing impairment. Using generalized estimating equations to treat repeated observations within subjects, 7,097 cumulative data were analyzed to assess the association between hearing status and the EDN1 G/T polymorphism with adjustment for age, sex, histories of ear disease, occupational noise exposure, heart disease, hypertension, and body mass index under additive, dominant, and recessive genetic models. Results: Comparison with wild-type homozygotes (GG), heterozygotes, and mutant homozygotes (GT/TT) showed a positive association with hearing impairment after adjustment for age in model 1 (odds ratio [OR] = 1.24; 95% confidence interval [CI] = 1.02,1.50; P = .033), for age and sex in model 2 (OR = 1.29; CI = 1.06,1.57; P = .0122), and for age, sex, history of ear disease, and history of occupational noise exposure in model 3 (OR = 1.31; CI = 1.07,1.60; P = .0092). The association was also significant in model 3 under the additive model. Conclusions: This study demonstrated that mutant T-allele carriers were associated with a higher risk of hearing impairment than carriers of wild-type homozygotes in middle-aged and elderly people. This result implies that endothelin-1 plays a valuable role in the cochlea. Laryngoscope, 2009 [source] C3H/HeJ Mouse Model for Spontaneous Chronic Otitis Media,THE LARYNGOSCOPE, Issue 7 2006Carol J. MacArthur MD Abstract Objectives/Hypothesis: Chronic otitis media is a significant clinical problem. Understanding the mechanisms of chronic otitis media is critical for its control. However, little is known of these processes as a result of lack of animal models of spontaneous otitis media. The C3H/HeJ mouse has a single amino acid substitution in its toll-like receptor 4 (TLR4), making it insensitive to endotoxin. As a result, these mice cannot clear Gram-negative bacteria. The chronically inflamed middle ear in this animal provides us the opportunity to study spontaneous chronic otitis media. Study Design and Methods: Otoscopy and auditory brain response (ABR) evaluation of C3H/HeJ mice at 3, 5, 7, 9, and 11 months were carried out under sedation. At 12 months of age, mice were killed and histologic analysis of the middle ear, inner ear, and eustachian tube was carried out. Results: Tympanic membrane visualization and ABR thresholds in 7- to 8-month-old C3H/HeJ mice showed that approximately half developed middle and inner ear disease spontaneously. The significant elevation of thresholds suggested a sensorineural component in addition to the conductive loss. Middle and inner ear histology showed some degree of middle and inner ear inflammation in half the mice, paralleling the ABR data. Conclusions: The histopathologic changes reported here in the C3H/HeJ mouse model of chronic otitis media have been reported in human chronic otitis media. This spontaneous model of chronic otitis media will be valuable for the characterization of middle and inner ear inflammatory disease processes that are induced by middle ear infections. [source] History and Current Practice of TonsillectomyTHE LARYNGOSCOPE, Issue S100 2002Ramzi T. Younis MD Abstract Objective To review important developments in the history of adenotonsillectomy and describe current methods and results for the operation. Study Design Review. Methods Tonsillectomy practices since antiquity were reviewed, with emphasis on introductions of new surgical tools and procedures, anesthesia methods, and patient care practices. Past and current indications for and complications associated with tonsillectomy were also reviewed. Results Devices used for adenotonsillectomy have included snares, forceps, guillotines, various kinds of scalpels, lasers, ultrasonic scalpels, powered microdebriders, and bipolar scissors. General anesthesia, the Crowe-Davis mouth gag, and methods for controlling bleeding have contributed greatly to success with the operation. Past and current indications for adenotonsillectomy are similar, although the relative importance of some indications has changed. The complication rate has declined, but the problems that do occur remain the same. Currently, cost-effectiveness is a principal concern. Conclusion The instruments and procedures used for adenotonsillectomy have evolved to render it a precise operation. Today, the procedure is a safe, effective method for treating breathing obstruction, throat infections, and recurrent childhood ear disease. [source] Effectiveness of Adenoidectomy and Laser Tympanic Membrane Fenestration,THE LARYNGOSCOPE, Issue 2 2001Steven P. Cook MD Abstract Objective Adenoidectomy alone or with tonsillectomy (A±T) is an effective surgical intervention in the management of otitis media in children, especially when it is performed in conjunction with insertion of pressure equalization tubes (PETs). Otorrhea and persistent tympanic membrane (TM) perforation are frequent complications. This study evaluates the effectiveness of intermediate duration middle ear ventilation using laser tympanic membrane fenestration (LTMF) without tube insertion and as an adjunct to adenoidectomy in resolving middle ear disease within the first 90 days after surgery. Study Design This pilot study was a multicenter, prospective clinical cohort trial. Institutional review board approval and informed consent were obtained. The study involved four tertiary care pediatric otolaryngology departments. Fifty children (96 ears) were treated with LTMF in conjunction with A±T from June 1, 1998, through March 30, 1999. Ages ranged from 9 months to 12 years. Patients undergoing A±T who would have been recommended for PET insertion instead underwent middle ear ventilation with LTMF using the OtoLAMÔ device (ESC/Sharplan, Yokneam, Israel). Patients were seen at 30, 60, and 90 days postoperatively. Resolution of otitis media with effusion was determined by clinical examination, which included pneumatic otoscopy, audiometry, and tympanometry. Results Of the treated ears, 88%, 86%, and 83% had clinical resolution of middle ear disease at 30, 60, and 90 days, respectively. Preoperatively, 45% (n = 85) of ears had normal hearing; 92% (n = 49) had normal hearing at 90 days. Eighty-nine percent (n = 92) had type C2 or B tympanograms preoperatively, and 12% (n = 60) had type C2 or B at 90 days. Conclusion Laser tympanic membrane fenestration in conjunction with adenoidectomy was effective in restoring normal middle ear function at 90 days post-treatment in greater than 80% of children who otherwise may have had placement of PETs. [source] Hearing Results After Primary Cartilage Tympanoplasty,THE LARYNGOSCOPE, Issue 12 2000Matthew J. Gerber MD Abstract Objectives/Hypothesis Cartilage,perichondrium grafting of the tympanic membrane has been used in an effort to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties. Few studies in the literature address hearing results after cartilage tympanoplasty. The purpose of this study was to investigate the hearing results after primary cartilage tympanoplasty and compare them with results after primary tympanoplasty with temporalis fascia. Study Design A retrospective review of all ear surgeries using cartilage between 1994 and 1999 was performed. Methods Only primary cases in which the ossicular chain was intact and no mastoid surgery was performed were included. Indications for surgery included tympanic membrane perforation, retraction, and cholesteatoma. Pre- and postoperative speech reception thresholds and air,bone gaps at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz were compared. Results Eleven patients comprised the cartilage study group, and there were 11 age- and temporally matched control subjects. The mean improvement in speech reception threshold for both the study group and the control group was 10 dB. The majority of patients in both groups had ABG closure to within 10 dB at all frequencies examined. There were no statistically significant differences in speech reception threshold improvement or air,bone gap closures between the two groups. Conclusions These results demonstrate that hearing results after cartilage tympanoplasty are comparable to those after temporalis fascia tympanoplasty. Therefore, when indicated, a cartilage,perichondrium graft can be used for prevention of disease recurrence or progression without fear of impairing hearing. [source] Variability of Eustachian Tube Function: Comparison of Ears With Retraction Disease and Normal Middle Ears ,THE LARYNGOSCOPE, Issue 8 2000Marie Bunne MD Abstract Objective To explore the short-term and long-term variability of tubal opening and closing in ears with advanced retractions and in healthy ears. Study Design/Methods Twenty ears with retraction type middle ear disease (R-MED) and 20 normal ears underwent direct recording of the middle ear pressure during repeated forced openings, equalization of +100 daPa and ,100 daPa by swallowing, Valsalva inflation, and forceful sniffing. Tests were performed twice (separated by 30 min) on each of 2 days separated by 3 to 4 months. Results There was considerable intraindividual variability of the forced opening pressure and the closing pressure in both groups, within as well as between sessions and test days. Although the variability was 1.5 to 2 times higher in ears with retraction than in the normal group, mean Po and Pc did not differ between the groups. Compared with normal ears, ears with retraction changed more frequently from a positive to negative test response, or vice versa, when re-tested after 30 minutes. Rates of positive response in the equalization and Valsalva tests were significantly lower in diseased ears compared with normal ears. Conclusions Eustachian tube opening and closing functions vary more in ears with retraction disease than in normal ears, which is consistent with the variable clinical course of R-MED and implies that single tubal function tests have little prognostic value on the individual level. [source] Mastoid subperiosteal abscess as a first sign of unnoticed cholesteatoma in childrenACTA PAEDIATRICA, Issue 1 2010L Migirov Abstract Aim:, To present children who underwent mastoidectomy for congenital cholesteatoma presented as a subperiosteal abscess. Results:, All seven children (age range 7,14 years, six boys) presented with retroauricular swelling, erythema and fluctuation in the mastoid area, and one child also had a mastoid-cutaneous fistula. Five children had otorrhoea, while the other two had normal-appearing tympanic membranes. None of the children had a history of middle ear disease. Four children were treated with antibiotics for a recent episode of otitis media prior to admission. The main findings at surgery were pus, granulations and erosion of the mastoid cortex. Pseudomonas aeruginosa and Proteus sp. were isolated from the abscess in two patients, and the other five cultures were negative. All the patients demonstrated some degree of hearing impairment after surgery. Conclusion:, Surgical eradication of a mastoid SA in older children is essential as it may be the first indication of an underlying CC. [source] The use of the weber tuning fork test and ,scratch test' in postoperative tympanomastoid surgeryCLINICAL OTOLARYNGOLOGY, Issue 6 2006J.R. Buckland Objective., To compare the use of the Weber tuning fork test and ,Scratch test' in postoperative patients following tympanomastoid surgery. Method., Prospective cohort study with control group. Southampton University Hospitals NHS Trust. Secondary care. 19 patients undergoing routine tympanomastoid surgery for middle ear disease and 18 patients undergoing translabyrinthine surgery for lateral skull base lesions. Main Outcome Measures., Localisation of Weber tuning fork. Positive or negative Scratch test: clinician applies a gentle scratch using index finger to the bandage over the operated ear. Postoperative pure tone audiometry. Results., In the context of diagnosing a hearing or non-hearing ear, the Weber test had a specificity of 78% and sensitivity of 100%. The scratch test had a specificity of 100% and sensitivity of 100%. The Weber was 93% specific and 93% sensitive for diagnosing a unilateral conductive hearing loss. Conclusions., As a means of diagnosing an acute postoperative dead ear the Scratch test is an accurate alternative to the Weber test. References 1 Miltenburg D.M. (1994) The validity of tuning fork tests in diagnosing hearing loss. J Otolaryngol. 23, 254,259 2 Behn A., Laszlo C.A., Black D., et al. (2005) Which is mightier, the tuning fork or the bone oscillator? J Otolarygol. 34, 135,139 [source] Otomycosis in western NigeriaMYCOSES, Issue 1 2008James Fasunla Summary Otomycosis is a recognized clinical entity in the tropical regions of the world. However, there is scanty information on this disease in some parts of Sub-Saharan Africa. The aim of this study was to determine the prevalence and pattern of etiological agents of otomycosis in western Nigeria. Medical records of patients with otomycosis seen in the Otorhinolaryngology Department of the University College Hospital, Ibadan from 1996,2005 were reviewed for all essential clinical data. Of the 5784 patients with ear diseases, 378 (6.54%) had otomycosis which consisted of 145 (38.36%) males and 233 (61.64%) females. Seventeen patients (4.50%) had recurrence within six months of treatment, 4 (1.06%) had poorly controlled plasma glucose. A significant number of our patients, 52 (13.76%), had prior topical aural antibiotic treatment following misdiagnosis. The predominant etiological agents in our series were Aspergillus niger (48.35%) and Aspergillus fumigatus (33.96%). [source] Antibiotics in Dutch general practice: nationwide electronic GP database and national reimbursement rates,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Annemiek E. Akkerman PhD Abstract Purpose In order to assess whether different databases generate information which can be reliable compared with each other, this study aimed to assess to which degree prescribing rates for systemic antibiotics from a nationwide electronic general practitioner (GP) database correspond with national reimbursement rates, and to investigate for which indications antibiotics are prescribed. Methods Nationwide GP prescribing data were collected from the Second Dutch National Survey of General Practice (DNSGP-2) based on 90 general practices serving 358 008 patients in 2001. Dutch national reimbursement rates for GPs were derived from claims data of the Dutch Drug Information System/Health Care Insurance Board (GIP/CVZ) from 2001. We calculated antibiotic prescribing rates per 1000 patients/inhabitants for each database, and these rates were compared for the total rates and according to antibiotic subgroups. Indications for which GPs prescribed antibiotics were described. Results In national reimbursement data, 339 antibiotic prescriptions per 1000 inhabitants were prescribed by GPs, while the nationwide GP database showed 255 prescriptions per 1000 patients (75% coverage with reimbursement rates). The nationwide GP database showed high volumes of sulphonamides & trimethoprim, and small volumes of macrolides and quinolones. Half of the prescriptions (48%) were prescribed for respiratory diseases, a quarter (26%) for urinary diseases and 7% for ear diseases. Conclusions GPs voluntarily participating in a research network prescribe less antibiotics than Dutch GPs in general, and are cautious in prescribing newer and more broad-spectrum antibiotics. This point has to be taken into account when databases will be compared with each other. Copyright © 2007 John Wiley & Sons, Ltd. [source] Eosinophils are activated in middle ear mucosa and middle ear effusion of patients with intractable otitis media associated with bronchial asthmaCLINICAL & EXPERIMENTAL ALLERGY, Issue 7 2001Y. Iino Background Although patients with intractable otitis media associated with bronchial asthma have extensive accumulation of eosinophils in the middle ear mucosa and middle ear effusion, systematic histological and immunohistochemical studies have not been performed. Objectives To clarify the pathogenesis of middle ear diseases, we carried out immunohistochemical studies on middle ear specimens, particularly focusing on the characteristics of accumulated eosinophils. Methods Middle ear specimens obtained from eight adult patients and from 17 controls were immunohistochemically stained using monoclonal antibodies against EG1, EG2, mast cell tryptase, IgA and IgE. The concentration of eosinophil cationic protein (ECP) in middle ear effusion samples was also measured. Results In the asthmatic patients, severe round-cell infiltration was observed in the submucosa and most of the EG1-positive cells were also EG2-positive. In the control patients, the mucosa showed a fibrotic change with a few inflammatory cells, and EG1- or EG2-positive cells were quite few. The expression of IgE was found not only on the surface of mast cells but also within the plasma cells in the asthmatic patients, and the number of IgE-positive cells was about twice as high as that of mast cells. A significantly higher concentration of ECP was noted in middle ear effusion obtained from the asthmatic patients than that from the control patients. Conclusion Most of the eosinophils in the middle ear mucosa and middle ear effusion were activated, resulting in degranulation and release of ECP, and local IgE production occurs in the middle ear mucosa, indicating that the intractable inflammation is closely associated with IgE-mediated late phase response with eosinophil accumulation. 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