One-stage coclear implantation via a facial recess approach in children with otitis media with effusion

Objective:To investigate surgical indications, operative techniques, complications and auditory and speech rehabilitation for cochlear implant (CI) in children with otitis media with effusion (OME). Material and methods:This is a retrospective review of records of 24children with bilateral profound sensorineural hearing loss and OME who were implanted during January 2011 to November 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery at the PLA Hospital, using one-stage implantation via the facial recess approach and round window insertion. The incus was removed in 8 cases during the implantation procedure. Local infiltration of dexamethasone and adrenaline in the middle ear was also performed. Postoperative complications were examined. Preoperative and postoperative questionnaires including Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and the Meaningful Auditory Integration Scale (MAIS) were collected. Results: All electrodes were implanted successfully without any immediate or delayed complications. Inflammatory changes of middle ear mucosa with effusion were noted in all implanted ears. The scores of post-implant CAP and SIR increased significantly in all 24 cases (t ? ?25.95 and ?14.09, respectively for CAP and SIR, p<0.05). Conclusions:One-stage CI via the facial recess approach with round window insertion is safe and effective in cochlear implant candidates with OME, as seen in the 24 children in our study who achieved improved auditory performance and speech intelligibility after CI. Copyright ? 2015, PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Management of Otitis Media with Effusion

Otitis media with effusion is one of the most common diseases in children. Its treatment remains controversial. Clinical practice guidelines of OME allow watchful waiting for 3 months before treatment if the child with OME is not at risk for speech/language/or learning problems. Tympanostomy tube insertion is the preferred initial procedure when a child becomes a surgical candidate. Complementary or alternative medicine is not recommended as a treatment for OME. This paper provides a systematic review of management of OME, which we hope will be helpful for clinicians.

Comparison of tympanostomy tubes for endoscopic placement in adults with otitis media with effusion

Objective:To compare the therapeutic effects of two types of tympanostomy tube,in terms of extrusion time and recurrence rate,after endoscopic ventilation tube placement in adults with otitis media with effusion.Materials and methods:The clinical data for 125 ears from 91 patients who underwent endoscopic ventilation tube placement was retrospectively reviewed.The ears included in the study were divided into groups A and B.The Shepard tube was used in all ears from group A.The T-tube was used in all ears from group B.Extrusion time and recurrence rate were recorded and statistically analyzed.Results:Group A included 103 ears(82.4%).Group B included 22 ears(17.6%).The average extrusion time for group A was significantly shorter than that for group B(160.5±106.6 days vs 274.1±120.5 days,p<0.05).No significant difference in recurrence rate was observed between groups A and B(72.8%vs 63.6%,p=0.44).Conclusion:Compared with the Shepard tube,the T-tube lasts longer in the ear drum in adult patients with otitis media with effusion.However,use of the Shepard tube,compared with use of the T-tube,does not significantly reduce the recurrence rate after extrusion.

Applicability of PCR-DGGE and 16S rDNA Sequencing for Microbiological Analysis of Otitis Media with Effusion

Background: The aim of the study was to analyze the performance of PCR-DGGE based assay and its applicability as a tool for the identification of bacteria in the middle ear of children with otitis media with effusion (OME). Methods: The middle ear effusions from 20 children with OME were analyzed both by bacterial culture and by 16S rDNA-gene-targeted PCR assay, DGGE fingerprinting and sequencing analysis. Results: In bacterial culture assay, only three middle ear effusions (15%) showed bacterial growth. None of the samples were positive for anaerobic culture. The PCR assay with 16S rDNA-gene-targeted universal primers was positive in 10 (50%) cases. The subsequent DGGE fingerprinting and 16S rDNA sequencing analysis revealed that the most commonly encountered bacteria in the middle ear effusions of children with OME are Haemophilus influenzae, Alloiococcus otitidis and Bacteroides spp. Conclusions: The present study demonstrated the applicability of PCR-DGGE based assay and 16S rDNA sequencing for analyzing of bacterial diversity in the middle ear effusion of children OME. The results of our study may contribute to a better understanding of the etiology of OME.

Role of interleukin-10 and transforming growth factor beta 1 in otitis media with effusion

Background Otitis media with effusion （OME） is a disease with complicated pathogeneses which are not clearly known Increasing interest has been focused on immunological cells, cytokines and their roles in chronic inflammatory states. This study was designed to disclose the existence and roles of interleukin-10 （IL-10） and transforming growth factor beta1 （TGF-β1） in the cause of OME in adults, and to investigate the probable role of Foxp3^＋CD4^＋CD25^＋ T cells in OME. Methods The concentrations of IL-10 and TGF-β1 in the middle ear effusions （MEEs） and plasmas of 36 adults （45 ears） with OME were measured by means of enzyme linked immunosorbent assay （ELISA）. As contrast, the concentrations of IL-10 and TGF-131 in the plasma of 30 normal volunteers were measured using the same method. Furthermore, the proportion of Foxp3^＋CD4^＋CD25^＋ T cells in CD4^＋ T cells of blood was tested by flow cytometry. Results （1） The concentrations of IL-10 in all MEEs and plasmas of the chronic OME patients were higher than those in patients with acute OME （both P 〈0.05）, so was TGF-131 （both P 〈0.01）. The concentration of IL-10 in MEEs was significantly higher than that in plasmas, not only in acute OME （P〈0.01）, but also in chronic OME （P〈0.01）. In chronic OME, the concentration of TGF-β1 in MEEs had no statistical difference with those in plasmas of the same patients. However, the concentration of TGF-β1 in plasmas of patients with chronic OME was significantly higher than that in plasmas of normal volunteers （P 〈0.01）. （2） The concentrations of IL-10 and TGF-β1 in MEEs of the patients who had been treated more than once were higher than those MEEs of the patients who were treated for the first time, respectively （P〈0.05, P〈0.01）. The level of TGF-β1 in plasmas of the patients who had been treated more than once was higher than in those of the patients who were treated firstly （P 〈0.05）, while the level of IL-10 in plasmas had no difference. The concentration of IL-10 in mucoid MEEs was higher than those in serous ones （P〈0.05）, while TGF-β1 had no statistical difference between mucoid and serous MEEs （P〉0.05）. The concentration of IL-10 in MEEs had a strong correlation with the duration of the illness （r=0.547, P〈0.01）. The same correlation was also found between the concentration of TGF-β1 in MEEs and the times patients being treated （r=0.579, P 〈0.01）. （3） The proportion of Foxp3^＋CD4^＋CD25^＋T/CD4^＋ T cells in the blood of chronic OME was not only significantly higher than that in the acute OME （P〈0.01）, but also higher than that in normal volunteers （P 〈0.01）. In chronic OME, there was a correlation between the proportion of Foxp3^＋CD4^＋CD25^＋ T/CD4^＋ T cells in the blood and the concentration of IL-10 in the plasmas （r=0.602, P 〈0.05）. Conclusions IL-10 and TGF-β1, as two important immunoregulatory mediators, participate in middle ear inflammatory response, especially in chronic course of OME in adults. Foxp3^＋CD4^＋CD25^＋ T cells may play some immunoregulatory roles in the course of this disease.

Prevalence and associated risk factors of recurrent otitis media with effusion in children in Upper Egypt

Objective:We conducted this study to determine the associations of possible risk factors and prevalence of recurrent otitis media with effusion(OME)in a cohort of children in Upper Egypt.Methods:This was a cross-sectional study undertaken in two tertiary referral centers in Upper Egypt.Associations of possible risk factors with prevalence of recurrent OME were studied.Multi-factor logistic regression analysis was done to recognize the statistically significant risk factors associated with recurrent OME.Results:We collected the data of 2003 pediatric patients,of which 1016 were males(50.7%).A total number of 310 children have OME,including 159 males(51.3%).The prevalence rate of OME in our cohort was 15.5%.Multi-factor logistic regression analysis of the risk factors related to recurrent OME showed it was strongly associated with adenoid hypertrophy(P<0.0001),tonsil hypertrophy(P<0.0001),sinusitis(P<0.0001),posterior nostril polyps(P =0.009),allergic rhinitis(P<0.0001),recurrent URTIs(P=0.029)and gastroesophageal reflux(P=0.031).Conclusions: Our study showed that recurrent OME in children in Upper Egypt is a common multifactorial problem, especially in young age. In our locality, allergic rhinitis, recurrent upper respiratory tract infections, gastroesophageal reflux, adenoid and tonsil hypertrophy were the most important associated factors related to the etiopathogenesis of OME.

Frequency of otitis media with effusion among children aged 1-5 years presenting to immunization center of tertiary care hospitals,Rawalpindi

Objective:We conducted this study to assess the etiopathogenic relation of otitis media with effusion(OME)in a group of children aged 1-5 years among the local population of Rawalpindi.Methods:This was a cross-sectional retrospective study.Study was conducted among the children presenting to the immunization center of three tertiary care hospitals of Rawalpindi.Otitis media was assessed by clinical examination and tympanometry from August 2019 to January 2020.Multi-factor regression analysis was then applied to recognize the statistical significance and association of various risk factors to OME.Results:Out of 400 children enrolled in this study,108(27.0%)had OME,out of which 65(60.2%)were males and 30(27.8%)were of age group 2-3 years.Multivariable regression analysis of risk factors associated with OME showed it was strongly associated with snoring(P<0.001),last year symptoms(attack of ear aches with hearing loss[P=0.002]),drugs(URTI antibiotics[P=0.026],All 3 drugs[P=0.013]).Conclusions:We found out that OME is a common disease which if not identified or treated timely can lead to other hard to cure health problems.Control of its etiopathogenic factors can play a major role in its prevention.

The Role of Fibrinolysis in Adhesive Otitis Media(AOM)

Objective To study the effects of Batroxobin on otitis media with effusion(OME), an early stage of Adhesive Otitis Media(AOM), for the purpose of expanding our understanding of the role of fibrinolysis in the pathogenesis of AOM. Method Forty cases of OME(45 ears) were randomly selected to receive intratympanic administration of Dexamethasone at 5 mg/ml(Group 1 or G1), Batroxobin at 1 BU/ml(Group 2 or G2) or Batroxobin at 2 BU/ml (Group 3 or G3). Pre-and post-treatment changes in clinical symptoms, the Air conduction Hearing Threshold (AHT) in pure tone audiometry and average AHT over 0.25 to 2 kHz were compared. Results Data from 31 cases(33 ears) were available for analysis. AHTs among three groups were similar prior to treatment(P > 0.05). The rate of normal hearing following treatment in G3 was 70% or 7 / 10, higher than in G1(41.7% or 5 / 12) and G2 (54.5% or 6 / 11)(P < 0.05). The rate of improvement following treatment was 81.8% or 9/11 and 80.0% or 8 / 10 in G2 and G3, respectively, higher than that in G1(50.0% or 6 / 12)(P < 0.05). Conclusions Therapeutic effects of intratympanic injection of Batroxobin on OME is superior to traditionally used Dexamethasone. In addition, higher concentration of Batroxobin appears to be superior to lower concentrations. These findings confirm that fibrinolysis plays a pivotal role in the pathogenesis of middle ear adhesion and that fibrinolytic medicine can prevent or reduce adhesion development in the middle ear.

经鼓室口咽鼓管球囊扩张术的疗效及咽鼓管功能的影响

目的探讨经鼓室口咽鼓管球囊扩张(balloon dilatation Eustachian tuboplasty,BET)联合腺样体消融术对慢性分泌性中耳炎(chronic secretory otitis media,CSOM)患儿的疗效及咽鼓管功能的影响。方法选取2020年6月~2022年12月间在中山市小榄人民医院就诊的CSOM患儿82例作为研究对象,采用随机数字表法分为对照组和观察组,每组41例。对照组接受腺样体消融术+鼓膜切开置管术治疗,观察组接受腺样体消融术+鼓膜切开置管术+BET术。比较两组手术相关指标及住院时间、临床症状、咽鼓管功能、临床疗效及随访6个月并发症及复发情况。结果两组术中出血量比较,差异无统计学意义(P>0.05),与对照组相比,观察组手术时间更长,住院时间更短(P<0.05)。与对照组相比,观察组中耳积液消失时间、耳鸣消失时间、鼓膜愈合时间、听力恢复时间均更短(P<0.05)。与治疗前相比,治疗后两组咽鼓管评分(Eustachian tube score,ETS)升高、咽鼓管功能障碍评分量表(Eustachian tube dysfunction questionnaire-7,ETDQ-7)评分降低(P<0.05),观察组ETS评分高于对照组,ETDQ-7评分则低于对照组(P<0.05)。观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(14.63%vs.9.76%,P>0.05),与对照组相比,观察组复发率更低,差异具有统计学意义(21.95%vs.2.44%,P<0.05)。结论经鼓室口BET联合腺样体消融术有助于提高CSOM患儿的临床疗效,改善咽鼓管功能,促进术后恢复,减少复发率,且并发症发生率低。

耳内窥镜下鼓膜置管联合腺样体切除术与鼓膜穿刺治疗分泌性中耳炎患儿的临床疗效比较

目的探讨耳内窥镜下鼓膜置管联合腺样体切除术治疗分泌性中耳炎(OME)患儿的临床疗效。方法选取2021年1月~2022年3月SOM患儿120例,按术式分为穿刺组(n=60)和置管组(n=60),穿刺组给予耳内窥镜下鼓膜穿刺联合腺样体切除术,置管组给予耳内窥镜下鼓膜置管联合腺样体切除术,比较两组积液消退时间、听觉脑干诱发电位(ABR)阈值、ABRⅠ波潜伏期、干扰素γ(IFN-γ)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、治疗效果以及并发症。结果置管组积液消退时间显著低于穿刺组,差异有统计学意义(P<0.05);穿刺组和置管组术后ABR、ABRⅠ波潜伏期、IFN-γ、IL-6和TNF-α均显著低于术前(P均<0.05);置管组术后ABR、ABRⅠ波潜伏期、IFN-γ、IL-6和TNF-α均显著低于穿刺组,差异有统计学意义(P均<0.05);置管组治疗有效率显著高于穿刺组,差异有统计学意义(P<0.05);置管组并发症发生率显著低于穿刺组,差异有统计学意义(P<0.05)。结论耳内窥镜下鼓膜置管联合腺样体切除术可有效改善SOM患儿听力及炎症,有利于提高疗效,且可减少并发症,值得临床推广。

Eustachian tube involvement in a patient with relapsing polychondritis detected by magnetic resonance imaging:A case report

BACKGROUND Relapsing polychondritis(RP)is a rare inflammatory disease involving the systemic cartilage,such as the auricle,trachea,and bronchiole,among others.A patient with RP shows variable symptoms based on the involved cartilage.CASE SUMMARY A 72-year-old Japanese woman with a history of redness of the bilateral auricles for 3 d was referred to a clinician.The clinician prescribed antibiotics to the patient;however,the symptoms worsened;thus,she was referred to our hospital.Head and neck magnetic resonance imaging(MRI)showed edematous auricle with remarkable contrast,fluid collection in the bilateral mastoid cells,suggesting otitis media.The eustachian tube(ET)on the right side was also edematous with contrast enhancement.The patient was suspected of RP according to the diagnostic criteria.A biopsy of the auricular cartilage was performed by an otorhinolaryngologist,confirming pathological proof of RP.Treatments with steroids were immediately administered thereafter.CONCLUSION We highlight a rare case of RP with radiologically confirmed involvement of ET in the MRI.

巴曲酶对预防鼻咽癌放疗后分泌性中耳炎的临床分析

目的 探讨巴曲酶对预防鼻咽癌放射冶疗后分泌性中耳炎的临床效果。方法 选取2020年1月~2021年6月确诊为鼻咽癌并接受放疗的63例无分泌性中耳炎患者为研究对象。根据方案不同分为对照组(n=32)和观察组(n=31)。放疗开始后,对照组定期给予鼻咽部、鼻道及鼻窦口清理并冲洗鼻腔;观察组在同对照组治疗的基础上,应用巴曲酶。两组患者放疗结束后1周,比较两组患者分泌性中耳炎相关指征的出现情况。结果 观察组出现耳鸣、耳闷、鼓室积液、鼓室内陷、鼓室“B”型图、气-骨导差>10 dB HL、声反射消失的例数均少于对照组,差异有统计学意义(P<0.05)。结论 巴曲酶对预防鼻咽癌放疗后中耳炎的发生效果显著,值得临床推广应用。

Diagnosis of Middle Ear Diseases Based on Convolutional Neural Network

An otoscope is traditionally used to examine the eardrum and ear canal.A diagnosis of otitis media(OM)relies on the experience of clinicians.If an examiner lacks experience,the examination may be difficult and time-consuming.This paper presents an ear disease classification method using middle ear images based on a convolutional neural network(CNN).Especially the segmentation and classification networks are used to classify an otoscopic image into six classes:normal,acute otitis media(AOM),otitis media with effusion(OME),chronic otitis media(COM),congenital cholesteatoma(CC)and traumatic perforations(TMPs).The Mask R-CNN is utilized for the segmentation network to extract the region of interest(ROI)from otoscopic images.The extracted ROIs are used as guiding features for the classification.The classification is based on transfer learning with an ensemble of two CNN classifiers:EfficientNetB0 and Inception-V3.The proposed model was trained with a 5-fold cross-validation technique.The proposed method was evaluated and achieved a classification accuracy of 97.29%.

分泌性中耳炎鼓膜置管术后通气管阻塞的危险因素分析

目的分析分泌性中耳炎(OME)鼓膜置管术后通气管阻塞的发生情况及影响术后通气管阻塞的危险因素。方法回顾性分析2016年1月~2019年1月我院耳鼻咽喉科收治的152例因OME行双侧鼓膜置管手术患儿作为研究对象。根据术后是否出现通气管阻塞,将所选患者分为阻塞组(31例)和未阻塞组(121例)。分析不同特征人群术后通气管阻塞发生情况,并通过二分类Logistic回归分析影响术后通气管阻塞发生的相关危险因素。结果152例OME患儿均顺利完成双侧鼓膜置管术,术后共31例(20.4%)出现通气管阻塞,其中14例管腔内干痂阻塞,6例血痂阻塞或覆盖通气管,6例耵聍阻塞,5例脓性分泌物,另有8例患儿出现通气管脱出。单因素分析初步筛选出4个(年龄、使用氧氟沙星滴耳液、术后耳溢液、通气管留置时间)与术后通气管阻塞有关的因素。二分类Logistic回归分析结果显示未使用氧氟沙星滴耳液、术后耳溢液、通气管留置<10个月为最终进入模型的危险因素。结论OME行鼓膜置管术后影响患儿通气管阻塞的危险因素较多,包括未使用氧氟沙星滴耳液、术后耳溢液、通气管留置<10个月等,需尽早干预处理,做好相关预防工作,防止发生通气管阻塞,影响患儿康复。

咽喉反流与学龄前儿童分泌性中耳炎的相关性分析

目的分析咽喉反流与学龄前儿童分泌性中耳炎的相关性,为儿童分泌性中耳炎的诊治提供更多思路和方法。方法选取分泌性中耳炎合并咽喉反流的患儿为研究对象。通过反流症状指数评分量表(reflux symptom index,RSI)>13分及反流体征评分量表(reflux fingding score,RFS)≥7分诊断疑似咽喉反流。以病史结合耳内镜、声导抗检查确诊分泌性中耳炎。对患儿同时进行抗反流治疗,随访半年,观察疗效。结果分泌性中耳炎合并咽喉反流的患儿病例资料完整者18例,其中男12例,女6例,年龄3~6岁。1例手术,17例保守治疗。治疗前、治疗1个月、治疗2个月后的RSI评分及各项症状评分,差异有统计学意义。治疗前RSI评分和RFS评分无相关性(r=0.043,P=0.865)。治疗后1个月72%患儿中耳炎症状治愈,RSI>13分的患儿症状缓解率与用药时间呈负相关(r=-0.871,P=0.00);RSI≤13分的患儿症状缓解率与用药时间无相关性(r=-0.676,P=0.21)。治疗前的RFS评分与用药时间呈负相关(r=0.608,P=0.01)。随访半年,1例中耳炎复发,再次抗反流治疗后治愈。结论咽喉反流与儿童分泌性中耳炎有相关性。咽喉反流相关性中耳炎患儿病史长,病情反复,常规治疗无效或频繁发作。结合抗反流治疗可改善患儿的中耳炎症状并减少复发。

Neurotoxicity of Quinolinic Acid to Spiral Ganglion Cells in Rats

Our study investigated the neurotoxicity of quinolinic acid(QA) to spiral ganglion cells(SGCs),observed the protective effects of N-methyl-D-aspartate(NMDA) receptor antagonist MK-801 and magnesium ions on the QA-induced injury to SGCs,and analyzed the role of QA in otitis media with effusion(OME)-induced sensorineural hearing loss(SNHL).After culture in vitro for 72 h,SGCs were exposed to different media and divided into 4 groups:the blank control group,the QA injury group,the MK-801 treatment group,and the MgCl2 protection group.The apoptosis rate of SGCs was analyzed by Annexin V and PI double staining under the fluorescence microscopy 24 h later.SGCs were cultured in vitro for 72 h and divided into four groups:the low concentration QA group,the high concentration QA group,the MK-801 group,the MgCl2 group.The transient changes of intracellular calcium concentration were observed by the laser scanning confocal microscopy.Apoptosis rate in QA injury group was higher than that in blank control group and MgCl2 protection group(both P0.05).In high concentration QA group,there was an obvious increase of the intracellular calcium concentration in SGCs,which didn’t present in low concentration QA group.In MgCl2 group,the peak values of the intracellular calcium concentration in SGCs were reduced and the duration was shortened,but the intracellular calcium concentration in SGCs had no significant change in MK-801 group.It was concluded that QA could injure SGCs by excessively activating NMDA receptors on the cell membrane,which might be the mechanism by which OME induced SNHL,while Mg2+ could protect the SCGs from the neurotoxicity of QA.